The Ongoing Researches of Dissociative Identity Disorder, Its Symptoms and Effects

As described in the Psychology and Your Life book, “A person with a Dissociative Identity Disorder (DID) displays characteristics of two or more distinct personalities, identities, or personality fragments”. Many people are fascinated by this strange psychological disorder, yet question the reality of it. The media has grappled onto this captivation of DID and made it become widespread with movies such as Split and Me, Myself, & Irene. These movies, although entertaining, don’t quite show the full background and spectrum of this disorder. Dissociative Identity Disorder is a complicated issue with ongoing research to learn more about its many associated symptoms and trauma-related causes.

Dissociative Identity Disorder, called Multiple Personality Disorder until 1994, was reported for the first time approximately 4 centuries ago. However, it wasn’t accepted as a psychological disorder by the American Psychiatric Association until 1980. According to the American Journal of Psychotherapy, only 200 cases had been reported up until this point, but that number skyrocketed once the diagnostic criteria was added to the third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) (Piper, 1994). It is now believed that the prevalence of DID is, “approximately 1% among women in the general population and 6% in psychiatric out-patients”. No one can be sure that these numbers are accurate, though, as the diagnostic criteria is vague and can be interpreted differently. The whole Dissociative Identity Disorder industry grew as the number of patients diagnosed with it did, too. National conferences, new research, and marketing in hospitals were done to spread awareness on this obscure, booming disorder (Piper, 1994). Not much was known about this disorder at first, but the industry’s growth helped both experts and the public to better understand it.

As additional information has been learned about DID throughout the years, its description has become more detailed. With each new edition of the DSM, new facts on the disorder and a clearer method of diagnosing it is released. The most recent DSM-5 adds onto its previous descriptions of DID stating that it is characterized by, “disruption of identity characterized by two or more distinct personality states, with marked discontinuity in sense of self. . .accompanied by related alterations in effect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning”. This much more comprehensive description makes it easier to accurately diagnose people with this disorder. Not only has more information on the outward physical effects been found, but also more is now known about each individual personality within the patient. The previously mentioned Psychology and Your Life book notes how each personality is fully developed with its own opinions and reactions to situations. The personalities can also be wildly different in sexes, ages, handwriting, and values. The Journal of Genetic Psychology describes how patients with DID often have amnesia due to the fact that the personalities don’t have complete contact with one another (Murray, 1994). For the most part, each personality only has memories of what occurred when it was the dominant personality at the time. This new information on Dissociative Identity Disorder has made it easier to diagnose those with it, but it is still very difficult to help them considering this disorder’s many associated features.

DID is already an anomaly itself, but then add on the fact that most people with it also have several other interconnected disorders. Clinicians who are not familiar with this disorder may misdiagnose patients as schizophrenic because many of the symptoms are the same (Murray, 1994). One of these similar symptoms between the two is depression and suicide attempts. A study discussed in the American Journal of Psychotherapy showed that outpatients with DID were 15 times more likely to have a history of suicide attempts than any other psychosis, including alcohol abuse and PTSD. However, in DID the feature of depression may only occur in certain personalities, with the other personalities having no recollection of suicide attempts. Suicide isn’t the only associated issue with Dissociative Identity Disorder, though. Based on the medical journal Acta Psychiatrica Scandinavica, DID is actually considered a form of PTSD that developed at an early age. Both occurring after trauma, these disorders affect the brain in similar ways; the only exception being that DID patients dissociate from themselves in order to cope. DID is also related to many other dissociative and personality disorders, a main one being Borderline Personality Disorder. Once again discussed in the American Journal of Psychotherapy, it has been found that, “any practitioner treating a population of patients with BPD will predictably encounter a substantial minority of patients who also suffer from DID”. These many associated symptoms and disorders of DID make it extremely difficult to treat, especially when there is also a background of trauma with the patient.

The cause of Dissociative Identity Disorder is well-known to be childhood trauma, commonly in the form of abuse. Oftentimes abused children will create different personas, such as imaginary friends, that they can develop into their personality in order to escape from the reality of their life (Murray, 1994). Each created personality is a part of the whole individual, but has its own memories and linked traumas. An example of this is a sexually abused child dissociating to create a personality that did not remember being abused, this way they can properly sexually function. Although, not all abused children will get DID, and the trauma must occur during a specific developmental stage of the individual in order for this disorder to have a chance to develop. Traumatic experiences of abuse taking place early in the ego and identity formation stage will more likely cause a development of Borderline Personality Disorder, while those occurring later will cause Dissociative Identity Disorder (Murray, 1994). This is likely because younger children aren’t able to comprehend what is happening, unlike the older children who do understand and want to forget. Even though the cause of DID has been known to be trauma since it was first considered a psychological disorder, it was never known how the trauma mentally affected the patient until recently.

A study published in the Acta Psychiatrica Scandinavica journal in 2018 has been the first to compare the relationship between trauma and the brain anatomy of DID patients. In order to do this, the researchers took MRI scans of 32 DID women (29 of which having comorbid PTSD from childhood trauma), and 43 women without any psychological disorders. They used advanced technology to measure each patient’s cortical volume (CV), cortical thickness (CT), and surface area (SA); all three of these being brain structures with distinct developmental courses that appear similar in healthy controls. After studying the results, it was found that, “Women with DID showed significant and extensive volumetric reductions of regional gray matter in the insula, cingulate cortex, the dorsolateral, superior, medial, and orbitofrontal prefrontal cortex, and the superior and inferior temporal lobe”. The areas of the brain shown to be different in the women with DID are the regions responsible for emotion processing and regulation. These results are important in showing that environmental factors, specifically early-life trauma, significantly affects the neurodevelopment of the brain. Trauma and abuse can put so much stress on the emotion regulators of one’s brain to physically cause it to go off its developmental path, and make it more probable for the individual to get Dissociative Identity Disorder. This insight helps greatly in better understanding the mental effects of DID, but it does not give any ideas on how to properly treat this intricate issue.

Ever since its discovery, many different types of psychotherapy have been used to attempt to treat patients with DID, much to no avail. The boom of Dissociative Identity Disorder after its diagnostic criteria was added to the DSM-III caused psychologists to scramble to find a treatment for it. However, everything tried didn’t work because there wasn’t an effective, standard psychotherapy that took into account all the proponents of DID- from dealing with different personalities in each session to comorbidity. A lot of therapies tested on patients with this disorder also weren’t successful because they would cause stress to the patient, which would prompt a switch and prevent them from actually gaining any valuable information. Along with this, it didn’t help that up until recently it was believed that the proper “treatment” of Dissociative Identity Disorder was to fuse all the identities into one. Obviously this was very difficult and often fusion wouldn’t maintain if it occurred, as each identity is still a part of the whole individual. This method took an extremely long amount of time and wasn’t cost effective at all. A study described in the American Journal of Psychotherapy shows that fusion therapy doesn’t work as 123 patients participated in the treatment, but only 33 remained stably fused for 27 months, and most not lasting much longer than that. Thankfully, new treatment guidelines developed by the International Society for the Study of Trauma and Dissociation have helped to eliminate fusion treatment (Foote & Van Orden, 2016). After many studies, they found that a staged approach for treating DID is the most beneficial in treating all the symptoms.

Since suggesting that treating DID in stages works most effectively, many studies have been done to find which specific type of psychotherapy should be used. Brad Foote, M.D., and Kim Van Orden, Ph.D., claim in the American Journal of Psychotherapy that Dialectical Behavior Therapy (DBT), which is commonly used to treat Borderline Personality Disorder, is the best option (Foote & Van Orden, 2016). Since DID and BPD are very similar and often comorbid with each other, a successful therapy for BPD should theoretically be easy to adapt to treat DID. In this article, the authors state that stage one, addressing dangerous behavior, and stage two, working through trauma, of Dialectical Behavior Therapy would be heavily relied on (Foote & Van Orden, 2016). Doing this will decrease the chances of suicidality and focus on the main cause of Dissociative Identity Disorder: trauma. In this treatment, the therapist will also do the opposite of fusion by making it a key point that each personality, “contains valuable aspects of the whole, are all in fact parts of the whole person, and cannot be eliminated” (Foote & Van Orden, 2016). This shows the patient - who often dislikes having other personalities - that they are all valid. That then causes the personalities to have better communication, lessening amnesia and internal conflicts. Foote and Van Orden sum up their plan of adapting DBT for DID by saying, “alters are engaged directly in therapy, the alters’ existence is not automatically seen as a problem, and the therapist does not try to discourage them from existing, or prevent the patient switching from one to another”. Dissociative Identity Disorder is not an issue fundamentally, but treatment is necessary to prevent self-harm and help the patient become comfortable enough with their whole self to build a life worth living.

Dissociative Identity Disorder is a seemingly far-fetched issue that captivates both the public and psychologists. This interest in the disorder has caused a major increase in those diagnosed with it, which then also led to more research on it. Studies on DID are still occurring everyday, though, as its several associated symptoms and background of trauma make it a complicated disorder to understand and treat. As more information is learned about DID through this research, the media needs to update its portrayal of the disorder to be more accurate. Patients with Dissociative Identity Disorder aren’t scary and shouldn’t be looked down upon, as most of them are just victims of abuse that need validation that they are worthy in order to live a normal life.

References

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