Chapter 8 - Dissociative Identity Disorder

Dissociations

a disruption and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior

• transiently occur in 50% of the population at some point in their life

Effects of extreme and intense dissociations

memory loss, development of a false sense of reality, inability to function

Post traumatic explanation of dissociative disorders

• linked to childhood trauma (found in 90% of cases)

• dissociation may be an extreme form of PTSD resulting from early abuse

Dissociative identity disorder

• dissociation of personality

• adoption of several new identities that each display unique behaviors, voice, and postures

Alters

different identities or personalities, “parts”

Host

the identity that keeps all other identities together

Switch

quick transition from 1 personality to another

Dissociative identity disorder criteria

A. Disruption of identity characterized by two or more distinct personality states,

which may be described in some cultures as an experience of possession. The

disruption in identity involves marked discontinuity in sense of self and sense of

agency, accompanied by related alterations in affect, behavior, consciousness,

memory, perception, cognition, and/or sensory-motor functioning. These signs

and symptoms may be observed by others or reported by the individual.

B. Recurrent gaps in the recall of everyday events, important personal information,

and/or traumatic events that are inconsistent with ordinary forgetting.

C. The symptoms cause clinically significant distress or impairment in social,

occupational, or other important areas of functioning.

D. The disturbance is not a normal part of a broadly accepted cultural or religious

practice.

Causes of dissociative identity disorder

• severe, chronic trauma

• abuse in childhood

• closely related to/may be an extreme subtype of PTSD

• mechanism to escape the impact of trauma

Treatment of DID

• focus on reintegration of identities

• identify and neutralize cues/triggers that provoke memories of trauma/dissociation

• patient may have to relive and confront the early trauma (some achieve through hypnosis)

• current standard of care is described by the international society for the study of trauma and dissociation (ISSTD)

Stage 1 of ISSTD

building safety and stabilization

• emotional awareness and regulation

• impulse regulation

• interpersonal effectiveness

• grounding

• increase awareness of current reality/decrease dissociation

• communication and cooperation among alternates

• containment of intrusive materials

Stage 2 of ISSTD

processing the trauma

• exposure is completed in a modified form

• careful, slow processing of traumatic memories instead of constant and intense exposure

• grounding, affect regulation

Stage 3 of ISSTD

focusing on the future

• focus more on engaging in healthy relationships and meaningful activities