Causes and Treatment of Dissociative Identity Disorder

Dissociative Identity Disorder (DID) also known as multiple personality disorder is a mental disorder that develops when an individual has suffered from terrible traumatic experiences or abuse in their childhood over a long period of time. Dissociative identity disorder involves having two or more completely different personalities in one body, people who suffer from this disorder most likely created this personality as a child to have someone to protect them when something terrible was about to happen to them. There are two forms of this disorder a person can realize they have this mental illness and the other form is when a person doesn’t have a clue that they have the disorder.

A person who isn’t aware of having dissociative identity disorder will have moments where they will get to a place and not realize how they ended up there or when someone repeats to them the conversation they had, they might have no recollection of the conversation. On the other hand, a person who knows they suffer from this mental disorder will project their other identity in a time of need that they do not want to experience or when they feel like they need protection.

Many don’t believe in the disorder, they chose to believe that patients with DID have a wild imagination and are faking these personalities for attention, or these patients are just troubled and need to go see a psychiatrist.

Others in the religious faith believe that the person did such a terrible thing in another life that now God is punishing them, other religions believe that it is a sort of possession and through guidance from the church and prayer it will leave, like as if it was a sort of infection and with some antibiotics it will just leave the body.

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 Dissociative disorders tend to affect children more as compared to adults (TED Talk, 2017).

These disorders will most often manifest in young children that are continuously subjected to long-term emotional, physical and sexual abuse and they have no means to defend themselves. Other causes of dissociation include the stress of violence or war, natural disasters or a home environment that a child may consider frightening or a home environment that is unpredictable. In human beings, personal identity normally forms during the early childhood period. With such a fragile personality a traumatized child can easily step out of him/herself and view his/her suffering as if it was happening to a different individual other than him/her.

This way the child learns to cope with stressful or frightening situations. However as the child gets used to dissociation, it becomes a habit that finally develops into a voluntary or involuntary DID when getting into adulthood.Individuals with DID may develop varied forms of the dissociative disorders. Firstly, dissociative amnesia is characterized by an individual’s inability to remember important details about him/her. This form of amnesia often surrounds a specific issue or event in an individual’slife. For instance, war or sexual abuse and might last from a few minutes to several years.

Secondly, DID patients may suffer from another form of DID known as dissociative fugue which is characterized by reversible amnesia that deals with the identifying characters of individuality, such as memories and personality. Individuals may wander off or decide to travel unexpectedly or establish new identity (Vissia et al.,2016).

Thirdly an individual may experience depersonalization which involves dissociation of perceptions, where feelings are detached and separated from actions, own body or mental activity. Susanta, Jhanda, and Malhotra (2016) explain that individuals feel like they are in a dream or movie with this feeling spilling onto the rest of the word making it look unreal. Individuals may choose to create alters, which are different versions of their own personalities to help cope with trauma. In this state an individual will forget who they are, then create another version of themselves forgetting their original identities and its problems. Building on this knowledge, this paper demystifies the controversies surrounding DID, its causes and treatment.

Pierre Janet​

Pierre Janet was a French psychologist and philosopher who is credited with clarifying and systematically showing how dissociation is the most direct psychological defense against excessive trauma (Van Der Hart & Horst, 1989). He illustrated how dissociative phenomena take the center stage in broad diversified post-traumatic stress responses which he put under the study of hysteria. Through his patient Lucie he managed to prove the existence of several personalities within a single human being suffering from DID.

Eve and Sybil

Eve and Sybil were women who suffered from DID which was then known as multiple personality disorder (MPD) in the 1950’s. Eve had three personalities, Eve White, Eve Black and Jane where white and Black had extreme attitudes with Black being extremely dangerous while Jane the always absent personality was the most reasonable one. Sybil too had several personalities who all behaved differently, talked differently when confronted with life’s issues. Sybil’s psychologist explained that she had suffered sexual abuse as a child and that this had greatly affected her to an extent that she had developed split personalities to hide her painful past. While these were movie and book characters, the stories were of real-life individuals that had been written by their psychologist (Rita, 2017).

Psychiatric research view of DID​Apparently, most ordinary people’s in regards to DID have been greatly influenced by how such patients are presented in entertainment media presentations such as the film “Sybil”. However, as Dr. Kluft a psychologist puts it, only 6 percent of all individuals suffering from DID will portray the various versions of their split personalities in public. Additionally, he states as most of these people are consumed in shame they will try every possible way to conceal their personalities in public. Ordinarily, DID does not only present itself as multiple personalities but will employ a combination of both dissociative and post-traumatic behavior, as well as other non-trauma related symptoms such as drug and substance abuse, depression anxiety, eating disorders and others.

DID Controversies​

Due to the exaggerated portrayal of DID in movies and other fictional creations, a good number of individuals have resorted to believing that DID does not exist. Coupled with the over exaggeration of patients conditions in movies real life DID patients who require help find it hard to face other individuals and explain their problem for fear of being stigmatized. To this end, it is good to note that DID was officially identified as a mental disorder in 1980 when it was included in the Diagnostics and Statistical Manual of Mental Disorders.

Secondly, individuals are often too quick to equate schizophrenia to DID. According to Foote and Parke (2008), while the two mental conditions are somewhat related, schizophrenia is a psychotic disorder whose symptoms are delusions and hallucinations while DID is trauma. However, DID patients may sometimes experience psychosis which can result into schizophrenia.

Sociocognitive Model​

While psychiatrists and other medical practitioners try to conclude the discussion as to whether DID is a full psychiatric disorder, the Sociocognitive model of DID, the dissociative disorder does not qualify to be a valid psychiatric disorder with posttraumatic root. Instead, the model assumes it’s a creation of psychotherapy and the media. However recent research has cast the model as false arguing that there exists no reason to doubt the connection that lies between DID and trauma experienced in childhood. To this end, psychiatrist have warned that treatments arising from the sociocognitive model could be harmful since they overlook the posttraumatic symptomatology of individuals with DID (Foote & Park, 2008).

Cause of Dissociation

Child abuse​

In normal children consciousness, identity, memory, emotion, perception, motor control, body representation and behavior are highly integrated and organized. To some extent, there lies a certain degree of conscious control on the memories and sensations that a child can select for immediate attention as well as pick out the movements to carry out. However when a child is abused, which involves sexual abuse or other forms of childhood mistreatment children dissociate which results into the disruption of the integrated functions revolving around consciousness, identity, environment, and self-perception This disruption results into dissociative amnesia, with identity fragmentation resulting into DID while the disordered perceptions bringing forth depersonalization and derealization. The dissociation works as a mechanism to ensure oneself against the terrors and horrors of the abuse (TED Talk, 2017).

Nature and Nurture​​

Nature refers to all biological factors that are related to a human being, and in this contextit refers to the genetic makeup of an individual and the hereditability of certain disorders. As such, some psychotic and dissociative behaviors are obtained from the family bloodline making it harder to control the possibility of psychopathological individuals. On the other hand, nurture refers to the assortment of environmental factors and influences as well as the individual’s personal life experiences. This includes relationships with family, friends and schoolmates, childhood experience, and most importantly upbringing. While some inherited disorders may result in DID nurture plays a major role towards its development in an individual. As such, through nurture, it is possible to reduce the number of DID individuals in the future societies.

Examples of Individuals Who Suffer From DID

Eleanor Longden​

Eleanor Longden is a BSc and MSc holder in psychology. However, while she seems so successful and normal she has not had a rosy journey towards her achievements. In real life she has been a DID victim and patient, spending several years in the psychiatric system herself for the numerous voices she often heard in her head. However, she had to stand up and the numerous voices in her head in order to live a normal life. Longden (2013) explains that when she first heard the voices, with one speaking to her in third person perspective she was scared and took several weeks before opening up to anyone about her situation.

Even when she did friends and family thought she was insane. After several years of therapy, and her psychiatrist encouragement and support she managed to understand hers split self. The TED talk video andher book are both inspiring as they enable individuals with DID to realize that through talking to the right people before it is too late, it is possible to lead a normal life. On the other hand, it acts as an eye opener to normal people to come to a realization that not all mental disorders are insanity (Longden, 2013; TED Talk, 2017).

Treatment for DID

Chlebowski and Gregory (2012) allude that DID an under-researched area and there currently exist no clinical trials that use manual-based therapies and validated outcomes. However, they explain that some psychotherapists decide to talk to alters within an individual, although there’s growing concern about this technique as alters can result into the mutual shaping of each other posing bigger problems. Secondly, hypnosis is a commonly used modality, but there still lacks enough research into the area. This involves the therapist attempting to uncover and understand traumatic experiences associated with specific alters.

However, out of 20 clients treated with hypnosis and psychodynamic therapy, only 5 successfully achieved a complete integration in a 3 year period on treatment.​Commonly, DID symptoms concurrently manifest Borderline Personality Disorder(BPD). As such a good treatment method towards DID with BPD is the Dynamic Deconstructive Therapy (DDP). To this effect, Gregory and colleagues carried out three treatments in 2008, with varied timelines for each of the three participants. Interestingly each of them showed significant improvement in the reduction of DID symptoms (Chlebowski & Gregory, 2012; Bayne, 2002).

Treatment 1​

The patient in this controlled treatment was a woman, Ms. A. who had a history of dissociation, severe depression, narcissistic as well as BPD. She also suffered from self-mutilation and experienced dissociative symptoms such past memories of past experiences, derealization, depersonalization, and psychogenic amnesia. Upon admission, her dissociativeexperience scale was 57. The DES is a report with 28 items for self-assessment and is used to measure the severity of dissociation. This patient had a sad childhood and was angry at almost everything in and about life, which led to her dissociation (Chlebowski & Gregory, 2012; ).

Results

​Gregory reports that at the 6th-month mark, the first’s patient, Ms. A. showed positivitytowards treatment and had developed a good rapport between her and the therapist. She also had improved on her anger, guilt and shame articulation mechanisms, which saw her, see no need of punishing herself, reducing her self-mutilating stunts, as well as their severity (Chlebowski & Gregory, 2012). Her DES score also dropped from 57 to 29 at the same period. However, during vacation she would slip into severe depression due to the absence of her idealized therapist, whom she now saw as a friend. Interestingly, at the 12th-month mark her final DES was 12 before she was moved to another therapist, without her feeling too attached. Five years on, she was an integrated citizen, although she still attended to her program.

Treatment 2​

The second patient, Ms. B. was a middle-aged married woman with a history of serious psychopathology. She had five alters with separate names, genders and different ages of which she could slip into any involuntarily. She also experienced severe time lapses and could rarely account for her lost time. Apart from dissociative phenomena, she also had other disorders such as Axis I and Bipolar as well as alcohol and drug dependence among others. On starting the program her DES score was 62 (Chlebowski & Gregory, 2012).

Results​

At the end of the first six months, her DES moved from 62 to 45 and later dropped to 35 at the end of the 12 month period. Her other disorders symptoms improved over time and there was a reduction her antipsychotic and mood stabilizers medicines (Chlebowski & Gregory, 2012).

Additionally, her time lapses became less frequent and short and she could now control them. Personality shifts too became less frequent and she felt whole again. During the follow-upperiod, Gregory discovered that she too was fully integrated into the society.

Treatment 3​

The last lady in Gregory’s trial DDP treatment was a middle-aged woman with an alcoholand cocaine dependence. Her lifelong miseries that had resulted into addiction also came with dissociative symptoms such as derealization, fugue, and feelings of spaciness. She also had varied alters, all with varied names with Sunlight being her dominant alter who enjoyed manipulating men. Sunlight felt no pain or saw no need for treatment, unlike her true self. Her DES was 41 DID and BPD at the start of the program (Chlebowski & Gregory, 2012).

Results

​Her DES fell from 41 to 35 in six months, and her dissociation showed improvement and she managed to create friendship with women, losing her manipulative self. At 9 months she could account for herself but her craving for substances became stronger (Chlebowski & Gregory, 2012). As such the therapist had to help her mourn the loss of her drug-filled past in order to embrace the future. To avoid over attachments she was let out of the program early, where she managed to stay clean in the follow-up 30 months, then started working fulltime (Reinders et al.2012)

Conclusion

This paper has elaborately demystified the issues surrounding the dissociative disorders. As discussed, DID is a mental disorder that individuals develop in order to cope with trauma, or mask part of themselves that they think unpleasant. It has varied symptoms and individuals may either be aware or unaware of the condition, with those who are aware using their numerous personalities at will to hide from, or hide their pain.

This paper has taught me that DID is real and is a serious mental disorder that needs redress. As opposed to how it has been portrayed in movies and fiction works, DID’s symptoms manifest in various ways apart from the split personalities. I have also learned that DID patients may have several personalities where one or two may have behaviors that oppose each other, as well as be extremely, bad or good.The aim of this paper is to shed light into a rather ignored area and inform readers that DID is controllable. It’s also meant to help alleviate stereotyping and give families of DID individuals a mechanism of handling their patients.

References

  1. Bayne, T. J. (2002). Moral Status and The Treatment of Dissociative Identity Disorder. Journal of Medicine and Philosophy, 27(1), 87-105.
  2. Chlebowski, S., & Gregory, R. (2012). Three Cases of Dissociative Identity Disorder and Co-Occurring Borderline Personality Disorder Treated with Dynamic Deconstructive Psychotherapy. American Journal Of Psychotherapy, 66(2), 165-180.
  3. Foote, B., & Park, J. (2008). Dissociative Disorder and Schizophrenia: differential diagnosis and theoretical issues. Curr Psychiatry, 10(3), 217-222.
  4. Longden, E. (2013, February 22). The Voices in My Head. Retrieved April 28, 2018, from TED: Ideas Worth Spreading: www.ted.com/talks/eleanor_longden_the_voices_in_my_head.
  5. Padhy, S., Jhanda, S., & Malhotra, S. (2016). Dissociative Disorder in Children and Adolescents. In S. Malhotra, & P. Santosh, Child and Adolescent Psychiatry (pp. 19-32).
  6. Chandigarh: Springer India.Reinders, A., Willemsen, A., Vos, H., den Boer, J., & Njenhuis, E. (2012). Fact or Factitious?A Psychobiological Study of Authentic and Simulated Dissociative Identity. PloS One, 7(7), https://doi.org/10.1371/annotation/4f2000ce-ff9e-48e8-8de0-893b67efa3a4.
  7. Rita, R. S. (2017). Dissociative Identity Disorder in Robert Louis Stevenson’s The Strange Case of Dr. Jekyll and Mr. Hyde. ASA University Review, 11(1), 75-80.
  8. TED Talk. (2017, May 22). Dissociative Identity Disorder. Retrieved April 28, 2018, from Youtube: www.youtube.com/watch?v=mJQI6wRns4w.
  9. Van Der Hart, O., & Horst, R. (1989). The Dissociation Theory of Pierre Janet. Journal of Traumatic Stress, 2(4), 1-11.
  10. Vissia, E. M., Chalavi, S., Nijenhuis, E., & Draijer, N. (2016). Is it Trauma- or Fantasy-based? Comparing dissociative identity disorder, post-traumatic stress disorder, simulators, and controls. Acta Psychiatrica Scandinavica, 1(1), 1-18.

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Causes and Treatment of Dissociative Identity Disorder. (2021, Apr 24). Retrieved from http://studymoose.com/causes-and-treatment-of-dissociative-identity-disorder-essay

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