Dissociative Identity Disorder (DID)
DISSOCIATIVE IDENTITY DISORDER (DID) 13
DissociativeIdentity Disorder (DID)
DissociativeIdentity Disorder (DID)
Inspite of long and auspicious research in the history of psychiatry,dissociative identity disorder (DID) remains a controversial anddebatable personality condition. The mystery surrounding the disorderrevolves around its validity, occurrence, diagnosis, and treatment.However, a wide range of research findings concludes that DID is avalid psychiatric condition that can accurately be isolated fromother disorders, especially in situations in which structureddiagnostic interviews examine identity changes and amnesia. Further,DID is aetiologically linked to a combination of complexdevelopmental and cultural issues, an example being traumatic eventsexperienced during one’s childhood. Again, it is imperative to notethat DID’s prevalence in the general population is estimated tostand at about 1%(Dorahy et al., 2014).It is on this basis that this research paper seeks to discuss the. The primary objective of theinvestigation is to provide a clear understanding of the condition bydefining what it is, the causes, symptoms, diagnosis, a case study ofDID and its impacts, treatment, and the myths surrounding it,especially the controversial medical debate on its validity.
Accordingto American Psychiatric Association’s Diagnostic Statistical ManualDSM-5, Dissociative Identity Disorder is a condition characterized byinstances in which one has two or more distinct personality states.The DSM-5 manual specifies that dissociative symptoms likediscontinuity in self or consciousness can be observed by others orthrough self-reporting by an individual. In a research carried out byBarlow and Chu (2014), the analysis states that neurological andcognitive studies demonstrate that alternative identities in DIDpatients present qualities of separate people. However, they alsostate that they may not be different or separate from each other. DIDis a disorder that is characterized by identity fragmentation asopposed to a proliferation of different characters. Some researchstudies, for instance, demonstrate that different patterns of neuralsystem activation and cerebral blood may flow in an individual whilealternating characteristics. The fragmentation of thoughts andinformation occurs when the information is either relevant to theperson or in their attempt to transfer the information between theirdifferent types. The process is necessary for people affected by thecondition due to the claim that it services their alternating roles.Imperatively, some research studies have attempted to examine how andwhy individuals with DID switch among their alternate identities(Barlow & Chu, 2014).In most of these studies, alternate identities occur after particularones and that the tendency for some characters to be followed byothers cannot be ignored.
Thefundamental conflict between or among the alternate identities inpatients with DID can be described theoretically. The basis of thehypothetical evaluation is the development of a dissociative disorderknown as “structural dissociation” as developed by Onno van derHart, Ellen Nijenhuis, and Kathy Steele. According to the authors,there are two main types of alternate identities among the DIDpatients: The categories include the Apparently Normal Personalities(ANPs) and Emotional Personalities (EPs). The ANPs avoid trauma andare phobic of forming relationships and experiencing emotions.Conversely, the EPs stick to the past experiences or “distresstime” based on the abuses that they have experienced as children.The attribute rests on the notion that they have inflicted apermanent loop in their brains(Van der Hart et al., 2013).The ‘dissociation” experienced by DID patients is described as aparallel owning and disowning situation whereby one part of theindividual possesses the experience while the other part does theopposite. People with dissociative identity disorders, therefore, donot feel integrated poignantly on the fact that they have thoughts,feelings, memories, and behavior which they acknowledge as foreignand uncharacteristic. In most cases, the patients claim that they donot possess the features. It follows that DID is often characterizedby a simultaneous owning and disowning of a traumatic experience,constant denial struggles with the result being confusion concerningone’s identity(Boon et al., 2011).
Itsuffices to note that most studies have focused on the fragmentationof the thoughts, feelings, behavior and experiences as opposed totheir integration in both diagnosing and treating of the DIDcondition. Complete integration denotes to the fusion of allidentities into one personality but remains a controversial attributeof DID. This is because what creates the disorder is more about thedisintegration of personality, feelings, thoughts, memories, andexperiences(Wolf et al., 2012).When the integration occurs, the experience is usually lengthy andsubtle. Some studies have, however, indicated that with effectivetreatment interventions, a complete and stable operation is possible.Amalgamation offers several benefits, mainly reduced dissociativesymptoms and other associated signs related to the disorder. However,research studies on measuring tools for integration and fragmentationin people with DID do not exist since many believe that DID developswith the aim of having different parts of the memory that areseparate from next.
Validity,Prevalence, and Comorbidity of Dissociative Identity Disorder
Accordingto Elisabeth Cronin and colleagues (2014), Dissociative Disorders(DD) possess an underlying neurobiological formation that consists ofexcessive limbic inhibition and changes that involve different bodysystems, among them the endogenous opioid system. Imperatively,Dissociative Identity Disorder is considered one of the most severedissociative disorders. The seriousness is characterized by differentpersonality states that demonstrate dissociation or discontinuity inone’s persona based on the alterations in conduct, memories,cognitions, and feelings among other things. Despite thisdescription, many still question the validity of DID as they advancethe notion that it is a rare condition. This type of prognosis opensup and creates a validation of myths that hinder the understanding,diagnosis, and treatment of the condition. DID is a valid ailmentbased on a range of markers and can accurately be distinguished fromother Dissociative Disorders. Examples of this include BorderlinePersonality Disorder and Post Traumatic Stress Disorder which canassess identity changes and amnesia through structured diagnosticinterviews.
Intheir empirical overview of dissociative identity disorder, Dorahy,Brand, Vedar, Kruger, Stavropoulos, Martínez-Taboas,Lewis and Middleton (2014), opine that the validity andphenomenology of DID can be established using various approaches(Dorahyet al., 2014).These include content validity that must provide consistent anddetailed clinical presentation, independent studies and criterionvalidity that offers results that concur with the clinicalpresentation based on data from psychological, neurobiological, andlaboratory findings. Thirdly, construct validity states that thedisorder can be isolated from other maladies and simulations(Dorahy et al., 2014).Imperatively, most of the available information, data, and findingssupport the validity of DID.
Theprevalence of DID in clinical populations stands at about 5% ofinpatients while in the general population, it is estimated thatclose to 1% suffer from Dissociative Identity Disorder. Studies alsoindicate that females are more likely to get a DID diagnosis asopposed to males whose ratio stands at 9:1(Brand et al., 2014).Results also show that there is a disproportionately high number offemales with the condition which disrupts the notion that incestabuse is responsible for the development of most DID cases.
Co-morbidityis common among individuals with DID as most of them are diagnosedwith both Post Traumatic Stress Disorder and Borderline PersonalityDisorder. Additionally, most of those diagnosed with DID have had aprior schizophrenia diagnosis, though some contend that suchco-morbidity findings may present a misdiagnosis since both theconditions involve Schneiderian symptoms. However, other possiblecauses of co-morbid include substance abuse, eating disorders, andpersonality disorders among others(Brand et al., 2014).Most symptoms of DID are complex, and the presence of multipleadditional symptoms complicates both the diagnosis and treatment ofthe condition.
Accordingto Dorahyet al. (2014),universal and cultural processes impact the development andphenomenology of DID. Dissociation and Dissociative Disorders can betraced in all cultural backgrounds. Dissociative identity disorderhas been documented in different cultural settings in addition toboth developed and developing countries(Dorahy et al., 2014).Many studies have demonstrated that DID is intrinsically associatedwith self and natural experiences. Imperatively, the culturalconstruction of self implies that DID should be considered a responseto excessive traumatic experiences shaped by cultural behaviors andnorms of the context in which they occur. DID is a developmentaldisorder that is caused by early childhood exposure to trauma and insome cultures, sexual abuse(Myrick et al., 2013).The decision to disassociate from one’s real self is, therefore, animportant coping mechanism that protects individuals from bothfearful situations and emotions. The separate identity created inthis circumstance is a brain’s biological response to the extremeand extended experiences handed by traumatic stimuli. Most of the DIDcases are associated with early childhood abuse that one mayexperience before the age of nine years (Cronin et al., 2014).Therefore, individuals find solace in dissociating from theirdominant personality by having sub-personalities tasked withconfronting difficult emotions or experiences while emerging fromthem unscathed.
Froma behavioral perspective, DID is a result of a cyclical method ofdissociation from daily memory processes that are learned over time.In fact, with time, a person learns an “escapist behavior” thatallows them to dissociate more often, and to develop a higher levelof intimacy from their healthy or dominant personality. Imperatively,it is essential to note that DID is different from post-traumaticstress disorder (PTSD) since it resembles, and is in some cases,misdiagnosed as PTSD(Dorahy et al., 2014).DID is a fragmentation of negative emotions that are apportioned todifferent personalities, and is in most instances an involuntary actof mental escape aimed at alleviating bad experiences. PTSD is,however, a more direct and voluntary kind of emotional repression.
Cardena(1994) developed three broad classes of dissociation which can resultto DID. The first class involves separation or detachment as anon-integrated psychological system or module. The second kindinvolves an alteration in awareness which entails a disconnectionfrom the world or self. The third category is detachment that acts asa defense mechanism. According to Cardena (1994), the first categoryis demonstrated by dysfunction in one’s actions, memory, andperception. The leading type of dissociation is irrevocable even ifthe patient has a will to change the situation. The second categorymanifests during preserved occasions. It involves derealization anddepersonalization. The advantage of the second type is that it isreversible. The third grouping refers more to the role ofclassifications one and two (Cardena 1994).
Asper the diagnostic criteria outlined by the DSM-5, it is clear thatthe diagnosis of DID requires the existence of particular symptoms.Also, another manifestation is the presence of at least twopersonalities in between the said symptoms. A persona is identifiedas a separate and unique pattern of perception, thought, and stylethat consists of both self and surrounding(Lanius, 2015).The personalities need to display a model in which there is theexertion of control on one’s behavior.
Anadditional symptom of DID is extensive and significant memory loss.The patient experiences difficulty in remembering both crucial andminor information. These features or symptoms must cause clinicallysignificant distress or impairment to the individual based on theirsocial and occupational functioning. Certain identities may arise inparticular situations, and psychosocial stress usually stimulatestransitions from one character to the next. In the possession-forminstances of DID, other characteristics can be visible to thosearound the person while in non-possession-form, a majority ofindividuals do not display the alternate identities for longdurations.
Thosesuffering from the condition may describe feelings of beingdepersonalized. This is usually apparent with keen observation ismade of their body functions and actions, for example, speech(Dorahy et al., 2014).They may report hearing things or voices with the latter accompanyingmultiple streams of thought that the person cannot control. Thepatient may also experience sudden impulses and strong emotions theycan neither control nor own. In other instances, some may reportstrange feelings in their bodies, for example, some patients whoclaim that they possess huge muscles, yet in reality, they do nothave such physical attributes. It suffices to note that over seventypercent of people with DID have attempted suicide with self-inflictedinjuries being a common phenomenon among this population(Wolf et al., 2012).Treatment is critical because it improves the quality of their liveswhile at the same time reduces the number of suicidal thoughts.
CaseStudy and Impacts Of DID
TheMark Peterson Case
MarkPeterson went out to a coffee shop with a twenty-six -year-old ladyon June 11th,1990. The two come across each other at a park in Oshkosh, Wisconsin.After getting out of the restaurant, Peterson proposed that theyshould be more intimate by having a sexual encounter in his car. Thelady consented. Days later, Peterson was detained for sexualviolation. Apparently, the woman had a mental illness that revealeddifferent personalities. One temperament was that of a six-year-oldwho looked on as the event took place, while the other was a twenty-six- year- old who agreed to the sexual experience. During the trial,the lady presented six different dispositions when giving hertestimony. For instance, at one point she stated that she was notaware of what sex was all about when Peterson requested to ‘’lover’’ her. When questioned the second time, she stated thatshe accepted to have sex with Peterson. During a different trialpreceding, she indicated that Emily (another six -year-oldpersonality) witnessed as Peterson and Jennifer made love, meaningthat she was a minor who watched the event (TheNational Registry, 2017).
AlthoughPeterson was convicted of the crime due to consciously assaulting thevictim despite her psychological disorder, he was later releasedbecause the prosecutors did not want to subject the patient to toomany trials. Based on the Case, it is apparent that DID can affectan individual’s personality to the extent of exposing them to riskyepisodes such as sexual defilement (TheNational Registry, 2017). It is, therefore, imperative to identify such persons and to providethem with the right psychological treatments.
Theoutcome of treatment concerning DID has been researchedsystematically for close to three decades using case studies, caseseries, naturalistic surveys with long-term follow-ups andcost-effective studies. Most of these studies indicate that therapyusing aphasic trauma treatment model consistent with accepted expertguideline can be effective in treating the disorder. Treatment of DIDresults in reduced diagnoses of co-morbidity, suicidal thoughts, andsubstance abuse. Imperatively, a psychotherapeutic approach isusually used with the ultimate goal of integrating the functioning ofthe alternate personalities(Lanius, 2015).However, in most cases, close to 70% of this involve the presence ofmultiple co-morbid conditions, trauma experiences, and safetyconcerns thereby implying that a comprehensive treatment plan is anecessity.
TheInternational Society for Study of Dissociation (ISSD) has put inplace guidelines that can help clinicians to treat DID. Theguidelines seek treatment to follow a particular framework thatfocuses on safety, stabilization, and reduction of symptoms(Dorahy et al., 2014).Secondly, the clinicians must work directly and comprehensively withtraumatic memories, and in the third instance, identify and promoteintegration and rehabilitation. The use of medication in treating thecondition has never yielded any important outcome that can bedocumented. Some studies, for instance, have found thatantidepressants may offer solutions, but at the same time acknowledgethat more needs to be examined to ascertain how useful these optionscan be in the integration of the alternate personalities.Psychotherapy remains the most successful way of treating DIDpatients in a more long-term perspective. However, other treatmentoptions may include creative and cognitive therapies(Wolf et al., 2012).Much of the conventional medicines like tranquilizers may berecommended to help control the mental symptoms.
Itfollows that Dissociative Identity Disorder is a mental healthproblem that exists and affects close to one percent of the generalpopulation. Further, increased research on DID has helped cliniciansto understand its causes, appropriate diagnosis, and treatment.Cultural settings have a significant influence on the occurrence ofthe condition with DID omnipresent in all communities around theworld. Studies seek to find better ways of diagnosing and treatingthe syndrome, with the emphasis being placed on integrating thealternate personalities that individuals with the said conditiondemonstrate. However, more research and public awareness are neededto dispel the myths surrounding the existence of the disorder and itsvalidity.
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