1. Diagnosis and Treatment of Dissociative Identity Disorder
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Samantha Bryan, MSW Candidate
GRC MSW Program
Abstract
Dissociative Identity Disorder (DID) is considered by the general public and mental health field to be a controversial diagnosis. Published, peer reviewed articles were reviewed concerning the diagnosis, history, theories, and treatment of DID. The diagnosis of DID is to be considered the most severe form of dissociative disorders. This is where clients go into dissociative states but also have alternate identities. The alternate identities (alters) have their own personality traits. The theories and treatments of DID have changed from the first written accounts in Those who are diagnosed went from being called hysterics in the 19th century, multiple personality disorder in the 1980’s, to currently DID. Some research indicated that DID is caused by early childhood, complex trauma; while others believe that DID is more fantasy based with those diagnosed being highly susceptible to influence. Treatment for DID has been found to minimize symptoms and in some cases help those diagnosed integrate personalities through building report and the therapeutic process.
History
Alters
Diagnosis
1586: First published cases of DID
19th Century: DID patients were considered to be hysterics
1980’s – Called Multiple personality Disorder; average 2-3 alters; took approximately 7 years in treatment to be diagnosed
1990’s to Current – Called DID; Posttraumatic and Socio-cognitive theories; approximately 7 years in treatment to be properly diagnosed; average is 13 alters; looking for best treatments
Alters are the alternate identities that take temporary control of the body, mind, behaviors of a single person. They present with different behaviors, thought processes, perception, and a sense of their own will.
Trauma-related: remember and protect the host from the past trauma
Trauma-neutral: remembers some of the trauma
Trauma-avoidant: either do not remember the trauma or try to avoid it
Possession-form: the alter’s behaviors “appear as if a ‘spirit’, supernatural being, or outside person has taken control
The presence of two or more distinct personality states or an experience of possession and recurrent episodes of amnesia
Cause a clinically significant distress in the patient’s social, occupational, or other areas of functioning
Belief the symptoms are a disturbance not accepted as part of their culture or religious group.
Symptoms cannot be contributed to substance use or any other medical condition
Amnesic Dissociation: is the inability to recall autobiographical information. Amnesic can manifest by having gaps in memory of personal events, leaps in dependable memory, and finding they do not recollect doing everyday activities
Theories
Treatments
Posttraumatic Verse Socio-cognitive: one argues DID is a coping mechanism due to complex trauma while the other argues DID is based off influence of society. They often have aspects of each other.
Cognitive: brake down in memory encoding and retrieval between alters. Memory and a sense of self collapse as these alters are essentially originated from the memories for them.
Neurobiology: Identifying neurobiological pathways; aspects of brain functioning and growth are considered as cause and or effect
The patient should be seen as a whole person and be responsible as a whole person for behaviors during any time. Treatment should include identities when they appear but not take away from the whole person.
Herman Model: three stages to work with trauma; use with other therapeutic models; therapeutic relationship
Cognitive Behavior Therapy: modifying dysfunctional emotions, behaviors, and thoughts
Eye Movement Desensitization and Reprocessing (EMDR): intended to change the way that the memory is stored in the brain
Dialectical Behavior Therapy: change patterns of behavior that are not helpful, such as self-harm, suicidal ideation, and substance abuse
References
See reference list