Definition of DISSOCIATIVE IDENTITY DISORDER (DID)
DISSOCIATIVE IDENTITY DISORDER (DID) is a severe condition in which two or more distinct identities, or personality states, are present in—and alternately take control of—an individual. The person also experiences memory loss that is too extensive to be explained by ordinary forgetfulness. It is a disorder characterized by identity fragmentation rather than a proliferation of separate personalities. The disturbance is not due to the direct psychological effects of a substance or of a general medical condition, yet as this once rarely reported disorder has become more common, the diagnosis has become controversial. Some believe that because DISSOCIATIVE IDENTITY DISORDER (DID) patients are easily hypnotized, their symptoms are iatrogenic, that is, they have arisen in response to therapists' suggestions. Brain imaging studies, however, have corroborated identity transitions in some patients. DISSOCIATIVE IDENTITY DISORDER (DID) was called Multiple Personality Disorder until 1994, when the name was changed to reflect a better understanding of the condition—namely, that it is characterized by a fragmentation, or splintering, of identity rather than by a proliferation, or growth, of separate identities.
DISSOCIATIVE IDENTITY DISORDER (DID) reflects a failure to integrate various aspects of identity, memory and consciousness in a single multidimensional self. Usually, a primary identity carries the individual's given name and is passive, dependent, guilty and depressed. When in control, each personality state, or alter, may be experienced as if it has a distinct history, self-image and identity. The alters' characteristics—including name, reported age and gender, vocabulary, general knowledge, and predominant mood—contrast with those of the primary identity. Certain circumstances or stressors can cause a particular alter to emerge. The various identities may deny knowledge of one another, be critical of one another or appear to be in open conflict.
Symptoms of DISSOCIATIVE IDENTITY DISORDER (DID)
The individual experiences two or more distinct identities or personality states (each with its own enduring pattern of perceiving, relating to, and thinking about the environment and self).
The reported range of identities is from 2 to more than 100. Half of the reported cases of DISSOCIATIVE IDENTITY DISORDER (DID) include individuals with 10 or fewer.
At least two of these identities or personality states recurrently take control of the person's behavior. Each may exhibit its own distinct history, self-image, behaviors, and, physical characteristics, as well as possess a separate name.
Particular identities may emerge in specific circumstances. Alternative identities are experienced as taking control in sequence, one at the expense of the other, and may deny knowledge of one another, be critical of one another or appear to be in open conflict. Transitions from one identity to another are often triggered by psychosocial stress.
Frequent gaps are found in memories of personal history, including people, places, and events, for both the distant and recent past. Different alters may remember different events, but passive identities tend to have more limited memories whereas hostile, controlling or protective identities have more complete memories.
Symptoms of depression, anxiety, passivity, dependence and guilt may be present.
In childhood, problem behavior and an inability to focus in school are common.
Self-destructive and/or aggressive behavior may take place.
Visual or auditory hallucinations may occur.
The average time that elapses from the first symptom to diagnosis is six to seven years.
The disturbance is not due to the direct psychological effects of a substance or of a general medical condition.
Causes of DISSOCIATIVE IDENTITY DISORDER (DID)
Why some people develop DISSOCIATIVE IDENTITY DISORDER (DID) is not entirely understood, but they frequently report having experienced severe physical and sexual abuse, especially during childhood. Though the accuracy of such accounts is disputed, they are often confirmed by objective evidence. Individuals with DISSOCIATIVE IDENTITY DISORDER (DID) may also have post-traumatic symptoms (nightmares, flashbacks, and startle responses) or Post-Traumatic Stress Disorder. Several studies suggest that DISSOCIATIVE IDENTITY DISORDER (DID) is more common among close biological relatives of persons who also have the disorder than in the general population. As this once rarely reported disorder has grown more common, the diagnosis has become controversial. Some believe that because DID patients are highly suggestible, their symptoms are at least partly iatrogenic— that is, prompted by their therapists' probing. Brain imaging studies, however, have corroborated identity transitions.
Treatment for DISSOCIATIVE IDENTITY DISORDER (DID)
The primary treatment for DISSOCIATIVE IDENTITY DISORDER (DID) is long-term psychotherapy with the goal of deconstructing the different personalities and uniting them into one. Other treatments include cognitive and creative therapies. Although there are no medications that specifically treat DISSOCIATIVE IDENTITY DISORDER (DID), antidepressants, anti-anxiety drugs or tranquilizers may be prescribed to help control the mental health symptoms associated with it.
An intense interest in spiritualism, parapsychology, and hypnosis continued throughout the 19th and early 20th centuries, running in parallel with John Locke's views that there was an association of ideas requiring the coexistence of feelings with awareness of the feelings. Hypnosis, which was pioneered in the late 1700s by Franz Mesmer and Armand-Marie Jacques de Chastenet, Marques de Puységur, challenged Locke's association of ideas. Hypnotists observed second personalities emerging during hypnosis and wondered how two minds could coexist.
The 19th century saw a number of reported cases of multiple personalities which Rieber estimated would be close to 100. Epilepsy was seen as a factor in some cases and discussion of this connection continues into the present era.
By the late 19th century there was a general realization that emotionally traumatic experiences could cause long-term disorders which may manifest with a variety of symptoms. Between 1880 and 1920, many great international medical conferences devoted a lot of time to sessions on dissociation. It was in this climate that Jean-Martin Charcot introduced his ideas of the impact of nervous shocks as a cause for a variety of neurological conditions. One of Charcot's students, Pierre Janet, took these ideas and went on to develop his own theories of dissociation. One of the first individuals with DID to be scientifically studied was Clara Norton Fowler, under the pseudonym Christine Beauchamp; American neurologist Morton Prince studied Fowler between 1898 and 1904, describing her case study in his 1906 monograph, Dissociation of a Personality. Fowler went on to marry one of her analyst's colleagues.
In the early 20th century interest in dissociation and DISSOCIATIVE IDENTITY DISORDER (DID) waned for a number of reasons. After Charcot's death in 1893, many of his "hysterical" patients were exposed as frauds and Janet's association with Charcot tarnished his theories of dissociation. Sigmund Freud recanted his earlier emphasis on dissociation and childhood trauma. Freud, a man who actively promoted his ideas and enlisted the help of others, won out over the "lone wolf" Janet who did not train students in a teaching hospital.
In 1910, Eugen Bleuler introduced the term "schizophrenia" to replace "dementia praecox" and a review of the Index medicus from 1903 through 1978 showed a dramatic decline in the number of reports of multiple personality after the diagnosis of schizophrenia "caught on," especially in the United States. A number of factors helped create a large climate of skepticism and disbelief; paralleling the increased suspicion of DISSOCIATIVE IDENTITY DISORDER (DID) was the decline of interest in dissociation as a laboratory and clinical phenomenon.
Starting in about 1927, there was a large increase in the number of reported cases of schizophrenia, which was matched by an equally large decrease in the number of multiple personality reports. Bleuler also included multiple personality in his category of schizophrenia. It was found in the 1980s that DID patients are often misdiagnosed as suffering from schizophrenia.
The public, however, was exposed to psychological ideas which took their interest. Mary Shelley's Frankenstein, Robert Louis Stevenson's Strange Case of Dr Jekyll and Mr Hyde, and many short stories by Edgar Allan Poe, had a formidable impact. In 1957, with the publication of the book The Three Faces of Eve, and the popular movie which followed it, the American public's interest in multiple personality was revived. DISSOCIATIVE IDENTITY DISORDER (DID) began to emerge as a separate disorder in the 1970s when an initially small number of clinicians worked to re-establish it as a legitimate diagnosis.
In 1974, the highly influential book Sybil was published, and six years later the diagnosis of multiple personality disorder was included in the DSM. There has since been additional controversy over Sybil as a research case study with allegations over the legitimacy of the data. As media coverage spiked, diagnoses climbed. There were 200 reported cases of DISSOCIATIVE IDENTITY DISORDER (DID) as of 1980, and 20,000 from 1980 to 1990. Joan Acocella reports that 40,000 cases were diagnosed from 1985 to 1995. The majority of diagnoses are made in North America, particularly the United States, and in English-speaking countries more generally with reports recently emerging from other countries.
Controversy
DISSOCIATIVE IDENTITY DISORDER (DID) is a controversial diagnosis and condition, with much of the literature on DISSOCIATIVE IDENTITY DISORDER (DID) being generated and published in North America, to the extent that it was regarded as a phenomenon confined to that continent. Even within North American psychiatrists there is a lack of consensus regarding the validity of DISSOCIATIVE IDENTITY DISORDER (DID). Practitioners who do accept DISSOCIATIVE IDENTITY DISORDER (DID) as a valid disorder have produced an extensive literature with some of the more recent papers originating outside North America. Criticism of the diagnosis continues, with Piper and Merskey describing it as a culture-bound and often iatrogenic condition which they believe is in decline.There is considerable controversy over the validity of the multiple personality profile as a diagnosis. Unlike the more empirically verifiable mood and personality disorders, dissociation is primarily subjective for both the patient and the treatment provider. The relationship between dissociation and multiple personality creates conflict regarding the DISSOCIATIVE IDENTITY DISORDER (DID) diagnosis. While other disorders require a certain amount of subjective interpretation, those disorders more readily present generally accepted, objective symptoms. The controversial nature of the dissociation hypothesis is shown quite clearly by the manner in which the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders (DSM) has addressed, and re-addressed, the categorization over the years.
The second edition of the DSM referred to this diagnostic profile as multiple personality disorder. The third edition grouped MPD in with the other four major dissociative disorders. The current edition, the DSM-IV-TR, categorizes the disorder as DISSOCIATIVE IDENTITY DISORDER (DID). The ICD-10 (International Statistical Classification of Diseases and Related Health Problems) continues to list the condition as multiple personality disorder.
Sources:
American Psychiatric Association
National Institute of Mental Health
Handbook of Psychology, Vol. 8 (John Wiley)
psychologytoday
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