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Dissociative Identity Disorder

Dissociative Identity Disorder is the more modern term for what was previously called Multiple Personality Disorder. These people cope with internal splits in their sense of self that feel like different identities, which also known as “alters”. A single person can have many alters, with one being the “dominant” personality. These alters have different memories, consciousness, behaviors, and personalities, all of which develop from severe trauma early in life. The symptoms usually begin in childhood or adolescence, though sometimes they can lie dormant for years before being awakened by more trauma in adulthood.

Although dissociation is not an uncommon disorder, most of these people are quite efficient at hiding their symptoms. Outside observers can only very rarely identify an obvious ‘switch’ in personalities. Dissociative symptoms usually hide among many other issues, such as depression, anxiety, substance use disorders, and self-harm. These other disorders usually come to medical attention first, while the dissociation issues and trauma history can be missed easily. Most people do not volunteer information about past trauma or dissociative experiences to therapists or doctors, let alone friends and family. Additionally, many of the symptoms people experience are largely internal and have few observable aspects. These include internal struggles between the alters, flashbacks, and disconnections from some of their actions and emotions.

The most outwardly obvious signs usually relate to lapses in memory and changes in behavior. After one alter takes control for a brief period, the person may travel to a new place, meet new people, or buy new items, but the other alters sometimes lack memories of these events. They find themselves suddenly in strange areas, unsure of how they got there. People they met during these episodes feel like strangers to the other alters, which can be frightening to say the least. Friends and family can notice unusual behaviors during these times as well. Other alters bring out different tones of voice and manners of speaking, which are telling for any observer.

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Causes and Risk Factors

Rates and gender

About 1.5% of people experience symptoms at some point in their lives, with roughly equal rates in men and women. Unfortunately, the separate ways that men and women experience the disorder lead men to treatment a lot less frequently than women because men are much less likely than women to be open about their traumas. Their dissocative symptoms can translate into violence and criminal behavior more often than those of women, although both are more likely to be a danger to themselves than to anyone else.

Early, severe trauma

The most widely accepted concept of how this disorder develops centers around the experience of significant trauma in childhood, especially before age 5. Dissociation rarely, if ever, develops after trauma in adulthood without some sort of trauma having already occurred in childhood. The key is that the person suffering the trauma is not yet fully mature and is therefore much more vulnerable.

Coping mechanisms

Severe trauma leads these children to develop different, separate sections of their personalities as a way of containing the harmful effects. It is a coping mechanism that helps them continue to function in other parts of their lives while essentially hiding the trauma away in another part of themselves. Some alters are dedicated to everyday functioning, and others deal with the trauma. As a result, adults with Dissociative Identity Disorder have different personalities that lack certain early-life memories, specifically memories of trauma. More severe, long term trauma involving more perpetrators seems to lead to increasingly complex systems of separate identities. Dissociation also appears to be more likely in people who are naturally creative, intelligent, and prone to withdrawing into fantasy worlds.

Poor parental connections

When children experience trauma, be it emotional, physical, or sexual, they look to their parents or caregivers to help them cope with what has happened. Part of a parent’s role in those situations is to guide the child’s emotions and reactions and enable them to move forward in a healthy way. However, when children lack a good connection with a caregiver, they are left on their own to process their pain, which puts them at higher risk for Dissociative Identity Disorder.

Triggers in adulthood

Anything that reminds people of their trauma or brings them to a similar emotional state as when they were suffering can trigger a dissociative episode. This might be a different trauma in adulthood, like a car accident, witnessing violence, or being in combat. Retraumatization through physical or sexual assault could also trigger dissociation. Even a person’s children attaining the same age at which they were originally traumatized can evoke symptoms. Contact with or learning news about their old abusers may also cause problems.

Co-occuring disorders

Because of the nature of Dissociative Identity Disorder, other disorders can be very difficult to diagnose. The disorder that most commonly appears alongside it is Post Traumatic Stress Disorder, which results from the same kinds of trauma that cause dissociation. Other disorders often related to trauma frequently appear as well, including Borderline Personality Disorder, eating disorders, and substance use disorders.

Diagnosing Dissociative Identity Disorder

What it looks like

These people possess two or more separate personalities that they uncontrollably vary between. They experience episodes where they become disconnected from their voices and actions. They feel like their ‘true self’ has lost control and that a different identity inside of them is coming out. Some people describe a separate voice or train of thought in their minds that interferes with and, at times, dominates their ideas. New emotions, moods, desires, and opinions emerge that may conflict with the person’s original identity. People sometimes perceive their own bodies differently during these times, like they are another gender, age, or race. The intensity of these experiences can vary significantly. Sometimes they are only noticeable by the individual, but other times, especially when voices or actions are affected, any watchful friend, family member, or physician could tell.

Missing memories

People with Dissociative Identity Disorder also experience disturbing gaps in their memories. The different identities that take over may not have the same memories as the person’s true self. They might respond to different names and have separate recollections of early life events that may have never actually happened. These identities can also lack certain learned skills that the person may have, like reading, speaking a second language, or playing a musical instrument. These people can also experience dissociative “fugue” states, where they completely disconnect from their true self for a few hours to several days. During these times they may travel far from their homes and then find themselves in a new, unfamiliar place without any memory of their travel.

“Possession” identities

These forms of Dissociative Identity Disorder include instances where people feel like their bodies are taken over by some sort of spiritual form. People may describe them as ghosts, demons, or angels, any of numerous kinds of supernatural beings. Many cultures around the world allow for similar experiences as part of religious or spiritual practices, but that is not part of this disorder. In this disorder, these episodes happen repeatedly, are very disturbing, and are not part of any established religious tradition.

Treating Dissociative Identity Disorder

Therapeutic goals

One-on-one psychotherapy is the primary treatment for Dissociative Identity Disorder, and the goal is to unify, as much as possible, the separate personalities into one self. When the different personalities stop seeing each other as separate, this is called “fusion”. Although “final fusion”, where all the identities become one, is an ideal goal, it is unrealistic to expect all people to be able to get to this point. A better end for many people is to unify aspects of their identities, like age, gender, or specific skills.

Treatment guidelines

Treating this disorder effectively requires experience, and professional guidelines help direct therapy. People with this disorder harbor multiple identities, and each has its own unique perspective and concept of “self”. Each identity also understands that there are other identities that are not seen as part of that “self”. The idea with therapy is to gradually help all the identities recognize that they are all part of a single, unified self. Although some identities are more prominent and appear more than others, they all need to be treated as equally valid and real parts of a single person. Healthy therapy will not discard or throw away any of these identities, nor will any of them be judged as better, worse, or preferable to others.

Stages of therapy

The process of treating Dissociative Identity Disorder usually follows three basic stages. The first stage begins with building a trusting relationship between the individual and the therapist, which is a major step for people who have suffered significant abuse in their lives. This stage also focuses on improving general functioning and increasing safety. This involves developing strategies to manage the dangerous and harmful behaviors that are all too common in the disorder.

The second stage of treatment involves carefully exploring the traumatic memories that led to the creating of multiple identities early in life. This is often a very emotionally trying process. The therapist and individual work together to undo the divided, fragmented memories of youth and rework them into a more unified personal history. During this process, the identities that harbor the traumatic memories share them with the identities that lack the memories. This is a cautious, gradual process that requires sufficient time and a slowed pace to enable people to deal with acknowledging these memories in a safe way.

The third and last step consists of translating the advances made in stage two into attempting to fuse the separate identities into a unified whole. As this happens, people’s symptoms become less dramatic, and their general functioning improves. When their personalities are less fractured, they need to learn coping skills that do not involve dissociating or switching personalities. They practice dealing with the everyday emotional and stressful hurdles of life in more healthy, constructive ways.

Supportive medications

Although no medications directly treat the dissociation, some medications can help reduce the severity of the disorder’s other symptoms. People with this disorder who also struggle with depression can benefit from Selective Serotonin Reuptake Inhibitors (SSRIs). Another antidepressant, trazodone, may help some people sleep. Minipress (prazosin) is a blood pressure medication that also helps reduce trauma-related nightmares and flashbacks.

Managing Dissociative Identity Disorder

Suicide and self-harm

At least 70% of people with Dissociative Identity Disorder will try to commit suicide at some point in their lives. Additionally, over 40% of these people harm themselves, such as by cutting or burning. Gaps in memory can make dealing with suicide and self-harm even more difficult. People may not remember these actions, and not all an individual’s personalities would want to hurt themselves. The personalities that have the most vivid memories of trauma, those who carry the most pain, carry this risk, while the others do not.

Can hypnosis help?

Though it may seem outside the realm of the standard forms of medical treatment, hypnosis provides a useful tool for accessing different alters during therapy. Hypnosis helps bring out certain alters during therapy to address problems related to them. It offers a relaxation tool as well to manage disruptive feelings from alters that are more closely in touch with past trauma. Controversy around hypnosis as a treatment tool points to people confusing fantasies created by alters with their actual memories. This has more to do with too much suggestion by the therapist during hypnosis, so a cautious approach with an experienced therapist is key.

Emotional monitoring

A life with Dissociative Identity Disorder can feel emotionally hectic and exhausting. However, keeping an emotion diary can help keep track of subjects that bring out alters and trigger traumatic memories. Naming and measuring the severity of emotions and moods is an important skill for these people to cultivate and is helpful in treatment. These journals help people identify negative emotional spirals and head off destructive behavior.

Types of Dissociative Disorders

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References
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