Dissociative Identity Disorder or dissociation is a mental process in which a person’s thoughts and feelings may be separated from his or her immediate reality and may involve the recognition of parts or personalities that control the individual’s behavior at different times. Memory disruption, often referred to as amnesia or time loss, can happen during these episodes, with one part or personality holding that memory. Individuals with dissociative identity disorder can have two or more “parts”. This diagnosis has been formerly known as Multiple Personality Disorder.
As a mental health practitioner, I concur with the belief of many mental health practitioners and researchers that dissociation, or dissociative disorders exist on a continuum. This continuum of symptoms may range from mild instances that appear to be daydreaming to more complex dissociation that removes the individual from being wholly present in the moment and from functioning in social, work and home environments. Often people with DID are depressed or even suicidal, and self-mutilation is common in this group. Approximately one-third of patients complain of auditory or visual hallucinations. It is common for these patients to complain that they hear voices within their head.
According to the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (p. 529, 2000), Dissociative Identity Disorder (DID) is:
- The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
- At least two of these identities or personality states recurrently take control of the person’s behavior.
- Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
- The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures).
NOTE: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.
While the causes of DID are not entirely known, it is believed that the disorder stems from physical or sexual abuse in childhood. It is believed that children develop this disorder when during abusive situations they slip into dissociative states in order to remove themselves from the situation. If the abuse continues over time, it is believed that children may then begin to split into alter identities during these times of dissociation.
Treatment for DID consists primarily of psychotherapy with hypnosis, art therapy and narrative therapy can be combined in treatment. The therapist seeks to make contact with as many alters as possible and to understand their roles and functions in the patient’s life. In particular, the therapist seeks to form an effective relationship with any personalities that are responsible for violent or self-destructive behavior, and to curb this behavior. The therapist seeks to establish communication among the personality states and to find ones that have memories of traumatic events in the patient’s past. The goal of the therapist is to enable the patient to achieve breakdown of the patient’s separate identities and their unification into a single identity.
Individuals with DID have a great variety of symptoms, including depressive tendencies, anxiety, conduct problems, episodes of amnesia, difficulty paying attention in school, and hallucinations. The diagnosis can be difficult to identify in children, and often children are misdiagnosed as having schizophrenia. By the time the child reaches adolescence, it is less difficult for a mental health professional to recognize the symptoms and make a diagnosis of DID.
Information in this article has been provided from publications by NAMI, RAINN, “Image and Mirage: Art Therapy with Dissociative Clients” by Dee Spring.