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Background information on Dissociative Identity Disorder for all my readers.
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General Overview
Dissociative Identity Disorder (more commonly known as multiple personality disorder)
What is DID?
□ chronic emotional illness
□ relatively new form of personality disorder: the earliest cases of persons reporting DID symptoms were not recorded until the 1790s
□ hence, there are a lot of speculations about this disorder and its causes
When a patient has DID:
□ he plays host to two or more personalities, called alters
□ alters occur spontaneously and involuntarily, and function more or less independently of each other
□ they periodically control the patient's behaviour as if several people were alternately sharing the same body
More about DID:
□ patient has split off entire personality traits or characteristics as well as memories
□ when a stressful or traumatic experience triggers the reemergence of these dissociated parts, the patient switches into an alternate personality
□ this switch is usually fast and occurs within seconds
□ some patients have histories of erratic performance in school or in their jobs caused by the emergence of alternate personalities during examinations or other stressful situations
□ alters can sometimes show very different biological characteristics from host and from each other (eg. heart rate, blood pressure, body temperature, pain tolerances, eyesight abilities)
What are the causes of DID?
□ not confirmed, but theorised
□ may be due to overwhelming stress, insufficient childhood nurturing and an innate ability to dissociate memories or experiences from consciousness
□ common cause of DID: repeated episodes of severe physical, emotional or sexual abuse at a developmentally sensitive stage in childhood
o Most DID patients either physically or sexually abused as children, and this is often so especially when the abuse is repeatedly extreme and the child does not have time to recover emotionally.
□ due to emotional trauma and the lack of medium to express their trapped emotions, the child becomes detached from reality, starting to switch to a self-hypnotic state, also called dissociation, which is a defence mechanism to protect the child from feeling overwhelmingly intense emotions
□ dissociation blocks off these thoughts and emotions so that the child is unaware of them
□ with time, the dissociated thoughts and feelings may take on lives on their own
□ DID may also worsen with the lack of supportive or comforting person to counteract the trauma (e.g. an abusive relative).
How do I know whether if someone has DID?
□ variety of symptoms with wide fluctuations across time: from severe impairment in daily functioning to normal or high abilities in some areas
□ extremely broad array of other symptoms that resemble epilepsy, schizophrenia, anxiety, mood, posttraumatic stress, personality and eating disorders
□ patients may be frequently misdiagnosed and treated ineffectively
□ symptoms can include: headaches and other body pains, distortion or loss of subjective time, depersonalization, amnesia, depression
□ amnesia occurs when there are gaps in the patient's memory for long periods of their past, in some cases, their entire childhood. Most DID patients have amnesia for periods when other alters surfaces. They may report finding items in their house that they can't remember having purchased, finding notes written in different handwriting, or other evidence of unexplained activity.
Profile
Me and my blogging life.
The one and only blogger here...
Name: Sebrina
Occupation: Doctor
Marital Status: Single
Horoscope: Aquarius
Birthday: 14 February 1981
Favourite colour: Blue
Wishlist: Promotion
Boyfriend
All my patients to recover
Hobbies: Reading, watching documentaries
The one and only blogger here...
Name: Cordelia
Occupation: Emo kid, if it counts.
Marital Status: Single (and never wanting to get married.)
Birthday: 30 February 1992
Favourite colour: Black
Wishlist: Amnesia.
Death.
Hobbies: Cutting my wrist with a penknife, etc.
The one and only blogger here...
Name: Daisy
Occupation: Mummy and Daddy's sweetheart!
Marital status: I think I'm single, but there's a boy in class that REALLY likes me!
Birthday: 1 December 2000 - you want to give me a present?
Favourite colour: Pink!
Wishlist: A BIG teddybear!
That Barbie doll that I saw on TV yesterday...
A pink pretty dress!
Pretty flowers!
Today I came upon a blog in which the girl was very confused about herself, so just some words for her in case she stumbles upon this blog, since I have no other way of contacting her:
To Cordelia,
What you are encountering now is Dissociative Identity Disorder. And I hope that you can receive treatment immediately. But before that, you need to know the causes. Several studies suggest that DID is more common among people with close biological relatives who also have the disorder than general population. Besides, after long term abuse, if one does not have enough time to recover emotionally, and the brain's storage, retrieval, and interpretation of childhood memories cannot be fully understood, the disassociated thoughts and feelings may begin to take on lives of their own. Each cluster of thoughts tends to have a common emotional theme such as anger, sadness, or fear. Eventually, these clusters develop into full-blown personalities, each with its own memory and characteristics.
However, multiple personality disorder is sometimes triggered by purely organic causes. For instance, temporal lobe epilepsy sometimes can lead to personality split. Other organic causes of multiple personality disorder include sleep loss, sensory deprivation, stroke, Alzheimer and encephalitis. Or the corpus callosum (the part of the brain that joins the left and right halves of the cerebral cortex) may be severed due to trauma or surgery designed to cure severe epilepsy, and this may in turn cause the rise of multiple personalities. This particular type of MPD is often described as ekyll and Hyde, because the two halves act as two independent entities, two dominant personalities, instead of the traditional dominant single personality and subordinate other personality or personalities. Psychotherapists and researchers theorize that part of what is happening is the sequestering of harmful information. Instead of sharing space with the rest of the memories, the traumatic incidences are shoved into their own little corner, and the only way they can be accessed is through fragmented and incoherent neural pathways.
-jesica
2:58 AM
What's up, it's Cordelia here.
She was holding on to a wine bottle. Her hair covered her face, making her look slightly deranged. She came towards me. I tried to duck but before I could, blood gushed out of my arms. If that was the first attack from her in my life, I would have been surprised. I would have cried and sobbed through the night. I would have retorted and run away. But after numerous such encounters, I know better now. I know that I should just stand still and let her continue her ventings while I sink deeper and deeper into nothingness… if I do not want a more serious consequence of pinching, kicking, scratching, and all the violent actions in the world that you can think of….Because she is my mother. When it happens, I am just left there alone, so lonely, so vulnerable, with no supportive or comforting person to counteract her abusive actions. It feels funny somehow, that kind of sensation, that kind of fear seems like a series of perceptual information which is constantly revealed to me through fleeting images, olfactory, auditory, or olfactory sensations…… so near, yet so far.
I can’t forget this, never. Because it just affected me too much, so much such that I will have flashbacks of it consistently, and even during my sleep, I visit it through my worse nightmares. Even more than being locked up in the room and neglected after Baby Berry was born. Sometimes, I wished that I could just become another person, to detach myself from this pain etched deep in my mind. I know that this is not right, but I always have the urge to do this whenever I feel anxious or threatened. It allows me to escape from reality, to escape from the pains deep down, when everything seems hopeless. It allows me to deem what is happening as a movie or television, watching it as a bystander, so that it reduces the pain that eats away your heart. Perhaps you may call it self-hypnotic, or dissociation from consciousness, but it is a defense mechanism that protects me from feeling overwhelmingly intense emotions.
It just feels as if a part of my brain intimately involved in transforming experiences into speech, is suppressed during the recovery of these memories---- it just impossible for me to express in coherent terms my traumatising experience and memories. As such, no one really understand how I feel. NO ONE.
-jesica
Thursday, February 28, 2008
7:00 PM
Sebrina says...
This is my very first entry on this blog, which was started based on the advice of my trusted colleagues. According to them, it would prove to be beneficial to me if I start to record down my findings online, in order to share it with those that are still looking for answers. In addition to this, I would also be posting about my experiences at work, in order to better sort my thoughts out.
In my introduction page, I have already written out a general overview of the Dissociative Identity Disorder, which is the aspect of personality disorder which I specialise in. Here I would like to elaborate on this disorder using information I have gathered from various resources.
According to statistics, DID occurs 8 times more frequently in women than in men. Also, female MPD patients often have more identities than men, averaging fifteen as opposed to eight for males.
Memory and other aspects of consciousness are said to be divided up among "alters" in the MPD. The number of "alters" identified by various therapists ranges from several to tens to hundreds. There are even some reports of several thousand identities dwelling in one person.
Upon reading that, my experience with a patient, X, (who must remain unknown, for who hasn’t heard of professional ethics?) resurfaced in my mind. X was in my office talking about his stressful day at work, when suddenly he switched to his other alter. It happened in a few seconds, which is characteristic of DID. However, his other alter was extremely different from his main alter in terms of character and abilities. While the profile of X’s main alter is introverted and is a typical Singaporean with a basic grasp of English and Chinese with average intelligence, the other alter that he took on that day was something I have never seen before despite my past experiences with him. X had a totally different personality, and acted like a gothic teenager, adopting another body posture immediately after the switch, and having different hand gestures and way of talking than before. This alter is the fifth I have noticed appearing in X.
1. How do you know whether you have DID?
Physicians can identify certain suggestive signs and symptoms. Some examples are as below:
- Severe headaches and other pain syndromes
- Time distortion, time lapses or frank amnesia
- Being told of disremembered behaviours
- Discovery of objects, productions or handwriting in one’s possession that one cannot account for or recognise
- Hearing voices (80% or more experienced as within the head) that are experienced as separate, often urging the patient towards some activity
- Patient’s use of “we” in a collective sense and/or making self-referential statements in the third person
- History of child abuse
- Inability to recall childhood events from the years 6 to 11
When a doctor is evaluating a patient for DID, he or she will first rule out physical conditions that sometimes produce amnesia, depersonalization, or derealisation. These conditions include head injuries; brain disease; side effects from medications; substance abuse; AIDS dementia complex; or recent periods of extreme physical stress and sleeplessness. In some cases, the doctor may give the patient an electroencephalograph (EEG) to exclude epilepsy or other seizure disorders.
If the patient appears to be physically normal, the doctor will next rule out psychotic disturbances. Many patients with DID are misdiagnosed as schizophrenic because they may "hear" their alters "talking" inside their heads. If the doctor suspects DID, he or she can use a screening test called the Dissociative Experiences Scale (DES). And if the patient has a high score on this test, he or she can be evaluated further with the Dissociative Disorders Interview Schedule (DDIS) or the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). The doctor may also use the Hypnotic Induction Profile (HIP) or a similar test of the patient's hypnotisability.
The diagnostic criteria in DSM-IV Dissociative disorders section 300.14 requires:
o 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.
o At least two of these identities or personality states recurrently take control of the person's behavior.
o Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
o Disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). In children, the symptoms are not attributable to imaginary playmates or other fantasy play.
A patient history, x-rays, blood tests and other procedures can be used to eliminate symptoms being due to traumatic brain injury, medication, sleep deprivation or intoxicants, all of which can mimic symptoms of DID.
2. I read that signs and symptoms of DID is rather similar to other disorders. Won’t physicians ever make a misdiagnosis?
Hohoho! Physicians have made many misdiagnoses! The diagnosis of DID is complex: some physicians believe it is often missed, others feel it is over-diagnosed. Patients have been known to have been treated under a variety of other psychiatric diagnoses for a long time before being re-diagnosed with DID. The average DID patient is in the mental health care system for six to seven years (around 6.8 years) before being diagnosed as a person with DID. Many DID patients are misdiagnosed as depressed because the primary or "core" personality is subdued and withdrawn, particularly in female patients. However, some core personalities, or alters, may genuinely be depressed, and may benefit from antidepressant medications. One reason misdiagnoses are common is because DID patients may truly meet the criteria for panic disorder or somatisation disorder.
Misdiagnoses include schizophrenia, borderline personality disorder, somatisation disorder and panic disorder. DID patients are often frightened by their dissociative experiences, which can include losing awareness of hours or even days of time, meeting people who claim to know them by another name, or feeling "out of body." Persons with the disorder may go to emergency rooms or clinics because they fear they are going insane.
3. Can DID be treated?
Yes, DID can be treated. Treatment attempts to ‘reconnect’ and integrate the identities of the various personalities into a single functioning identity and/or may be symptomatic to relieve distressing aspects of the condition and ensure the safety of the individual.
The most common form of treatment long-term psychotherapy to deconstruct different personalities and integrate them. There are no medications that specifically treat this disorder, but antidepressants, anti-anxiety drugs or tranquilizers may be prescribed to help control the mental health symptoms associated with it. Without treatment, MPD doesn't disappear by itself, although the rate of personality switching does seem to slow down in middle age.
Treatment recommendations that follow from models that do not believe in the traumatic origins of DID might be harmful due to the fact that they ignore the posttraumatic effects of people with DID. Treatment may last for five to seven years in adults and usually requires several different treatment methods.
4. Can you elaborate more about how to treat DID?
These are various methods of treatment for DID:
• Psychotherapy
During therapy sessions, the therapist must develop a trusting relationship with the core personality and each of the alters. Psychotherapy consists of several stages:
Initial phase: uncovers and “maps” patient’s alters
2nd phase: Help patient to acknowledge and accept abuse he/she endured as a child and to learn new coping skills so that dissociation is no longer necessary
3rd phase: Integrating the host and alters by encouraging them to communicate with each other. This is often done using hypnosis.
Last phase: Patient consolidates his/her newly integrated personality
Most therapists who treat DID recommend further treatment after personality integration, on the grounds that the patient has not learned the social skills that most people acquire in adolescence and early adult life. In addition, family therapy is often recommended to help patient’s family understand DID and the changes that occur during personality integration.
• Medications
Some doctors will prescribe tranquilizers or antidepressants for DID patients because their alter personalities may have anxiety or mood disorders. However, other therapists who treat DID patients prefer to keep medications to a minimum because these patients can easily become psychologically dependent on drugs. In addition, many DID patients have at least one alter who abuses drugs or alcohol, substances which are dangerous in combination with most tranquilizers.
• Hypnosis
While not always necessary, hypnosis is a standard method of treatment for DID patients. DID patients are easily hypnotised and hypnosis may help patients recover repressed ideas and memories. Further, hypnosis can also be used to control problematic behaviours that many DID patients exhibit, such as self-mutilation, or eating disorders like bulimia nervosa. In the later stages of treatment, the therapist may use hypnosis to "fuse" the alters as part of the patient's personality integration process.
• Alternative treatment
Alternative treatments that help to relax the body are often recommended for DID patients as an adjunct to psychotherapy and/or medication. These treatments include:
- Hydrotherapy
- Botanical medicine (primarily herbs that help the nervous system)
- Therapeutic massage
- Yoga
Homeopathic treatment can also be effective for some people. Art therapy and the keeping of journals are often recommended as ways that patients can integrate their past into their present life. Meditation is usually discouraged until the patient's personality has been reintegrated.
5. Are chances of recovery high?
As a general rule, the earlier the patient is diagnosed and properly treated, the better the prognosis. Individuals with primarily dissociative symptoms and features of posttraumatic stress disorder normally recover with treatment. Those with comorbid addictions, personality, mood or eating disorders face a longer, slower and more complicated recovery process. Individuals still attached to abusers face the poorest prognosis; treatment may be long-term and consist solely of symptom relief rather than personality integration.
Some therapists believe that the prognosis for recovery is excellent for children and good for most adults. Although treatment takes several years, it is often ultimately effective.
6. Is it very difficult to treat DID?
Yup! There are many challenges facing the treatment of DID. Firstly, the patient might just be faking the condition. Hence, physicians have to first disentangle the condition and its therapy from the controversies that surround them. Moreover, it is difficult to discriminate between the dissociative disorders and bipolar disorder, borderline personality disorder and even schizophrenia, hence often the improper treatment may be used.
There are few specific treatments available for DID, so researchers are working hard on that. Another problem is that due to the long period of treatment, it is really costly and difficult to treat DID.
7. I’ve heard that some safety issues may crop up during treatment… Some people become suicidal and ‘emo’… Is it true?
Unfortunately, yes, it’s true…
During treatment, many problems of safety issues may recur. This is because patients are made to re-enact events of being abused or having their safety disregarded. They may then vent their aggression, shame, fear, horror, etc onto themselves through self-destructive behaviours.
Patients may exhibit suicidal behaviours; alcohol/substance abuse; eating disorder symptoms, violent or aggressive behaviour towards others driving recklessly; engaging in unsafe sexual practices; failure to attend to medical problems, etc.
But you need not worry too much… Therapists usually sign contracts with their patients regarding their responsibility for keeping themselves safe, for example agreeing with patient to use alternative strategies for management of problems and also insisting that the patient seeks treatment for existing medical problems. Therapists also use symptom management strategies such as grounding mechanisms, crisis planning, self-hypnosis and/or medications to provide alternatives to unsafe behaviours.
8. Do people fake DID because they are criminals and they want to get away from their crime on the grounds of mental illness?
Yes, that could be a possible reason. However, surveys and studies have shown that true sufferers of DID may not even be aware of their psychiatric condition and remember very little of their childhood (total or partial amnesia). They either claimed that the abuse never occurred or minimised the abuse.
Another controversy regarding DID is whether it occurs naturalistically or whether it is iatrogenic. Although it is clear that DID’s phenomenology may at times respond to social pressures and suggestions, many observations that demonstrate DID can occur in the absence of suggestive influences. Studies in Turkey and Norway (nations in which DID was not part of the popular culture and in which patients were not exposed to antecedent suggestive influences) found similar percentages of DID and dissociative disorders as in North America and the Netherlands, where such influences are much stronger. Some say that DID patients are somewhat influenced by the media, but this implies that places such as North America would have a greater percentage of patients, which is not the case. Hence the available information strongly indicates that DID occurs naturalistically, but that the condition, once begun, is sometimes somewhat responsive to suggestive influences.
