Dissociative Identity
Disorder
Defined as the occurence 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 vy 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 assymetrical, 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.
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
Coding Note
In children, the symptoms cannot be attributed to fantasy
play, including imaginary playmates.
Also see our Dissociative Disorders Links Page
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