Dissociative Identity Disorder: An Explanation of Treatment

Dissociative Identity Disorder, previously known as Multiple Personality Disorder until 1994, is a disorder which has been increasing in terms of diagnosis in the present years. According to the DSM-IV TR (2000), the criteria for Dissociative Identity Disorder, often referred to as DID is as follows: "the presence of two or more distinct identities or personality states [...] at least two of these identities or personality states recurrently take control of the person's behavior [...] the inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness [...] the disturbance is not owing to the direct physiological effects of a substance."

The act of dissociating is a mental process which results in a person having a lack of connection between thoughts, memories, feelings, actions and identity. During this time a person is not able to associate information with other information in a way you normally would which helps them mentally escape from the trauma (Sidran, 2003).

When Multiple Personality Disorder changed its name to DID in 1994, the name isn't the only thing that changed, a criterion was added as well. When it was first published in the DSM in 1980, the inability to recall important personal information was not necessarily needed to diagnose someone with MPD/DID (Kennett & Matthews, 2002). Researchers felt that the name Multiple Personality Disorder gave the wrong impression because there aren't really different personalities, just different alters (Sidran, 2003). Some people argue that DID isn't a legitimate disorder, that people will create "personalities" just to make themselves feel better. Someone saying that DID is a made up disorder would be comparable to someone saying that schizophrenia isn't a real disorder because someone's brain isn't physically split (Ross, 1990).

According to Kennett and Matthews (2002), one of the criteria for diagnosing someone with DID is that they cannot control the switch into an altered state of mind. This doesn't follow the clip we saw on the Three Faces of Eve however. In the clip, the interviewer asked Eve if he could speak with one of the other alters and she acknowledged his request by switching to another. Skeptics use this idea to argue the possibility of DID being a fictitious disorder that people make up either for attention from their therapist or possibly for the medications they may receive (McAllister, 2000).

Although the causation of DID may vary from person to person, the majority of sufferers have experienced some kind of traumatic event during childhood. This event causes them to disconnect their feelings and emotions of that experience from their every day lives, allowing them to escape reality. Something with enough negativity and horrid feelings will make someone constantly resort to escaping and it may eventually lead to something very disturbing, such as DID (Sidran, 2003). According to Swartz (2001), the most common alters which are created in the development of the disorder fit the mold of a depressed, exhausted host, a strong, angry protector, a scared, hurt child, a helper, and an internal persecutor who blames themselves for the abuse or trauma they at one time experienced. Although Swartz suggests five alters, DID can be diagnosed with as few as two or as many as hundreds (NAMI, 2000).

The symptoms of Dissociative Identity Disorder make it easy for clinicians to misdiagnose this disorder as something else, usually more familiar psychological problems. Some of those symptoms include headaches, mood swings, time lapses, auditory hallucinations, and anxiety (McAllister, 2000). Since most suffers have experienced some sort of trauma causing them to dissociate, there are five ways that the central nervous system is effected that are linked to memory, learning, and emotional control. These five aspects include, "intrusive symptoms such as flashbacks, nightmares; avoidance symptoms such as avoiding thinking of events; hyper autonomic arousal symptoms such as heightened startle reflex, vigilance, sleep disruptions; numbing symptoms such as detachment; distortions of the self system [...]" (McAllister, 2000).

Since diagnosing DID tends to be difficult, several assessment tools have been designed, especially to differentiate between DID and other disorders which share similar symptoms. The Structural Analysis of Social Behavior was created by Alpher in 1996 and is used to separate DID from other mental disorders. Another tool used is the Dissociative Disorders Interview Schedule which is used as a structured interview, one to one, to help make a differential diagnosis between somatization disorder, borderline personality disorder, major depressive disorder, and all of the dissociative disorders. A third tool is a 28 item questionnaire, known as the Dissociation Experiences Survey, and is used to determine the degree or dissociation an individual experiences in their daily life (McAllister, 2000).

There are different categories for the alters, mutually amnesic, one way amnesic, and mutually cognizant. If the person is said to be mutually amnesic it means that none of the identities have any awareness that any of the others even exist, they think they are the only real person in that body. One way amnesic, most common in DID, is when some of the alters are aware of some of the others but not all of them. Finally, mutually cognizant is defined by all identities being aware of all of the others (UNC, date unknown).

Dissociative Identity Disorder is sometimes hard to treat because it isn't always properly diagnosed to begin with. The most beneficial method used today is talk therapy, also known as individual psychotherapy but can also be very long and painful to the sufferer since they have to recall memories often from a traumatic experience (Sidran, 2003). Hypnosis is often used to aid in the recollection of memories, re-associating or bringing consciousness back together in order to join the different alters (McAllister, 2000). The primary goal of treatment is to merge all of the different alters into one identity (Chu, 2005).

Something that a lot of people have a hard time deciding is the responsibility of people with DID, if one alter commits a crime that the host alter is not aware of, should they be held accountable? There are two different beliefs, Multiple Persons Thesis and the Single Person Thesis. The Multiple Persons Thesis claims that each alter is responsible for itself, that they are all separate people who are independent of one another. The Single Person Thesis states that each alter is just a part of the person who experience global self-delusion due to their psychological state of mind (Kennett & Matthews, 2002).

When it comes to the law, it is very interesting to see who believes in the Single Person Thesis and who believes in the Multiple Persons Thesis. If a case dealing with Dissociative Identity Disorder goes to court, the ruling made by the judge will determine if the host alter should be held responsible for all actions using the Single Person Thesis or if each alter should be held accountable for their own individual actions, following the Multiple Persons Thesis.

An example of the court system following the Multiple Persons Thesis was the 1993 Denny-Shaffer case. She suffered from DID and one of her alters kidnapped a baby from a hospital but her host alter had no idea that anything had happened. The court ruled that because the host alter was unable to see the wrongfulness in the action that she should be held not guilty (Kennett & Matthews, 2002). Without knowing what state this case was tried in, it is assumed that the following case, the Grimsley case, was tried in another state due to their Single Person Thesis ruling. In this incidence, one of Grimsley's alters, Jennifer, was charged with drunk driving. The court found her guilty using the reasoning that there was only one person in the car and only one person was drunk, this person is responsible for their actions no matter what state of mind they are in (Kennett & Matthews, 2002).

Dissociative Identity Disorder has been around for years but not until recently has it become an interest to researchers. There are skeptical psychologists who feel that DID is a made up disorder while others truly believe that this is a growing problem which has wrongly been diagnosed for years. When a person dissociates from a traumatic experience they create new identities in order to escape from their surroundings and may eventually have no control over it and as soon as it starts causing disruptions to their life or anyone else's, it then turns into a disorder.

References

Sidran Institute (2003). Dissociative Disorders. Retrieved April 27, 2006 from http://www.sidran.org/didbr.html

Ross, C. (1990). Twelve cognitive errors about multiple personality disorder. American Journal of Psychotherapy, 44(3), 348-357.

Kennett, J. & Matthews, S. (2002). Identity, control and responsibility: the case of Dissociative Identity Disorder. Philosophical Psychology, 15(4).

McAllister, M. (2000). Dissociative identity disorder, a literature review. Journal of Psychiatric & Mental Health, 7, 25-33.

Swartz, A. (2001). Dissociative Identity Disorder. Retrieved April 27, 2006 from http://allpsych.com/journal/did.html

Nami (2000). Dissociative Identity Disorder. Retrieved May 1, 2006 from http://www.nami.org/Template.cfm?Section=Helpline&Template=/ContentManagement/ContentDisplay.cfm&ContentID=20562

University of North Carolina. Dissociative Disorders. Retrieved May 1, 2006 from http://www.unc.edu/~sacksm/Dissout.htmChu, J. (2005). Guidelines for treating dissociative identity disorder in adults. Retrieved May 1, 2006 from http://www.issd.org/indexpage/treatguide1.htm#goalsoftreatment