Dissociative Identity Disorder (Did) Is the Name

¶ … Dissociative Identity Disorder (DID) is the name that the Diagnostic and Statistical Manual for Mental Disorders-IV-Text Revision (DSM-IV-TR) uses for the disorder previously known as Multiple Personality Disorder (American Psychiatric Association [APA], 2000). Dissociative disorders are a heterogeneous set of disorders described in the DSM-IV-TR that all involve some form of identity loss (APA, 2000). The concept of a personality describes, in fairly generalized terms, a sense of integration regarding the way one feels, thinks behaves. Even though a single personality can have many different aspects to it, the concept of personality relates a sense of oneness to the self. DID is a dissociative disorder in which the individual has two or more totally separate and distinct personalities, each determining the attitudes and behavior of the person at the time that it is dominant. DID is considered one of the more serious of all the psychiatric disorders listed in the DSM-IV-TR (APA, 2000).

Prior to 1800 persons afflicted with DID were likely considered to be possessed (APA, 2000). The American psychiatrist Benjamin Rush provided a clinical description of DID (Kluft, 1996) and Freud and Bleuer both recognized the pathology although both believed it to have different etiologies (Kluft, 1996). In 1980, the DSM-III recognized Multiple Personality Disorder (APA, 1980) and of course public awareness of the disorder came about through a series of popular books in people purporting to have DID and from Hollywood films.

According to the current diagnostic criteria include the presence of at least two distinct personalities, at least two of the personalities recurrently take over control of the person's behavior, an inability of the person to recall important personal information that is too extensive to be explained by ordinary forgetfulness, and the symptoms are not due to substance use/abuse or to a medical condition (e.g., dementia).

The primary personality (the one that is the original personality) is often not aware of the existence of the other personalities (Ross, 2006). In fact the amnestic component of DID is crucial to the diagnosis (APA, 2000). The shift from one personality to the other is often sudden and dramatic. During each personality state the person is generally unaware of the other personalities or the events occurring when these other personalities were dominant (Kluft, 1996). However, in some cases one or more personalities is aware of the others or certain aspects of the others; however, this is rarely the case with the primary personality (Kluft, 1991). In the classic cases each personality has its own name, identity, history, and memories. The secondary personalities are often childlike, disparate from the primary personality, or may be a different gender and age from the person with the disorder (Ross, 2006).

The prevalence of DID is hotly debated with one extreme believing it is very rare and the other believing it is enormously underdiagnosed (Gleaves, May, & Carden, 2001). Some of the better studies indicate that 0.5 to three percent of psychiatric hospital admissions meet the diagnostic criteria for DID (APA, 2000). However, the diagnosis is much more common in women than men and the ratio of women to men with DID is somewhere from 5:1 to 9:1 (APA, 2000). The cause of DID is unknown; although inevitability people suffering from this disorder have experience some form of traumatic event, most often childhood abuse (APA, 2000). Ross (1996) discusses four types of causal factors associated with DID: 1) a traumatic life event, 2) a vulnerability for the disorder to develop in the person (e.g., susceptibility to being hypnotized), environmental factors such as poor coping skills or role models and, 4) a lack of or absence of external support.

On examination patients with DID will not appear to be unusual except for some instances of forgetfulness. Often a clinician can detect the disorder by having the patient keep a diary and the alternate personalities often record notes in the diary. Other times corroborative evidence, hypnotic or drug assisted interviews, or actual personal experience can lead to a diagnosis (Ross. 2006). Differential diagnosis includes ruling out personality disorders, schizophrenia, bipolar spectrum disorders, epilepsy, and substance abuse. Treatment for DID is most often insight oriented therapy and this treatment can be supplemented with hypnosis and sometimes with antidepressants or other psychotropic medications although these are most often not needed. Kluft (1991) has outlined successful therapeutic principles for the treatment of DID which are still considered relevant today.