9.2 Dissociative Disorders

Jo Ann Jankoski

9.2 Dissociative Disorders

Dissociative Identity Disorder (DID) By Holly Chapman (Spring 2021)

It was known as Multiple Personality Disorder (MPD) until 1994, when it was changed to dissociative identity disorder (DID) with the introduction of the DSM-IV. The defining feature of DID is the presence of two or more personality states in an individual (APA, 2013). The individual has a lack of connection to their memories, thoughts, feelings, actions, and their sense of identity (WebMD). The disorder is mainly caused by significant trauma that an individual has experienced in their life. The disorder itself is rare.

Individuals with DID, have their main personality, which is the person’s actual self. A person with DID then has other identities known as their “alters.” Each alter can have their own identity. With each identity there can be variations in memory, gender, age, etc (Cleveland Clinic). An example of this could be an individual being a 20-year-old male but when they have a switch in their identity, they are now a 30-year-old female who has memories of being a nurse during World War II.

This disorder usually causes a lot of distress for the individual. They often downplay or try to hide their symptoms out of embarrassment. Since an individual experiences alternating identities, this can have a negative impact on their social and work lives. Switches in identity is not something the individual causes or can control. They happen involuntarily and are typically recurrent and persistent.

What DID is not:

A Personality Disorder
A part of Trauma and Stressor Related Disorders

Women typically are diagnosed more than men are. However, men are more likely to deny their symptoms which can prevent them from getting an accurate diagnosis and treatment. Men that are diagnosed with DID typically show more violent or criminal behavior than what women do (APA, 2013).

CAUSES

A main cause for a person developing DID is experiencing something traumatic and overwhelming in their life. This experience and/or event usually occurs during childhood. To help deal with the trauma, that one has experienced they may use dissociation as a defense mechanism. One cause of DID, is experiencing abuse or maltreatment as an adult or child. Long medical procedures that are experienced early in life can also be a traumatic event that can cause DID (APA, 2013).

The changes in identity can be triggered by several ways (APA, 2013):

Removal from the traumatizing situation (e.g., through leaving home)
The Individual’s children reaching the same age at which the individual was originally abused or traumatized
Later traumatic experiences, even seemingly inconsequential ones, like a minor motor vehicle accident
The death of, or the onset of a fatal illness in, their abuser(s)

DIAGNOSING

To meet a diagnosis of DID, the individual must meet the following diagnostic criteria provided by the American Psychiatric Association (APA, 2013):

Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.
Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
The disturbance is not a normal part of a broadly accepted cultural or religious practice.

Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play.

The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

Individuals typically experience dissociative amnesia and dissociative fugue which ties in with Criterion B. Dissociative amnesia can occur in three different ways in individuals with DID (APA, 2013):

Gaps in remote memory of personal life events (e.g., periods of childhood or adolescence; some important life events, such as the death of a grandparent, getting married, giving birth).
Lapses in dependable memory (e.g., what happened today, of well-learned skills such as how to do their job, use a computer, read drive).
Discovery of evidence of their everyday actions and tasks that they do not recollect doing (e.g., finding unexplained objects in their shopping bags or among their possessions; finding perplexing writings or drawings that they must have created; discovering injuries; “coming to” in the midst of doing something).

Dissociative Fugue is when the individual travels to a location and has no recollection of getting to where they are at.

DID can often be misdiagnosed, or it can take a long time for an individual to get a diagnosis of DID, as the disorder can appear similar to other mental disorders. Disorders that DID may appear as are (APA, 2013):

Other specified dissociative disorder – DID and other specified dissociative disorder have a similar symptom regarding disruptions of conscious functioning and sense of self. It can be distinguished by the presence of chronic or mixed dissociative symptoms that do not meet criterion A for DID or they are not followed by amnesia.
Major depressive disorder – Individuals with DID can be depressed. This may seem like major depressive disorder. However, they may not meet the criteria for major depression. The depression can fluctuate, as one identity may have depression, but the others do not.
Bipolar disorders – Commonly individuals with DID are given a misdiagnosis of bipolar II disorder. The shifting in moods due to identity switching can happen quickly, which may appear to be a bipolar disorder.
Posttraumatic stress disorder (PTSD) – Individuals can have both PTSD and DID, or they may just have PTSD only. PTSD can cause dissociative symptoms, so it is important for clinicians to determine whether the dissociative symptoms are characteristic to PTSD.
Psychotic disorders – DID can be thought to be schizophrenia or other types of psychotic disorders. The thoughts related to other identities may be originally thought of as hallucinations. Individuals with DID do not have delusions.
Substance/medication-induced disorders – DID can be thought to be related to a substance if the substance is believed to relate to any disturbances.
Personality disorders – Symptoms of DID can appear to look like severe personality disorders, such as borderline personality disorder.
Conversion disorder (functional neurological symptom disorder) – Conversion disorder can be ruled out if there is an absence of identity disruption.
Seizure disorders – Electroencephalographic findings can differentiate between non-epileptic seizures and the seizure-like symptoms that can come from DID.
Factitious disorder and malingering – Individuals who fake having DID often do not report subtle, less known about symptoms of DID. The symptoms that they report tend to be well-known symptoms. People who genuinely have DID are disturbed by their symptoms, while individuals are feigning the disorder tend to be happy about their “disorder.” People who malinger display stereotypical identities of the disorder. They fake amnesia when a personal gain can be found. Instances like this would be trying to get out of a crime.

Symptoms can occur at any age. Although, some ages may be less likely to receive a diagnosis. In adolescents, if sudden changes in identity are noticed, it may be looked at as being related to adolescence and being a moody teenager or thought to be another disorder. In older individuals, it may be believed to be a mood disorder. Forgetting memories may be looked at as being related to age (APA, 2013).

Individuals with DID often have other disorders as well. This can result in them not getting treated for DID but receiving treatment for their comorbid disorder. If an individual is just receiving treatment for their comorbid disorder, the treatment can be time consuming and has limited effectiveness. Some comorbid disorders are:

PTSD – Most individuals with DID will develop PTSD.
Depressive disorders
Trauma- and stressor-related disorders
Personality disorders – Individuals with a DID diagnosis can especially have a comorbid personality disorder of avoidant and borderline personality disorders.
Conversion disorder (functional neurological symptom disorder)
Somatic symptom disorder
Eating disorders
Substance-related disorders
Obsessive compulsive disorder
Sleep disorders

SUICIDE RISK

Individuals who are diagnosed with DID have a high risk of suicide. 70% of individuals diagnosed with DID have attempted suicide. Multiple attempts are common (APA, 2013).

TREATMENT

DID can be treated through different methods and techniques. Such forms of treatment include:

Psychotherapy – Known as talk therapy. This is the most used form of treatment for DID. The goal of treatment is to merge all the personalities into one. Psychotherapy works through the trauma and the triggers that cause the dissociative symptoms.
Cognitive Behavioral Therapy (CBT) – This can help treat and change any dysfunctional thinking patterns, feelings and/or behaviors that individuals with DID may have.
Eye Movement Desensitization and Reprocessing (EMDR) – EMDR is a treatment that can be used in individuals with PTSD. Since individuals with DID have typically experienced a lot of trauma in their life, or they also have PTSD, EMDR may be helpful in reducing symptoms.
Dialectic Behavior Therapy (DBT) – DBT can be used to help treat severe personality disturbances.
Family Therapy – Family therapy can be beneficial for the individual’s family. This allows the family to receive more education on the disorder and teaches them ways they can help their loved one.
Creative Therapies – This allows the individual a safe place where they can express any emotions that they may have.
Clinical Hypnosis – Hypnosis can help integrate the other personalities into one while also accessing repressed memories an individual may have. It can be good when used along with psychotherapy and done safely.
Medication – There is no one specific medication that is on the market today that would “cure” DID. Medications can be used to help with other symptoms that the individual may have such as antidepressants being used to treat anxiety or depression, and other medications can be used to help with sleep disturbances.

If an individual with DID receives appropriate treatment, there can be improvement in their occupational and personal functioning. The individual can respond slowly to treatment with a slow reduction in their dissociative or post-traumatic symptoms. Long-term supportive treatment may be better at slowly helping the individual manage their symptoms.

Portrayal in Media:

DID is often not accurately portrayed in media. The media has portrayed individuals with DID as being dangerous or having obvious different personalities. Symptoms of DID presented by the media, may also be stereotyped symptoms.

Some examples of DID being portrayed in the media include: