Disassociative Personality Disorder - Causes & Treatment

What is Dissociative Identity Disorder?

Dissociative Identity Disorder is a complex psychological condition that is becoming prevalent in people with time. It can be caused due to many factors, which may include traumatic events experienced during childhood. According to American Psychiatric Association (APA), the dissociative identity disorder definition states:

“It is a type of mental illness that can be characterized by alternating between multiple personalities.”

DID is commonly known as multiple personality disorder that involves disruption or breakdown of perception, identity, or memory. People from all age groups, socioeconomic backgrounds, and ethnicity can experience DID. Around 75% of people experience at least one episode of DID in their life.

What are the symptoms of Dissociative Identity Disorder?

DID is usually characterized by the presence of two or more split or distinct personalities or identities. These states have continuous power over the behavior of a person. There is also an inability to remember or recall key personal information. Other common Dissociative Identity Disorder symptoms may include:

• Depersonalization or derealization
• Feeling disconnected from one’s own self or lack of sense of self-identity
• Depression or mood swings
• Substance abuse
• A sense of detachment from emotions
• Out of body experiences
• Eating and sleeping problems
• Anxiety, depression, suicide attempts
• Severe headache or pain in other body parts
• Significant memory loss of certain people, events, or time
• Change in level of functioning
• Feeling dissociation from the surrounding environment.
• Self-injurious behavior

Not every person experience DID the same way; for some people, different identity states have their own age, sex, or race. Each has a distinct way of talking, its own gestures, and postures. Usually, the alters are imaginary people, but sometimes they are animals or some other species. According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), DID influence a person’s lives in the following ways:

• Derealization: It is a mental state in which a person feels disconnected from the surroundings. People, objects, the world, and everything looks unreal, foggy, or far away.
• Depersonalization: It is a feeling when a person experiences disconnectedness or detachment from one’s own body and feelings. It is usually referred to as an “Out-of-body” experience.
• Dissociative Amnesia: It is referred to as memory loss or unable to create new memories. People cannot recall significant personal information, everyday events, places, or people.
• Identity Confusion or Alteration: It includes a sense of confusion about who a person is. It also involves the feeling of having multiple or alternative identities.

The signs of DID completely depend on the type of dissociative disorder a person is experiencing. However, it is mostly associated with childhood trauma and is believed to be the main cause of DID.

Dissociative Identity Disorder Examples

DID is both an old and new personality disorder associated with overwhelming experiences or traumatic events. Usually, people with DID have split or multiple personalities. However, some people may not be aware of other personalities or remember the times when the other one is dominant. Examples of dissociative identity disorder include:

• People find themselves doing something they would not normally do, such as stealing, speed driving, and feeling compelled to do it.
• Not having control over the behavior.
• People have trouble defining the things they have an interest in. For example, professional ambitions, sexual orientation, or views about religion or politics, etc.
• Some people experience distortion in situations, places, and time.
• Losing touch with the awareness of immediate surroundings, people, or events.
• Getting lost in a movie as if they are playing a character in a movie.
• Some people experience highway hypnosis, or they daydream about anything.
• Change in personal preference or attitude towards clothes, activities, food, etc.
• People become observers of their own actions or speech.
• Some experience that their bodies feel different, like having a huge and muscular body, opposite gender, or feel like a child.

These examples are commonly observed in people with DID. It has also been observed that a person with DID does not have control over their behavior. However, these behaviors and identities are unwanted and occur involuntarily while causing distress.

More often, DID causes discomfort and problems in work and personal relationships and creates chaotic life. But in some cases, it brings benefits for people in particular situations, for example:

• A shy or introverted person may use a more assertive alter to negotiate or a contract.
• People who have social anxiety may meet people repeatedly with an ‘alter’ personality.
• A person who forgets bad memories and experiences does not remember anything bad that happened to him in the past.

Each of the ‘alter’ personalities controls a person’s thoughts and behavior. It is also called “Switching”, which means becoming one person to another. It may take seconds to minutes to days and so on.

What Causes Dissociative Identity Disorder?

People do not have enough information about DID, and they have several questions about it. Do some people ask what type of abuse causes dissociative identity disorder? And some usually ask what kind of trauma leads to dissociative disorder? Below we have tried to answer all of your concerns and queries about DID.

There are not so many causes of dissociative identity disorder. However, it is usually associated with continuous and repetitive traumatic experiences. It mostly forms in children exposed to long-term sexual, physical, or emotional abuse. The traumatic events can be associated with war, natural disaster, or accidents.

A history of trauma is a key feature of DID, and about 90% of the cases have a history of abuse. Prolonged isolation, an early loss of an important person, such as parents, may also be the causes of developing DID.

People with dissociative identity disorder dissociate themselves from their surrounding environment, situation, and people. This dissociation is considered a coping mechanism that a person uses to disconnect from a traumatic or stressful situation. It may also be for separating normal awareness from traumatic memories. It is a way for people to create distance from an awareness of surroundings or disconnect themselves from the outside environment.

Dissociation can serve as a defense mechanism against the pain of the stressful or traumatic experience and physical or emotional abuse. A person can maintain a healthy level of functioning by dissociating from painful memories, as though trauma has never occurred. But, DID episodes can be triggered by various symbolic or real traumas, including reminders of childhood abuse, stress, illness, or accident.

How to Diagnose Dissociative Identity Disorder?

Diagnosing dissociative identity disorder is hard, and it takes a lot of time. According to research estimation, a person spent approximately 7 years in the mental health system before an accurate diagnosis. This is because the symptoms of DID are very similar to many other mental health problems.

In fact, people who have DID usually have coexisting anxiety, depression, or a borderline personality disorder with dissociatives. However, the following criteria are defined by DSM-5 for the diagnosis of DID:

• Physical examination and evaluation of complete medical history are required.
• No laboratory test can possibly diagnose DID, but various diagnostic tests can help rule out medical side effects or physical illness. It may include MRIs, CT scans, X-rays, and blood tests.
• Two or more different personality states should be present, each having its own pattern of thinking and perception of the surrounding.
• Amnesia must occur.
• Having trouble with everyday functioning because of DID. The discomfort or disturbance should not be something part of religious or cultural practices.
• The symptoms should not be due to any physiological effects of a substance like alcohol.
• Also, ensure that the signs are not of any general medical condition like complex seizures.

However, the distinct personality symptom provides a better and clear insight in diagnosing DID than any other symptom. That is why it has given the most important in the diagnosis mechanism.

What Treatments are available for Dissociative Identity Disorder?

Since there is no complete cure available for DID, long-term treatment can be beneficial if the patient shows commitment. The goal is to relieve symptoms, ensure the patient’s safety and the people around him. Treatment also aims to reconnect the distinct personalities into one well-functioning and integrated identity.

Moreover, no formal or evidence-based guidelines are currently available to treat DID. All treatments are based on case reports, and few of them are even controversial. However, with appropriate treatment, many people successfully report symptoms, improve daily function, and live a productive life. The treatment can also improve optimal functioning, relationships, life hacks, and the ability to express and process painful memories.

The best treatment plan entirely depends on the individual, severity of symptoms, and identifiable triggers nature. The most effective treatment involves the combination of therapies and medication.

Therapy Treatment

Therapies are the effective treatment for any kind of mental health problem, so is for the DID. It helps people to have control over the symptoms and dissociative process. The therapy could be difficult and intense as it involves remembering and coping with the traumatic event experienced in the past. The following therapies are commonly used for DID:

• Psychotherapy: Psychotherapy or talk therapy is the main therapy treatment used for DID. It is designed to identify what triggered and triggers DID and to control them.
• Cognitive Behavioral Therapy: It is focused on improving dysfunctional behavior, feelings, or thinking patterns. It is also commonly known as a type of psychotherapy.
• Dialectical Behavioral Therapy (DBT): It is another form of psychotherapy used to treat symptoms occurring after trauma or abuse.
• Eye Movement Desensitization and Reprocessing (EMDR): It is another type of psychotherapy. It was originally designed to reduce distress attached to traumatic memories. It is mostly used to treat Post-Traumatic Stress Disorder (PTSD), persistent flashbacks, and nightmares.
• Hypnotherapy: Hypnotherapy or Clinical hypnosis is usually used in conjunction with psychotherapy. It uses intense concentration and attention to get into an altered state of consciousness. The aim is to explore repressed memories, feelings, or thoughts that might not be present in their conscious mind.
• Adjunctive Therapy: Adjunctive is a supplement added to something, which means it assists the primary treatment. Art or movement therapies help people connect the shut-off pieces of their minds to cope with trauma.
• Family Therapy: This therapy is basically designed for the patient’s family members. The aim is to teach them about the disorder, recognize symptoms, and how they can help their loved ones.
• Creative Therapy: Creative therapies usually include music therapy or art therapy. They are designed to help an individual explore and express his feelings and thoughts in a safe and creative environment.
• Meditation and Relaxation Techniques: Yoga, breath focus, mindfulness meditation are some techniques used to reduce DID symptoms. These techniques help people become aware of their internal state and tolerate the dissociative symptoms.

Medication

There are no established medications to treat DID, which makes therapy treatment the mainstay. However, anti-anxiety or antidepressant medicines or medication used for other disorders like depression and anxiety can be used for DID. But, these medicines are only effective when given with the therapy.

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