Dissociative Identity Disorder

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What is Dissociative Identity Disorder?

Dissociative identity disorder (DID) is a personality condition. The primary characterization is the existence of at least two distinguishable identities or personality states. They have separate identities, tastes, beliefs, and even memories.

They may also differ in age, sexual orientation, intelligence quotient, knowledge, allergies, visual acuity, or blood pressure. The International Classification of Diseases ICD-11 defines dissociation as “the complete or partial loss of normal integration between memories, sense of self, immediate sensations, and control of voluntary body movements.”

Symptoms

Dissociative identity disorderTrusted Source involves the development of different personalities that take control of a person's behavior.

The first symptoms of DID are usually unexpected, severe panic attacks, withdrawal from social life, and feelings of alienation. A person may live with such symptoms for up to several years until the typical symptoms of dissociative identities appear. Sudden mood changes, sleep and memory disorders, and psychotic episodes characterize headaches. Severe behavioral problems and difficulties with learning and concentrating at school are observed in children and adolescents. There may also be episodes of depression and periods of alcohol or drug addiction.

The first personality change in life is often sudden and is a consequence of a stressor. Subsequent changes may appear without the involvement of an inflammatory factor. It is never sure whether and when control will be taken over. Personalities can care for each other, but they can also ridicule and mock each other.

Characteristic symptoms of the disorder at a later stage are repeated memory gaps, difficulties recalling everyday events, or significant autobiographical facts. The period in which another personality takes control of the behavior is covered by amnesia, which may last from a few minutes to many hours or days.

Patients with dissociative identity disorder often hear other people's accounts of what they did or find evidence that they did something they do not remember and often observe bodily injuries and bruises. Individual personalities usually do not know about each other. It also happens that the dominant personality, which has given up control over another personality, observes its actions as if it were watching a movie.

Another symptom is identity disruptionTrusted Source, associated with an apparent discontinuity in the sense of self and will. This disruption involves mood, actions, thoughts, awareness, recall, or interpretation alterations.

Dissociative Identity Disorder: What Is, Symptoms, Causes, and Diagnosis

Another symptom is dissociation, which can take two forms: depersonalizationTrusted Source (i.e., a sense of unreality, alienation from oneself) and derealizationTrusted Source (a sense of unreality of the surrounding world).

It is also characteristic that different personalities have different skills, talents, preferences, and addictions. It involves experiencing intrusive thoughts. For example, when one personality drinks alcohol – the other does not, they may feel a strong, incomprehensible desire to drink.

It is worth emphasizing that dissociative identity disorder may cause several symptoms characteristic of other disorders, including schizophrenia, bipolar disorder, or borderline disorder.

Causes

The causeTrusted Source is a traumatic event from the past, such as molestation, rape, being a victim of physical violence, participation in a war, accident, disaster, or death of a loved one. There may be more triggers for this phenomenon. That is because they are very individual.

Dissociative identity disorder may develop due to substance abuse and other mental conditions and problems.

DissociationTrusted Source is an attempt to separate oneself from the trauma; the patient creates a separate personality with different memories, habits, and behaviors. It is a defense mechanism that lets you isolate yourself from the experienced trauma.

The mechanisms leading to the development of this condition are not fully explained by psychology and psychiatry. However, as mentioned above, dissociative identity disorder may appear as a result of traumatic experiences. Generating separate personalities is intended to free oneself from the painful past and enable normal functioning. It is a type of defense mechanism.

The most common causes of split personality, according to the ICD-11 psychiatric classificationTrusted Source, are:

Tragic events and the emotions that accompany them suppressed in the psyche may develop into alternative personalities. They result from the psyche being broken under the influence of some event. Multiple personality disorder is often accompanied by symptoms such as self-harm, addictions, sleep disorders, headaches, and depression. The patient may also engage in compulsive behavior. People with this disorder are withdrawn from social life, distrustful, and have low self-esteem.

There is a period of particular sensitivity or susceptibility during which traumatic events may lead to the development of multiple personalities. This period ranges from several months to 9–10 years of age. The existence of such a critical period for the development of the disorder in question is related to processes that, under the influence of the child's traumatic experiences, may lead to the fragmentation of self and memory.

The developmental model considers three mental processes normal in childhood, which, under the influence of a traumatic event, may become the basis for developing multiple personalities: children's typical susceptibility to dissociation, imagination, and fantasy, and behavioral states of consciousness. Children's typical susceptibility to dissociation. It seems that dissociation is one of the psychological processes with both adaptive and defensive functions. It can be considered a continuum from daydreaming through light states of trance while watching a movie to such dissociative severe phenomena as amnesia or escapes. The dissociation process becomes pathological when the related phenomena exceed a certain intensity and frequency limit.

Children have a grander ability than adults to enter a dissociative state, i.e., a state characterized by significant changes in the integrating functions of memory relating to thoughts, feelings, and actions, as well as changes in feeling yourself. This ability decreases as we grow through childhood and into adolescence. Thus, the normal defensive functions of the dissociation process may become the basis for the development of alternative personalities in those children who experience physical abuse or severe psychological trauma. The most noteworthy defensive functions of dissociation include:

Dissociative Identity Disorder: What Is, Symptoms, Causes, and Diagnosis

Another developmental background that may play a role in the etiology of dissociative identity disorder is children's ability to fantasize, especially to project their personality onto objects and situations. Research indicates three features characterizing children's fantasy that may be important for the etiology of multiple personality disorder:

Differentiation from Other Disorders

Of course, it is necessary to differentiate dissociative personality disorders from other disorders.

Schizophrenia

People suffering from schizophreniaTrusted Source may have delusional beliefs about changing their own identity or being subject to foreign influences. This symptom usually co-occurs with thinking disorders and a sudden, significant deterioration of social functioning.

Simulation

In the case of simulationTrusted Source, differentiation is challenging. When there is a suspicion that a patient may be faking symptoms, the first thing to consider is what benefits such a pretended “multiple personality” may offer him.

Borderline Personality Disorder

A borderline personality disorderTrusted Source is characterized by high mood variability, which in some respects may resemble the presence of two different personalities. In the differentiation process, it should be taken into account that multiple personality disorder may co-occur with borderline personality disorder.

Bipolar Affective Disorder with Rapid Cycling

Again, in bipolar affective disorder with rapid cyclingTrusted Source the symptoms are similar to those of dissociative personality disorder. Still, the personality differences are not as extreme as in the case of DID.

Diagnosis

Due to the complexity of the phenomenon and several coexisting disorders, detecting dissociative identity disorder is very difficult and requires knowledge, experience, and attentiveness from the diagnostician. The diagnosis is based on a detailed interview, observation, and a series of personality tests. Information obtained from the person's relatives or people whose presence the dissociation occurred may be significant.

According to DSM-5 criteria, dissociative identity disorder is characterized by the presence of at least two separate personalities and the presence of memory gaps. Manifestations of DID may also include changes in affect, states of consciousness, behavior, and perception skills, as well as movement and sensation disorders. DSM-5 Diagnostic Criteria for DIDTrusted Source:

The patient's environment usually notices different personality states. Individual personalities are most often unaware of their existence; they may state different identities, genders, ages, sexual orientations, or interests and also differ in the dominant hemisphere of the brain, which most often manifests itself as right- or left-handedness.

The ICD-11 classification emphasizes the dynamics of this condition over time. The first personality shift in life is usually sudden and is directly connected to the effect of a stressor. Subsequent changes are often limited to traumatic events or during therapeutic sessions, including relaxation, hypnosis, or release.

Treatment

The basis for proposing effective forms of treatment is, first of all, the correct diagnosis of the symptoms of dissociative disorders. Unfortunately, despite the growing awareness and knowledge about this disease, many patients are still misdiagnosed. Many patients with dissociative identity disorder, presenting positive psycho and somatoform symptoms, are diagnosed with schizophrenia. However, it should be remembered that the treatment of these two diseases is significantly different. While the appropriate selection of medications plays a significant role in the course of schizophrenia, in the course of dissociative disorders, especially dissociative identity disorders, the most important thing is to undergo psychotherapy.

Dissociative Identity Disorder: What Is, Symptoms, Causes, and Diagnosis

In therapeutic proceedings, it is also crucial to establish the relationship between the experienced symptoms and a past traumatic experience. The main goal of treatment for dissociative identity disorder is the integration of individual alternative personalities that the individual has developed through dissociation. The desired effect of therapyTrusted Source may be the disappearance of dissociative personalities and their integration with the patient's original personality. For this purpose, therapists use various systems and therapeutic techniques, among which hypnosis plays an important role. Important information is that patients undergoing systematic psychotherapy can achieve not only a reduction in the symptoms they experience but, above all, an improvement in functioning in all areas of life.

Nevertheless, it should be noted that the knowledge, skills, and experience of the psychotherapist are of great importance for the success of the therapy. Pharmacological treatmentTrusted Source, however, plays an auxiliary role in the treatment of dissociative disorders. Individual therapeutic agents are administered to patients depending on the nature, severity, and frequency of symptoms.

Antidepressants, especially selective serotonin reuptake inhibitors (SSRIs), are most often administered to patients suffering from depression in the course of dissociative identity disorders. Benzodiazepines and beta-blockers are recommended for patients who experience anxiety or vegetative symptoms of anxiety due to severe dissociative symptoms. Stabilizing drugs are given to patients who show hyperactivity or aggression.

Sources

December 27, 2023
11 minutes read
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