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Dissociative Identity Disorder

Clinical Description

  • Formerly known as multiple personality disorder

  • Defining feature is dissociation of personality

  • Adoption of several new identities (as many as 100; may be just a few; average is 15)

  • Identities display unique behaviors, voice, and postures

DSM-5 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 of 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. Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.

  • E. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

Unique Aspects

  • Alters – different identities or personalities

  • Host – the identity that keeps other identities together

  • Switch – quick transition from one personality to another

Controversy

  • Some patients presenting with DID symptoms are faking (possibly subconsciously)

    • Example: Patients more likely to “produce” a fake alter when therapist suggests this possibility

  • Some DID patients are not faking

    • Case studies reveal changes in physiological and brain function when switching between alters

Statistics

  • Prevalence: not well known, perhaps 1 to 2%

  • More common in females

  • Onset is almost always in childhood or adolescence

  • High comorbidity rates with other psychological disorders

  • Typically follows lifelong, chronic course

Causes

  • Typically linked to a history of severe, chronic trauma, often abuse in childhood

    • Risk increases if there is no social support after the trauma

  • Mechanism: Dissociation offers an opportunity to escape from the impact of trauma

  • Closely related to PTSD, possibly an extreme subtype

  • Biological vulnerability possible but not well understood; almost all risk is environmental

Treatment

  • Focus is 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

Dissociative Identity Disorder

Clinical Description

  • Formerly known as multiple personality disorder

  • Defining feature is dissociation of personality

  • Adoption of several new identities (as many as 100; may be just a few; average is 15)

  • Identities display unique behaviors, voice, and postures

DSM-5 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 of 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. Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.

  • E. The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

Unique Aspects

  • Alters – different identities or personalities

  • Host – the identity that keeps other identities together

  • Switch – quick transition from one personality to another

Controversy

  • Some patients presenting with DID symptoms are faking (possibly subconsciously)

    • Example: Patients more likely to “produce” a fake alter when therapist suggests this possibility

  • Some DID patients are not faking

    • Case studies reveal changes in physiological and brain function when switching between alters

Statistics

  • Prevalence: not well known, perhaps 1 to 2%

  • More common in females

  • Onset is almost always in childhood or adolescence

  • High comorbidity rates with other psychological disorders

  • Typically follows lifelong, chronic course

Causes

  • Typically linked to a history of severe, chronic trauma, often abuse in childhood

    • Risk increases if there is no social support after the trauma

  • Mechanism: Dissociation offers an opportunity to escape from the impact of trauma

  • Closely related to PTSD, possibly an extreme subtype

  • Biological vulnerability possible but not well understood; almost all risk is environmental

Treatment

  • Focus is 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

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