This article is part of a series of awareness articles published in dA news by the club *ItDoesNotHaveMe in conjunction with the cathARTsis contest.

The winner of the first ever cathARTsis contest (all entries can be found here) was *freys for her entry about Multiple Personality Disorder



The first point of interest is the name of the disorder. Many people still know it as Multiple Personality Disorder (MPD), but it was renamed Dissociative Identity Disorder (DID) in 1994. The DSM-IV defines DID as "two or more distinct identities or personality states" alternating control over an individual's behavior and consciousness. It is not split personality, as each identity is complete. It is not schizophrenia, though common caricatures of schizophrenia refer to changing identities. This is inaccurate, as DID is a distinct disorder from schizophrenia.

In DID, each identity has its own distinct pattern in interacting with its environment and the world. This is why it was referred to as multiple personalities, the term personality implying a completeness (another reason why "split personality" is inaccurate). Diagnosis requires at least two personalities be present, with periods of shifting control accompanied by a loss of memory of events that went on, as if completely separate individuals are inhabiting the same body, taking turns running the complex machine of the human body. Diagnosis also requires that substance abuse or other medical conditions not be leading to the shifting personalities.

Alternate personalities occur spontaneously and involuntarily. That is to say, a person cannot switch personalities on purpose or with the intent to deceive, it simple happens. There does not appear to be a limit to how many personalities can develop, and there are psychiatric records of cases where thousands of identities inhabited one person. Alternate personalities average at about 2-10 per case of DID. The earliest case was not recorded until the 1790s, leading some researchers to see it as a western and contemporary phenomenon. However, it is also possible that DID was simple misdiagnosed until this point, or that it is being overdiagnosed now. It was usually considered a medical oddity until the 1970s when it became prevalent in the United States. So much was it reported in North America that by many other continents it was considered a phenomenon confined to the continent, seeing it as inextricably bound to the culture. Whatever the case, much controversy surrounds DID because of it's obscure roots.

Childhood trauma is thought to be a factor in the development of DID, so some researchers see it as an outcropping of Post Traumatic Stress Disorder (PTSD), as both illnesses have dissociation as a main component. It occurs almost 9 times as often in females as in males, which is attributed to levels of abuse of female children being higher. Still others think the discrepancy could be due to males with DID being in prison for having committed violent crimes, therefore going undiagnosed and unreported.



The alternate identities are the most distinct feature of DID, and each "alter" has its own name, history, personality traits, and even their own ages, genders, and nationalities. The causes are speculated to stem from a range of origins. An innate propensity for dissociating traumatic memories from one's consciousness may predispose a person to develop DID if other factors come into play. The combination of this tendency and repeated abuse renders an individual vulnerable to developing DID, especially in the absence of a support system to counter the effects of abuse.

There are four major symptoms DID patients experience that are disassociative: amnesia, depersonalization, derealization, and identity disturbances. Amnesia occurs when a person loses time while their personality is "out" and an alter takes its place. It can also span before the appearance of alternates, where a person cannot remember his or her entire childhood. DID patients often report finding unknown objects in their houses or notes written in an unrecognized handwriting (that of their alternates). Depersonalization is the feeling that one's body is unreal, such as feeling outside of one's body as if watching a movie of the events unfolding. Derealization is related to depersonalization; it is feeling that the world or surrounding environment is unreal, such as seeing walls or buildings that change shape, size, color, location, etc. This also extends to people in the environment, and DID patients may not recognize close friends and relatives at times (which also ties in with amnesia). Identity disturbances describe the switching of one personality to an alter. If a repressed memory is triggered and reemerges, or a time of great stress comes on, in a split second the person's consciousness can switch to an alternate. The emergences of alternate personalities can sometimes be seen in a patient's history as erratic and irregular performance in school or at work that may have been triggered by examinations, performance reviews and presentations, etc.


Treatment of DID is complex and often takes place over the course of 5-7 years or more of multiple methods and approaches. It is important that therapy is undertaken with a psychiatrist who specializes in dissociation because not only can a personality switch be confusing or startling to an untrained psychotherapist, but many times an alternate could be suicidal or violent and this must be dealt with and addressed during therapy. Therapy takes on a number of stages, first with an initial phase to uncover all of the patient's alters, then a phase to address traumatic memories and end dissociation as a coping mechanism, ideally fusing the alters. Lastly, a phase of consolidating the integrated personality can begin. After integration, patients should still be treated in order to maintain recovery and maximize mental health. Many times a patient may need to relearn certain social skills during this phase, which can be stressful both for the patient and his or her family and is another reason why continued therapy is ideal. Group treatment can also be very beneficial when restricted to patients with DID.
Many doctors avoid or minimize medication in the treatment of DID because it is easier for these patients to develop psychological addiction, in part because it is so common that an alternate personality has a substance abuse problem. Hypnosis is sometimes used to minimize destructive behavior of alternates as well as in the "fusing" process. Alternative therapies can also be helpful, particularly anything that helps to relax the body such as hydrotherapy, massage, and yoga.

Art therapy and journaling are usually recommended, especially during integration, to help cope with and track experiences. For children, the prognosis can be excellent and it can be good for adults, but it often takes many years of hard work both on the part of the patient, the team of doctors, and the family and support system of the patient. It does not resolve on its own and symptoms can change over time, most common of which is the development of new personalities.


While DID can be debilitating, misunderstood, and unpredictable, there is hope for patients who commit to long-term care to regain a fulfilling life. The biggest obstacle in the research and development of treatments has been researchers who discount the existence of DID as a disease, sometimes seeing it as psychosomatic, faked, or induced through hypnosis by therapists. In this disease and others, it becomes widely apparently that denial of the very existence of a problem should be the first thing tackled by the medical community, as without proper attention both to the patient and all potential illnesses, it is impossible to find effective solutions to restore function to the lives of those of us affected directly and indirectly (friends and family of patients) by disease.



Further reading:
NAMI.org
psychnet
Sidran Institute