Everything about Dissociative Identity Disorder totally explained
Dissociative Identity Disorder, as defined by the
American Psychiatric Association's
Diagnostic and Statistical Manual of Mental Disorders (DSM), is a psychiatric
diagnosis that describes a condition in which a single person displays multiple distinct
identities or
personalities, each with its own pattern of perceiving and interacting with the environment. The diagnosis requires that at least two personalities routinely take control of the individual's behavior with an associated
memory loss that goes beyond normal forgetfulness; in addition, symptoms can't be due to
substance abuse or medical condition. Earlier versions of the DSM named the condition
multiple personality disorder (MPD) and the term is still used by the
ICD-10. There is controversy around the existence, possible causes, appearance across cultures, and
epidemiology of the condition.
Controversy
DID is a
controversial diagnosis and condition, with much of the literature on DID being generated and published in North America, to the extent that it was regarded as a phenomenon confined to that continent. Even within North American psychiatrists, there's a lack of consensus regarding the validity of DID, with some researchers considering it a
culture bound,
iatrogenic condition. The
DSM is explicit about the controversy over the condition, identifying both the objective evidence of
physical and
sexual abuse in the history of individuals diagnosed with DID and that individuals accused of abuse are motivated to deny or distort past actions, but also points out that childhood memories may be distorted, and that individuals with DID are highly
hypnotizable and unusually vulnerable to
suggestion.
Signs and symptoms
Individuals with DID demonstrate a variety of symptoms with wide fluctuations across time; functioning can vary from severe impairment in daily functioning to normal or high abilities. Symptoms can include:
Patients may experience an extremely broad array of other symptoms that resemble
epilepsy,
schizophrenia,
anxiety,
Mood disorders,
posttraumatic stress,
personality, and
eating disorders, with frequent misdiagnoses and ineffective treatment. often confirmed by objective evidence. though this idea is neither confirmed nor universally accepted. Many of the investigations include testing and observation in the one person but with different alters. Different alter states have shown distinct
physiological markers and some
EEG studies have shown distinct differences between alters in some subjects, while other subjects' patterns were consistent across alters. Another study concluded that the differences involved intensity of concentration, mood changes, degree of muscle tension, and duration of recording, rather than some inherent difference between the brains of persons with multiple personalities and those of persons with single personalities. Brain imaging studies have corroborated the transitions of identity in some DID sufferers. One EEG study comparing DID with
hysteria showed differences between the two diagnoses. A postulated link between
epilepsy and DID has been disputed by a number of authors. Some
brain imaging studies have shown differing
cerebral blood flow with different alters, and distinct differences overall between subjects with DID and a healthy control group. A different imaging study showed that findings of smaller
hippocampal volumes in patients with a history of exposure to
traumatic stress and an accompanying stress-related psychiatric disorder were also demonstrated in DID. This study also found smaller
amygdala volumes. Studies have demonstrated various changes in visual parameters between alters. One
twin study showed hereditable factors were present in DID.
Diagnosis
The diagnostic criteria in
DSM-IV Dissociative disorders section 300.14 require:
The presence of two or more distinct identities or personality states, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.
At least two of these identities or personality states recurrently take control of the person's behavior.
Inability to recall important personal information that's too extensive to be explained by ordinary forgetfulness.
The disturbance isn't due to the direct physiological effects of a substance (for example, blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (for example, complex partial seizures). In children, the symptoms are not attributable to imaginary playmates or other fantasy play.
Individuals diagnosed with DID may have a psychiatric history containing multiple previous diagnoses of various mental disorders and previous treatment failures. The belief by some doctors that the diagnosis is fallacious may contribute to the frequency of its misdiagnosis. may be used to make a diagnosis. This interview takes about 30 to 90 minutes depending on the subject's experiences.
The Dissociative Disorders Interview Schedule (DDIS) is a highly structured interview which discriminates between various DSM-IV diagnoses. The DDIS can usually be administered in 30-45 minutes.
The Dissociative Experiences Scale (DES) is a simple, quick, and validated questionnaire that has been widely used to screen for dissociative symptoms. Tests such as the DES provide a quick method of screening subjects so that the more time-consuming structured clinical interview can be used in the group with high DES scores. Depending on where the cutoff is set, people who would subsequently be diagnosed can be missed. An early recommended cutoff was 15-20 and in one study a DES with a cutoff of 30 missed 46 percent of the positive SCID-D diagnoses and a cutoff of 20 missed 25%. The reliability of the DES in non-clinical samples has been questioned. There is also a DES scale for children and DES scale for adolescents.
Treatment
Treatment of DID may attempt to "reconnect" the identities of the disparate alters into a single functioning identity and/or may be symptomatic to relieve the distressing aspects of the condition and ensure the safety of the individual. Treatment methods may include psychotherapy and medications for comorbid disorders. It has been stated that treatment recommendations that follow from models that don't believe in the traumatic origins of DID might be harmful due to the fact that they ignore the posttraumatic symptomatology of people with DID.
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|Switzerland || 0.05-0.1%|| Modestin (1992)
|-
| China || 0.4% || Xiao et al (2006)
|-
| Germany || 0.9% || Gast et al (2001)
|-
| The Netherlands || 2% || Friedl & Draijer (2000)
|-
| U.S. || 10% || Bliss & Jeppsen (1985)
|-
| U.S. || 6-8% || Ross et al (1992)
|-
|U.S. || 6-10% || Foote et al. (2006)
|-
| Turkey || 14% || Sar et al (2007)
|}
Figures from the general population show less diversity:
| Country |
Prevalence |
Source study |
| Canada |
1% |
Ross (1991) |
| Turkey (male) |
0.4% |
Akyuz et al (1999) |
| Turkey (female) |
1.1% |
Sar et al (2007) |
Dissociative identity disorder can be found in a sizable minority of patients in drug abuse treatment facilities. running in parallel with John Locke's views that there was an association of ideas requiring the coexistence of feelings with awareness of the feelings. Hypnosis, which was pioneered in the late 1700s by Franz Mesmer and Armand-Marie Jacques de Chastenet, Marques de Puységur, challenged Locke's association of ideas. Hypnotists observed second personalities emerging during hypnosis and wondered how two minds could coexist. The 19th century saw a number of increasingly sophisticatedly reported cases of multiple personalities which Rieber estimated would be close to 100. Epilepsy was seen as a factor in some cases
By the late 19th century there was a general realization that emotionally traumatic experiences could cause long-term disorders which may manifest with a variety of symptoms. Between 1880 and 1920, many great international medical conferences devoted a lot of time to sessions on dissociation. It was in this climate that Jean-Martin Charcot introduced his ideas of the impact of nervous shocks as a cause for a variety of neurological conditions. One of Charcot's students, Pierre Janet, took these ideas and went on to developed his own theories of dissociation.
In the early 20th century interest in dissociation and MPD waned for a number of reasons. After Charcot's death in 1893, many of his "hysterical" patients were exposed as frauds and Janet's association with Charcot tarnished his theories of dissociation. A number of factors helped create a large climate of skepticism and disbelief; paralleling the increased suspicion of MPD was the decline of interest in dissociation as a laboratory and clinical phenomenon.
Starting in about 1927, there was a large increase in the number of reported cases of schizophrenia, which was matched by an equally large decrease in the number of multiple personality reports. Bleuler also included multiple personality in his category of schizophrenia. It was found in the 1980's that MPD patients are often misdiagnosed as suffering from schizophrenia. Joan Acocella reports that 40,000 cases were diagnosed from 1985 to 1995. The majority of diagnoses are made in North America, particularly the United States, and in English-speaking countries more generally with reports recently emerging from other countries.. In one study, DID was found to be a genuine disorder with a constant set of core features.[ ]
The DSM-II used the term multiple personality disorder, the DSM-III the diagnosis with the other four major dissociative disorders, and the DSM-IV-TR categorizes it as dissociative identity disorder. The ICD-10 continues to list the condition as multiple personality disorder.
Cultural references
The Three Faces of Eve by Thigpen and Cleckley introduced DID to the public.
In Herschel Walker's book Breaking Free, he describes his struggles with DID that almost led him to suicide.
The movie Fight Club is about a character portrayed by Edward Norton who starts an underground fighting league. At the end of the movie, several of the scenes are played back, showing just Norton in otherwise crowded places, showing Norton is a sufferer of Dissociative Identity Disorder.
A frequently held misconception is that the condition is an equivalent for schizophrenia. The term schizophrenia comes from root words for "split mind" but refers more to a fracture in the normal functioning of the mind rather than a division of the mind into several personalities.
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