DISSOCIATIVE IDENTITY DISORDER: SYMPTOMS, CAUSES - ECONOMÍA - 2024

The dissociative identity disorder or multiple personalities characterized in that the person who has it can take up to 100 identities that coexist in your body and mind. Another characteristic is that there is a memory loss that is too extensive to be explained by ordinary forgetfulness.

Adopted personalities or alter egos usually follow two types of patterns: 1) Have complete identities, with unique behavior, speech and gestures. 2) Identities differ only partially on some characteristics.

The main characteristic of this disorder is that there are certain aspects of the personality of the person that are dissociated. For this reason, the name "multiple personality disorder" was changed to "dissociative identity disorder" (DID).

Therefore, it is important to understand that there is a fragmentation of identity, rather than a proliferation of separate personalities.

How do multiple personalities act in dissociative identity disorder?

DID reflects a failure to integrate various aspects of identity, memories, or consciousness into a multidimensional "self." Typically, a primary identity has the person's name and is passive, depressive, or dependent.

Dissociated identities or states are not mature personalities, but a disjointed identity. Different states or identities recall different aspects of autobiographical information, something favored by amnesia.

When there is a change from one personality to another it is called "transition", which is usually instantaneous and can be followed by physical changes. The identity that usually asks for treatment is the host personality, while the original personality rarely does so.

Different personalities may have different roles to help the person cope with life events.

For example, the person may come to treatment with 2-4 alter egos and develop more than 10 as treatment progresses. There have also been cases of people with more than 100 personalities.

Life events and environmental changes produce the change from one personality to another.

Effects edit

There are several ways in which DID affects the person who has it in their life experiences:

• Depersonalization: feeling of being separated from one's own body.
• Derealization: feeling that the world is not real.
• Amnesia: inability to remember personal information.
• Alteration of identity: feeling of confusion about who a person is. Distortions of time or place may also be experienced.

Symptoms

These are the main symptoms of DID:

• The person experiences two or more distinct identities, each with its own pattern of perception, relationship, and thought.
• The number of identities can range from 2 to more than 100.
• At least two of those identities or personality states take control of the person's behavior on a recurring basis.
• Identities can arise in specific circumstances and can deny knowledge of each other, be critical of each other, or be in conflict.
• The transition from one personality to another is usually due to stress.
• Autobiographical memory losses occur in the short and long term. Passive personalities tend to have fewer memories and hostile or controlling personalities tend to have fuller memories.
• Symptoms of depression, anxiety or dependence can occur.
• Behavior and school adjustment problems are common in childhood.
• Visual or auditory hallucinations can occur.

Diagnosis

Diagnostic criteria according to DSM-IV

A) Presence of two or more identities or personality states (each with its own and relatively persistent pattern of perception, interaction and conception of the environment of itself).

B) At least two of these identities or personality states control the behavior of the individual on a recurring basis.

C) Inability to remember important personal information, which is too broad to be explained by ordinary forgetting.

D) The disorder is not due to the direct physiological effects of a substance (eg, automatic or chaotic behavior from alcohol intoxication) or medical illness.

Differential diagnosis

People with DID are usually diagnosed with 5-7 comorbid (co-occurring) disorders, a higher rate than in other mental illnesses.

Due to similar symptoms, the differential diagnosis includes:

• Bipolar disorder.
• Schizophrenia.
• Epilepsy.
• Borderline personality disorder.
• Asperger syndrome.
• The voice of personalities can be mistaken for visual hallucinations.

The persistence and consistency of identity behavior, amnesia, or suggestibility can help distinguish DID from other disorders. Also, it is important to distinguish TID from simulation in legal problems.

People who simulate DID often exaggerate symptoms, lie, and show little discomfort about the diagnosis. In contrast, people with DID show confusion, discomfort, and shame about their symptoms and history.

People with DID adequately perceive reality. They may have positive first-order K. Schneider symptoms, although they lack the negative symptoms.

They perceive voices as coming from inside their heads, while people with schizophrenia perceive them as coming from outside.

Differences between DID and schizophrenia

Schizophrenia and DID are often confused, although they are different.

Schizophrenia is a serious mental illness that involves chronic psychosis and is characterized by hallucinations (seeing or hearing things that are not real) and believing things without a basis in reality (delusions).

People with schizophrenia do not have multiple personalities.

A common risk in patients with schizophrenia and DID is the tendency to have suicidal thoughts and behaviors, although they tend to be more frequent in people with DID.

Causes

Most people with this disorder have been victims of some type of traumatic abuse in childhood.

Some believe that because people with DID are easily hypnotizable, their symptoms are iatrogenic, that is, they have arisen in response to suggestions from therapists.

Trauma or abuse

People with DID often report that they have suffered physical or sexual abuse during childhood. Others report that they have suffered early losses of close people, serious mental illness or other traumatic events.

Memories and emotions of painful events can be blocked from awareness and alternate between personalities.

On the other hand, what can develop in an adult as post-traumatic stress, can develop in children as DID as a coping strategy, due to greater imagination.

It is believed that for DID to develop in children, three main components have to be present: childhood abuse, disorganized attachment, and lack of social support. Another possible explanation is the lack of care in childhood combined with the child's innate inability to dissociate memories or experiences from consciousness.

There is growing evidence that dissociative disorders - including DID - are related to traumatic histories and specific neural mechanisms.

Therapeutic induction

It has been hypothesized that the symptoms of DID may be increased by therapists using techniques to retrieve memories - such as hypnosis - in suggestible people.

The socio-cognitive model proposes that DID is due to the person behaving consciously or unconsciously in ways promoted by cultural stereotypes. Therapists would provide cues from inappropriate techniques.

Those who defend this model note that the symptoms of DID are rarely present before intensive therapy.

Treatment

There is a lack of general consensus on the diagnosis and treatment of DID.

Common treatments include psychotherapeutic techniques, insight-oriented therapies, cognitive-behavioral therapy, dialectical behavioral therapy, hypnotherapy, and eye movement reprocessing.

Medication for comorbid disorders can be used to decrease certain symptoms.

Some behavioral therapists use behavioral treatments for an identity, then use traditional therapy when a favorable response has been given.

Brief therapy can be complicated, as people with DID may have a difficult time trusting the therapist and need more time to establish a trusting relationship.

Weekly contact is more common, lasting more than a year, being very rare that it lasts weeks or months.

Important aspects of therapy

Different identities may appear throughout therapy based on your ability to deal with specific situations or threats. Some patients may present with a large number of identities initially, although these may be reduced during treatment.

Identities may react differently to therapy, fearing that the therapist's goal is to eliminate identity, especially that related to violent behaviors. An appropriate and realistic goal of treatment is to try to integrate adaptive responses into the personality structure.

Brandt and colleagues conducted an investigation with 36 clinicians who treated DID and who recommended a three-phase treatment:

• The first stage is learning coping skills to control dangerous behaviors, improve social skills, and promote emotional balance. They also recommended trauma-focused cognitive therapy and dealing with dissociated identities early in treatment.
• In the middle stage they recommend exposure techniques along with other interventions that are needed.
• The last stage is more individualized.

The International Society for the Study of Trauma and Dissociation has published guidelines for the treatment of DID in children and adolescents:

• The first phase of therapy focuses on symptoms and reducing discomfort caused by the disorder, ensuring the person's safety, improving the person's ability to maintain healthy relationships, and improving functioning in daily life. Comorbid disorders such as substance abuse or eating disorders are treated at this stage.
• The second phase focuses on gradual exposure to traumatic memories and the prevention of re-dissociation.
• The final phase focuses on reconnecting identities into a single identity with all your memories and experiences intact.

Pathophysiology

It is difficult to establish biological bases for DID, although investigations have been carried out with positron emission tomography, single photon emission computed tomography or magnetic resonance imaging.

There is evidence that there are changes in visual parameters and amnesia between identities. Furthermore, patients with DID appear to show deficiencies in tests of attention control and memorization.

epidemiology

DID occurs most commonly in young adults and decreases with age.

The International Society for the Study of Trauma and Dissociation states that the prevalence is between 1% and 3% in the general population, and between 1% and 5% in hospitalized patients in Europe and North America.

DID is diagnosed more frequently in North America than in the rest of the world, and 3 to 9 times more frequently in women.

How can you help if you are a family member?

The following tips for the family are recommended:

• Find out about the TID.
• Seek help from a mental health professional.
• If the close person has identity changes, they may act differently or strangely and not know who the relative is. Introduce yourself and be nice.
• See the possibility of looking for support groups with people with DID.
• Observe if there is a risk that the person commits suicidal behavior and contact the health authorities if necessary.
• If the person with DID wants to talk, be willing to listen without interruption and without judgment. Don't try to solve problems, just listen.

Possible complications

• People with a history of physical or sexual abuse, including those with DID, are vulnerable to addiction to alcohol or other substances.
• They are also at risk of committing suicide.
• If the prognosis of DID is not treated properly, it is usually negative.
• Difficulties maintaining employment.
• Poor personal relationships.
• Lower quality of life.

Forecast

Little is known about the prognosis for people with DID. However, it rarely clears up without treatment, although symptoms can vary over time.

On the other hand, people with other comorbid conditions have a worse prognosis, as do those who remain in contact with abusers.

And what experiences do you have with dissociative identity disorder?

References

1. "Dissociative Identity Disorder, patient's reference". Merck.com. 2003-02-01. Retrieved 2007-12-07.
2. Noll, R (2011). American Madness: The Rise and Fall of Dementia Praecox. Cambridge, MA: Harvard University Press.
3. Schacter, DL, Gilbert, DT, & Wegner, DM (2011). Psychology: Second Edition, page 572. New York, NY: Worth.
4. Hacking, Ian (August 17, 2006). "Making up people". London Review of Books 28 (16). pp. 23–6.
5. Walker, H; Brozek, G; Maxfield, C (2008). Breaking Free: My Life With Dissociative Identity Disorder. Simon & Schuster. pp. 9. ISBN 978-1-4165-3748-9.