Dissociative Identity Disorder is also referred to as multiple personality disorder, in which an individual's identity dissociates, or fragments, creating additional identities that exist independently of each other within the individual (Gale 2001). Each personality is specifically distinct from the other, such as tone of voice and mannerisms, vocabulary and posture (Gale 2001). Most people exhibit only one or two personalities, however, there are cases in which an individual will have more than a hundred identities (Gale 2001). Whether one or a hundred, the criteria for diagnosis is the same (Gale 2001). Until the publication of DSM-IV, this disorder was referred to as multiple personality disorder, a name abandoned due to psychiatric explicitness, hence, the name should reflect the "dissociative aspect of the disorder" (Gale 2001).
The DSM-IV lists four criteria for diagnosing someone with dissociative identity disorder. The first being the presence of two or more distinct 'identities or personality states.' At least two personalities must take control of the person's identity regularly. The person must exhibit aspects of amnesia-that is, he or she forgets routine personal information.
And, finally, the condition must not have been caused by 'direct physiological effects,' such as drug abuse or head trauma" (Gale 2001).
Persons suffering from DID usually have a main personality referred to as the host, although this is generally not the individual's original personality, but rather one developed along the way and it is this personality that usually seeks psychiatric help (Gale 2001). The other personalities are referred to as 'alters' and the transition phase between the alters is called the 'switch' (Gale 2001).
Alters not only vary in number, but in gender as well, men may have female alters and women may have male alters (Gale 2001). The most baffling aspects of this disorder are the physical changes that occur in a switch between alters, such as different voices and postures (Gale 2001). A 1986 study found that in thirty-seven percent of patients, "alters even demonstrated different handedness from the host" (Gale 2001). DID sufferers statistically average fifteen identities and is nine to one more common among females than males, with the usual age of onset in early childhood, generally four years of age (Gale 2001). If not treated, this disorder will last a lifetime as new identities can accumulate over time as the person faces new situations and circumstances (Gale 2001).
Although there are no reliable figures, this disorder has begun to be reported with increased frequency over the last several years (Gale 2001).
People suffering DID generally have other severe disorders as well, such as depression, substance abuse, borderline personality disorder, eating disorders, and others (Gale 2001). In almost every case of DID, there is present horrific instances of physical or sexual child abuse, even torture (Gale 2001). One study found that out of one hundred patients, ninety-seven of them had suffered child abuse (Gale 2001). "It is believed that young children, faced with a routine of torture and neglect, create a fantasy world in order to escape the brutality. In this way, DID is similar to post-traumatic stress disorder" (Gale 2001). Recent thinking in psychiatry suggests that the two disorders may be linked and some are "beginning to view DID as a severe subtype of post-traumatic stress disorder" (Gale 2001).
Treatment of DID is a long and difficult process and success, the total integration of identity, is rare (Gale 2001). One 1990 study found that roughly one-fourth, five of the twenty patients studied, were successfully treated (Gale 2001). Treatment involves having DID patients recall childhood memories and often includes hypnosis to help the patient remember because the memories are often subconscious (Gale 2001). There is need for caution however, as recovered memories can be so traumatic for the patient that they may cause more harm (Gale 2001).
There is much controversy regarding the nature, and even the existence, of dissociative identity disorder (Gale 2001). One reason for such skepticism is the alarming increase in reports of DID during the last few decades (Gale 2001).
In an article published in 'Insight on the News' (1993), Eugene Levitt, a psychologist at Indiana University School of Medicine, noted that "In 1952 there was no listing for DID in the DSM, and there were only a handful of cases in the country. In 1980, the disorders got its official listing in the DSM, and suddenly thousands of cases are springing up everywhere" (Gale 2001). Another concern is the notion of suppressed memories, a crucial component in DID (Gale 2001). Many memory experts state that it is "nearly impossible for anyone to remember things that happened before the age of three, the age when much of the abuse supposedly occurred to DID sufferers" (Gale 2001). However, regardless of the controversy, people who are diagnosed with DID are clearly suffering from some profound disorder (Gale 2001).
According to a Minnesota study, specific associations were found between early experience and antisocial behavior, anxiety, depression, and dissociative symptomatolgy (Sroufe 2003). The premise in attachment theory is "that the need for human contact, reassurance, and comforting in the face of illness, injury, and threat is a normal response throughout the life span" (Sroufe 2003). This need is especially prominent early in development when physical and emotional survival depends on the caregiving relationship (Sroufe 2003). Development of an infant-caregiver attachment is an essential adaptation of the human species, based in evolutionary history - humans, like other primates, are born vulnerable and remain so for years (Sroufe 2003). The attachment system is believed to have evolved to ensure that infants and caregivers remain in physical proximity, guaranteeing infant protection, thus the caregiver serves as a safe haven (Sroufe 2003). All infants with sufficient access to adults become attached to their caregivers regardless of treatment even in the face of maltreatment and severe punishment (Sroufe 2003).
Recent findings indicate a coherent pattern: self-reported anger is higher in insecure females, who are likely to develop a tendency to use dissociation as a coping style (Pini 2003). The study examined the relationships among dissociative experiences, anger proneness, and attachment styles in young adult females (Pini 2003). Results confirm the importance of psychological intervention on the part of educational agencies and mental health services in helping young adults integrate anger experiences in gendered self-schema as a means of preventing emotional disturbances (Pina 2003).
Symptoms of Dissociative Identity Disorder include:
Multiple personalities, on average 10 though there can be as few as two and as many as 100.
Exhibits different personalities, behavior and even physical characteristics.
Episodes of amnesia or time loss i.e.: don't remember people, places etc.).
Often they are depressed or suicidal
Self-mutilation is common
1/3 of patients experience visual or auditory hallucinations
The average age for the development of alters is 5.9 years
An inability to focus in school (in childhood)
Conduct problems (in childhood) (Psychology 2002).
To be clinically diagnosed with DID, the following symptoms must be identified:
The presence of at least two distinct personalities with their own relatively enduring pattern of sensing, thinking about, and relating to self and environment.
At least two of these personalities assume control of behavior repeatedly.
Extensive inability to recall major personal information cannot be attributed to common forgetfulness.
This behavior is not caused directly by substance abuse or a general medical condition. (Psychology 2002).
Standardized tests have been developed to supplement the clinician's judgment, and to aid in treatment plans (Psychology 2002). A diagnosis is reached by a mental status examination supplemented by questions concerning dissociative symptoms, such as episodes of amnesia, fugue, depersonalization, derealization, identity confusion, and identity alteration, age regressions, autohypnotic experiences and auditory hallucinations (Psychology 2002). "Screening tools (i.e.: Dissociative experience scale, dissociative questionnaire, questionnaire of experiences of dissociation) and psychological tests, such as the Rorschach, have been used to establish a diagnosis," as well as hypnotherapy (Psychology 2002).
The Dissociative Experience Scale, DES, developed by Frank W. Putnam and Eve B. Carlson, is an assessment instrument that can be completed by a client in about ten minutes (Gale 1998). It asks the patient to indicate the frequency with which certain dissociative or depersonalization experiences occur (Gale 1998). Disorder Interview Schedule, DDIS, is a structured thirty-forty-five-minute interview developed to standardize the diagnosis of DID (Gale 1998).
Developed by Ross, Heber, Norton and Anderson, the DDIS has been used in several research studies and has good clinical validity by showing that DID is a valid diagnosis with a consistent set of features (Gale 1998). Structured Clinical Interview for DSM-IV Dissociative Disorder, SCID-D, developed by Marlene Steinberg, enables a trained interviewer to assess the nature and severity of dissociative symptoms (Gale 1998). Mapping is a technique used to learn about an individual's internal personality system by asking the client to draw a map or diagram of his or her personality states (Gale 1998). As therapy progresses, the client is asked to update the map (Gale 1998). Dissociation Questionnaire, DIS-Q, is a sixty-three item measure that explores trauma-related (dissociative) symptomatology, which is often associated with psychological, sexual, and/or…