Multiple Personality Dissociative Identity Disorder


The”standard” definition of this is:
Multiple personality disorder, or MPD, is a mental disturbance classified as one of the dissociative
disorders. It is also known as dissociative identity disorder (DID).

MPD or DID is defined as a condition in which
"two or more distinct identities or personality states"
alternate in controlling the patient's consciousness and behaviour.

Note: It is not correct or accurate to use MPD or DID as synonyms for "Split personality" or to
confuse it for schizophrenia.


Introduction (the “other” description/definition):
We all have many (or multiple) “personalities: generally we call them “facets”, or “sides”. It is quite
normal, for we act differently in different situations and around different people – and at different
times.
  • In “normal” circumstances, those “aspects”, “sides” or “personalities” are connected and
    integrated, and we are generally aware of them.
  • It isn’t as if we are many totally “different” people. It is just that we adjust to the
    circumstances we find ourselves in.
  • But, and here’s the difference, there is a basic set of characteristic that reflect the “overall
    person” that remains consistent through the range of “sides”.

However, trauma and other contributing factors such as those described below can have such
devastating impact, that the connection between each “facet” or “side” is broken or lost – and they
become compartmentalized into separate compartments, or “personalities”.

Each “side” acts and operates independently from the other(s) – frequently unaware, or no longer
aware, that they exist. It is then, that problems occur and that we refer to it as: Multiple Personality  
Disorder, or Dissociative Identity Disorder (due to the “identity” having been lost – for it becomes   
a question of,
“which one is the “real” one”?).

In the strongest sense, they are NOT disorders – they are coping mechanisms.

The following gives a somewhat adequate explanation (it is adapted from other sources).

Description: The exact nature of DID (MPD) and its relationship to other mental disorders is not
clear. Some researchers think that DID is a
relatively recent development in western society.
  • It may be a culture-specific syndrome found in western society, caused primarily by both
    childhood abuse and unspecified long-term societal changes. Unlike depression or anxiety
    disorders, which have been recognized, in some form, for centuries, the earliest cases of
    persons reporting DID symptoms were not recorded until the 1790s.
  • Because childhood trauma is a factor in the development of DID, some doctors think it may be
    a variation of post-traumatic stress disorder (PTSD).

DID and PTSD are conditions where dissociation is a prominent mechanism. The female to male  
ratio for DID is about 9:1,
but the reasons for the gender imbalance are unclear.
  • Some have attributed the imbalance in reported cases to higher rates of abuse (and-or
    rape/incest) of female children; and some to the possibility that males with DID are under-
    reported because they might be in prison for violent crimes (it can also be socio-cultural).

The most distinctive feature of DID is the formation and emergence of alternate personality states,
or "alters (alter egos)."
  • People with DID experience their alters as distinctive individuals possessing different names,
    histories, and personality traits. It is not unusual for DID patients to have alters of different
    genders, sexual orientations, ages, or nationalities.
  • The average DID patient has between two and 10 alters. It is frequently associated with the
    Lost Child Syndrome (also see Dysfunctional Families Children’s ROLES page on this site:
    related articles are “Post Traumatic Stress” and “Dissociative Disorder”)

Causes and symptoms
The severe dissociation that characterizes patients with DID is currently understood to result from a
set of causes:
•        An innate ability to dissociate easily
•        Repeated episodes of severe physical or sexual abuse in childhood
•        The lack of a supportive or comforting person to counteract abusive relative(s)
•        The influence of other relatives with dissociative symptoms or disorders

The relationship of dissociative disorders to childhood abuse has led to intense controversy and
lawsuits concerning the accuracy of childhood memories. The brain's storage, retrieval, and
interpretation of childhood memories are still not fully understood.

The major dissociative symptoms experienced by DID patients are amnesia, depersonalization,  
derealization, and identity disturbances.

Amnesia: Amnesia in DID is marked by gaps in the patient's memory for long periods of their  
past, in some cases, their entire childhood. Most DID people have amnesia, or "lose time," for  
periods when another personality is "out." They frequently 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.

Depersonalization: Depersonalization is a dissociative symptom in which the person feels that  
his or her body is unreal, is changing, or is dissolving. Some DID individuals experience
depersonalization as feeling to be outside of their body, or as watching a movie of themselves.

Derealization: Derealization is a dissociative symptom in which the person perceives the external
environment as unreal. Some may see walls, buildings, or other objects as changing in shape, size,
or color. DID patients may fail to recognize relatives or close friends.

Identity disturbances: Identity disturbances in DID result from the individual's having split off
entire personality traits or characteristics as well as memories.
  • When a stressful or traumatic experience triggers the re-emergence of these dissociated parts,
    the person switches -- usually within seconds -- into an alternate personality. Some have
    histories of erratic performance in school or in their jobs caused by the emergence of alternate
    personalities during examinations or other stressful situations.
  • People vary with regard to their alters' awareness of one another.

Diagnosis: The diagnosis of DID is complex and some physicians believe it is often missed, while
others feel it is over-diagnosed. People 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
individual is in the mental health care system for six to seven years before being diagnosed as a
person with DID.

Many DID people are misdiagnosed as depressed because the primary or "core" personality is
subdued and withdrawn, particularly in females. However, some core personalities, or alters, may
genuinely be depressed, and may benefit from antidepressant medications. One reason
misdiagnoses are common is because DID individuals may truly meet the criteria for panic disorder
or somatization disorder.

DID people 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.


Treatment
Treatment of DID may last for five to seven years in adults and usually requires several different
treatment methods.

Psychotherapy: Ideally, individuals with DID should be treated by a therapist specializing in
dissociation. Most therapists who treat multiples, or DID people, recommend further treatment after
personality integration, on the grounds that the individual 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 the person's family understand DID and
the changes that occur during personality reintegration.
Many DID people are helped by group as well as individual treatment.


Medications: Some doctors will prescribe tranquilizers or antidepressants for DID people, other
therapists 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. 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.


Prognosis: 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. As a
general rule, the earlier the patient is diagnosed and properly treated, the better the prognosis.


Prevention: Prevention of DID requires intervention in abusive families and treating children with
dissociative symptoms as early as possible.


Key Terms
Alter:
An alternate or secondary personality in a patient with DID.

Amnesia: A general medical term for loss of memory that is not due to ordinary forgetfulness.
Amnesia can be caused by head injuries, brain disease, or epilepsy as well as by dissociation.

Depersonalization: A dissociative symptom in which the patient feels that his or her body is
unreal, is changing, or is dissolving.

Derealization: A dissociative symptom in which the external environment is perceived as unreal.

Dissociation: A psychological mechanism that allows the mind to split off traumatic memories or
disturbing ideas from conscious awareness.

Dissociative identity disorder (DID): Term that replaced Multiple Personality Disorder (MPD). A
condition in which two or more distinctive identities or personality states alternate in controlling a
person's consciousness and behavior.

Hypnosis: An induced trance state used to treat the amnesia and identity disturbances that occur in
dissociative identity disorder (DID).

Multiple personality disorder (MPD): The former, though often still used, term for dissociative
identity disorder (DID).

Primary personality: The core personality of an DID patient. In women, the primary personality
is often timid and passive, and may be diagnosed as depressed.

Trauma: A disastrous or life- threatening event that can cause severe emotional distress. DID is
associated with trauma in a person's early life or adult experience.


Books
  • "Dissociative Disorders." In Diagnostic and Statistical Manual of Mental Disorders. 4th ed.
    Washington, DC: The American Psychiatric Association, 1994.
  • Eisendrath, Stuart J. "Psychiatric Disorders." In Current Medical Diagnosis and Treatment,
    1998. 37th ed. Ed. Stephen McPhee, et al. Stamford: Appleton & Lange, 1997.
  • Napier, Nancy J. Getting Through The Day: Strategies for Adults Hurt as Children. New York:
    W. W. Norton & Co., 1994.
  • Nemiah, John C. "Psychoneurotic Disorders." In The New Harvard Guide to Psychiatry, ed.
    Armand M. Nicholi Jr. Cambridge, MA: The Belknap Press of Harvard University Press, 1988.
  • Noll, Richard. The Encyclopedia of Schizophrenia and the Psychotic Disorders. New York: Facts
    On File, 1992.
  • Pascuzzi, Robert M., and Mary C. Weber. "Conversion Disorders, Malingering, and Dissociative
    Disorders." In Current Diagnosis. Vol. 9. Ed. Rex B. Conn, et al. Philadelphia: W. B. Saunders
    Co., 1997.
  • van der Kolk, Bessel A., and Onno van der Hart. "The Intrusive Past: The Flexibility of Memory
    and the Engraving of Trauma." In Trauma: Explorations in Memory, ed. Cathy Caruth.
    Baltimore: The Johns Hopkins University Press, 1995.
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