This study will focus on Dissociative Identity Disorder (DID), its causes and symptoms, controversies in its diagnosis, challenges faced by clinicians as well as patients in handling the disorder, and treatment of DID. Dissociative Identity Disorder was once referred to as Multiple Personality Disorder due to existence of numerous distinct personality states. Dissociative disorders are quite rare among the general population, and usually develop from childhood when children are exposed to severe physical or even sexual abuse. Individuals with DID usually experience trauma and forgetfulness, as they attempt to understand different alternating personalities. Some of the symptoms of DID include substance abuse, eating disorders, PTSD, memory loss, and suicide attempts. The controversy behind DID is that clinicians still believe it is a rare disease despite many people reporting the ailment. Its symptoms resemble other mental disorders, thus, making it difficult for clinicians to diagnose it. Psychotherapy and hypnosis are some of the methods applied in treating DID, though some clinicians advise patients to use medicines in case of mood disorder or depression.
Dissociative Identity Disorder
Understanding the progress of multiple personalities is quite complex that even the highly qualified professionals are having the problem of explaining the ailment. Dissociative Identity Disorder (DID), which was earlier referred to as Multiple Personality Disorder (MPD), has been on the increase for the last two decades, despite numerous mental health professionals being skeptical about its existence. This has created a controversy in the diagnosis of the disorder. Dissociative identity disorder is believed to emanate from disturbance experienced by individuals suffering from mild dissociation during childhood. Many questions have been raised about DID, as some medical experts have challenged the legitimacy of its diagnosis while others have challenged its authenticity. The complexity in diagnosis of DID has become a challenge to therapists whose level of training cannot offer complete remedy to individuals with DID.
Defining Dissociative Identity Disorder
Dissociative Identity Disorder (DID) incorporates a rigorous form of dissociation where the person suffering from the disorder experiences a disconnection of thoughts, feelings, as well as sense of identity. According to American Psychiatric Association (APA), dissociative identity disorder is described in DSM-5 as an existence of two or more discrete personality states, where dissociative symptoms such as switching of characters, are observed from the person or reported by the patient (Barlow & Chu, 2014). The aspect of disconnection is perceived as a coping mechanism. Individuals suffering from DID usually educe two, or more distinct personalities, and each personality depicts a unique set of behaviors, thoughts, and emotions. Persons with DID cannot recall significant personal information, which is too broad to be described through ordinary forgetfulness.
Few researches have been carried out to explain how and why individuals suffering from DID switch from one personality to another. According to Sinason (2011), DID is not only unrecognized, but the nature of vicious abuse that is believed to cause it is also less recognized. Although the causes of DID are not well known, researchers have claimed that approximately 1% of the world’s population is affected by the disorder (Fox, Bell, Jacobson & Hundley, 2013). DID does not chose class or ethnic group, but its effect on women is almost ten times as compared to men (Swartz, 2001). DID is characterized by fragmentation of identity, rather than propagation of separate identities. Each alternative identity may be influenced by the preceding identity, making it hard to determine the standard measurement of diagnosis of DID.
Causes and Symptoms of Dissociative Identity Disorder
Mental health practitioners believe that DID is normally caused by repeated incidents of severe physical abuse that occur during childhood. Persistent and prolonged trauma that individuals encounter during childhood, and lack of support to counteract abuse from family members are termed as the main cause of DID. Individuals living with DID are usually depressed while some complain of visual hallucination. They often struggle to gain stability, given that their inner feelings are fragmented, resulting to depressive disorders. The major symptoms of DID include substance abuse, post-traumatic stress disorder, as well as seizure disorder. Other symptoms include:
- Inability to recognize events
- Derealization, or perceiving external environment as illusory
- Frequent memory loss and identity disturbances
- Sudden flashback of memories or traumatic incidents
- Attempts of suicide or self-inflicted injuries
- Alternating levels of functioning
Comorbidity rates are quite high for patients with DID, especially on eating disorders, as well as substance abuse. Nonetheless, alternative identities within a single client usually differ depending on eating disorders and substance misuse behaviors. Eating disorders and misuse of drugs are common secondary symptoms found in individuals experiencing severe, persistent abuse (Krakauer, 2001).
A Controversial Diagnosis
For many years, practitioners have conceptualized DID as a rare disorder. Effective diagnosis of DID is usually complicated due to some symptoms of DID that overshadow symptoms of other mental sufferings. When the person suffering from DID decides to seek medical help, he/she is not sure of what to tell the clinician. When a clinician is assessing DID patient, he/she usually rules out physical conditions that may generate amnesia or derealization. If DID patient appears healthy physically, the clinician should eliminate psychotic disturbances, which include schizophrenia, as many DID patients are usually declared schizophrenic due to the claim of hearing alters speaking inside their heads.
However, the major controversy surrounding the diagnosis of DID result from purported symptoms. The difficulties experienced in diagnosing DID result from inadequate information among clinicians concerning dissociation, clinician bias, and the effects of emotional trauma (“Guidelines for treating dissociative identity disorder,” 2011). Most clinicians still perceive DID as a rare disorder, which does not have a specific diagnosis. Most victims of DID exhibit a combination of dissociative and PTSD (posttraumatic stress disorder) symptoms, which are entrenched in supposedly nontrauma-related symptoms. This has led to clinicians overlooking the real symptoms of DID, which results to unsuccessful treatment of the disorder. They believe that it is almost impossible for an individual to memorize events that occurred before the third birthday, the time that DID victims are perceived to have encountered abuse.
Most clinicians utilize the standard diagnostic interviews that they learn in colleges to enquire about their patients’ conditions. However, the standard interview does not incorporate questions pertaining to dissociation nor history of psychological trauma. In most cases, DID victims do not volunteer to offer information on dissociation symptoms, making it hard for clinicians to get adequate information concerning such disorders. According to Fox et al (2013), approximation of the number of alters experienced by each individual, as well as the number of persons suffering from DID are questionable, considering the complexity of diagnosing the illness and isolating alter shift. Lack of proper training on DID symptoms make clinicians fail to recognize symptoms of DID that may occur spontaneously (“Guidelines for treating dissociative identity disorder,” 2011).
Challenges Faced by DID Patients and Therapists
Problems of DID start in childhood and usually haunt individuals up to their adulthood. Trauma is particularly widespread among persons with DID. Statistics has shown that 71% of DID patients have encountered childhood physical abuse while 74% have experienced sexual abuse (Fox, et al., 2013). Individuals who have survived the ordeal of DID encounter numerous challenges, which include media-induced misconceptions about DID and decreased functioning. They also face problems of intimate relationships, which interfere with their quality of life. Individuals with DID often fall into risk of committing suicide, substance abuse, victimizing other people, or becoming extremely violent.
Clinicians who attend to DID clients also experience challenges since dissociate disorders are normally symptomatic mystery. Individuals with DID experience numerous psychiatric syndromes, such as PTSD, depression, uneasiness, substance abuse, relationship problems, eating disorders, and suicide attempts. More confusion emerges because studies that explain effective treatment of DID are usually clinical case studies. Few studies have illustrated the lives people with DID, thus, making it quite difficult to refer on how to tackle identity disorders.
Treatment of Dissociative Identity Disorder
Treating DID has been proven difficult due to symptoms that resemble other mental disorders. Nevertheless, professional organizations, such as the International Society for the Study of Trauma and Dissociation (ASSTD), has for the last 20 years worked to guide therapists on effective methods of treating DID (Brand, Loewenstein & Spiegel, 2014). Hypnosis is among the best methods of treating dissociation disorders. Hypnosis assists DID patients to recuperate subdued ideas and memories. Besides, hypnosis can be utilized to manage problematic behaviors, such as eating disorders, exhibited by DID patients. A therapist has to contact numerous alters in an individual to understand how they function in that particular individual’s life. Hypnotized people appear to be relaxed and focused, thus, enhancing their capacity to respond to suggestions. The problem with hypnosis is that traumatized persons who are struggling to maintain their control, and who appear to be hyper-vigilant, may feel intimidated by relaxation approaches (Kluft, 2012). Hypnosis is vital in treating DID, but should be administer to individual patients.
Psychotherapy is another form of treating DID, where a therapist teaches patients on how to respond to life’s challenges. Psychotherapy enables patients to understand diverse identities, restructure their ways of thinking, and reclaim their sense of control. It also assists DID patients to pinpoint challenges that contribute to the feelings of helplessness, in addition to regaining pleasures of life. Effective psychotherapy facilitates individuals with DID to find words that can make them feel free to mingle with other people, as well as building a support system. Patients with DID can respond well to psychotherapy, which should be performed by therapists who have acquired specialized training on dissociation disorders. Specialized training is crucial since switching of personalities can be perplexing to therapists who are only trained on standardized techniques. Therapists who handle DID patients are expected to sign contracts that bind them to their clients to ensure their safety.
In the initial stage of psychotherapy, a therapist requires to focus on strengthening the host to allow the traumatic events to be shared among distinct identities (Ringose, 2012). This is because DID patients are likely to be experiencing intrusion coming from different identities that are stuck in the mind since the last time a trauma occurred. The next stage of therapy enables DID patients to have a clear understanding of multiple identities. This would enable patients to reduce self-harming behaviors and increase social activities. The last stage of therapy enables patients to break flexible boundaries of working consistently with alternate identities.
Essentially, no medicines exist to offer remedy to DID. Some clinicians advise DID patients to take tranquilizers, or antidepressants to suppress alternative personalities that develop mood disorders, anxiety, or depression. Other clinicians and therapists advocate for a restraint in using medicines, as such medicines can make DID patients become psychologically dependent on them. Apart from hypnosis, psychotherapy, and medicine, family therapy is essential; as patients require family support to enable them handle their daily routines without much difficulty. Hypnosis has been proved appropriate in the treatment DID due to its urgency in creating relaxation to DID patients.
The intricacy in diagnosis of DID has created a challenge to therapists attempt to treat the disorder, but their training standards cannot offer complete remedy to DID patients. DID involves having several identities, or personality states, which intermittently control individual’s actions, in addition to being unable to recall essential personal information. The causes of DID emanate from childhood trauma resulting from physical abuse. Many therapist are skeptical about DID, as some do not believe DID is real. A controversy has emerged in the diagnosis of DID, as individuals with DID have been misdiagnosed for many years amidst claim by clinicians that it is a rare disease (Steinberg, 2008). Numerous methods exist to treat DID, which include hypnosis, psychotherapy, and medicines. According to Kluft (2012), hypnosis is closely associated to complex chronic dissociative disorders, thus, appropriate in treating DID successfully.
Barlow, M. R., & Chu, J. A. (2014). Measuring fragmentation in dissociative identity disorder: the integration measure and relationship to switching and time in therapy. European Journal of Psychotraumatology, 51-8. doi:10.3402/ejpt.v5.22250
Brand, B. L., Loewenstein, R. J., & Spiegel, D. (2014). Dispelling Myths About Dissociative Identity Disorder Treatment: An Empirically Based Approach. Psychiatry: Interpersonal & Biological Processes, 77(2), 169-189. doi:10.1521/psyc.2014.77.2.169
Fox, J., Bell, H., Jacobson, L., & Hundley, G. (2013). Recovering Identity: A Qualitative Investigation of a Survivor of Dissociative Identity Disorder. Journal Of Mental Health Counseling, 35(4), 324-341.
International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults. Journal of Trauma & Dissociation, 12(2), 115-187.
Kluft, R. P. (2012). Hypnosis in the treatment of Dissociative Identity Disorder and Allied States: an overview and case study. South African Journal Of Psychology, 42(2), 146-155.
Krakauer, S. Y. (2001). Treating dissociative identity disorder: The power of the collective heart. New York, NY: Routledge.
Ringrose, J. L. (2012). Understanding and treating dissociative identity disorder (or multiple personality disorder). London: Karnac Books.
Sinason, V. (2011). Attachment, Trauma and Multiplicity: Working with Dissociative Identity Disorder and multiplicity. New York, NY: Routledge.
Steinberg, M. (2008). Understanding the Dissociative Disorders. Strange in the Mirror. Retrieved on 13 Jan. 2015 from http://www.strangerinthemirror.com/dissociative.html
Swartz, A. (2001, Decemer 10). Dissociative Identity Disorder. AllPsych, Psych Central’s Virtual Psychology Classroom. Retrieved on 13 Jan. 2015 from http://allpsych.com/journal/did/