An Overview of Dissociative Identity Disorder, Its Types, Diagnosis, and Treatment

Dissociative identity disorder is a condition in which the affected individual has a minimum of two distinct personalities. It refers to a severe form of dissociation which is a mental process that produces a lack of connection in a person’s thoughts, feelings, memory, actions, or sense of identity. This also includes the inability to recall everyday events, and important personal information that would not typically be lost with ordinary forgetfulness. This condition was also previously known as multiple personality disorder or split personality. Although it is very common for a person to have moments of dissociation between thoughts and actions, it is more severe for a person living with dissociative identity disorder.

This disorder, like many others, is thought to stem from multiple factors that may include trauma experienced as early as childhood. The dissociative aspect is thought to be a coping mechanism. When a person experiences something that is violent, traumatic, or painful, they will completely shut down or dissociate from the situation or event. The causes of dissociative identity disorder are not yet determined but research indicates that is it likely a psychological response to interpersonal and environmental stress. This is most likely to occur during early childhood when emotional abuse or neglect can interfere with personality development. “As many as 99% of individuals who develop dissociative disorders have recognized personal histories of recurring, overpowering, and often life-threatening disturbances at a sensitive developmental stage of childhood.”

Types of Dissociative Identity Disorder

Dissociative identity disorder can be classified into two forms, possession, and non-possession. In the possession form, the identities are usually displayed as a supernatural being, or another person who has taken control of the person, causing them to speak and act in an unfamiliar way. In this case, the different identities are very overt. On the other side, the non-possession form tends to be much less overt. A person may feel as though they have a sudden alteration in their identity. They may feel as though they are observers of their own speech, emotions, and actions.

Signs and Symptoms

The signs and symptoms of dissociative identity disorder vary from each of the two forms. In the possession form, the different identities are very apparent. The patient will speak and act in a manner as though someone or something has taken over their body. In the non-possession form, the different identities are not as observable. Instead, the person feels like they are watching themselves inside of a movie and that they cannot control what is going on. They feel very removed from self, and detached from their mental and physical state. They may feel as though their body is that of a small child or the opposite sex that does not belong to them. Some things such as a sudden change in a person’s attitude, opinion, or general preferences may be observable but most of the non-possession form of dissociate identity disorder is not noticeable.

Another symptom that people with dissociative identity disorder typically have is known as amnesia. This creates gaps in past personal events, lapses in dependable memory, and the discovery of evidence of things that they have said or done that they don’t remember doing and that seem unlike themselves. This may lead a person to have something in their possession that they cannot account for having, or end up in different place from where they last remember being and have no recollection of how they got there. Amnesia may be noticed by others when a person cannot remember things they have said or done, as well as things such as what their name is. There are also mental health issues that are comorbid with dissociative identity disorder. These are:

• Depression
• Mood Swings
• Anxiety
• Sleep disorders
• Eating disorders
• Suicidal thoughts and/ or self-harm.

Diagnosis

Diagnosis of dissociate identity disorder usually involves different types of assessments and then looking to rule out medical conditions that could cause the symptoms. A diagnosis is made by a mental health professional after a referral is made. The three types of evaluations are physical exams, psychiatric exams, and diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders 5 (DSM-5). Physical exams may be completed by a family physician. In depth questions are asked and a person’s history is reviewed. A mental health professional would complete a psychiatric exam by asking questions about thoughts, emotions, feelings and behavior and then discussing the results. The mental health professional may then compare a person’s symptoms to the criteria for the DSM-5. The DSM-5 provides the following criteria to diagnose dissociative identity disorder:

1. Two or more distinct identity or personality states are present.
2. Amnesia must occur.
3. The person must be distressed by the disorder or have trouble functioning in one or more major life areas because of the disorder.
4. The disturbance is not part of normal culture or religious practices.
5. The symptoms cannot be due to the direct psychological effects of a substance or a general medical condition.

Although having dissociative identity disorder can be detrimental to a person’s life, with time and proper treatment, it can become manageable. On the other hand, if left untreated, it can last a lifetime. Persons with this disorder should be treated by a mental health professional that has training and experience with dissociation. There are three types of treatment for dissociative identity disorder. They are:

Psychotherapy - treatment primarily consists of psychotherapy and can last for an average of five to seven years in adults. Individual therapy is the most common form as opposed to family, group, or couples’ therapy. The main goal is to integrate the separate personalities states into one personality unless the person is not ready. Psychotherapy treatment may include the following steps:

• Uncovering and mapping out the different personalities.
• Treating the traumatic memories.
• Fusing the personalities together.
• Taking a look at the new personality.

Family therapy - this is recommended to help educate the family on dissociative identity disorder and also to understand the changes that may take place as the person goes through psychotherapy.

Medications - there is no medication to treat the disorder however, there are antidepressants and anxiolytics that may help with mood disorders.

Conclusion

To conclude, dissociative identity disorder is diagnosed when two or more personalities are present in a person. There are signs and symptoms that can allow family, friends, and medical specialists to be aware that a person may have this disorder. Once diagnosed, there are treatment options available for anyone that is living with dissociative identity disorder. It is important to be educated on the topic and to know when and how to take interventions.