What is Dissociative Identity Disorder?
Dissociative identity disorder (DID) is a rare mental health condition that can cause serious behavioral symptoms. Before 1994, it was referred to as Multiple Personality Disorder. Around 1.5% of people worldwide have been diagnosed with this condition. Those with DID often end up in emergency situations, frequently involving self-harm or substance abuse.
Interestingly, this disorder has been recognized and described in many countries, using terms such as “outer world possession” and “possession by demons.” However, understanding the connection between trauma and DID came about much later. Even though these descriptions have been used in many case reports, the link between DID and traumatic experiences was recognized later.
What Causes Dissociative Identity Disorder?
Dissociative identity disorder is often linked to severe trauma and abuse suffered during childhood. An existing explanation of this disorder was based on elements like suggestion and fantasy. However, recent studies by Dalenberg and his team have highlighted the significant role of distinct forms of trauma (physical, emotional, or sexual) in causing this condition, while also considering some influence of mental suggestion.
The type of stress an individual undergoes due to such trauma can result in the person developing an incorrect sense that the traumatic incidence isn’t real. This can even cause certain after-effects like feeling detached from one’s body and poor sleep. Yet, according to the theory that relates this disorder to fantasy, it’s observed that individuals who are highly susceptible to imaginative thoughts, prone to psychological symptoms, influenced by media, and likely socially isolated, demonstrate increased vulnerability.
Noted psychologists like Kluft have consolidated the theory behind dissociative identity disorder. This theory explains that certain factors need to be in place for it to develop, such as a capability to dissociate, unsettling traumatic events that warp reality, the creation of ‘alters’ with distinct names and identities, and a lack of stability in one’s surroundings leading to the child finding solace within themselves to deal with these pressures. For the disorder to form, all these components need to be present.
Risk Factors and Frequency for Dissociative Identity Disorder
Dissociative disorders, which include severe dissociative identity disorder, are found in about 1% to 5% of people globally. Out of this group, 1% to 1.5% experience severe dissociative identity disorder. Unfortunately, it may take a long time to diagnose this condition, with patients being in treatment for an average of 5 to 12.5 years before receiving a diagnosis. There’s also an increased likelihood of non-suicidal self-harming behavior and suicide attempts among people with dissociative identity disorder.
- Between 1% and 5% of people worldwide have dissociative disorders.
- Severe dissociative identity disorder is experienced by 1% to 1.5% of these individuals.
- On average, it can take 5 to 12.5 years of treatment before a diagnosis of dissociative identity disorder is made.
- People with this disorder have higher rates of non-suicidal self-harm and suicide attempts.
Signs and Symptoms of Dissociative Identity Disorder
Dissociative identity disorder (DID) is diagnosed through a thorough history examination carried out by expert psychologists and mental health practitioners. People with DID are often mistakenly diagnosed with other personality disorders, including borderline personality disorder, due to observed elements of dissociation and amnesia. Comprehensive assessments over a long period and detailed history-taking are usually needed to produce accurate diagnostic evaluations. This information is usually obtained from a variety of sources. Tests are also carried out to rule out autoimmune encephalitis. These tests can include brain scans, spinal fluid sampling and brainwave measurements.
Dissociative disorders disrupt normal consciousness, memory, identity, and behavior. They produce “positive” symptoms, like emergence of new personalities or feelings of unreality, and “negative” symptoms like impaired social skills and physical immobilization. Dissociative identity disorder belongs to a broader group of dissociative disorders, but it has distinct diagnostic criteria according to the Diagnostic And Statistical Manual Edition-5.
According to the Diagnostic and Statistical Manual (DSM-5), to be diagnosed with DID, a person must exhibit at least two or more distinct identities. These identities have different behaviors, perceptions of the world, senses of consciousness, and memories. People with DID also experience periods of forgetting and distinct memory lapses for daily and traumatic events. These symptoms should not be directly related to the use of substances or the person’s cultural norms or practices. It is crucial that these symptoms cause significant disruption or distress in a person’s daily life to be considered DID.
Testing for Dissociative Identity Disorder
To diagnose Dissociative Identity Disorder (DID), it’s essential to have a comprehensive history from various sources and multiple evaluations over time. There are also some evaluation tools that doctors use to assist with diagnosing DID. Let’s take a look at some of these:
The Dissociative Experiences Scale is a self-report questionnaire with 28 items. This tool focuses on topics like how well you can absorb outside information, your use of imagination, feelings of being detached or disconnected from yourself (depersonalization), feelings of the world not being real (derealization), and memory loss.
Next is the Dissociation Questionnaire, which contains 63 questions. This tool aims to measure identity confusion and fragmentation, loss of self-control, amnesia, and the tendency to get caught up in thoughts or daydreams (absorption).
The Difficulties in Emotion Regulation Scale (DERS) is another tool that doctors use. This 36-question test asks about challenges related to goal-focused activities, impulsivity, emotional responses to situations, and ability to control or adjust emotions appropriately.
Treatment Options for Dissociative Identity Disorder
The treatment of Dissociative Identity Disorder (DID) generally involves three main steps:
1. Creating a safe environment to lessen symptoms
2. Facing and dealing with traumatic memories
3. Helping the patient understand their full identity and improve how they relate to the world
The first step ensures patients are safe as they often think about harming themselves. The next phase involves dealing with traumatic memories from the past. As part of this process, different identities may remember the same traumatic events differently, and the goal is to reconcile these different memories. Finally, the focus shifts to helping the patient understand themselves as a whole individual and improve their relationship with the outside world. Throughout these steps, forming a strong bond of trust with the therapist is crucial.
The most common treatment technique is psychodynamic psychotherapy. More recent methods include trauma-focused cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). Despite these different approaches, all therapy aims to educate the patient, help them control their emotions, cope with stress, and function daily.
Hypnosis is another form of treatment. Studies show that people with DID are more likely to be hypnotized than other clinical populations, and hypnosis can help with therapy.
Eye Movement Desensitization and Reprocessing (EMDR) is also used, but only when the patient is stable and can cope well.
Finally, while medication is not the main treatment for DID, it can be used to ease certain symptoms related to mood disorders and post-traumatic stress disorder (PTSD). However, using medication can be challenging as different identities in a patient may report different symptoms. While a variety of medications, including antipsychotics, mood stabilizers, and stimulants, have been used to treat DID, none have been effective on their own.
What else can Dissociative Identity Disorder be?
The process of diagnosing Dissociative Identity Disorder (DID) often involves ruling out other possible conditions that can cause similar symptoms. These may include Borderline Personality Disorder, Histrionic Personality Disorder, and more severe mental disorders like Schizophrenia or Schizoaffective disorders.
People with DID often experience symptoms such as personality changes, known as ‘alters’, and memory loss. These symptoms could be mistaken for others, like those found in Borderline Personality Disorder. Sometimes, these ‘alters’ can look like hallucinations which are a sign of psychosis. This can lead doctors to mistakenly prescribe medications for psychosis.
Since DID is often linked to past trauma, another condition that doctors may consider is Post Traumatic Stress Disorder (PTSD). PTSD can also result from severe trauma and present symptoms that might be confused with DID. Similarly, Borderline Personality Disorder may be mistaken for DID since it is also linked to past trauma and can feature periods of altered reality and mental disconnect.
What to expect with Dissociative Identity Disorder
Regrettably, Dissociative identity disorder (DID) is usually diagnosed later in life, and it’s not uncommon for patients to be diagnosed with other conditions beforehand. As a result, they might be prescribed medications or therapies that aren’t specifically designed to treat DID.
Once diagnosed accurately, treatment for DID usually continues throughout a patient’s life, focusing on reality-based strategies that help them stay grounded. Ongoing safety planning also forms a vital part of ongoing care for those with DID.
Without the right diagnosis and treatment, the outlook for those with Dissociative identity disorder is generally not favorable.
Possible Complications When Diagnosed with Dissociative Identity Disorder
Patients with multiple personalities and unprocessed trauma are at a higher risk of self-harm. Recent research has found that these individuals often have thoughts of suicide, particularly during dissociative episodes. These episodes are marked by an enhanced sensitivity to pain and emotional instability. To prevent harmful behavior, treatments often prioritize making safety plans and practicing differentiating between reality and non-reality, before introducing more complex forms of psychotherapy.
For patients dealing with frequent self-harm ideation or those who struggle to control their impulses or stabilize their mood on their own, inpatient treatment _ spending all day, every day in a hospital or clinical setting _ and day treatment programs _ spending part of the day in a medical setting _ may be suggested. Mood-stabilizing medication may also be prescribed.
Preventing Dissociative Identity Disorder
It’s essential to educate patients properly about their diagnosis once it’s confirmed. Their family members should also be made aware of the specifics of the condition, including the existence of different identities or ‘alters’, and methods to ensure safety and emotional balance. A critical part of this process is to maintain a good relationship with the healthcare team and practice safety techniques.
It’s important to understand that some ‘alters’ may not communicate with each other, and education may need to be provided to each one separately. However, many patients with Dissociative Identity Disorder (DID) may not want their condition made public. It’s crucial to respect their wishes and uphold their privacy.
