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Dissociative Identity Disorder

Multiple Personality

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:

Severe Pain
  • 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[symptoma.com]
Dermatitis
  • This case leads us to suggest that patients with dermatitis artefacta might have comorbid dissociative experiences, which cannot be identified easily.[ncbi.nlm.nih.gov]
  • Ozman M, Erdogan A, Aydemir EH, Oguz O: Dissociative identity disorder presenting as dermatitis artefacta. Int J Dermatol 2006;45:770–771. Peterson G: Children coping with trauma: diagnosis of ‘dissociation identity disorder’.[doi.org]
Ulcer
  • Multiple large, deep ulcerations with unnatural shapes were seen on her left forearm. The ulcerations were thought to be self-inflicted.[ncbi.nlm.nih.gov]
Gustatory Hallucination
  • In addition to hearing voices, patients with dissociative identity disorder may have visual, tactile, olfactory, and gustatory hallucinations. Thus, patients may be misdiagnosed with a psychotic disorder.[merckmanuals.com]
Schizoid Personality Disorder
  • Schizoid Personality Disorder refers to a “pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings.”[guidetopsychology.com]
Headache
  • Dissociators frequently experience headaches and other psychosomatic complaints. Comorbid disorders include PTSD, addictions such as substance abuse, borderline personality disorder, eating disorders, depression and anxiety.[nypl.org]
  • 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[symptoma.com]
  • DID shares many psychological symptoms as those found in other mental disorders, including: Changing levels of functioning, from highly effective to disturbed/disabled Severe headaches or pain in other parts of the body Depersonalization (feeling disconnected[my.clevelandclinic.org]
  • […] phobias (flashbacks, reactions to stimuli or "triggers") Alcohol and drug abuse Compulsions and rituals Psychotic-like symptoms (including auditory and visual hallucinations ) Eating disorders Other symptoms of dissociative identity disorder may include headache[webmd.com]
Personality Change
  • Because dissociation is an unconscious process, the person experiencing it is not aware of any personality changes that occur during an episode.[humanillnesses.com]
  • Google Scholar Parker, Neville ( 1980 ), 'Personality change following accidents. The report of a double murder', British Journal of Psychiatry, cxxxvii, 401 - 9.[doi.org]
  • In a small proportion of cases the condition may follow a chronic course over many years, with eventual transition to an enduring personality change (F62.0).[web.archive.org]
Somnambulism
  • The repressed impulse giving rise to the anxiety may be discharged by, or deflected into, various symptomatic expressions, such as depersonalization, dissociated personality, stupor, fugue, amnesia, dream state, somnambulism, etc.[goodreads.com]
  • It described the possible occurrence of alterations in the patient's state of consciousness or identity, and included the symptoms of "amnesia, somnambulism, fugue, and multiple personality".[en.wikipedia.org]
Cognitive Disorder
  • Difficulties in differential diagnosis are increased in children.DID must be distinguished from, or determined if comorbid with, a variety of disorders including mood disorders, psychosis, anxiety disorders, PTSD, personality disorders, cognitive disorders[en.wikipedia.org]
Pendular Nystagmus
  • Differences in visual acuity, frequency of pendular nystagmus, and handedness were observed in this patient both when the alter personalities appeared spontaneously and when elicited under hypnosis.[ncbi.nlm.nih.gov]

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.

Sex distribution
Age distribution

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

Article

  1. Kluft RP. An update on multiple personality disorder. Hosp Community Psychiatry. Apr 1987;38(4):363-73.
  2. Graves SM. Dissociative disorders and dissociative symptoms at a community mental health center. Dissociation 1989; 2:119.
  3. 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.
  4. Latz TT, Kramer SI, Hughes DL. Multiple personality disorder among female inpatients in a state hospital. Am J Psychiatry 1995; 152:1343.
  5. Sar V, Akyüz G, Doğan O. Prevalence of dissociative disorders among women in the general population. Psychiatry Res 2007; 149:169.
  6. Ross CA. History, phenomenology, and epidemiology of dissociation. In: Handbook of Dissociation, Michelson LK, Ray WJ. (Eds), Plenum, New York 1996.
  7. 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.
  8. Aderibigbe YA, Bloch RM, Walker WR. Prevalence of depersonalization and derealization experiences in a rural population. Soc Psychiatry Psychiatr Epidemiol 2001; 36:63.
  9. Foote B, Park J. Dissociative identity disorder and schizophrenia: differential diagnosis and theoretical issues. Curr Psychiatry Rep. Jun 2008;10(3):217-22.
  10. Gentile JP, Dillon KS, Gillig PM. Psychotherapy and pharmacotherapy for patients with dissociative identity disorder. Innov Clin Neurosci. Feb 2013;10(2):22-9. 
  11. Putnam FW. Diagnosis and Treatment of Multiple Personality Disorder. New York, NY: Guilford Press; 1989.

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Last updated: 2019-07-11 20:11