TR

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