Dissociative Identity Disorder

Dissociative Identity Disorder (DID) previously known as Multiple Personality Disorder, falls into a questionable diagnosis amongst clinicians. The concept and validity of the anomaly of a person possessing multiple personalities, has caused much debate and disagreement between U.S. mental health care professionals and their European counterparts. This paper does not question the validity of DID, but instead, reveals truthful facts by discussing the history, etiology, major symptoms, criteria for diagnosis, treatment, and myths about this disorder.

History

Evidence of patients possessing multiple personalities was seen as early as 1791. During that time, Eberhardt Gmelin, credited for being the first to report a case, treated a German woman with dual personalities (Disorders). Gmelin's assessment stated "[She] suddenly "exchanged" her own personality for the manners and ways of a French-born lady, imitating her and speaking French perfectly and speaking German as would a Frenchwoman. These "French" states repeated themselves. In her French personality, the subject had complete memory for all that she had said and done during her previous French states. As a German, she knew nothing of her French personality" (Disorders).

In 1816 an article was published in the "Medical Repository" by Dr. Samuel Latham Mitchell regarding the case of Mary Reynolds that was more influential than Gmelin's. The Mary Reynolds case was the first case to grab the public's attention with articles appearing in "Harper's New Monthly Magazine" in 1860. The articles described her symptoms when alternating between two different personalities that she had no memory of when the alter personality was in control (History).

More cases of multiple personalities were reported in the late 1900s and early 20th century by French psychiatrist Pierre Janet and William James, a philosophy and psychology student (Dissociative). In 1906, Morton Prince published an article titled "The Dissociation of a Personality" based on the Christine Beauchamp case. Ms. Beauchamp had three distinct personalities: one childlike, one extremely regressive, and one presented as normal. Morton introduced the term co-consciousness to clarify what takes place as a patient becomes aware of the dissociative process and how the process controls their life (Dissociative). Dissociation was later described by O'Regan as "an unconscious defense mechanism in which a group of mental activities split off from the main stream of consciousness and function as a separate unit" (Dissociative).

The dedicated work of pioneers in the field of multiple personality disorder appeared in the publication of the DSM-III by the American Psychiatric Association in 1980. A separate category was created for the dissociative disorders and the criteria for diagnosing Multiple Personality Disorder giving validity to the condition. In 1994, the condition was renamed Dissociative Identity Disorder with the Publication of the DSM-IV. During the same time "Guidelines for Treating Dissociative Identity Disorder in Adults" was published by the International Society for the Study of Dissociation (History). The commitment and hard work put forth in creating the diagnostic features and criteria for this disorder allows clinicians to make sound diagnosis based on specific symptoms and conditions.

Etiology

DID is considered a developmental disorder caused by severe trauma, grief and loss, situational stressors, internal conflict, or attachment issues resulting from neglect or extremely inconsistent parenting styles (Haddock). If a child experiences an overwhelming trauma and is unable to process it, the child may dissociate to survive. DID results when the dissociation becomes severe enough to allow the child to compartmentalize parts of herself/himself from consciousness and experience them as separate from the core self (Haddock). In essence, the child will dissociate or split off from the parts that hold those experiences in order to survive otherwise unendurable trauma (Spring). While the human brain is built to process trauma, it is not meant to have to deal with severe trauma on an ongoing basis. Although DID appears to be a dysfunction, on the contrary, DID is a creative coping mechanism. However, when the environment is no longer traumatic and yet the person and all the dissociated personalities of that person still act and live as if it is, DID becomes dysfunctional (Spring). When the brain continues to be overwhelmed with traumatic stimuli, the aftermath is an array of symptoms.

"DID always develops during childhood but may only become manifest in adulthood as a result of dissociative defenses giving way following a build-up of life stresses or 'triggers'. According to a recent study, 86% of the sample of DID patients reported a history of sexual abuse. Many clinicians position DID in a post-traumatic framework and there are arguments for it to be reclassified in the upcoming DSM-V" (Brand et al).

Major Symptoms

The major symptoms experienced by DID patients are amnesia, depersonalization, derealisation, and identity disturbances (Signs). DID patients frequently describe a number of symptoms that are similar to other mental disorders as well as various physical disorders. Some symptoms suggest that another disorder is present, but some symptoms may indicate the intrusions of past experiences into the present. For example, sorrow or unhappiness may be a sign of coexisting depression, or that one of the personalities is reliving emotions connected to past abuse or trauma (Signs).

DID patients have recurrent gaps in memory for both remote and recent personal history. Their passive personality(s) tend to have more constricted memories, while the more hostile, controlling, or protector personality(s) have more complete memories (DSM). An identity that is not in control may however obtain access to consciousness by producing auditory or visual hallucinations (DSM). Although the personalities may be aware of one another, only one personality is in control at a time. Most of the personalities are aware of the loss of time that takes place when another personality is in control (Morrison). Other indicators of the disorder are: panic attacks, depression, eating disorders, chemical dependency, body memories, handwriting differences, and severe headaches that are often associated with the switching behavior (Haddock).

Switching between personalities and the lack of awareness of behavior in the other personalities makes life chaotic for patients with this disorder. Since the personalities often interact with each other, patients report hearing inner conversations

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