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Dissociative identity disorder (DID) is a mental illness that involves the sufferer experiencing at least two clear identities or personality states, each of which has a fairly consistent way of viewing and relating to the world. Some individuals with DID have been found to have personality states that have distinctly different ways of reacting, in terms of emotions, pulse, blood pressure, and blood flow to the brain. This disorder was formerly called multiple personality disorder (MPD) and is often referred to as split personality disorder. Although statistics regarding this disorder indicate that the incidence of DID is about 3% of patients in psychiatric hospitals and is described as occurring in females nine times more often than in males, this may be due to difficulty identifying the disorder in males. Also, disagreement among mental-health professionals about how this illness appears clinically, and if DID even exists, adds to the difficulty of estimating how often it occurs.
Some professionals continue to be of the opinion that DID does not exist. The nature of this skepticism is sometimes due to questions about why many more individuals who have endured the stress of terrible abuse as young children do not develop the disorder, why more children are not diagnosed as having DID, and why some DID sufferers have no history of tremendous trauma. One explanation for what some believe to be these inconsistencies is that given the highly complex and unknown nature of the human brain and psyche, many of those whom one would expect to develop dissociative identity disorder are spared due to their resilience. Another concern about the diagnosis of DID involves having to rely on the traumatic memories of those who suffer from this disorder. That DID is significantly more often assessed in individuals in North America compared to the rest of the world, for the most part, leads some practitioners to believe that DID is a culture-based myth rather than a true disorder. As with many other mental-health issues, symptoms of the same disorder in children look very different than in adults. Studies that verify the presence of DID using multiple resources add credibility to the diagnosis. Research on individuals with DID that have little to no media exposure to information on the illness lends further credibility to the reliability of this diagnosis.
Movies about DID have been well known in the United States since the 1950s. The 1953 movie The Three Faces of Eve tells the story of Chris Sizemore, a real-life woman with the disorder. She was thought to develop DID in reaction to witnessing several terrible accidents at a young age. That movie described three personalities that were successfully merged or integrated into one within one year. More accurately, the person depicted in that movie had to contend with 22 personalities that took more than 45 years to be able to coexist in a functional way. A miniseries about DID was Sybil. The character of Sybil Dorsett portrayed the life story of Shirley Ardell Mason, who experienced severe physical, emotional, and sexual abuse that was inflicted by her mother. She was thought to develop 16 distinct identities. As with the diagnosis in general, the veracity of the story of Sybil remains a controversy, with claims that the illness in general, and Sybil specifically, is a hoax.
Signs and symptoms of dissociative identity disorder include:
- lapses in memory (dissociation), particularly of significant life events, like birthdays, wedding, or birth of a child;
- blackouts in time, resulting in finding oneself in places but not recalling how one traveled there;
- being frequently accused of lying when they do not believe they are lying (for example, being told of things they did but do not recall);
- finding items in one's possession but not recalling how those things were acquired;
- encountering people with whom one is unfamiliar but who seem to know them as someone else;
- being called names that are completely unlike their own name or nickname;
- finding items they have clearly written but are in handwriting other than their own;
- hearing voices inside their head that are not their own;
- not recognizing themselves in the mirror;
- feeling unreal (derealization);
- feeling like they are watching themselves move through life rather than living their own life; and
- feeling like more than one person
While there is no proven specific cause of DID, the prevailing psychological theory about how the condition develops is as a reaction to childhood trauma. Specifically, it is thought that one way that some individuals respond to being severely traumatized as a young child is to wall off, in other words, to dissociate those memories. When that reaction becomes extreme, DID may be the result. As with other mental disorders, having a family member with DID may indicate a potential vulnerability to developing the disorder but does not translate into the condition being literally hereditary.
There is no specific definitive test, like a blood test, that can accurately assess that a person has dissociative identity disorder. Therefore, practitioners conduct a mental-health interview that looks for the presence of the signs and symptoms previously described. They usually ask questions to explore whether the symptoms that the client is suffering from are not better accounted for by another mental disorder, dissociative or otherwise. Other dissociative disorders include depersonalization disorder (feeling detached from themselves or surroundings), dissociative amnesia (memory problems associated with a traumatic experience), dissociative fugue (abandonment of familiar surroundings and memory lapse for the past), and dissociative disorder, not otherwise specified (episodes of dissociation that do not qualify for one of the specific dissociative disorders just described). As part of the assessment, mental-health professionals also usually ask about other mental conditions and ensure that the client has recently received a comprehensive physical examination so that any physical conditions that may mimic symptoms of DID are identified and addressed.
Psychotherapy is generally considered to be the main component of treatment for dissociative identity disorder. In treating individuals with DID, therapists usually try to help clients improve their relationships with others and to experience feelings they have not felt comfortable being in touch with or openly expressing in the past. This is carefully paced in order to prevent the person with DID from becoming overwhelmed by anxiety, risking a figurative repetition of their traumatic past being inflicted by those very strong emotions. Mental-health professionals also often guide clients in finding a way to have each aspect of them coexist and work together. The goal of achieving a more peaceful coexistence of each part of the person's sense of self is quite different than the reintegration of all those aspects into just one identity state. While reintegration used to be the goal of psychotherapy, it has frequently been found to leave individuals with DID feeling as if the goal of the practitioner is to get rid of, or “kill,” parts of them.
Hypnosis is sometimes used to help increase the information that the person with DID has about their symptoms/identity states, thereby increasing the control they have over those states when they change from one personality state to another. That is said to occur by enhancing the communication that each aspect of the person's identity has with the others. In this age of insurance companies regulating the health care that most Americans receive, having time-limited, multiple periods of psychotherapy rather than intensive long-term care provides what may be another effective treatment option for people with DID.
Medications are often used to address the many other mental-health conditions that individuals with DID tend to have, like depression, severe anxiety, anger, and impulse-control problems. However, particular caution is appropriate when treating people with DID with medications because any effects they may experience, good or bad, may cause the sufferer of DID to feel like they are being controlled, and therefore traumatized yet again. As DID is often associated with episodes of severe depression, electroconvulsive therapy (ECT) can be a viable treatment when the combination of psychotherapy and medication does not result in adequate relief of symptoms.
As with other mental-health conditions, the prognosis for people with DID becomes much less optimistic if not appropriately treated. Individuals with a history of being sexually abused, including those who go on to develop dissociative identity disorder, are vulnerable to abusing alcohol as a negative way of coping with their victimization. People with DID are also at risk for attempting suicide more than once. Violent behavior has a high level of association with dissociation as well. Other debilitating outcomes of DID, like that of other severe chronic mental illnesses, include inability to obtain and maintain employment, poor relationships with others, and therefore overall lower productivity and quality of life.
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