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Edit of: Dissociative Identity Disorder


Dissociative identity disorder (DID), previously known as multiple personality disorder (MPD),[1] is a mental disorder characterized by two or more distinct personality states, which have the technical term of subpersonalities or alternate personalities.[2][3] Episodes of altered personality states often associate with difficulty in recalling certain events that is generally inconsistent with a typical case of forgetfulness.[2] Individual subpersonalities have differing "memories, behaviors, thoughts, and emotions".[3] Individuals with DID portray various symptoms through altered behaviors[2] that are uniquely acquired to each person.[4] Many cases of DID are comorbid, or are accompanied by other disorders, including borderline personality disorder (BPD), post-traumatic stress disorder (PTSD), depression, substance misuse disorder, self-harm, or anxiety.[2][4][5] Studies have identified that 2% of the general population and 3% of mentally disabled individuals admitted into hospitals in Europe and North America have been diagnosed with DID.[6][7] The diagnosis of DID differs between sexes, where females more frequently makeup the population of DID diagnosed individuals compared to males.[8]

The etiology, or cause, of DID can not be concluded with certainty, yet many professionals have identified a significant correlation in the presence of DID with experiences of early childhood trauma.[9] Approximately 90% of the population diagnosed with DID have a history of abuse in childhood, while other cases link to other areas of distinct trauma, such as combat in war or experiences of severe illness during childhood.[2] Although early trauma has been calculated as a significant characteristic in the emergence of DID, professionals have also recognized genetic factors to the development of DID.[4] Many professionals claim that DID is an iatrogenic disorder, meaning that the disorder is a by-product of techniques employed by some therapists, especially those who include the technique of hypnosis.[4][10] This iatrogenic, therapist-induced, hypothesis identifies consistently with many studies that considers cases of diagnostic DID are associated with a specific group of individual clinicians, rather than a variety of clinicians.[11] When diagnosing DID, factors of substance abuse, seizures, imaginative play in children, or religious practices should be considered in the research of DID's etiology.[2] DID typically persists in strength when not addressed and treated.[9] Techniques of supportive care and counselling are often used in the treatment of DID.[9]

Since the latter half of the 20th century, the number of cases and the number of altered personalities in DID have both significantly increased.[12] The conclusion that rates of DID are increasing has not been thoroughly explained, but the emergence of the theory that sociocultural factors, such as media portrayals, or the better awareness and education of the disorder amongst the general population, has lead to a likely definition of the cause.[13] Media has influenced the fluctuation of the diagnosis of DID, as well as the symptomology of the disorder. This is supported through the notion in finding that DID depicts different symptoms cross-culturally.[13]

Signs and symptoms[edit]

According to the fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-V), DID symptoms include "the presence of two or more distinct personality states" accompanied by the inability to recall personal information beyond the characteristics of normal forgetfulness. Other DSM-V symptoms of DID include a loss of identity during altered personality states, the loss of time, the loss of one's sense of self, and the loss of consciousness.[14] In each individual, the clinical presentation of DID varies, with the level of functioning changing from severely impaired to adequate.[15][16] The symptoms of dissociative amnesia are subsumed under the DID diagnosis but are also diagnosed separately. Individuals with DID may experience distress from both intrusive thoughts or emotions and the failed ability to recall information that occurred during a dissociative state of personality.[17]

An individual suffering from DID often experiences the first signs of symptoms of the disorder in their childhood, yet in most cases these individuals are not diagnosed with DID until late adolescence and early adulthood. The initiation of DID in childhood may be related to reports of experiencing sexual or physical abuse, though controversy accompanies the reports' accuracy.[18] Individuals with DID may be reluctant to discuss symptoms due to associations with abuse, shame, and fear.[19] An individual's identities may be unaware of each other and may compartmentalize knowledge and memories, resulting in chaotic, intense, and frequent experiences and disturbances within an individual's personal life.[16][20]

Subpersonalities[edit]

Half of the population diagnosed with DID have less than ten distinct personalities, while the majority experience less than 100 distinct personalities; as many as 4,500 have been reported.[21]: 503  The average number of identities has increased over the past few decades, from two or three to now an average of approximately 16 different personalities. However, the cause of the increase in the number of personalities is unclear. Is the increase in the number of personalities due to the actual increase of different personalities, or is it due to the increased acceptance of a higher number of compartmentalized memory components?[21] The primary personality, often identified by the DID patient's given name tends to be "passive, dependent, guilty, and depressed" with the other personalities, which are more active, aggressive or hostile. The personality that seems to be the most dominant amongst the other personalities is often referred to as the primary or host personality.[3] Generally, an individual's differing identities are ordinary people, but some cases of historical, fictional, mythical, celebrity and animal identities have been reported.[21]: 503 

There are differing methods that an individual's subpersonalities interact with one another. In some cases of DID, each personality is equally aware of all the other identities, which is more technically described as a mutually cognizant pattern of awareness.[3] Due to the awareness that each personality has of all others, the subpersonalities are able to converse with one another or hear their voices.[3] More specifically, in some cases subpersonalities are aware of one another, but may sit back and listen to the more dominant being, not directly interacting with the less assertive identities. This case of interaction among subpersonalities is defined as coconscious subpersonalities.[3] Not all identities are aware of the presence of every other subpersonality, where it is most common that one personality has the capability to be aware of some of the others while the others do not share that same ability.[3] This very common case is better defined by the term one-way amnesic relationship.[3] In other cases of DID, the subpersonalities are not aware of any others whatsoever.[3] The unawareness between the differing identities is better defined as a mutually amnesic relationship.[3]

As discused above, each personality includes its own distinct characteristics and traits. The differing personalities encompassed in an individual's case of DID may be different genders and ages and may have different abilities, hobbies, passions, and preferences.[3] Researchers were shocked to find that subpersonalities even incorporate differing physiological states, such as different rates in blood pressure, allergies, and brain activity.[3]

  1. ^ "The ICD-10 Classification of Mental and Behavioural Disorders" (PDF). World Health Organization.
  2. ^ a b c d e f American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 291–298, ISBN 978-0890425558
  3. ^ a b c d e f g h i j k l Comer, Ronald J. (5 February 2016). Fundamentals of abnormal psychology (Eighth ed.). New York. ISBN 9781464176975. OCLC 914289944.{{cite book}}: CS1 maint: location missing publisher (link)
  4. ^ a b c d Beidel, edited by Deborah C.; Frueh, B. Christopher; Hersen, Michel (2014). Adult psychopathology and diagnosis (Seventh ed.). Hoboken, N.J.: Wiley. pp. 414–422. ISBN 9781118657089. {{cite book}}: |first1= has generic name (help)
  5. ^ Brand, BL; Loewenstein, RJ; Spiegel, D (2014). "Dispelling myths about dissociative identity disorder treatment: an empirically based approach". Psychiatry. 77 (2): 169–89. doi:10.1521/psyc.2014.77.2.169. PMID 24865199. S2CID 44570651.
  6. ^ International Society for the Study of Trauma Dissociation. (2011). "Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision" (PDF). Journal of Trauma & Dissociation. 12 (2): 188–212. doi:10.1080/15299732.2011.537248. PMID 21391104. S2CID 44952969.
  7. ^ American Psychiatric Association (2013), Diagnostic and Statistical Manual of Mental Disorders (5th ed.), Arlington: American Psychiatric Publishing, pp. 291–298, ISBN 978-0890425558
  8. ^ Beidel, edited by Deborah C.; Frueh, B. Christopher; Hersen, Michel (2014). Adult psychopathology and diagnosis (Seventh ed.). Hoboken, N.J.: Wiley. pp. 414–422. ISBN 9781118657089. {{cite book}}: |first1= has generic name (help)
  9. ^ a b c "Dissociative Identity Disorder". Merck Manuals Professional Edition. July 2017. Retrieved 5 January 2018.
  10. ^ Reinders AA (2008). "Cross-examining dissociative identity disorder: Neuroimaging and etiology on trial". Neurocase. 14 (1): 44–53. doi:10.1080/13554790801992768. PMID 18569730. S2CID 38251430.
  11. ^ Beidel, edited by Deborah C.; Frueh, B. Christopher; Hersen, Michel (2014). Adult psychopathology and diagnosis (Seventh ed.). Hoboken, N.J.: Wiley. pp. 414–422. ISBN 9781118657089. {{cite book}}: |first1= has generic name (help)
  12. ^ Beidel, edited by Deborah C.; Frueh, B. Christopher; Hersen, Michel (2014). Adult psychopathology and diagnosis (Seventh ed.). Hoboken, N.J.: Wiley. pp. 414–422. ISBN 9781118657089. {{cite book}}: |first1= has generic name (help)
  13. ^ a b Beidel, edited by Deborah C.; Frueh, B. Christopher; Hersen, Michel (2014). Adult psychopathology and diagnosis (Seventh ed.). Hoboken, N.J.: Wiley. pp. 414–422. ISBN 9781118657089. {{cite book}}: |first1= has generic name (help)
  14. ^ American Psychiatric Association (June 2000). Diagnostic and Statistical Manual of Mental Disorders-IV (Text Revision). Vol. 1. Arlington, VA, USA: American Psychiatric Publishing, Inc. pp. 526–529. doi:10.1176/appi.books.9780890423349. ISBN 978-0-89042-024-9.
  15. ^ Cardena E, Gleaves DH (2007). "Dissociative Disorders". In Hersen M, Turner SM, Beidel DC (eds.). Adult Psychopathology and Diagnosis. John Wiley & Sons. pp. 473–503. ISBN 978-0-471-74584-6.
  16. ^ a b Simeon, D (2008). "Dissociative Identity Disorder". Merck & Co. Retrieved 2012-07-31.
  17. ^ Spiegel D, Loewenstein RJ, Lewis-Fernández R, Sar V, Simeon D, Vermetten E, Cardeña E, Dell PF (2011). "Dissociative disorders in DSM-5" (PDF). Depression and Anxiety. 28 (9): 824–852. doi:10.1002/da.20874. PMID 21910187. S2CID 46518635. Archived from the original (PDF) on 2013-05-01.
  18. ^ Maldonado, JR; Spiegel D (2008). "Dissociative disorders — Dissociative identity disorder (Multiple personality disorder)". In Hales RE; Yudofsky SC; Gabbard GO; with foreword by Alan F. Schatzberg (ed.). The American Psychiatric Publishing textbook of psychiatry (5th ed.). Washington, DC: American Psychiatric Pub. pp. 681–710. ISBN 978-1-58562-257-3.{{cite book}}: CS1 maint: multiple names: editors list (link)
  19. ^ Maldonado, JR; Spiegel D (2008). "Dissociative disorders — Dissociative identity disorder (Multiple personality disorder)". In Hales RE; Yudofsky SC; Gabbard GO; with foreword by Alan F. Schatzberg (ed.). The American Psychiatric Publishing textbook of psychiatry (5th ed.). Washington, DC: American Psychiatric Pub. pp. 681–710. ISBN 978-1-58562-257-3.{{cite book}}: CS1 maint: multiple names: editors list (link)
  20. ^ Onno van der Hart; Kathy Steele (1997). "Time Distortions in Dissociative Identity Disorder: Janetian Concepts and Treatment". Dissociation. 10 (2): 91–103.
  21. ^ a b c Lynn, SJ; Berg J; Lilienfeld SO; Merckelbach H; Giesbrecht T; Accardi M; Cleere C (2012). "14 - Dissociative disorders". In Hersen M; Beidel DC (ed.). Adult Psychopathology and Diagnosis. John Wiley & Sons. pp. 497–538. ISBN 978-1-118-13882-3.{{cite book}}: CS1 maint: multiple names: editors list (link)
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