Dissociative Identity Disorder (DID) Essay Example

Dissociative identity disorder (DID) is a psychological condition that is characterized by multiple identity and distorted personality. The causes of the condition are unknown but it is believed to be precipitated by physical, sexual, and/or emotional stress or abuse (Goldberg 1). DIDs have also been linked to posttraumatic events such as natural disasters and wars and inadequate parenting. Since DID shares many commonalities with other mental conditions, management of this condition will have a positive ripple effect on most other mental health conditions

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DID is a common mental illness among the general population with 0.01 to 1% of affected people (Goldberg 5). Over a third of patients with DID state to have a feeling of dissociation by seeing themselves in a movie most of the times. They complain of visual and auditory hallucinations. 7% of the affected individuals experience some form of DID that has not been diagnosed (Goldberg 5). Women have the highest likeliness of having DID and other dissociative disorders when compared to men (National Alliance on Mental Illness 1).

The DID has a long history with the terminology of its name changing from time to time (Natasha 1). In the year 1791, DID was referred to as an exchanged personality. The mental illness peaked in the 19th century with many of the people in the medical professional calling it as the multiple personality disorder (Waseem 2). Many studies where performed between the year 1880 and 1920 than in 1944 and the healthcare community became aware of the known cases of DID from the reports during that period (Natasha 1). In the 1970's the publication of the book, "Dissociative Identity Disorder: I am not Sybil" led to an increased number DIDs diagnosis by the medical professionals. The history of the DID in the Diagnostic and Statistical Manual (DSM) of Mental Disorders started in 1952. All the dissociative disorders were regarded as psychoneurotic disorders with the symptom of anxiety being a major indicator. The DSM-II in 1968 named DID as hysterical neurosis, a dissociative type defined through the alteration of identity and consciousness (Deville, Moeglin and Sentissi 1). The emergence of DSM-III in 1980 led to the publication of the word "dissociative" as a group of disorders. In the year 1994, the name multiple personality disorder was changed to dissociative identity disorder to help the healthcare community in reflecting the condition in a better way that can be understood easily (Natasha 1). Even though rarely reported, DID is common among patients.

The fifth Diagnostic and Statistical Manual of Mental Disorders (DSM-V) DID symptoms are the presence of two or more distinct personality states, identity loss, and signs of memory loss on personal information beyond the limits of normal forgetfulness appropriate for age. The personalities vary with gender, age, or race as the behavioral expressions of this cluster varies (American Psychiatric Association 1). DID is prevalent among 2% of the general population and 3% of all admissions at the mental health facilities in Europe and North America.

Individuals with DID could behave abnormally because of the different identities that could take the forms (Brand, Loewenstein and Spiegel 181). According to DSM-V, individuals with DID generally experience mood variations, suicidal tendencies, substance abuse disorders, and sleep disorders. DID is also associated with dissociative amnesia, self-persecution, violent bouts, time loss, and headache (American Psychiatric Association 1).

The organically-based DID is characterized by distorted memory, identity, and self-awareness in a way that they disconnect an individual from reality. An example of an organically-based DID is dissociative amnesia causing transient memory loss (Brand et al 183). Another example is dissociative fugue that is characterized by the abandonment of former self and the assumption of a new physical and social life. The DSM-V reports that multiple personality disorder is present in 1% to 3% of the general population. The mental illness was more prevalent in females than males as only 1% of the males had DID in 2013 (Martinez-Taboas 2). The rates are higher in the females because of their higher likelihood of getting physically or emotionally abused and owing to the fact that they rarely attend therapy sessions.

The impatient settings in the US were reported to manage 7% to 9% of patients with DID. In the same country, 6% of the DID patients were seen in the outpatient setting (American Psychiatric Association 1). The prevalence of the condition differs from setting to setting, and country to country. Multiple personality disorders are also characterized by social isolation and risks for self-harm. For instance, some clients with DID were reported to drive recklessly, engage in binge drinking, become violent, and even develop suicidal tendencies. Just like in other mental illness, the prompt diagnosis and initiation of treatment for DIDs improve the clinical outcomes and shortens the recovery process. The condition is managed through various strategies such as pharmacotherapy, psychotherapy, and rarely occupational therapy (Dorahy, Brand, Sar, Kruger, Stavropoulos, Martinez-Taboas, and Middleton 402) Psychotherapy is the typical treatment for DID since it allows individuals to have a process while identifying the signs and symptoms of multiple personality disorders. The session also enables an individual to have a full understanding of why dissociation occurs. During the process of therapy, hypnosis which can also refer to drug-facilitated interview is used to elevate the psychotherapy (Dorahy 403).

The DID has various similarities and differences with other mental conditions such as schizophrenia. When compared to DID, schizophrenia is different because the patient does not present multiple personalities such as voices, characteristics and own names, a symptom that is common with people who have DID (Goldberg 2). The different personalities of the patient take control of the individual's head. The patient has memory gaps in daily events, personal details and trauma experienced. A patient with schizophrenia presents different symptoms such as disorganized speech, negative behaviors, and catatonic behavior (Frankenburg 1). DID and schizophrenia have differences in treatment as the major choice for DID treatment is psychotherapy while schizophrenia is pharmacotherapy (Renard, Huntjens, Lysaker, Moskowitz, Aleman, and Pijnenborg 109).

However, both patients with schizophrenia and DID have similarities in the occurrence of hallucinations and delusions. Sometimes, negative behaviors present in schizophrenia are present in patients with dissociative disorders (Renard et al 108). Both mental problems present the patient with suicidal risks. Never the less, those with DID have a history of suicide attempts more often when compared to patients with schizophrenia (Goldberg 2). DID and schizophrenia have similarities in the treatment as both require a long-term treatment plan. Since the two mental disorders have overlapping symptoms, a combination of treatment is recommended (Renard et al 116). DID and schizophrenia require the treatment of co-occurring disorders for the overall improvement of the patient (Goldberg 5).

The different personalities of a person with DID play specific roles. The patient experiences two or more personalities including primary/first and alter/other (Deville et al 3). When active, the primary personality controls the individual. The person derives the personality from the particular given name that makes the patient passive, depressed, dependent and guilt. The host personality is not aware that are other personalities present within the individual.

The alter personality changes the patients to associate with a different history, identity, and self-image. The person may provide different personal information including their age, mood, name, gender, vocabulary and general knowledge. The alter personality makes the person deny knowledge, critical or be ready for a conflict with another. In that case, the person experiences living differently through depersonalization, derealization, amnesia, and identity confusion (Goldberg 3).

To function as a whole, the various personalities play distinct roles to help the patient cope with dilemmas in life (Goldberg 3). For example, the initial diagnosis may present the patient with up to four personalities. Over the course of treatment, it is possible to realize other personalities present even up to fifteen in number. The changes in personalities are triggered by environmental changes or life events and the patient responds differently to life dilemmas during every shift in personality (Goldberg 3).

A real case study of a person that had DID is Mrs. Mary, a 28-year-old woman presented to the psychiatrist. Based on the story she gave, Mary said that she hears of a crying voice recurrent. As she demonstrated, Mary said that she hears a baby crying all the time and that makes her sad throughout. The sadness makes her remain silent. She is now silent and her sitting posture and behavior change. While speaking to the psychiatrist, Mary changes her identity and calls herself Marion. As Marion, she starts narrating a different story from that of the baby. Marion talks of another person who is a wimp and will not put up with him. In fact, she will kill him and repeatedly saying, "I will kill him." When the psychiatrist asks her about the baby, Mary (now in the personality of Marion) does not remember about the baby. She asks "What are you talking about?" This case study gives a valuable insight into how the patient (Mary) is affected by the symptoms of DID on a daily basis. On one time, she hears of a crying baby, the next instance, she associates with a different personality of (Marion). The different personalities help the patient to cope with everyday dilemmas.

Psychotherapy is the mainstream management strategy for DID and is usually used as an adjunct therapy to pharmacotherapy in severe cases. The sessions open up the cognitive process to meaningful reflections and engagements that improve the cognitive functions. During psychotherapy sessions, the eye movement desensitization and reprocessing (EMDR) are also important because they help an individual and also aim at reprocessing the historical traumas safely. The interviews with the DID patients revealed that most had suffered from one form of abuse in their childhood lives. Most of them cited strain relationship with one or both of the parents in their earlier years. The results of the interviewed revealed a mood and affected congruence even though a majority of the interviewees had an elevated mood. The interviewees were also oriented in place and person but not in time and a considerable proportion of them could not remember some of the personal information about themselves such as the year of completion of school.

Psychopharmacology could be recommended in instances where the symptoms are severe and likely to cause self-harm or injury to others. Some of the psychopharmacological interventions that could be recommended include the use of mood stabilizers and anxiolytics for the relief of symptoms (Dorahy et al 407). Therefore, psychotropic medication improves the symptoms of DID by lowering the level of debilitating symptoms like poor concentration, depression, phobias, and anxiety and improving the cognitive functioning of the patients. According to DSM-IV no combination of medication has cured the patient with multiple personality disorder.

Conclusion

In summary, dissociative identity disorder is a psychological disorder that is characterized by multiple identity and distorted personality. The causes of the condition are unknown but in most of the cases, it has been associated with childhood trauma such...