Dissociative identity disorder, abbreviated as DID, belongs to a group of mental disorders characterized by development of two distinct personality states of the same individual. The distinct personality state governs or controls the behavior of an individual at different periods [1].
Presentation
Most often DID mimic the signs and symptoms of other mental disorders. The following are the signs and symptoms of DID:
- Drastic change in the levels of functioning
- Depression
- Mood swings
- Severe pain in body
- Substance abuse
- Changes in diet and sleep pattern
- Hallucinations
- Suicidal ideation
- Attempts to harm oneself
- Sexual malfunction
- Feeling of detachments from one’s body and thoughts
- Panic attacks
- Bouts of anxiety and nervousness
- Amnesia
- Depersonalization and derealization [8]
Entire Body System
- Anorexia
We then compared these rates with those of well-established diagnoses such as anorexia nervosa, alcohol abuse, and schizophrenia. We also systematically reviewed all publications involving dissociative amnesia that appeared in 2003. [ncbi.nlm.nih.gov]
Anorexia nervosa: A multidimensional approach. New York : Brunner Mazzel. Google Scholar Golub, D. ( 1995 ). Cultural variations in multiple personality disorder. in L. Cohen, J. Berzoff & M. [doi.org]
Knowing I was different with my OCD, anorexia and the voices that no one else seemed to hear made me feel isolated, disconnected. I took everything too seriously. I analysed things to death. [goodreads.com]
A 2006 study compared scholarly research and publications on DID and dissociative amnesia to other mental health conditions, such as anorexia nervosa, alcohol abuse and schizophrenia from 1984 to 2003. [en.wikipedia.org]
- Fever
One day, you might be able to know exactly who to blame for giving you a viral fever. [theodysseyonline.com]
- Fishing
Fish, V. (1998). The delayed memory controversy in an epidemiological framework. Child Maltreatment, 3, 204-223. Freyd, J. (1993). Personal perspectives on the delayed memory debate. Treating Abuse Today, 3 (5), 13-20. Freyd, P. (1992, February 29). [leadershipcouncil.org]
Psychiatrical
- Suggestibility
This paper suggests that such a dichotomy is unwarranted and that, in fact, both sides of the argument have merit. [ncbi.nlm.nih.gov]
La Suggestion mentale et l'action à distance des substances toxiques et médicamenteuses ( Paris : J. B. Baillière ). Google Scholar Braid, J. ( 1846 ). The Power of the Mind over the Body ( London : J. Churchill ). [doi.org]
- Depersonalization
Depersonalization disorder may be in line for the next “epidemic” of dissociation. Keywords [doi.org]
Depersonalization disorder may be in line for the next "epidemic" of dissociation. [ncbi.nlm.nih.gov]
Depersonalization disorder can be associated with body image distortions and feelings that the world is “unreal.” [pchtreatment.com]
- Delusion
Abstract Dissociative symptoms, first-rank symptoms of schizophrenia, and delusions were assessed in 40 schizophrenia patients and 40 dissociative identity disorder (DID) patients with the Multidimensional Inventory of Dissociation (MID). [ncbi.nlm.nih.gov]
"Schizophrenia is a severe mental disorder characterized by delusions, hallucinations, incoherence and physical agitation. it is classified as a 'thought' disorder" 3 and often first appears during late teen years or the early 20's. [religioustolerance.org]
Delusions are the most common psychotic symptom in schizophrenia; hallucinations, particularly hearing voices, are apparent in about half to three quarters of people with the illness. [webmd.com]
- Anxiety Disorder
Comorbidity profiles of patients with DID and DDNOS were very similar to those in PTSD (high prevalence of anxiety, somatoform disorders, and depression), but differed significantly from those of patients with depression and anxiety disorders. [ncbi.nlm.nih.gov]
F41.8 Other specified anxiety disorders Anxiety hysteria F41.9 Anxiety disorder, unspecified Anxiety NOS F43 Reaction to severe stress, and adjustment disorders This category differs from others in that it includes disorders identifiable on the basis [web.archive.org]
- Denial
Dermatitis artefacta is a rare psychiatric condition characterized by rubbing of skin blisters and denial of self-infliction. Dissociation may be comorbid with self-injurious behavior. [ncbi.nlm.nih.gov]
It is surprising that this kind of book is not yet on the market, because it is such a hot topic, and the negative consequences of psychiatric diagnosis range from loss of custody of a child to denial of health insurance and employment to removal of one's [books.google.com]
Rieber calls this a "letter of denial" of MPD/DID. There are many more instances in which Rieber misrepresents the material in the appendix to support his case. [web.archive.org]
The FMSF's noncritical acceptance of the denials of those accused of child abuse is particularly problematic given that offenders who molest children have been found to have an extraordinary capacity for denial and minimization. [leadershipcouncil.org]
But instead of following up on their suspicions, many have resorted to authoritarian rhetorical denial... [goodreads.com]
Neurologic
- Amnesia
Test results indicated no evidence of total interidentity amnesia for emotionally valenced material in DID. [ncbi.nlm.nih.gov]
[…] multiple personality states and amnesia DID MPD multiple personality multiple personality disorder [wikidata.org]
- Confusion
The core MID symptoms-exhibited at all ranges of MID scores-for DID patients (the presence of alters, identity confusion, and memory problems) and BPD patients (flashbacks, identity confusion, and memory problems) were ostensibly similar but were considered [ncbi.nlm.nih.gov]
Identity confusion or identity alteration. Both of these involve a sense of confusion about who a person is. [webmd.com]
Confusion about identity. This could manifest in a number of different ways. One example is enjoying something during a period of dissociation that would ordinarily be repulsive. [luxury.rehabs.com]
- Forgetful
[…] of two or more identities with distinct patterns of perception and personality which recurrently take control of the person's behavior; this is accompanied by a retrospective gap in memory of important personal information that far exceeds ordinary forgetfulness [icd9data.com]
The person also experiences severe memory loss that cannot be explained by ordinary forgetfulness. Thought to be a coping mechanism, dissociation helps a person leave the traumatic situation. [psychcentral.com]
Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. [elementsbehavioralhealth.com]
The disorder includes inability to recall everyday events, important personal information, and/or traumatic or stressful events, all of which would not typically be lost with ordinary forgetting. [merckmanuals.com]
- Neglect
Abstract Couple therapy in the context of dissociative identity disorder (DID) has been neglected as an area of exploration and development in the couple therapy and trauma literature. [ncbi.nlm.nih.gov]
Dissociation has also been linked specifically to childhood physical neglect in patients diagnosed with schizophrenia. [emedicine.medscape.com]
- Seizure
While the group median score of cases with complex partial seizures was higher than that of normal controls, it was significantly lower than that of the psychiatric patients with MPD. [ncbi.nlm.nih.gov]
The disorders that it is most important to consider in the differential diagnosis of DID are other dissociative disorders, psychotic disorders, affective disorders, borderline personality disorder, partial complex seizures, factitious disorders, and malingering [journals.lww.com]
EEG tests can differentiate between seizure disorders and seizure-like symptoms in DID. [traumadissociation.com]
The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (e.g., complex partial seizures). [psychcentral.com]
Depression, anxiety, substance abuse, self-injury, self-mutilation, nonepileptic seizures, and suicidal behavior are common, as is sexual dysfunction. [merckmanuals.com]
Workup
So far there are no clinical tests to diagnose dissociative identity disorder. The diagnosis of the condition primarily begins with gathering information about the medical history of the affected individual and a thorough physical examination. In addition, X–rays and blood tests would be carried out to rule out any underlying disease conditions. In many cases, injury to the head, brain diseases, medications side effects or alcohol intoxication may produce symptoms similar to DID. Amnesia may also occur as a result of these. Therefore, a thorough checkup becomes imperative to rule out any other medical illness [9].
Individuals with DID are unaware that they are living with a mental disorder and often seek medical help due to amnesia. During diagnosis this medical condition is identified.
Treatment
The major goal of treatment of DID is to relieve symptoms and help individuals cope with new skills so that they can comfortably express their emotions and feelings without any fear or hesitance. In many cases, combination of various methods is employed for treating DID [10] [11]. Individuals with DID are given psychotherapy and cognitive therapy to help change their thinking pattern.
Such therapies also make the individuals capable to communicate their problems and conflicts. Sometimes medications are prescribed to relieve symptoms of depression, panic attacks and anxiety. A kind of treatment known as clinical hypnosis is used that employs fundamentals of deep relaxation and concentration techniques to allow the individuals to explore those thoughts that they have always hidden from their conscious minds. Such a type of treatment helps the affected individuals come face to face with reality.
Prognosis
Prognosis of the disease depends on the stage at which the condition was diagnosed and the extent of severity of the symptoms. In rare cases, the condition resolves on its own. However, symptoms do recur after specific periods. Prognosis usually turns poor for those individuals who are still in contact with the abusers. In such cases, chances of secondary complications in terms of suicidal ideation and self harm techniques increase [7].
Etiology
The major and primary cause of dissociative identity disorder is trauma experienced by children during their developmental years. The trauma can occur in any form, physical, sexual and or emotional [3]. When children fall prey to such trauma and repeatedly experience the same, they go on to develop DID which gradually begin to show effect during their later years. Trauma experienced due to natural disasters, wars or loss of a parent during early childhood all significantly contribute to DID.
Research also points towards the fact that there is some kind of heredity factor known to play foul in causation of DID.
Epidemiology
The exact prevalence of DID is unknown, however females are more commonly affected by the disorder than males [4] [5]. This might be due to the fact that the female population is more prone to sexual abuse. It has been estimated that 1 in every 25 children develops DID. The incidence of child abuse has significantly increased from the year 1976. Reports state that there were about 3 million cases of child abuse in the year 1995. To add to this, about 2000 children die due to trauma associated with abuse.
Pathophysiology
Researchers consider dissociation as a psychophysiological process. Such a kind of process is responsible for altering an individual’s thought and behavior pattern. As a result of this, certain piece of information is not interpreted in the way it should be. This in turn causes a great degree of alteration in the individual’s memory and identity, giving rise to series of psychiatric symptoms which are collectively referred to as dissociative identity disorder.
Research has also pointed towards the fact that not all children who are victims of ill treatment or any form of abuse during their developmental years would develop DID. Even though not all, but majority of them would certainly develop DID. It has been estimated that the rate of incidence of DID is higher amongst the population who have being a part of abuse during childhood years [6].
Prevention
It is less likely to prevent the development of DID. However, onset of complications can be prevented if treatment is initiated when first sign and symptoms appear.
Summary
In the past, dissociative identity disorder (DID) was also referred to as multiple personality disorder. Such a kind of personality disorder is not a resultant reaction of substance abuse or any other medical condition. The symptoms of DID are not similar to direct psychological effects experienced due to alcohol consumption or medical illness. In children, the symptoms are far more complex than imaginary play games that form a part of certain type of mental disorders [2]. DID is a common mental disorder affecting both the adult and children population.
Patient Information
Definition
Dissociative identity disorder (DID) is a type of mental illness characterized by development of two personality states that takes charge of the affected individual at different times. It is a common condition affecting about 1 in every 25 children suffering from trauma of any kind. With timely initiation of treatment, the disorder can be effectively treated and onset of complications prevented.
Cause
Trauma is the major causative factor behind development of DID. Physical or emotional trauma or emotional stress due to wars or loss of any parent at an early age all cause DID to set in. Children who are victims of abuse during their early developmental years gradually showcase symptoms of DID during adulthood.
Symptoms
Symptoms of DID are similar to any other mental disorder and include depression, anxiety, amnesia, suicidal thoughts, hallucinations, substance abuse, mood swings, changes in sleep pattern, nervousness, depersonalization, severe headache and body ache.
Diagnosis
Information on the past medical history of the patient is gathered followed by thorough physical examination. In addition, certain blood tests are done to rule out presence of underlying disease conditions.
Treatment
Combination of various therapies such as cognitive therapy, psychotherapy and clinical hypnosis forms the basis of treatment regime. In addition, medications may also be prescribed to relieve certain associated symptoms.
References
- Kluft RP. An update on multiple personality disorder. Hosp Community Psychiatry. Apr 1987;38(4):363-73.
- Graves SM. Dissociative disorders and dissociative symptoms at a community mental health center. Dissociation 1989; 2:119.
- Shipman K, Taussig H. Mental health treatment of child abuse and neglect: the promise of evidence-based practice. Pediatr Clin North Am. Apr 2009;56(2):417-28.
- Latz TT, Kramer SI, Hughes DL. Multiple personality disorder among female inpatients in a state hospital. Am J Psychiatry 1995; 152:1343.
- Sar V, Akyüz G, Doğan O. Prevalence of dissociative disorders among women in the general population. Psychiatry Res 2007; 149:169.
- Ross CA. History, phenomenology, and epidemiology of dissociation. In: Handbook of Dissociation, Michelson LK, Ray WJ. (Eds), Plenum, New York 1996.
- Edwards VJ, Holden GW, Felitti VJ, Anda RF. Relationship between multiple forms of childhood maltreatment and adult mental health in community respondents: results from the adverse childhood experiences study. Am J Psychiatry. Aug 2003;160(8):1453-60.
- Aderibigbe YA, Bloch RM, Walker WR. Prevalence of depersonalization and derealization experiences in a rural population. Soc Psychiatry Psychiatr Epidemiol 2001; 36:63.
- Foote B, Park J. Dissociative identity disorder and schizophrenia: differential diagnosis and theoretical issues. Curr Psychiatry Rep. Jun 2008;10(3):217-22.
- Gentile JP, Dillon KS, Gillig PM. Psychotherapy and pharmacotherapy for patients with dissociative identity disorder. Innov Clin Neurosci. Feb 2013;10(2):22-9.
- Putnam FW. Diagnosis and Treatment of Multiple Personality Disorder. New York, NY: Guilford Press; 1989.