What is Dissociative Identity Disorder? by Ariany Baltazar
Formerly known as multiple personality disorder, dissociative identity disorder is a rare mental disorder affecting around 1.5% of the general population (Mitra & Jain, 2021). D.I.D is one of three Dissociative Disorders, the other being dissociative amnesia and depersonalization/derealization disorder. A key part of D.I.D is dissociation which is a disconnection between a person's memories, thoughts, actions, feelings, or sense of who they are (Drescher, 2022). Individuals with D.I.D. are oftentimes losing touch with reality to a more extreme level, not merely daydreaming. On top of dissociation, a big symptom of D.I.D involves the formation of two or more identities or personality states within a human being. Each distinct personality has a set of characteristics that separate them from another identity like different thinking patterns, memories, and behavior. Another key symptom of D.I.D is major gaps in memory, “Ongoing gaps in memory about everyday events, personal information and/or past traumatic events” (Drescher, 2022). The last major symptom of dissociative identity disorder is significant distress or impairment in various areas of functioning.
Unlike popular depictions of individuals with D.I.D., as seen in the movie Split, the different personalities one has aren’t dangerous nor a threat to society. Each personality, also called alters, has a different attitude and personal preferences as well as different age, gender, and sometimes even sexuality. Each alter also controls the behavior of the person affected with dissociative identity disorder (WebMD Editorial Contributors, 2022). It is important to also highlight the host which is the identity that keeps the other identities together and the notion of switching identities is called switch. Since this disorder is very complex, there’s one way to visually view it to better understand it. By taking a batch of a single-colored clay and splitting that up into as many separate pieces, you begin to understand that each piece is still fundamentally part of the original batch of clay. Hence, the different alters of someone with D.I.D. are still part of the individual but there's this sense of fragmentation until you press the clay, or merge the different personalities back into one. This very simple example may help many better understand how dissociative identity disorder works and helps combat the questions and stigma some may have towards D.I.D individuals.
The History of Dissociative Identity Disorder by Melanie Zepeda
Dissociative identity disorder (D.I.D.) has gone through significant transformations throughout the years, from being considered a possession through an evil spirit to being an official diagnosable illness. The first documented case, although not diagnosed, was recorded by Jeanne Fery in 1584, 298 years before the first official diagnosis of dissociative identity disorder. She recorded her own exorcism, which was often a treatment option for those who exhibited symptoms of the illness. The symptoms she exhibited included having multiple alters, which were possibly a result of childhood physical and sexual abuse (Dissociative Identity Disorder Research, 2016). Despite Jeanne being mistaken as someone who was possessed by an evil spirit, she was called the “most perfect case” of double personality disorder (a former name of dissociative identity disorder) by many researchers who studied her case many years after her exorcism (DIDR, 2016). After the idea of possession being the cause of mental illnesses had started to become unfavorable, people who were once seen as possessed were now labeled as hysterical.
In 1791, there was a shift from describing individuals who had multiple personalities as hysterical to describing them as an individual with dissociative disorder. Eberhardt Gmelin coined the term “exchanged personality” to describe a woman frequently switching between German and French nationality (Boulerice et al., 2019). As more cases showed characteristics of an “exchanged personality”, there was a shift from spiritual treatments, such as exorcisms, to mind-based treatments.
During the 1900s, D.I.D. was placed in the Hysterical Psychoneuroses subgroup in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which kept D.I.D. under the label of hysteria. In addition to this label, during the 1900s it was often believed that dissociative identity disorder was a characteristic of schizophrenia since the original diagnosis of schizophrenia included symptoms of multiple personalities. Many of those diagnosed with schizophrenia at the time were misdiagnosed and should have been diagnosed with dissociative identity disorder. However, because schizophrenia was more widely known, it was often the diagnosis that was given to D.I.D. patients. It wasn’t until the 1980s that dissociative disorders had their own category in the DSM-III instead of being placed under the Hysterical Psychoneuroses subgroup. In the dissociative disorders category, the term “multiple personality disorder” (MPD) was first introduced. However, the term MPD was short-lived as it was changed to the current name, dissociative identity disorder, in 1994 to reflect a better understanding of the disorder as a fragmentation of identity rather than the production of new personalities (Psychology Today, n.d.).
Today, dissociative identity disorder is much better understood than in previous years. Individuals diagnosed with D.I.D. have better treatment options than previously offered. There are still improvements that need to be made to help patients with D.I.D., but as we continue to research and bring awareness to the condition, the more we will understand what we can do to help patients with dissociative identity disorder.
Treatment Options for Dissociative Identity Disorder by Karen Huang
With increased research and awareness of D.I.D., there remains a positive outlook and future for patients to recover from dissociative symptoms. When patients are directed to proper treatment options and diagnoses, they can alleviate some of their dissociative symptoms. While there is no guarantee that treatment options will magically eradicate all dissociative symptoms in patients, treatment options can enable patients to regain some form of control of their lives and personal identity.
A recommended treatment option for D.I.D. patients is to take advantage of talk therapies, such as counseling and psychotherapy. Talk therapy is beneficial in helping patients openly express and uncover any vulnerabilities and past traumas that may be impacting their tendency to disassociate. By uncovering those past negative experiences, patients develop strategies to cope, process, and develop emotion-regulation skills to effectively navigate various domains in their lives.
When it comes to assessing talk therapies, it is highly suggested that patients find therapists who “specialize in dissociative disorders” (Mind, n.d.). If patients are experiencing socioeconomic barriers, there are affordable options for therapy sessions available that may be covered by Medi-Cal or Medicare. Furthermore, trauma-focused cognitive behavioral therapy and dialectical behavioral therapy are also alternative therapy treatments to help a patient understand and mold the different identities that they have, and adapt from past traumas (American Psychiatric Association, n.d.).
Another form of treatment option for D.I.D. patients is psychiatric medications, which include antidepressants, antipsychotics, and mood stabilizers. However, it is best to consult a doctor to prescribe specific psychiatric medications tailored to each individual’s disassociation levels. Psychiatric medications can only treat related symptoms in D.I.D., thus these medication options are not guaranteed to fully treat D.I.D. Antidepressants are a form of psychiatric drug that can be prescribed by doctors, after having been supervised to use it by psychiatrists. Antidepressants typically treat several other conditions, such as anxiety disorders, phobias, bulimia, and how to manage long-term pain (Mind, n.d.). Antipsychotics are another form of psychiatric medication that can be prescribed to treat psychotic experiences or psychosis. In terms of treating psychotic experiences, it is best recommended to only take antipsychotic medications when the patient is severely impaired or distressed. Antipsychotics can be prescribed in different forms, such as through swallowing a tablet or liquid, or injections every few weeks. Lastly, mood stabilizers are a form of psychiatric drug that can be used to treat bipolar disorder, mania and hypomania, recurrent depression, and schizoaffective disorders. Mood stabilizers are recommended by professionals to manage highs and lows in moods.
A fairly new treatment option for D.I.D. is EMDR, which refers to eye movement desensitization and reprocessing. EMDR has patients make rhythmic eye movements when processing and recalling past traumas and negative experiences (Mind, n.d.). In EMDR, patients engage in rapid eye movements, which are intended to replicate a similar effect in the way the brain processes experiences and memories (Mind, n.d.). This way, patients with D.I.D. can process their past traumatic experiences slowly. However, professionals have advised that D.I.D. patients only utilize the EMDR treatment when they are in a stable state of mind.
Reference
Boulerice, M., Chapman, M., & Van Aken, B. (2019, June 2). An Outside Perspective:
Dissociative Identity Disorder. Broken Brains, Broken Souls.
Drescher, J. (2022, October). What Are Dissociative Disorders? Psychiatry.org; American Psychiatric Association. https://www.psychiatry.org/patients-families/dissociative-disorders/what-are-dissociative-disorders
History of dissociative identity disorder. Dissociative Identity Disorder Research. (2016).
Mitra, P., & Jain, A. (2021, November 21). Dissociative Identity Disorder. PubMed; National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK568768/
Sussex Publishers. (n.d.). Dissociative Identity Disorder (Multiple Personality Disorder).
Psychology Today.
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WebMD Editorial Contributors. (2022, January 22). Dissociative Identity Disorder (Multiple Personality Disorder) (J. Begum, Ed.). WebMD; WebMD. https://www.webmd.com/mental-health/dissociative-identity-disorder-multiple-personality-disorder
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