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Dissociative Identity Disorder

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Image is courtesy of Hall Scientific.

What is Dissociative Identity Disorder (DID)?

As explained by WebMD, DID, previously known as multiple personality disorder, is believed to be a complicated psychological condition, most likely caused by factors such as severe and repetitive trauma during childhood, whether it be physical, sexual or emotional. It is an extreme form of dissociation from one’s reality. Dissociation is a mental process that disconnects a person from their thoughts, memories, actions, feelings, and sense of identity, and it is believed to be a coping mechanism. It may occur when a child is persistently neglected or emotionally abused, even when there is no physical or sexual abuse. Studies have indicated that DID affects around 1% of the population.

How to recognize DID?

According to WebMD, DID is characterized by the presence of two or more split identities that continually take over the person’s behaviour. The patient is often unable to recall key personal information that cannot be explained by forgetfulness. While everyone might experience DID differently, some of the alters or other identities have a different age, sex, or race to the biological body of the person, with different postures, gestures, and ways of talking. “Switching” is when each identity is revealed and takes control over the individual’s behaviour and thoughts. It can take seconds to days to occur. Sometimes switching may require a therapist’s request.

There are other symptoms that can be found in a person with DID, such as headaches, amnesia, time loss, trances, and out-of-body experiences. Some of them might have a tendency to self-sabotage, self-persecute, and to be violent. Some believe themselves to be a passenger in their body instead of the driver, meaning they believe that they do not have a choice in their actions.

Main Psychological Processes of DID

WebMD further identifies a few main psychological processes of DID:

Depersonalization: A sense of being detached from one’s body. Often described as an out-of-body experience.

Derealization: A feeling that the world is not real (looking foggy or obscure).

Amnesia: A failure to recall notable personal information and cannot be blamed on forgetfulness.

Identity confusion or identity alteration: A sense of confusion about who a person is. For instance, when a person finds it difficult to define what interests them in life, or their political and religious beliefs, or their sexual orientation, etc.

It is now recognized that the dissociated states are not mature personalities, and they are only a fragmented sense of identity. There is usually a “host” personality, who identifies with the individual’s real name. This host personality is usually not aware of the presence of other identities.

False-Positive and Imitated Dissociative Identity Disorder

The ICD-10 is the International Classification of Diseases and it is a globally used diagnostic tool. The DSM-5 is the Diagnostic and Statistical Manual of Mental Disorders and it is the product of more than 10 years of work by international experts in mental health. It defines and classifies mental disorders in an effort to improve diagnoses, treatment, and research.

Both of these do not provide clear instructions and guidelines on the diagnosis of DID, making it difficult to differentiate genuine DID from imitated or false-positive cases. In a study published in May of 2021, researchers got 85 people who reported elevated dissociative symptoms recognized by the Somatoform Dissociation Questionnaire SDQ - 20, clinical assessments using the Trauma and Dissociation Symptoms Interview, and a psychiatric interview.

Six women who had an earlier DID diagnosis were disconfirmed and five main themes were observed after an interpretive phenomenological analysis.

  1. Acceptance and identification with the diagnosis.

  2. Justification of identity confusion and competing ego-states the notion of dissociative parts.

  3. Affected clinical presentation after gaining knowledge about DID.

  4. Their split personality becomes a relevant topic of conversation with others.

  5. Ruling out the DID diagnosis leads to anger or disappointment.

Patient Story: Sandra*

This patient story is courtesy of American Psychiatric Association.

A 25 year-old soldier was hospitalized due to sudden changes in behaviour and episodes of memory loss. She was confused about her history and believed that she was located in a different hospital 800 miles from where she had been admitted. Initially, the diagnoses considered included schizophrenia, bipolar disorder, antisocial personality disorder, and substance abuse; thus, she was started on neuroleptics which did not help much.

Later on, she was believed to have dissociative fugue or amnesia, and she was found to be highly hypnotizable. She was asked to think of the time when she was admitted to the other hospital and she remembered earlier experiences. She had many gaps in her memory and significant, sudden changes in her expression of emotions and behaviour.

Sandra began psychotherapy, which aided her in seeing these parts of her identity as immature portions of herself, rather than different personalities. She learned how to appreciate her host identity, Sandra’s, competitiveness and her other part, “Mary’s”, assertiveness in moderation. She said, “I came to understand Mary as me, Sandra as me. Before that I didn’t want to – then I’d have to be responsible...”

As she started to understand herself and her diagnosis, she worked through memories of her troubled childhood. When she was six years old, her parents got divorced. Her mother got involved with a man who abused drugs and would sexually abuse Sandra when she was 11. In her psychotherapy sessions, Sandra learned how to restructure her memory of the abuse and to disrupt it. She began taking antidepressants and she responded well to the mixture of antidepressants and psychotherapy, which helped her to decrease her dissociations. She was capable of forming stable and healthy relationships and was diagnosed with dissociative identity disorder.

*The identity of the patient has been changed for privacy reasons.

Article Author: Celine Guirguis

Article Editors: Victoria Huang, Sherilyn Wen