Dissociative Identity Disorder

PsychologyAbnormal Psychology

The DSM-5 lists several dissociative illnesses, including dissociative identity disorder (DID). Dissociative identity disorder is associated with temporal memory loss because of which, the individual plays different roles at a time.

What is the Meaning of Dissociative Identity Disorder (DID)?

Formerly known as multiple personality disorder (MPD), dissociative identity disorder is a mental issue in which at least two separate, permanent personality states must be maintained with different credentials.

Memory lapses that are not consistent with common memory problems are a symptom of the disorder. At least two unique and different personalities must exist within an individual. Only one person's many personalities (alters), each with its memories, habits, and life preferences, are ever visible at once.

Characteristics of DID

DSM 5 lists the following criteria of dissociative identity disorder (DID):

• There is the presence of two or more separate identities or personality states, each with a relatively stable pattern of perception, interaction, and identity.
• There must be amnesia, characterized by gaps in the memory of daily occurrences, significant personal information, and/or catastrophic or major traumatic life events.
• The disorder must cause significant distress to the person or cause impairment in the functioning of one or more important aspects of their lives, such as social, educational, or occupational life.
• The disturbance is not attributed to any normal cultural or religious practices.
• At any given time, a person's behavior is influenced by at least two identities. Additionally, the disturbances must not be caused by a drug or alcohol addiction or a general medical condition like an epileptic seizure.

Diagnosing DID and its Clinical Manifestations:

Many mental health professionals have disputed the DID diagnosis for years, attributing it to misdiagnosis, social contagion, or plain old hypnotic suggestion. As a result, most DID, a small number, exclusively make diagnoses of highly qualified psychiatrists. Thus, the ambiguous presentation of dissociative identity disorder (DID) can make it difficult to diagnose because many of its symptoms might be mistaken for those of other medical or mental conditions, such as post-traumatic stress disorder (PTSD), borderline personality disorder (BPD), schizophrenia, substance use disorder or seizure disorders.

Apart from the DSM 5 criteria, the symptomatology often includes the following clinical manifestations:

• A lack of ability to recollect significant early memories from one’s childhood;
• Inability to explain recent occurrences in daily life; and if they do remember them, such as being unable to explain how the patient arrived somewhere or how they acquired an item or personal possession;
• Memory loss;
• Unexpected or abrupt recollection of memories;
• Feelings of detachment or dissociation from the body or mind are often referred to as depersonalization and derealisation, where there is a significant disconnect;
• Hallucinations or hearing voices;
• The individual with dissociative identity disorder (DID) may also engage in self-harm or suicidal ideation;
• Alterations to the handwriting of the individual;

Infrequent and rare clinical manifestations of Dissociative Identity Disorder (DID):

It includes:

• Sudden shifts in mood and depressed mood states;
• Occurrence of panic attacks, anxiety, nervousness, or phobias;
• Eating and food related issues;
• Unexplained sleep disturbances;
• Headaches;
• Body pain;
• Sexual dysfunction, sex addiction, or sexual avoidance
• Anhedonia.

Screening tools for Dissociative Identity Disorder (DID)

For a diagnosis of dissociative identity disorder (DID) to be made, often self-report inventories that serve as potential screening measures are used by clinicians. Some of the most commonly used self-report inventories include:

• Dissociative Experiences Scale (DES)
• Dissociation Questionnaire (DIS-Q)
• Multidimensional Inventory of Dissociation (MID)

Etiology of Dissociative Identity Disorder (DID)

Dissociative identity disorder (DID) is a chronic psychiatric condition based on neurobiological, cognitive, and interpersonal non-integration as a reaction to excessive stress with a strong empirical foundation. The illness is still understudied even though the available evidence is sufficient to support its etiological position. While genetic research on dissociative identity disorder (DID) sheds more light on how a person interacts with external stress, research investigations define the neurological and cognitive characteristics of the condition. As a result, dissociative identity disorder (DID) can serve as an excellent example of a disorder in the context of the biopsychosocial paradigm in psychiatry.

Dissociative identity disorder (DID) is a chronic post-traumatic condition with central and typical etiological components, including developmental stressors in childhood such as abuse, emotional neglect, dysfunctional attachment styles, and boundary violations. Family, societal, and cultural variables may contribute to the trauma and impact how DID manifests.

Memory and self-identity development are cognitive processes markedly and centrally appear disturbed in DID and are associated with its genesis. Through persistent psychological mode decoupling, which may also result in separate self-experiences, inter-identity amnesia may arise. The divide between storing experienced experiences (i.e., how the human memory system works) and acknowledging ownership of those events as a part of the autobiographical experience is thus linked to the apparent etiological aspect of dissociative identities (i.e., self-referencing the events). In other words, there is no longer a link between memory and self-awareness.

As per research, there are neurobiological differences between dissociative identities among DID patients and between DID patients and controls. Increased cerebral blood flow was seen in the amygdala, insular cortex, somatosensory areas in the parietal cortex, the basal ganglia, as well as in the occipital and frontal regions and anterior cingulate in a dissociative identity centered on painful memories and defensive operations.

Treatment

The most effective treatment approach for DID is psychotherapy. Although it cannot be cured completely, medications including antidepressants, anti-anxiety medications or antipsychotic drugs can be given to alleviate depression or anxiety related symptoms in DID. Individual, group, or family therapy is beneficial for those with DID. Therapy particularly focuses on:

• Recognizing and healing from prior experience of abuse or trauma;
• Managing unexpected changes in behavior; and
• Creating a new identity by combining and integrating the existing identities.

Conclusion

DID is a chronic illness and unfortunately, it does not have a cure. However, most people live their entire lives managing the disorder and a combination of therapeutic approaches along with medication can reduce the symptoms. DID cannot be prevented, either. However, early detection and medical attention might help control the symptoms. Parents, caregivers, and educators should watch out for warning indications in young children. Early intervention following instances of abuse or trauma may be a preventive factor for the progression of DID. Additionally, living with DID can be made easier to handle if the individuals have adequate social support.

References

• Martin J Dorahy, Bethany L Brand, et al. Dissociative Identity Disorder: An empirical overview. (URL -https://journals.sagepub.com/doi/abs/10.1177/0004867414527523 )
• Paul F. Dell. A new model of dissociative identity disorder. (URL - https://doi.org/10.1016/j.psc.2005.10.013)
• DH Gleaves. The Socio-cognitive Model of Dissociative Identity Disorder: A Reexamination of the Evidence. (URL -https://psycnet.apa.org/journals/bul/120/1/42/)
• Richard P. Kluft. Dissociative Identity Disorder. (URL -https://link.springer.com/chapter/10.1007/978-1-4899-0310-5_16 )
• Eric Vermetten M.D. et al. Hippocampal and Amygdalar Volumes in Dissociative Identity Disorder. (URL -https://ajp.psychiatryonline.org/doi/full/10.1176/ajp.2006.163.4.630 )
• Rodewald, Frauke, et al. Axis-I Comorbidity in Female Patients with Dissociative Identity Disorder and Dissociative Identity Disorder Not Otherwise Specified. (URL -https://journals.lww.com/jonmd/Abstract/2011/02000/Axis_I_Comorbidity_in_Female_Patientxs_With.10.aspx )
• Kelly A. Forrest. Toward an Etiology of Dissociative Identity Disorder: A Neurodevelopmental Approach. (URL -https://www.sciencedirect.com/science/article/abs/pii/S1053810001904933 )
• Onno van der Hart Et al. Memory Fragmentation in Dissociative Identity Disorder. (URL -https://www.tandfonline.com/doi/abs/10.1300/J229v06n01_04 )