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DID diagnosis Essay

They are “strangers to themselves. ” Perhaps that is the most simplistic yet most accurate description of people suffering from a dissociative disorder. Their whole life can feel like one big dream, but the worst part is that it isn’t even their dream—it’s someone else’s. Everything seems to operate in slow motion, the outside world seems like an eternally ungraspable perception, and they feel like nothing more than a perception…. nothing more than a mere fleeting thought. This sort of depersonalization is the key characteristic of Dissociative Identity Disorder, separating it from the amnesias and the fugues (Sidran Foundation, 2003).

And this disorder appears to be what Aaron will use as a defense for his murder trial in the movie Primal Fear. Aaron certainly displays the classic symptoms of this Axis I diagnosis. When the psychologist is speaking to him, he stutters and twitches (an Axis III physical characteristic) (Brown & Barlow, 2001) and generally seems very incapable of establishing a connection with his surroundings. It is as if he is in a perpetual fog, waiting for any reason to run screaming into the protective mist.

That flight appears to happen briefly when the lady recording the session starts fiddling with her camera. Then, Aaron’s polite “Aw, shucks” demeanor abruptly transforms into a fleeting moment of exasperated cursing—almost as if, for that brief moment, he was a different person. The change seems to go unnoticed for a while, until an intense argument with his lawyer reveals the truth about Aaron. In all of his previous interviews, the young murder suspect has displayed other key physical, Axis III symptoms that should have indicated all was not right (Dissociative disorders, 2005).

He reported feelings of overwhelming exhaustion, claimed he did not remember the time surrounding the archbishop’s death (blackouts which, he claimed, had been experienced since the age of twelve), and often grabbed his head as if it were about to explode. Once Aaron’s lawyer starts to scream at him and demand the truth, Aaron jumps up and starts banging his head against the wall, in an effort to murder the pain in his head. Instead, that simple headache explodes into a sneering, cursing, chair-kicking, lawyer-slapping, sarcastic, non-stuttering, confident, and angry young man who calls himself “Roy.

” His whole demeanor has changed. The key criterion of a DID diagnosis, the “alter” (a distinct state of consciousness that assumes control repeatedly) (Sidran Foundation, 2003) has been introduced with dramatic flair. Roy is someone who seems to be a living personification of Aaron’s missing confidence and aggressiveness. As his shocked lawyer looks on, Roy claims responsibility for the murder, boldly proclaiming how Aaron had run to him for help because he was not strong enough to handle things himself.

Since Aaron’s apparent Axis I disorder has such a strong impact on his personality and development, any Axis II diagnosis should be deferred until Aaron has completed treatment and confronted his “other self. ” But what lies at the root of this contentious new force? Aaron’s entire early socio-cultural experiences were molded in fear and terror. Patients with DID more often than not have the prolonged agony of severe childhood abuse to overcome (Chaves, Kirsch, Lynn, Lilienfield, Powell, & Sarbin, 2007), and Aaron is no exception. The prisoner, in an early interview, briefly mentions his father, who was “not a nice man.

” He also gets very uncomfortable when the subject of sex with his girlfriend is broached. These incidents point to possible sexual abuse (incest is a common precursor to DID) by the father. In response to the extreme physical and emotional pain accompanying their abuse, and more importantly to the overwhelming shame associated with keeping the secret, highly creative individuals may adapt their rich fantasy life as a lifeline (such a coping mechanism may be more prevalent in an individualistic Western society which encourages open and innovative expression).

They can be their own hypnotist (Brown & Barlow, 2001). In Aaron’s case, his somewhat restrictive religious upbringing (serving as an altar boy) could have contributed to his repressive tendencies in dealing with his traumas. Since Aaron’s blackouts began around the age of twelve, this is probably the time when Roy made his first appearance as a protector to Aaron. The “protective” alters are usually aware of their role, while the “host” remains trapped in the unconscious world of “not knowing. ” After the early childhood onset, the alters usually reappear when certain new life

experiences provide triggers or cues (Chaves et al, 2007). For Aaron, the alleged pornography he was forced to engage in with his girlfriend for the priest brought out Roy in full-force. The repressed anger he felt for this authority figure in his life, who had betrayed his trust, just as his father likely had, became a brutal realization in Roy’s fierce murderous impulses. In the interviews, the camera the psychologist used probably accounted for Roy’s brief appearance, as it was a reminder of the pornography.

And the lawyer’s abusive language and actions brought him out, guns-blazing, for the final truth. This volatility and instability—characteristic of many DID patients—often places them on the lowest ends of the global functioning scale. In Aaron’s case, his doctors have obviously agreed, as all of his encounters take place in the controlled atmosphere of a prison setting. However, I would advise those doctors to take a closer look at Aaron. Something seems amiss.

Perhaps they could utilize some of those personality, GSR, and neurophysiological tests that have proven so effective in spotting “fakers” (Cherry, 2008). Maybe they should check “Aaron”’s room for any possible extracurricular reading…. or should I say Roy’s room? By trial’s conclusion, the acquitted young man coldly and even joyfully informs his swindled lawyer that he has performed the ultimate con, and the film concludes with Roy taunting and boasting about his victory in fooling everyone. The audience learns that “Aaron” is likely the real illusion,

and this revelation makes the character amoral and devoid of any rooting value. Dissociative Identity Disorder remains one of the most enduring controversies within the psychiatric community. In spite of the documented cases and the current DSM recognition, many educated scholars still maintain that the disorder is a popular myth, brought about by socio-cultural factors of role-playing and a thirst for sensationalism (Chaves et al, 2007). Skeptics might use cases such as that of Hillside Strangler Kenneth Bianchi as an example.

This convicted multiple murderer tried to blame his crimes on a killer alternate personality. He was soon found to be faking, an assumption solidified by the discovery of various psychology books in his jail cell (Cherry, 2008). Individuals such as the real Bianchi and the fictional Aaron set the psychiatric community’s standing and progress back decades, but such individuals likely would not care in the slightest, as their true diagnosis is decidedly “antisocial”: failure to follow social norms, deceitfulness, lack of remorse, recklessness, danger to others (Brown & Barlow, 2001)….

Or, in the words of an 1885 physician, whose patient sounds eerily familiar: “(Having) no capacity for true moral feeling – all his impulses and desires, to which he yields without check, are egoistic, his conduct appears to be governed by immoral motives, which are cherished and obeyed without any evident desire to resist them. ” (Vaknin, 2009) Perhaps that Axis II diagnosis should not be deferred after all…. References Brown, T. A. & Barlow, D. H. (2001).

Dissociative Identity Disorder. Casebook in Abnormal Psychology (2nd ed. ). Pacific Grove: Wadsworth Thomson Learning. Chaves, J. F. , Ganaway, G. K. , Kirsch I. , Lynn, S. J. , Lilienfeld, S. O. , Powell, R. A. & Sarbin, T. R. (2007). Dissociative Identity Disorder and the socio-cognitive model: Recalling the lessons of the past. ” Psychological Bulletin 125(5), 507-523. Cherry, A. A. (2008). Multiple personality disorder: fact or fiction? Retrieved February 23, 2009,

from Personality Research: http://www. personalityresearch. org/papers/cherry2. html Dissociative disorders. (2005). The Merck Manual of Diagnosis and Therapy. Rahway: Merck Publishing Group. Sidran Foundation. (2003). Dissociative disorders. Towson: Sidran Institute. Vaknin, S. (2009). The history of personality disorders. Retrieved February 23, 2009, from Mental Health Matters: http://www. mental-health-matters. com/index. php? option=com_ content&view=article&id=1087


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