Multiple Personality Disorder or Dissociative Identity Disorder(DID)

According to the American Psychiatric Association (APA) dissociative identify disorders (DID) is when a person has the presence of at least two distinct identities or personality states that take control of the persons behavior, when the person tends to forget important personal information that its too important to be considered part of ordinary forgetfulness. It is often characterized as a identity fragmentation rather than a large number of different personalities.

Commonly it consists in one host personality and several alter personalities. The host and each alter personality has its own beliefs, values feelings and actions toward a same event. Most of the time, the host doesn’t have access to retrieve important information.

This happens because there are important amnesic barriers. Researchers have long debated if this disorder is a unique character because it tends to confound with other disorders such as borderline or narcissistic disorders, however they have realized that in this personality disorder, the defense mechanism that predominates is dissociation (detachment from emotional and physical experiences).

Characteristics and profile of patient

A person that suffers from this disorder will have rapid shifts in mood, related with posture, voice tone and vocabulary.

Dissociative disorders affects memory, as mentioned above they exhibit amnesic symptoms and a feeling of lost time. They have no memories of things they have done (disremembered actions, conversations), this can last for years. Even though, some people can be functional, have jobs, be parents and have “stable lives”-
The alters most of the time will feel bad, stupid or useless, with an urge to be punished.
Sometimes they don’t have a strong sense of reality, they may not be able to distinguish what is real, what is imaginary or dreamed. We have to be patient with them because they might be overconfused when the alters switches. It is important to acknowledge these individuals and what they are doing, or what they do(by pointing out their forgotten actions), trying to give them greater continuity experience.

The alters take control of the host, sometimes they can have their own name and different ages. They are continually moving backwards(in a involuntary way) to their past lives, where they are dissociated with fragments of memories. There will be inconsistencies and cognitive distortions around the traumatic events, most of them from childhood.

Dissociative disorder is often the result of severe trauma, often physical trauma or abuse since childhood. These will result in a series of acute and chronic symptoms such as depression, anxiety, low self-esteem, extreme mood swings and dissociations According to some researchers, it seems that some individuals affected by dissociative disorder also carry eating disorder diagnoses and posttraumatic stress disorders. Related with eating disorders, it seems that they tend to have a strange relationship with their bodies such as tactile hallucinations, body-image distortions or strong psycho- physiologic responses.

Sexual dysfunction is predominantly in this population, with behaviors ranging from precocious sexuality to excessive aggression and pedophilia. Therapists almost agree that is very common to see female patients that have at least one alter ego that is a male trapped into a woman’s body and feel very bad about it.

Most of individuals present suicidal behavior, self-mutilation, substance abuse. They have a history of being unresponsive to medications, they don’t react to emotions as normal people do(they can laugh when it’s time to cry, for example). They also exhibit psychotic symptoms such as hallucinations.

Considerations of treatment

Psychotherapy needs to be long term. Due to experienced repeated trauma, it needs to be anything between two and ten years. As sexual abuse and trauma is always present, it is particularly complex.

Longer session lengths. A typical psychotherapy session lengths about one hour, about one hour and half may me need for working with incidents of trauma. Sessions need to be more frequent at least twice a week.

Treatment encourages communication cooperation and collaboration between alters and the host, this will reduce the boundaries between the alters, encourages unity, and aims for reducing the memory loss. Treatment will focus on traumatic events and memories.

Sources
Ringrose, J. L. (2011). Meeting the needs of clients with dissociative identity disorder: considerations for psychotherapy. British Journal Of Guidance & Counselling, 39(4), 293-305
Everest, P. (1999). The multiple self: working with dissociation and trauma. The Journal Of Analytical Psychology, 44(4), 443-463.
Levin, A., Kahan, M., Lamm, J., & Spauster, E. (1993). Multiple personality in eating disorder patients. The International Journal Of Eating Disorders, 13(2), 235-239
Brenner, I. (1996). The characterological basis of multiple personality. American Journal Of Psychotherapy, 50(2), 154-166.