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Dissociative
Identity Disorder
Defined
as the occurrence of two or more personalities within the same individual,
each of which during sometime in the person's life is able to take control.
This is not often a mentally healthy thing when the personalities vie
for control.
Symptoms
are of course somewhat self-explanatory, but it is important to note
that often the personalities are very different in nature, often representing
extremes of what is contained in a normal person. Sometimes, the disease
is asymmetrical, which means that what one personality knows, the others
inherently know.
The patient has at least two distinct identities or personality states.
Each of these has its own, relatively lasting pattern of sensing, thinking
about and relating to self and environment.
At least two of these personalities repeatedly assume control of the
patient's behavior.
Common forgetfulness cannot explain the patient's extensive inability
to remember important personal information.
This behavior is not directly caused by substance use (such as
alcoholic blackouts) or by a general medical condition.
Associated
Features:
Trauma
Depression
Mood
swings
Suicidal
tendencies
Sleep
disorders (insomnia, night terrors, and sleep walking)
Panic
attacks
Phobias
Alcohol
and drug abuse,
Differential
Diagnosis
Some disorders have similar or even the same symptoms. The clinician,
therefore, in his/her diagnostic attempt has to differentiate against
the following disorders which need to be ruled out to establish a precise
diagnosis.
Effects
of a substance - Alcohol Intoxication
General Medical Condition - (e.g., complex partial seizures)
Post-Traumatic
Stress Disorder (PTSD)
Cause:
When faced with
overwhelmingly traumatic situations from which there is no physical
escape, a patient may resort to "going away" in his or her
head. This ability may be used and is extremely effective defense against
acute physical and emotional pain, or anxious anticipation of that pain.
By this dissociative process, thoughts, feelings, memories, and perceptions
of the traumatic experiences can be separated off psychologically, allowing
the patient to function as if the trauma had not occurred.
Often, even after
the traumatic circumstances are long past, the left-over pattern of
defensive dissociation remains. Chronic defensive dissociation may lead
to serious dysfunction in work, social, and daily activities. Repeated
dissociation may result in a series of separate entities, or mental
states, which may eventually take on identities of their own. These
entities may become the internal "personality states,"
Changing between these states of consciousness is described as "switching."
Treatment:
Treatment methods
include psychotherapy and the use of specific medications either on
their own or , which is more effective in conjunction with each other.
Psychotherapy is the treatment of choice for individuals suffering
from any type of dissociative disorder. Approaches vary widely, but
generally take an individual modality (as opposed to family, group or
couples therapy) and emphasize the integration of the various personality
states into one, cohesive whole personality. The role of hypnosis remains
controversial partly because of concerns that hypnosis may increase
the risk of creating false memories.
Pharmacotherapy
[ See Psychopharmacology
Section ] :
The use of medication, except for the treatment of acute, specific
concurrent Axis I disorders, is not recommended. Maintenance and effective
use of prescriptions given the multiple personality states is difficult
to attain. If medication is prescribed, it should be carefully monitored.
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