Dissociation is a common, naturally occurring defense against childhood trauma. When faced with overwhelming abuse, children can dissociate from full awareness of a traumatic experience. Dissociation may become a defensive pattern that persists into adulthood and can result in a full-fledged dissociative disorder.
Formerly known as Multiple Personality Disorder, Dissociative Identity Disorder (DID) is a condition in which a person has two or more distinct identity or personality states, which may alternate within the individual's conscious awareness. The different personality states usually have distinct names, identities, temperament, and self-image. At least two of these personalities repeatedly assert themselves to control the affected person's behavior and consciousness, causing long lapses in memory that far exceed typical episodes of forgetting. Additionally, physiological conditions, such as direct effects from substance use or general medical conditions such as seizures, must be ruled out.
Having a loved one who has DID can be painful, confusing, and may evoke all kinds of emotional reactions. If you become aware of the abuse, you may feel angry, anxious, sad, or disgusted, along with empathy and worry. It may be hard keeping track of all the personalities (or "alters") if you have experienced them. Often, persons with DID cannot tell which of the alters is out at a given time and do not expect their loved ones to know either. A major adjustment for relatives and friends is the constant switching between personalities. Integration can bring about significant changes in a personality as the different alters grow and change dramatically. Although you may feel like the person you knew no longer exists, the part that you knew before integration still exists. Now you know more of him or her.
The main cause of DID is believed to be severe and prolonged trauma experienced during childhood, including emotional, physical or sexual abuse.
The development of dissociative identity disorder is understood to be a result of several factors:
- Recurrent episodes of severe physical, emotional or sexual abuse in childhood.
- Absence of safe and nurturing resources to overwhelming abuse or trauma.
- Ability to dissociate easily.
- Development of a coping style that helped during distress and the use of splitting as a survival skill.
- While abuse is frequently present, it cannot be assumed that family members were involved in the abuse.
Many symptoms of DID are similar to those of other physical and mental disorders, including substance abuse, seizure disorder and post-traumatic stress disorder.
The common symptoms of DID include:
- Inability to remember large parts of childhood.
- Unexplained events and inability to be aware of them (such as finding yourself somewhere without remembering how you got there or new clothes that you have no recollection of buying).
- Frequent bouts of memory loss or "lost time."
- Sudden return of memories, as in a flashback and/or flashback to traumatic events.
- Episodes of feeling disconnected or detached from one's body and thoughts.
- Hallucinations (sensory experiences that are not real, such as hearing voices talking to you or talking inside your head).
- "Out of body" experiences.
- Suicide attempts or self-injury.
- Differences in handwriting from time to time.
- Changing levels of functioning, from highly effective to nearly disabled.
Persons with DID may also have problems with:
- Depression or mood swings.
- Anxiety, nervousness, panic attacks and phobias (flashbacks, reactions to stimuli or "triggers").
- Eating disorders.
- Unexplained sleep problems (such as insomnia, night terrors, and sleep walking).
- Severe headaches or pain in other parts of the body.
- Sexual dysfunction, including sexual addiction and avoidance.
The diagnosis of DID requires medical and psychiatric evaluation which can include specific questions about dissociation, prolonged interviews, and journals between visits. Specially designed questionnaires are used to screen and diagnose DID.
Seek professional medical help if you (or a loved one) have significant, unexplained memory loss, a chronic sense that your identity or the world around you is blurry or unreal, and you experience a major change in behavior when under stress. Immediate emergency care should be sought if there are serious thoughts of self-harm, suicide or homicide.
Early intervention and psychotherapy for experiences of abuse/trauma in both children and adults can help prevent the formation of dissociative symptoms and dissociative disorders.
Intervention and Treatment
Left untreated, DID can last a lifetime. While treatment for DID may take several years, it is effective. Persons with DID may find that they are better able to handle the symptoms in middle adulthood. Stress, substance abuse, and sometimes anger can cause a relapse of symptoms at any time. As a good standard of care, persons with DID should be treated by a mental health professional with specialized training and experience with dissociation. Since physical illness can sometimes mimic or contribute to a psychological disorder, a complete physical examination by a physician is warranted when there are concerns about physical conditions. For significant mood disorders and psychiatric conditions, a psychiatric consult is necessary.
- Psychotherapy. Treatment for DID consists primarily of individual psychotherapy and can last for an average of five to seven years in adults. Individual psychotherapy is the most widely used modality as opposed to family, group or couples therapy. The main goal for treatment is the integration of the separate personality states into one cohesive, unified personality, unless the person with DID is not ready or motivated to work with trauma. Psychotherapy for dissociative disorders often involves techniques that help work through the trauma that triggers dissociative symptoms. Treatment may include the following stages: uncovering and "mapping" the alters or parts; treating the traumatic memories and "fusing" the alters; and consolidating the newly integrated personality.
- Family Therapy is recommended to help educate the family about DID and its causes, to understand the changes that can take place as the personality is being reintegrated, as well as help family members recognize symptoms of recurrence. Family therapy for a person with DID may produce significant negative and traumatic memories of other family members which can hinder clinical progress.
- Group therapy may be beneficial in addition to individual therapy, provided the group is exclusively for people with dissociative disorders. Persons with DID can sometimes have setbacks in mixed therapy groups because others may be bothered or disturbed by the personality switches.
- Medications. There is no medication to treat DID since it is not an organic disorder or a chemical imbalance. However, antidepressants and anxiolytics might help with mood disorders.
- Clinical Hypnosis. Despite controversy about therapists implanting false memories by suggestion, clinical hypnosis can be used in conjunction with psychotherapy when conducted safely by a trained therapist. Hypnosis can help clients access repressed memories, control problematic behaviors, such as self-mutilation and eating disorders, and help fuse the alters during the integration process.
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