The Abnormal Psychological Disorder: Dissociative Identity Disorder

The Abnormal Psychological Disorder: Dissociative Identity Disorder

A further exploration at the abnormal psychological disorder.

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Dissociative identity disorder (DID) was first documented back in 1584. A woman, by the name of Jeanne Fery, recorded what she believed to be her exorcism in great detail. Her fellow “exorcists” also provided additional details. Her recordings resemble symptoms that are a similar match for those found currently in people diagnosed with DID.

Jeanne had many alternating identities ("alters"), each with their own name, identity, and identifying features that are consistent with our current understanding of this disorder. Jeanne’s "alters" were associated with an array of actions, ranging from helping her to heal from self-harm and eating disorders, taking control of her body, hearing voices in her head, and alterations in skills and knowledge. The "alters" were a direct result of childhood physical and sexual abuse. Because of all of the above phenomena, Jeanna was dubbed a perfect case of “dedoublement de la personnalite” (multiples of the personality).

In 1623, there was another case of DID. Sister Benedetta was reported to be periodically possessed by “three angelic boys” who would assault her, resulting in chronic pain. Each of the three boys was very distinct when taking control, as each had their own individual dialect and voice tone while using alternate facial expressions. “Benedetta had amnesia for some of their actions, including a sexual relationship that they had initiated” (Deborah Haddick). Similar to Jeanne Fery, Benedetta was a victim of self-harm and eating disorders.

“Her parents had also shown signs of dissociation and had been rumored to be possessed, and one of the ‘angels’ was frozen at age nine, the same age at which Sister Benedetta’s father had died, her symptoms had become uncontrollable, and she had been sent to the convent” (Haddick). “The first person to be officially diagnosed with multiple personality disorder (instead of double personality disorder as had eventually come into use in France) was Louis Auguste Vivet in 1882. Louis was physically abused and neglected as a child and had frequent “attacks of hysteria.”

One such attack occurred when he was 17 and bitten by a snake. He lost the use of his legs for almost one year, and when the use returned after a 50-hour attack, he didn’t remember any of the physicians who had been treating him in an asylum for the last month or any of his fellow patients. His manner, morals, and appetite were different as well. Following additional attacks, the next year, his character would change from impulsive and dangerous to calm and gentle. In 1884, he had another attack that left him gentle of manner but unable to walk, and yet another attack returned the use of his legs but left him quarrelsome and inclined to steal as he had done as a child in order to survive.

Amnesia for intervals spanning episodes was noted. By 1888, he had been recorded as having 10 personality states, each of which was different in character, memory, and somatic symptoms. In 1885, integration of the youngest 'alters' began” (Haddick). The history of this disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) actually has roots in the very first edition (1952). In that time period, dissociative disorders were “included as psychoneurotic disorders, in which anxiety is either ‘directly felt and expressed or...unconsciously and automatically controlled’ by various defense mechanisms” (Healthy Place).

Using that umbrella, dissociative disorders were associated with amnesia, dream states, depersonalization, stupor, dissociated/multiple personality, fugue, and somnambulism. Then in 1968, the DSM-II labeled DID as “hysterical neurosis, dissociative type” and was “defined as an alteration to consciousness and identity” (Healthy place). The DMS-III’s publication in 1980 first displayed the term “dissociative” as a class of disorders.The revision (DSM-III-R) stated that an essential feature of DID was “a disturbance in the normally integrative functions of identity, memory, consciousness” (HP). Then, the DSM-IV added the specific type of amnesia that goes along with multiple personality disorder (which was then renamed to dissociative identity disorder).

Now, the criteria for diagnosis of DID was: “The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self); At least two of these identities or personality states recurrently take control of the person's behavior; Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness; The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.

The DSM-5 changed this definition to allow self-reports and specify that amnesia may occur with regards to everyday events and not just traumatic ones” (HP). Studies in 1997 on genetic factors and its contribution to DID present mixed data. But there is one study that included both monozygotic and dizygotic twins that found “considerable variance in experiences of pathological dissociation could be attributed to both shared and non-shared environmental experiences, but heritability appeared to have no effect” (IQJ). In 2004, Dr. Becker-Blease utilized objective ratings of DID behavior that found that similar or shared environmental factors had very little effect in twin pairs and adopted siblings. “However, dissociative behavioral correlations of r = 0.21 for fraternal twins and r = 0.60 for identical twins suggests the presence of a genetic effect.

As this study did not specifically investigate pathological dissociation, more research is needed to determine if the genetic tendency to experience dissociation varies according to the type of dissociation (pathological or non-pathological), and whether trauma influences the pathological development of a pre-existing tendency to dissociate” (IQJ). In 2003, Dr.s Morgan, Lippmann, and Ballew discovered that anxiety-reducing activities and properties can be very helpful in memory retrieval for individuals with DID who suffer from Amnesia, specifically with memories that contain traumatic materials.

They used diazepam to successfully enact memory retrieval in a client who suffered from amnesia and was unable to remember his identity or location. “The authors of this study concluded that ‘intravenous diazepam is an effective, safe intervention to consider for facilitation of memory retrieval in amnestic patients’” (IQJ). However, because the benefits of diazepam have not been displayed, or diazepam even used, in a significant number of DID cases, it is not possible to say that this medication is 100% beneficial for DID in itself.

DID is believed to be a complex psychological condition that is likely to be caused by many factors, commonly including severe trauma during early childhood such as repeated, extremely physical, sexual, or emotional abuse. DID is believed to stem from a combination of factors that may include trauma that the individual has experienced. The dissociative aspect (similar to distancing oneself from a situation) is believed to be a coping mechanism, wherein the person quite literally dissociates themselves from a situation that is too violent, painful, or traumatic to go through in their conscious self. The symptoms of DID are characterized by the presence of two or more distinct or “split” identities or personality states that repeatedly have control over the individual’s behavior/mind/body.

With this disorder, there is typically an inability to recall vital personal information, which is more intense than your average forgetfulness. Also, there are extremely distinct variations in memory, that fluctuate with the “personality” in control. The other “personalities” are also referred to as “alters”, and each of these has their own individual age, gender, sexual orientation, and/or even race. They also have their own postures, gestures, tones, distinct speech patterns, mannerisms, vernacular, and even body chemistry.

There was one case where one of the person’s "alters" was allergic to orange juice, while the other "alter" was not, despite both alters inhabiting the same exact body. When the immune "alter" was in control, there was absolutely no reaction to the orange juice. But when the allergic "alter" would drink it, they would break out. More interestingly, if the allergic "alter" would take control during the digestion of the orange juice, despite not being in control during the consumption, then they would still break out.

But if the immune one did, then the reaction would completely dissipate. All of this having occurred in the same physical body. There are also cases in which one "alter" is colorblind and the very next "alter" is not. In other cases, two or more personalities require different prescriptions for their glasses, and sometimes even their eye color is different. Some other symptoms of this disorder include depression, suicidal thoughts or tendencies, sleep disorders (such as sleepwalking, insomnia, and night terrors), mood swings, flashbacks, reactions to stimuli or triggers, panic attacks, anxiety, phobias, drug and alcohol abuse, psychotic-like phenomena (auditory and visual hallucinations), eating disorders, compulsions and rituals, headaches, amnesia, time loss, trances, and “out of body experiences”.

Some people that have DID are known to exhibit behavior that involves self-persecution, self-sabotage, as well as violence toward others and themselves. This can be a person engaging in actions that they would not typically participate in, like speeding down a rainy, wet road at night, reckless driving, stealing. The people that do these things feel compelled to engage in these behaviors. Some of these people describe this sensation as being a passenger in their own body, instead of the driver.

They honestly believe that these are involuntary actions. Just like with any other mental condition, DID can have a huge impact on a person’s life. The four main ways of which are depersonalization, amnesia, identity confusion/alteration, and derealization. Depersonalization is a feeling of being detached from one’s body, and is often attributed as the “outside of body” experience. Amnesia in this case is the utter failure to recall significant personal information that is so severe that it merely cannot be attributed to your run-of-the-mill forgetfulness.

Identity confusion and alteration both involve a basic sense of confusion over who a person is. These are expressed when a person has difficulty identifying the things that interest them, including their social, religious, or political ideologies, their professional ambitions, or even their sexual orientation. Derealization is the sensation that the world is not real, or that it looks foggy or far away. “It is now acknowledged that these dissociated states are not fully mature personalities, but rather they represent a disjointed sense of identity.

With the amnesia typically associated with dissociative identity disorder, different identity states remember different aspects of autobiographical information. There is usually a "host" personality within the individual, who identifies with the person's real name. Ironically, the host personality is usually unaware of the presence of other personalities.” (WebMD). It is believed that the alters exist to serve in helping an individual to cope with life’s dilemmas. It is very common among patients with DID to have around two to four alters present upon official initial diagnosis.

Over the course of treatment, around 13 to 15 "alters" can make them known. While highly unusual, even among DID patients, there have been instances in which patients have had over 100 completely distinct, separate "alters". Life events (usually traumatic) and/or environmental triggers often cause a sudden shift from one "alter" to another. While the official cause of this disorder is still vague, research has shown that it is “likely a psychological response to interpersonal and environmental stresses, particularly during early childhood years when emotional neglect or abuse may interfere with personality development” (WebMD).

As many as 99% of people diagnosed with DID have identified personal histories of repeated, overpowering, and even life-threatening disturbances that occurred (usually) before the age of nine, a sensitive developmental stage of childhood. “Dissociation may also happen when there has been persistent neglect or emotional abuse, even when there has been no overt physical or sexual abuse. Findings show that in families where parents are frightening and unpredictable, the children may become dissociative” (WebMD).

To diagnose someone with this disorder takes a lot of time. This is because many of the symptoms are the same ones attributed to other mental disorders. These symptoms, headaches, anxiety, and depression, are all versatile in the world of diagnosing a mental illness. In fact, those diagnosed with DID may also be diagnosed with other personality disorders, anxiety, and depression.

However, the DSM-5 has provided the following criteria to diagnose somebody with DID: (1) Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self. (2) Amnesia MUST occur; this is defined as gaps in the recollection of everyday events, vital personal information, and/or traumatic events. (3) The person must be distressed by this disorder OR be having trouble functioning in one or more major areas of life because of this disorder.

(4) The disturbance is not part of normal cultural or religious practices. (5) The symptoms can’t be due to the direct physiological effects of a substance or a general medical condition. “Statistics show the rate of dissociative identity disorder is .01% to 1% of the general population. Considering dissociation more broadly, more than a third of people say they feel as if they're watching themselves in a movie at times (that is, possibly experiencing the phenomenon of dissociation), and 7% percent of the population may have some form of an undiagnosed dissociative disorder” (WebMD).

Unfortunately, there is no “cure” for DID. However, if a patient stays committed, then long-term treatment can be very helpful. Some of the most effective treatments include talk therapy, hypnotherapy, psychotherapy, and adjunctive therapies such as movement or art therapy. Since there are no established medication treatments for this disorder, psychologically-based therapy is the best bet for now.

Additionally, treatment of co-occurring disorders, such as depression or substance use disorders is vital to overall improvement. “Because the symptoms of dissociative disorders often occur with other disorders, such as anxiety and depression, medicines to treat those co-occurring problems, if present, are sometimes used in addition to psychotherapy” (WebMD).

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