Pharmacological Treatment Multiple personality or dissociative disorder is an exceptionally uncommon mental disorder in which an individual has two or more different personalities. Each of these personalities has unique characteristics such as mind-set, emotions behavioral patterns. Frequently, the personalities are totally differing and take over the real individual at unusual times. This transition takes place in sudden switches when the patient is triggered by painful events or miserable reminiscences. Each personality is perhaps completely uninformed about the others. However, the person is usually acquainted with the fact that there were mysterious gaps in times he/she remembers ("multiple personality," 2013).

According to the Diagnostic and Statistical Manual for Mental Disorders, dissociative disorders are "characterized by the presence of two or more distinct identities or personality states, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self, that recurrently take control of the individual's behavior" (American Psychiatric Association, 2000).

It was in the nineteenth century that Pierre Janet, a renowned French physician, recognized and explained multiple personality/dissociative disorder for the first time. The reason behind the development of multiple personality disorder is still not evidently understood. However, this rare condition is almost always linked with rigorous physical abuse and abandonment during the early years of a person's life. It is widely acknowledged that amnesia i.e. The loss of memory is the main factor due to which separate personalities are formed. Amnesia is believed to occur as a psychosomatic obstruction to cordon off excruciatingly agonizing experiences from one's conscious mind. A majority of people develop this disorder in their but it remains unrecognized till they reach a mature age. People with dissociative disorder are found to have mild to severe social and emotional mutilations. Thus, dissociation acts "as a creative survival mechanism in the face of overwhelming trauma, whereby the mind shields itself by segregating the experience, or splitting it off into its constituent parts rather than experiencing it as what would be an unendurable 'whole'" (Spring, 2011).

Dissociative disorders have been categorized according to their severity. The severity spectrum is based on the extreme chronic traumas the person experienced as a child. Thus, Post-traumatic stress disorder is considered as the least extreme dissociative disorder whereas dissociative identity disorder is regarded as the most extreme. Other dissociative disorders between the mentioned ones are dissociative loss of memory/forgetfulness (amnesia), dissociative fugue, de-personalization disorder, de-realization disorder and DDNOS. DDNOS is the dissociative disorder not otherwise specified in which a person is unable to call important personal information to mind that is excessively general to be elucidated by normal absentmindedness/lack of memory (Spring, 2011).

Treatments and Drugs

Dissociative disorders require continuing, tete-a-tete and relationally-based psychiatric therapy as the primary treatment choice. In a majority of cases, once-in-a-week therapy sessions are required. However, it depends on various factors for instance the client's functioning capacity, assets, support and inspiration. Some clients need to be dealt with for a longer period (more than an hour). In general, it may take the therapy to extend for 5 years or more. Psychotherapists make use of miscellaneous techniques to treat dissociative conditions. These techniques include "cognitive behavioral therapy (CBT), dialectical behavior therapy (DBT), eye movement desensitization and reprocessing (EMDR), and sensor-motor psychotherapy" (Spring, 2011).

It is extremely important to mention here that a therapist must adjust EMDR protocols to work with dissociative identity disorder. This is because if a practitioner is not familiar with standard EMDR treatment and dissociative disorders, his unskilled methods may lead to hazardous overflow of hurtful matter and consequent deterioration of the mental health of the client.

Medication/Pharmacological Treatment

Till date, no medications have been found to particularly treat such disorders of dissociation. However, doctors all around the world recommend their dissociative patients to treat the disorder with antidepressants, medications to curb anxiety or tranquilizers. This kind of pharmacological treatment is helpful in controlling the mental health symptoms that are the characteristics of dissociative disorders ("Dissociative Disorders: Treatments and Drugs," 2011). In the early phases of PTSD, pharmacotherapy is used to treat dissociative disorders. It has been found that the major symptoms of PTSD are re-experiencing, chaotically awakening, and forestalling. Co-morbid symptoms of PTSD comprise of anger, violent behavior, impulsivity, misery, fright, substance abuse, and feelings to have nothing to live for.

Medication is found to have an effect on both primary and co-morbid symptoms of PTSD. PTSD is thus treated with "selected serotonin reuptake inhibitors (SSRIs) and the serotonin/norepinephrine reuptake inhibitors...

Clonidine is another medication that is found to lessen the symptoms of disturbing nightmarish dreams, invasive memories, manic alertness, sleeplessness, frightening responses and mad flare-ups. Moreover, anticonvulsants are also employed to treat mild dissociative disorders. Naltrexone can significantly reduce the length and strength of dissociative symptoms. It is especially useful for patients who have borderline personality disorder (Kreidler, Zupancic, Bell, & Longo, 2000).
Psychotherapy

For dissociative disorders, psychotherapy is the most important treatment. It has also been given the name of talk therapy or psychosocial therapy. In this kind of treatment, a client talks about his/her disorder and the problems related with it with the therapist. It then becomes the responsibility of the therapist to help the client in understanding the cause of his/her condition. The therapist also has the responsibility of helping the client to find ways to deal with the hurting and depressive situations. Most of the times, various techniques are involved in psychotherapy such as hypnosis.

Hypnosis helps a client by making him/her remember and solve the problem by working through the disturbance that triggers his/her symptoms of dissociation. In hypnosis, the therapist creates a condition of deep rest for the client that quiets his/her mind. When the client is hypnotized, he/she starts concentrating on a particular idea, reminiscence, sensation or feeling in an intense manner at the same time as the distractions are blocked. A client is more open to advices and suggestions under hypnosis as compared to normal circumstances. However, hypnosis can only be conducted by a trained therapist as a corresponding method for treating patients with dissociative disorders.

It is important to note here that the course of psychotherapy may take a really long time that is also rather disturbing and hurting. However, a number of researches indicate that this treatment approach is the most effective for the treatment of dissociative disorder as it helps the clients to incorporate their disconnected personalities ("Dissociative Disorders: Treatments and Drugs," 2011).

Creative Art Therapy

In this kind of treatment, creative processes such as art, dance, music etc. are used for helping those clients who have problems when asked to express their thoughts and share their emotions. Creative art therapy is a technique by which an individual is helped to increase his/her sense of self. It also helps people in coping with dissociative symptoms and incidents of trauma by encouraging positive changes ("Dissociative Disorders: Treatments and Drugs," 2011).

Cognitive Therapy

Cognitive therapy is another effective treatment for dissociative disorders as it is that kind of talk therapy that helps the clients in the recognition of detrimental and pessimistic attitude and behaviors. After identification of such off putting behavioral patterns, clients are helped in replacing them with mindset that is positive, optimistic and delightful. Cognitive therapy is founded on the notion that an individual's thoughts are the determinants of his/her behavior and behavior is not controlled by others. It teaches the client that even if a startling and unwanted circumstance has not changed; one can change his/her thoughts and attempt to bring positivity in his/her behavior to cope with the situation ("Dissociative Disorders: Treatments and Drugs," 2011).

It has been found that cognitive behavioral therapy works best and offer great outcomes to help the patient put together the feelings of a hurtful incident, decreasing dissociation as a consequence. As mentioned above, systematic desensitization and flooding are brought in use to treat PTSD patients. They are found to have an effect on the patient as they minimize re-experiencing and hyper-arousal. Prolonged Exposure is the best effective method for the reduction of dissociative disorder symptoms during the early stages of therapy. As far as rape victims are concerned, the best treatment option for them is Cognitive processing therapy (CPT). SIT, assertiveness training, and supportive psychotherapy are other therapeutic methods that are successful in reducing suffering, evasion, and disturbance by improving an individual's eloquence and self-worth (Kreidler, Zupancic, Bell, & Longo, 2000).

It is exceedingly important to mention here that it is not safe to use every behavioral technique with individuals who suffer from dissociative disorders. Flooding can have inadvertent effects on the patients that may include aggravation of hopelessness and despair, alcoholism reversion and panic disorder re-occurrence. It is being recommended that adjunctive cognitive therapy and medications must be employed to prevent and treat patients in case of any complications (Kreidler, Zupancic, Bell, & Longo, 2000).

The use of cognitive-behavioral techniques in group therapy is also a useful method to treat patients with dissociative disorder. It helps the group members to address feelings of estrangement, loneliness, vulnerability, and lack of dependence. Group therapy helps them to validate their feelings. As a consequence, there…