Dissociative Identity Disorder - DID aka Multiple Personality Disorder - MPD

Dissociative Identity Disorder Introduction, Causes, Symptoms, Diagnosis and Treatment. Read less

1. DISSOCIATIVE IDENTITY DISORDER M.REETHUSHA PHARM D 2 ND YEAR GEETANJALI COLLEGE OF PHARMACY

2. INTRODUCTION Dissociative Identity Disorder (DID) also known as Multiple personality disorder (MPD) is a complex and rare mental disorder of ‘ multiple selves in a single body’. It is a psychological condition that involves the fragmentation of one’s identity, awareness, perception, and memory into different personality states known as ‘alters’. 

3. What is Dissociative Identity Disorder(DID)? Dissociative identity disorder (DID) refers to a mental condition when a person develops two or more noticeable identities or personalities. The individual often has a main or primary personality along with one or more alternate personalities. The primary identity of the person may be depressed, dependent or passive. The alternate personalities often ‘take control‘ of the individual and function with or without the main personality’s knowledge.  Although the primary identity carries the given name of the person, it fails to incorporate different aspects of the individual into a multidimensional, yet single self.

4. The alternative personalities or identities are referred to as alters. The n ames , gender, age, vocabulary and general knowledge of an alter may be completely different from the primary personality. Moreover, the alters also show distinct characteristics, preferences, attitudes, behaviours, moods, mannerisms, and ways of talking. It is believed that these alternative personalities take turns to be in control of the individual. H owever , when an ‘alter’ or even the main personality is not in charge, it completely detaches and dissociates. Hence, it can be completely unaware of the latest occurrences in the individual’s life. Research has found that specific triggers can cause different personalities (alters) to take control. These alters might not know about each other or the main identity, or they might be aware and even conflict with each other. However, these alters are not fully developed identities but parts of a fragmented personality.

5. Causes of Dissociative Identity Disorder (DID) Individuals with DID are usually victims of severe and repetitive abuse and trauma during early childhood, which the disorder acts as a coping mechanism against the trauma. T he transition to alternate personalities is involuntary, usually the person with the disorder is “not aware of the transition or has any memory of the event.” This means that people with DID may not consciously develop alternate personalities. DID may also be related to large-scale trauma, such as natural disasters or war. Familial, societal, and cultural factors can also contribute to trauma and influence the expression of DID. DID may result from significant disruptions to self-consciousness and internal conflict within a single self.

6. How DID can affect a person? Dissociative identity disorder can significantly change how an individual lives their lives. Here are some of the common ways to know how this psychological process affects a person: 1. Depersonalization - The sufferer feels a recurring sensation of being outside their body. Similar to an out-of-body experience, they have a sense of getting detached from their own physical body. 2. Derealization - The person gets a strong feeling that their surroundings or even the world around them is not real. They believe that whatever is happening with them or around them is fake or imaginary. 3. Dissociative amnesia - T he person experiences a deficit in memory or memory loss, which is not a result of a medical condition or injury. This is not similar to general forgetfulness. 

7. 4. Dissociative fugue - It is a certain episode of amnesia or memory loss. The person is unable to remember specific events or personal information for a period of time. They can also experience micro-amnesias and forget about a discussion or parts of a conversation immediately afterward. They may also detach from certain emotions. 5. Identity alteration/identity confusion - The person is generally confused about their own selves and their identity. They may suddenly become confused about their interests, career goals, sexual orientation, and perceptions about politics, religion, and society. They may also be confused about a particular situation, location and may even experience time distortions. 6. Blurred identities - T he person feels like multiple people are living inside them or multiple voices talking inside their head. They might even feel that they have been ‘possessed’ by one or more entities or identities.

8. SYMPTOMS People with dissociative identity disorder show various noticeable symptoms when they switch between alters at different times . DID shares several symptoms found in other mental conditions and disorders like trauma and PTSD. Some of the common symptoms of DID in adults include: -Exhibition of multiple personalities or alters -Feelings of dissociation & detachment  -Behaviour inconsistent with character (primary identity) -Anxiety, depression, panic attacks and mood swings -Sense of lost time -Confusion and disorientation

9. -Severe headaches -Pain in different parts of the body -Amnesia and gaps in memory  -Depersonalization  -Derealization -Hallucinations & delusions -Obsessive-compulsive symptoms -Psychotic symptoms -Different levels of functioning  -Changes in appetite and sleeping problems -Out of body experiences -Self-persecution and self-sabotage -Issues with sexual performance -Substance abuse -Self-injury related behaviours -Suicidal thoughts

10. However, the symptoms of DID may vary between adults and children. Symptoms of DID in children may include: -Dissociating or becoming unresponsive (zoning out). -Having recurring nightmares, frightening dreams & memories. - Triggering or mental distress to reminders of abuse & trauma. -Sudden physical reactions to memories related to trauma & abuse.  -Sudden unexpected and unparalleled changes in appetite, preferences, interests & activities.

11. DIAGNOSIS Diagnosis of dissociative identity disorder can be a complex and time-consuming procedure. DID is diagnosed in a very similar way as most other psychiatric diagnoses. The following criteria, laid down by the DSM-5, must be met by a person to be effectively diagnosed with this mental disorder: -The person must exhibit two or more distinct alters or personality states or identities. Each alter must have their own separate pattern of “perceiving, relating to, and thinking about the environment and self.”

12. -There should be noticeable changes in self-identity and control, affecting thoughts, consciousness, memory, movement, behavior, and perception. -The condition should cause significant distress or problems in important life areas like social, personal, or work-related activities. -The individual should experience recurring memory gaps, making it difficult to recall daily events, personal information, or traumatic experiences. -The experience or distress should not be a part of the religious or cultural practices, like spiritual possession. - The symptoms of DID should not be due to the direct impact of substance abuse, like alcohol or drugs, or a medical condition.

13. Treatment options for DID Although there is no cure for dissociative identity disorder in the traditional sense, effective & dedicated treatment over a period of time can help the patient recover and get better. The objective of treatment is not to eliminate or get rid of the ‘alters’ or extra personalities, but to help the person identify the triggers for ‘switching’ and be prepared. This will help them live harmoniously with all the personalities, including the primary one. A mental health professional with significant experience with dissociative disorders can help an individual to integrate separate personalities into a single identity.

14. Doctors usually take a multiple stage approach for the treatment of DID: Stage 1 involves managing the symptoms and making the patient feel safe & secure. Stage 2 focuses on processing memories of abuse and trauma in a supportive & safe environment. Stage 3 focuses on integrating the different alters into a unified personality. Effective treatment options for dissociative identity disorder include the following: 1. Psychotherapy : Involves talking with a mental health professional to understand triggers and different personalities, aiming to combine the alters into one and reduce the impact of triggers.

15. 2. Adjunctive Therapy : Includes creative and cognitive therapies to help individuals connect with dissociated aspects of their identities and minds. 3. Hypnotherapy : Used alongside psychotherapy, it helps access repressed memories and integrate all alters into one. 4. Medications : Currently, no medications are available that can be specifically recommended for treating DID. However, a therapist might suggest some medications for associated and co-occurring mental disorders, like anxiety and depression. These medications are used along with psychotherapy. Some commonly suggested medications to help psychological symptoms associated with DID are: -Antidepressants: Imipramine, fluoxetine, desipramine. -Anti-anxiety drugs: Alprazolam, diazepam, chlordiazepoxide. -Antipsychotic medications: Chlorpromazine, aripiprazole, haloperidol. -Tranquilizers: Iproniazid, diazepam.  Studies have found that effective treatment over a long period of time has been known to help people with DID. Treatment can significantly improve their functional ability in their personal and professional lives. 

16. SUMMARY Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder, is a severe form of dissociation, a mental process where a person disconnects from their thoughts, feelings, memories, or sense of identity. DID is characterized by the presence of two or more distinct personality states or identities, each with its own pattern of perceiving and interacting with the world. These identities may have unique names, ages, histories, and characteristics. DID often arises as a response to severe trauma or abuse during early childhood, as a coping mechanism.

17. REFERENCES themindsjournal.com www.clevelandclinic.org www.mayoclinic.com

18. THANK YOU