Dissociative identity disorder: causes, symptoms, diagnosis, treatment

Dissociative identity disorder, formerly referred to as a multiple personality disorder, is characterized by the presence of two or more individuals who succeed one another and an inability to recall important personal information associated with one of the individuals. The cause is usually severe trauma in childhood. The diagnosis is based on an anamnesis, sometimes in conjunction with hypnosis or an interview with the use of medication. Treatment consists in psychotherapy, sometimes in combination with drug therapy.

The fact that one person is unknown can be known to another. Some people can know about others and interact with them in a special inner world.

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Causes of Dissociative Identity Disorder

Dissociative identity disorder is associated with the effects of excessive stress (usually ill-treatment), inadequate attention and compassion during periods of extremely destructive life experiences in childhood and with a tendency to dissociative manifestations (the ability to separate one's memory, sensations, identity from awareness).

Children are not born with the feeling of an integral personality - it develops under the influence of many factors. In children who have suffered excessive stress, those parts of the personality that must be integrated remain fragmented. In patients with dissociative disorder, chronic and severe violence (physical, sexual or emotional) was often noted in childhood. Some patients did not tolerate violence, but experienced an early loss (such as a parent's death), severe illness or excessive stress.

Unlike most children who develop a holistic, integrated assessment of themselves and others, in children who have grown up in dysfunctional conditions, different feelings and emotions remain divided. Such children can develop the ability to eliminate themselves from cruel conditions through "withdrawal" or "removal" into their own world. Each of the phases of development can lead to the development of different personalities.

Symptoms of dissociative identity disorder

A number of symptoms are characteristic: a fluctuating clinical picture; a changing level of activity, from high to inactivity; severe headaches or other painful sensations in the body; time distortions, memory failures and amnesia; depersonalization and derealization. Depersonalization is a feeling of unreality, remoteness from himself, detachment from his bodily and mental processes. The patient feels like a third-party observer of his own life, as if he sees himself in the cinema. The patient can even have transient feelings that his body does not belong to him. Derealization is struck by the perception of familiar people and the environment as unfamiliar, strange or unreal.

Patients can find objects, products, handwriting samples that they can not identify. They can call themselves in the plural (we) or in the third person (he, she, they).

The switching of personalities and the amnestic barriers between them often lead to chaos in life. Since individuals often interact with each other, the patient usually claims to hear an inner conversation with other personalities that discusses the patient or is addressed to him. Therefore, the patient may be mistakenly diagnosed with psychosis. Although these voices are perceived as hallucinations, they are qualitatively different from typical hallucinations in psychotic disorders, such as schizophrenia.

Often, patients have symptoms similar to those with anxiety disorders, mood disorders, post-traumatic stress disorder, personality disorders, eating disorders, schizophrenia, epilepsy. Suicidal intentions and attempts, as well as episodes of self-harm, are often found in such patients. Many patients abuse psychoactive substances.

Diagnosis of dissociative identity disorder

In a history of patients, there are usually indications of 3 or more mental disorders with previous resistance to treatment. The skeptical attitude of some physicians to the validity of isolating a dissociative identity disorder also has significance in diagnostic errors.

Diagnosis requires a specific survey of dissociative phenomena. Sometimes a long interview, hypnosis or interview using medicines (metohexital) is used, the patient can be recommended to keep a diary between visits. All these measures contribute to the change of personality in the assessment process. Specially developed questionnaires can help.

The psychiatrist can also try to directly contact other individuals by offering to speak to that part of the consciousness that is responsible for the behavior for which the patient developed amnesia or where depersonalization and derealization were observed.

Treatment of dissociative identity disorder

Integration of personality is the most desired result. Medication can help in the treatment of symptoms of depression, anxiety, impulsivity, substance abuse, but treatment for achieving integration is based on psychotherapy. For patients who can not or do not want integration, the goal of treatment is to facilitate cooperation and collaboration between individuals and in the reduction of symptoms.

First of all, before assessing traumatic experience and researching problematic personalities in the process of psychotherapy, it is necessary to provide the patient with a sense of security. Some patients benefit from hospitalization, in which constant support and monitoring help with painful memories. Hypnosis is often used to study traumatic memories and reduce their impact. Hypnosis can also help in providing access to individuals, facilitating communication between them, stabilizing and interpreting them. When the reasons for dissociation are worked out, therapy can reach the point where the patient's personality, relationships and social functioning can be reunited, integrated and restored. Certain integration can occur spontaneously. Integration can be facilitated by negotiations and the installation of a fusion of personalities or integration can be facilitated by the reception of "imposition of images" and hypnotic suggestion.

The prognosis of dissociative identity disorder

Symptoms grow and decrease spontaneously, but dissociative identity disorder spontaneously does not go away. Patients can be divided into three groups. Patients of the 1st group have predominantly dissociative symptoms and post-traumatic symptoms, generally function well and are completely recovered by treatment. Patients of the 2nd group have dissociative symptoms in combination with symptoms of other disorders such as personality disorders, mood disorders, eating disorders, eating disorders. Such patients recover more slowly, the treatment is less successful or longer and is more difficult for the patient to experience. Patients of the 3rd group not only have expressed symptoms of other mental disorders, but emotional attachments to people allegedly committed violence against them may also persist. These patients often need long-term treatment, the goal of which is primarily to help control symptoms, and not achieve integration.