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Dissociative Identity Disorder

Multiple personality disorder (MPD), now called dissociative identity disorder (DID), remains a controversial diagnosis.

According to the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), DID is defined by these major characteristics:

  • At least two or more distinct personalities existing within one person, with each personality being dominant (in control) at different times
  • The person’s behavior is determined by the personality that is dominant at any given time
  • The person cannot remember personal information, which is beyond typical forgetfulness

In addition to the above criteria, therapists and psychiatrists also look for situations where the personality disorder suggesting DID cannot be explained by substance abuse or another condition.

What Causes DID?

In the majority of cases, DID is caused by extreme and prolonged trauma in childhood, such as childhood physical and/or sexual abuse. Some psychiatrists feel that other extreme and prolonged trauma such as being subject to combat, natural disasters, or severe emotional abuse can cause this condition. The theory is that in order to deal with such extreme and prolonged trauma, a child will create alternative personalities to compartmentalize and thus deal with the ongoing trauma.

According to experts in the field, the original personality of a person with DID is often unaware of the other distinct, alternative personalities. Control of the individual is switched to an alternative personality by triggers that are often related in some way, at least in the patient’s mind, to the underlying trauma that caused the disorder. When control switches back to the original personality, some patients do not recall any of the time when they were under the control of one of the alternative personalities, while others do remember. DID is basically the inability to integrate together the individual’s memory function, his consciousness, and his identity.

What Are the Risk Factors for DID?

Having a family history of DID (especially if it is a first degree relative) and experiencing severe childhood abuse increase the risk of developing this condition.

What Is the Treatment?

Although different therapists use different techniques to treat DID, there are four elements to the treatment of DID that appear to be widely accepted by experts in the field:

  • First, the therapist must diagnose the condition and communicate the condition to the patient. This task is considered quite difficult, since the patient may often react with both fear and disbelief.
  • Second, the therapist must acquire the trust of the individual. This too is considered quite difficult, since trust must be gained from each of the patient’s distinct personalities.
  • Third, the therapist must help the patient to confront and work through the original trauma that underlies the DID. Depending on the severity of the patient’s condition, this part of the process can take months or years.
  • And finally, the therapist tries to help the patient fuse, or integrate, the diverse and distinct alternative personality (or personalities) back into the patient’s original personality.

In addition to therapy, anti-anxiety medicines or antidepressants may be prescribed.

What Is the Controversy?

The controversy concerns whether DID is a greatly under-diagnosed condition or a condition that is grossly mis- (and thus over-) diagnosed. Mental health professionals continue to take sides on this issue. Some skeptics even feel that DID can be created by a therapist in a susceptible patient. Or, the patient himself may pretend to have this condition to get attention. Given this, what should the lay public conclude about DID?

Although impossible to clearly prove due to the complexity of the condition and diagnosis, the majority of practitioners seem to believe that the clinical manifestation of DID is a real, but extremely rare condition.

According to Dr. Jeffrey Miner, a Boston-area clinical and forensic psychologist who has evaluated criminal defendants claiming to suffer from DID, “I am convinced that DID exists, but I am equally certain that genuine cases are quite rare.” Miner further notes that although he thought it may have been over-diagnosed for a few years, most practitioners are very careful before they make a diagnosis of DID. Miner further notes that such a diagnosis should only be made over a significant period of time, not on the basis of just a few interviews with a client.

Seeking Help

Finally, Miner points out that if you think you suffer from DID, or are concerned because you are suffering from periods of amnesia for various events, do not try and diagnose the condition. Instead, Miner stresses, you should find a psychologist or psychiatrist and discuss your concerns openly and honestly.

REFERENCES:

Cherry A. Multiple personality disorder: fact or fiction? Great Ideas in Personality website.

Foote B, Park J. Dissociative identity disorder and schizophrenia: differential diagnosis and theoretical issues. Current Psychiatry Reports. 2008;10:217-222.

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