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What is dissociative identity disorder?
Dissociative identity disorder (DID), formerly called multiple personality
disorder, is one of a group of conditions called dissociative disorders.
Dissociative disorders are mental illnesses that involve disruptions or
breakdowns of memory, awareness, identity and/or perception. When one or more of
these functions is disrupted, symptoms can result. These symptoms can interfere
with a person’s general functioning, including social activities, work
functions, and relationships. People with DID often have issues with their
identities and senses of personal history.
Dissociation is a key feature of dissociative disorders. Dissociation is a
coping mechanism that a person uses to disconnect from a stressful or traumatic
situation or to separate traumatic memories from normal awareness. It is a way
for a person to break the connection between the self and the outside world, as
well as to distance oneself from the awareness of what is occurring.
Dissociation can serve as a defense mechanism against the physical and emotional
pain of a traumatic or stressful experience. By dissociating painful memories
from everyday thought processes, a person can use dissociation to maintain a
relatively healthy level of functioning, as though the trauma had not occurred.
Dissociation can be described as a temporary mental escape (similar to
self-hypnosis) from the fear and pain of the trauma. Even after the trauma is
long past, however, the leftover pattern of dissociation to escape stressful
situations continues. When dissociation is done repeatedly—as in the case of
prolonged abuse—these dissociated mental states can take on separate
identities of their own.
A person with DID, the most severe type of dissociative disorder, has two or
more different personality states—sometimes referred to as "alters"
(short for alternate personality states)—each of whom takes control over the
person’s behavior at some time. Each alter might have distinct traits,
personal history, and way of thinking about and relating to his or her
surroundings. An alter might even be of a different gender, have his or her own
name, and have distinct mannerisms or preferences. The person with DID may or
may not be aware of the other personality states and might not have memories of
the times when another alter is dominant. Stress or a reminder of the trauma can
act as a trigger to bring about a "switch" of alters. This can create
a chaotic life and cause problems in work and social situations.
What causes DID?
It is generally accepted that DID results from extreme and repeated trauma
that occurs during important periods of development during childhood. The trauma
often involves severe emotional, physical or sexual abuse, but also might be
linked to a natural disaster or war. An important early loss, such as the loss
of a parent, also might be a factor in the development of DID. In order to
survive extreme stress, the person separates the thoughts, feelings and memories
associated with traumatic experiences from their usual level of conscious
awareness.
The fact that DID seems to run in families also suggests that there might be
an inherited tendency to dissociate. DID appears to be more common in women than
in men. This might be due to the higher rate of sexual abuse in females.
What are the symptoms of DID?
Symptoms of DID are similar to those of several other physical and mental
disorders, including substance abuse, seizure disorder and post-traumatic stress
disorder. Symptoms of DID can include the following:
- Changing levels of functioning, from highly effective to nearly
disabled
- Severe headaches or pain in other parts of the body
- Depersonalization (episodes of feeling disconnected or detached
from one’s body and thoughts)
- Derealization (perceiving the external environment as unreal)
- Depression or mood swings
- Unexplained changes in eating and sleeping patterns
- Anxiety, nervousness, or panic attacks
- Problems functioning sexually
- Suicide attempts or self-injury
- Substance abuse
- Amnesia (memory loss) or a sense of "lost time"
- Hallucinations (sensory experiences that are not real, such as
hearing voices)
A person with DID might repeatedly meet people who seem to know him or her,
but whom he or she does not recognize. The personal also might find items that
he or she does not remember buying.
How is DID diagnosed?
If symptoms are present, the doctor will begin an evaluation by performing a
complete medical history and physical examination. While there are no laboratory
tests to specifically diagnose dissociative disorders, the doctor might use
various diagnostic tests—such as X-rays and blood tests—to rule out physical
illness or medication side effects as the cause of the symptoms. Certain
conditions—including brain diseases, head injuries, drug and alcohol
intoxication, and sleep deprivation—can lead to symptoms similar to those of
dissociative disorders, including amnesia. In fact, it is amnesia or a sense of
lost time that most often prompts a person with DID to seek treatment. He or she
might otherwise be totally unaware of the disorder.
If no physical illness is found, the person might be referred to a
psychiatrist or psychologist, health care professionals who are specially
trained to diagnose and treat mental illnesses. Psychiatrists and psychologists
use specially designed interview and personality assessment tools to evaluate a
person for a dissociative disorder.
How is DID treated?
The goals of treatment for DID are to relieve symptoms, to ensure the safety
of the individual, and to "reconnect" the different identities into
one well-functioning identity. Treatment also aims to help the person safely
express and process painful memories, develop new coping and life skills,
restore functioning, and improve relationships. The best treatment approach
depends on the individual and the severity of his or her symptoms. Treatment is
likely to include some combination of the following methods:
- Psychotherapy—This kind of therapy for mental and
emotional disorders uses psychological techniques designed to encourage
communication of conflicts and insight into problems.
- Cognitive therapy — This type of therapy focuses on
changing dysfunctional thinking patterns.
- Medication — There is no medication to treat the
dissociative disorders themselves. However, a person with a dissociative
disorder who also suffers from depression or anxiety might benefit from
treatment with a medication such as an antidepressant or anti-anxiety
medicine.
- Family therapy — This kind of therapy helps to educate
the family about the disorder and its causes, as well as to help family
members recognize symptoms of a recurrence.
- Creative therapies (art therapy, music therapy) —
These therapies allow the patient to explore and express his or her thoughts
and feelings in a safe and creative way.
- Clinical hypnosis — This is a treatment technique that
uses intense relaxation, concentration and focused attention to achieve an
altered state of consciousness or awareness, allowing people to explore
thoughts, feelings and memories they might have hidden from their conscious
minds.
What are the complications of DID?
DID is serious and chronic (ongoing), and can lead to problems with
functioning and even disability. People with DID also are at risk for the
following:
- Suicide attempts
- Self-injury
- Violence
- Substance abuse
- Repeated victimization by others
What is the outlook for people with DID?
People with DID generally respond well to treatment; however, treatment can
be a long and painstaking process. Some people with DID are reluctant to
reconnect their separate identities because these different identities help them
to cope. To improve a person’s outlook, it is important to treat any other
problems or complications, such as depression, anxiety or substance abuse.
Can DID be prevented?
Although it may not be possible to prevent DID, it might be helpful to begin
treatment in people as soon as they begin to have symptoms. In addition, an
immediate intervention following a traumatic event can help reduce the risk of a
person’s developing dissociative disorders.
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