Dissociative Identity Disorder is a rather complicated psychological condition. In addition to dissociative amnesia and depersonalization-derealization disorder, it’s one of the three major dissociative disorders.
Formerly known as multiple personality disorder, Dissociative Identity Disorder is a condition that is thought to have many different potential sources of causation. This could include, among others severe trauma during early childhood including extreme, repetitive physical, emotional or sexual abuse. There are various treatment options for Dissociative Identity Disorder however before we discuss those, it is important to understand a little about the illness itself, how it may develop and how the life of someone diagnosed with Dissociative Identity Disorder may be impacted. Dissociative disorders are diagnosed in people of all ages, races, ethnicities, and backgrounds. The National Alliance on Mental Illness (NAMI) estimates that about two percent of people experience dissociative disorders.
What is Dissociative identity disorder?
Dissociative Identity Disorder is a severe form of dissociation. Dissociation is a mental process which results in a lack of connection between a person’s thoughts, memories, feelings, actions or even their sense of identity. Dissociative Identity Disorder is thought to originate from variety of different factors including trauma experienced by the person who has been diagnosed with the disorder. For these individuals, dissociation is thought to be a coping mechanism. Due to the trauma they experienced or a trigger that brings about memories of the trauma, the person literally shuts off or dissociates themselves from the situation or experience that is too violent, traumatic or painful to handle with their conscious self.
Who is most at risk for Dissociative Identity Disorder?
As noted above, Dissociative Identity Disorder can be a confusing and complicated disorder. The risk factors can be equally as complicated. Most research indicates the primary cause of Dissociative Identity Disorder is likely a psychological response to interpersonal and environmental stresses. Most commonly, these stresses occurred during the early childhood years when situations of emotional neglect or various forms of abuse may interfere with personality development. According to statistics, a staggering ninety-nine percent of individuals who eventually develop dissociative disorders have a verifiable personal history of recurring, overpowering and often life-threatening disturbances or traumas during what is considered a sensitive developmental stage of childhood. This is usually considered to be before the age of six.
A dissociation disorder may also develop if someone has been the victim of persistent neglect or emotional abuse. This can occur even without the presence of overt physical or sexual abuse. There are studies that show when children grown up in families where the actions of the parental figures are frightening or unpredictable, the children may also become dissociative.
Fortunately, studies also show the overall occurrence of Dissociative Identity Disorder are rather low. Research shows that currently Dissociative Identity Disorder effects between one and three percent of the population.
What are the symptoms of Dissociative Identity Disorder?
Dissociative Identity Disorder is characterized by the presence of two or more distinct (or split) identities or personality states. These personality states continually have power over the person’s perceptions and behaviors. With Dissociative Identity Disorder there is also a clear inability to recall pertinent personal information. This inability is so overarching that it cannot be confused with mere forgetfulness. Additionally, individuals with Dissociative Identity Disorder will have noted variations in their memories which will fluctuate and change with frequency.
Not everyone who is diagnosed with Dissociative Identity Disorder will experience the illness in the same way. However, for many, the different identities (sometimes referred to as “alters”) all have their own age, sex or race. They will each have their own postures, gestures and distinct ways of talking which are uniquely separate from the individual and each other. Sometimes the alters are people and sometimes they may be animals. When a particular personality reveals itself and controls the persons thoughts and behaviors it is referred to as switching. There is no concrete timeframe for how long a switch can last. Sometimes it may be minutes or seconds and in other cases it could last days.
It is believed that each of the individual distinct personalities play a diverse role in helping the individual with Dissociative Identity Disorder, to cope with the challenges and dilemmas they face each day. For example, when a person is first diagnosed there is an average of two to four personalities that have made themselves present. The presence of these personalities is what pushes a person to seek treatment. As treatment progresses and the history and triggers are explored it is often found that there are more than fifteen different personalities. Again, each of these personalities plays a role in helping the person cope with their experiences and triggers.
Other symptoms of Dissociative Identity Disorder could include:
Dissociative amnesia: This is a type of memory loss beyond that of simple forgetfulness that cannot be attributed to a medical condition.
Dissociative fugue: A dissociative fugue is an episode of amnesia that involves not having memory of certain personal information including where someone lives or who their spouse is. m
Blurred identity: This occurs when someone feels like there are two or more people talking or living in their head.
Some other symptoms may include headache, time loss, trances and “out of body experiences”. Some individuals with Dissociative Identity Disorder will participate in self-persecution, self-sabotage and even violence inflicted on themselves or others. A classic example of this would be a person with Dissociative Identity Disorder may find themselves doing something they would not normally do such as driving recklessly, yet they will do so because they feel compelled to do so by one of their alters who is in control at the time.
How is Dissociative Identity Disorder diagnosed?
Making a diagnosis for Dissociative Identity Disorder is not a quick process; it takes time. It is estimated that someone who has Dissociative Identity Disorder may spend up to seven years in various elements of the mental health system before they receive an accurate diagnosis. Unfortunately, this is common because the list of symptoms someone with Dissociative Identity Disorder may experiences that causes them to seek treatment can be very similar to other mental health diagnoses. Indeed, many people who have some form of dissociative disorder also have co-occurring conditions such as borderline personality (and other personality disorders), Depression and anxiety.
Along with the dissociation and multiple or split personalities, people with dissociative disorders may experience a number of other psychiatric problems. These could range from common symptoms such as mood swings to more intense diagnosable mental health issues. Some of the more common symptoms and co-occurring disorders can include:
- Mood swings
- Suicidal tendencies
- Sleep disorders including insomnia, night terrors, and sleep walking
- Anxiety, panic attacks, and phobias which can occur due to flashbacks, reactions to stimuli or “triggers”
- Alcohol and drug abuse
- Compulsions and rituals
- Psychotic-like symptoms which can include auditory and visual hallucinations
- Eating disorders
What’s the Treatment Plan for Dissociative Identity Disorder?
Now that we have explained a little about Dissociative Identity Disorder and how it develops and may eventually be diagnosed, we can talk about some of the treatment methods commonly used to treat this mental health condition. First, it is important to note there is not a “cure” for Dissociative Identity Disorder however, certain forms of long-term treatment have been shown to be beneficial provided the patient remains committed to treatment. As with many mental health conditions, there are various treatments that are commonly used to treat Dissociative Identity Disorder. They can include:
The primary treatment for Dissociative Identity Disorder is psychotherapy. Psychotherapy, commonly known as talk therapy or psychosocial therapy is focused on talking with your mental health provider about your mental health and the current symptoms you are experiencing. The goal of psychotherapy is to help someone who is experiencing the symptoms of Dissociative Identity Disorder or a co-occurring disorder, is to learn how to understand the cause of their disorder and to cope with the symptoms they are experiencing. This is done by working through the triggers (both the initial trigger and current triggering events) associated with the Dissociative Identity Disorder. Another goal of psychotherapy is to help combine or fuse the separate personality traits into one consolidated personality that is capable of controlling symptoms and triggers. It is not uncommon for family members and loved ones to participate in some of the therapy sessions.
Hypnotherapy is not generally used as a standalone treatment. It is often used in conjunction with psychotherapy. Hypnotherapy is used (when the patient is susceptible to hypnosis) to help the therapist access repressed memories. This process can help the therapist and patient to better understand the originating trigger and how current triggers impact the patient’s symptoms. It can also help to control some of the problematic behaviors that accompany the Dissociative Identity Disorder symptoms as well as help to identify the separate personalities and work to combine them into one.
Adjunctive therapies are those therapies that are not spoken of as commonly as psychotherapy and other well-known techniques. These include techniques such as art therapy, music therapy and movement therapy. Movement therapy and art therapy for example, have been shown to help people experiencing symptoms of Dissociative Identity Disorder to connect with the parts of their mind that had been shut off due to traumatic experiences.
Medication is sometimes used in the treatment of Dissociative Identity Disorder however, there are no medications that are specifically recommended. Often, medications are used to treat the underlying symptoms related to co-occurring disorders such as depression and substance use disorders. Treating these co-occurring mental health conditions is essential to overall improvement of the symptoms related to Dissociative Identity Disorder. However, since there is not an established treatment regime psychologically based approaches remain the staple approach to therapy especially if co-occurring disorders are not present. If medications are used some of the more common choices are anti-anxiety medications, antipsychotic medications and antidepressants.
Outpatient and Inpatient treatments
Many of the above treatments can (and often do) take place in outpatient settings. These settings can include private therapy practices as well as programs that take place in clinics or hospital settings yet do not require a person to stay at the facility. If a person is able to cope successfully with triggers and day to day events while seeking outpatient treatment, then these settings may be the most successful.
However, it is not uncommon for people who are experiencing Dissociative Identity Disorder to be experiencing symptoms of other mental health conditions as well. This makes successful outpatient treatment options challenging. For example, someone who is experiencing Dissociative Identity Disorder as well as substance abuse issues may not only suffer from personality shifts but the symptoms and challenges associated with alcohol or drug addiction. It is unlikely this individual will be able to safely detox from substance use while seeking outpatient treatment for their Dissociative Identity Disorder symptoms. In situations like this a residential setting such as that offered at Hillcrest would be the most beneficial and offer the most potential for success. Remember, there is not a known “cure” for Dissociative Identity Disorder, however successful treatment can help an individual to experiencing a reduction in negative symptoms and learn to successfully cope with their disorder outside of an active treatment setting. Treatment for Dissociative Identity Disorder is not a brief process and often requires a steady, long term commitment from both patient and treatment provider. This is due to the challenging nature of fully understanding the depth of symptoms and the time it takes to help the individual identify triggers and learn adequate and healthy coping mechanisms.
At Hillcrest we specialize in individual treatments designed around the specific needs of the person. Everyone is different and requires different treatment elements to achieve success. At Hillcrest we will take the time to meet with your family member and determine which treatments and medical interventions (such as detox or medications) may be helpful in achieving success and developing adequate coping. If you or a loved one are experiencing symptoms of Dissociative Identity Disorder with or without a co-occurring disorder, contact us at Hillcrest and allow us to create a treatment plan designed around your needs and with your success and well-being in mind.