Monday, January 20, 2014

Multiple Personalities - DID

What most people know as Multiple Personality Disorder is now called Dissociative Identity Disorder (DID).

Yeah, I know. They went from a nice, simple name to a longer, more complicated one.

But there's a reason. Really. There is.

"Multiple Personalities" didn't actually describe what the disorder was; it left one to think that the individual's personality was split into pieces that, over time, became separate identities in their own rights.

But that's not how it works.

Dissociation is defined as "a detachment from or loss of integration (wholeness)
identity, memory, and/or consciousness." In the DSM (the Diagnostic and Statistical Manual of Mental Disorders), there is an entire group of disorders classified as "Dissociative." Because DID has to do with a loss of wholeness in both memory and identity, it is among them.

Julian Jaynes said "The unity of consciousness is an illusion. Man does more than one thing at a time--all the time--and the conscious representation of these actions is never complete." He's right. Being multi-channeled is a part of life. It keeps us going, makes us efficient, keeps our thoughts organized, helps filter out what we need to remember from what we don't, etc.

In other words, we all have dissociation at times: Here are some examples:

  1. Zoning out during class
  2. Not remembering what you just read...even after reading it three times
  3. Not knowing what time it is after looking at the clock multiple times in a row
  4. Driving on autopilot
  5. Staring at someone who's talking but not hearing a word he/she is saying
But what if
You come back from "zoning out" and you're not even in the same room as before.
You look down and your book is open 25 pages father along than you remember and has been scribbled in. 
You think you've been driving on autopilot...yet you're safely at a destination that you didn't plan on going to.
You go somewhere and there are people who come to talk to you but they're calling you by a different name.
You find items in your home that aren't yours and you have no recollection of buying them...but when you look at your account, they were purchased on your card.

If this happens, you may have DID.

The official DSM criteria are as follows:

  1. The obvious: Two or more distinct identities must be present
    1. Each identity must have a consistent and separate pattern of perceiving and thinking about both self and the surrounding environment.
  2. At least two identities take control of the person's behavior on a regular basis
  3. There is an inability to recall important personal information that cannot be attributed to everyday forgetfulness
  4. The symptoms are not due to any biological or other natural cause
Now for some quick fun facts about the disorder:
  1. The alters (individual identities) generally range in number from 2-100.
    1. The average number usually found in a person with DID is 15.
  2. Some alters are aware that others exist while most don't know that there are any others with them.
  3. Most of the time, there is a host identity (usually not the original person) who is aware of most of the other identities and tries to keep things as organized as best he/she can.
  4. For the most part, those who have it function as normal people; Hollywood really over-exaggerates everything about it.
Each alter has very specific defining characteristics:
When people with DID have consented to have an MRI done, the psychiatrists who are working with the person will ask the host to "please go and get __________ to come talk to us." As a new identity takes the stage, the MRI scanner records changes in eye condition (near-sighted to perfectly normal vision), brain activity in certain areas, etc.

In other words, this really is a completely separate identity.

So, what causes this beast?

There are two dominant theories speculating on a cause--and only one of them actually makes sense. 

The one that doesn't make sense:
The False Interpretation/False Memory Theory

Because is has been confirmed that those with DID are generally more susceptible to suggestion, this theory basically says that DID is caused by suggestion, hypnosis, or something that happened during a therapy process. In other words, DID doesn't really's just false memory implantation.

This theory used to be widely-held because many people on trial for murder or some other terrible thing would say that his/her "other personality" did it. But since MRI scanning to study DID has become so common, you can't really get away with that anymore.

Some people say that this theory might be true due to a higher rate of diagnosis among certain circles of psychologists/psychiatrists. But here's the thing: while mental health professionals have a general knowledge of disorders, they usually specialize in treatment of a certain type. Therefore, someone specializing in treatment of eating disorders would have a higher diagnosis rate of...eating disorders. go figure. The same goes with DID. Those who diagnose DID specialize in treatment for it. Thus, the fact that they diagnose it at a higher rate than others should be common sense.

The one that does make sense:

The Trauma/Abuse Theory

It's no secret that severe trauma can cause serious problems later in life. A very high percentage of those with DID (85-97%) report severe abuse as a child. Thirty-eight percent of severely sexually abused people with DID do not remember documented abuse (as in, abuse situations that were on official hospital records). This theory says that DID may be a protective mechanism that the human body develops as a result of abuse when the person has no support system. It's called betrayal trauma:

Trauma/abuse is played off by the perpetrator to be normal, yet it's done in secret, it's inescapable, repeated, and you have no support because it's happening from people that are supposed to be supporting you; people that you are supposed to be able to go to for help. So, the only thing left for your mind to do to protect you is develop an alternate identity who comes out during the abuse so "you" don't have to be there.
Other interesting fact: someone who is ultimately diagnosed with DID will be in the mental health system for an average of seven years before a confident diagnosis is made. Like schizophrenia, DID is not just diagnosed on the fly. The therapists have to be sure that DID is what they're dealing with. Many times, it's misdiagnosed because the symptoms are so similar to schizophrenia, bipolar, and other dissociative-type disorders.

But wouldn't it be obvious that it's DID if someone's personality were changing all the time?

Actually, no. Generally speaking, the personality is not changing all the time. The alters only come out in certain places/situations. They were created as defense mechanisms; they're not just going to come out and say hi.

Since 85-97% of DID clients reported severe childhood abuse, it stands to reason that therapy is the only course of action to treat DID; if the alters were created as a result of trauma, one must come to terms with the trauma in order to re-integrate the alters into the original person. A medicinal prescription won't resolve past problems. But with DID, therapy's not always the easiest thing; all of the alters need to be aware of the therapy sessions. I mean, if you made a therapy appointment your alters didn't know about, what would happen if the time came for the appointment and one of the alters were on stage? Answer: the client doesn't show up. To get around this, the therapist will generally have the host leave reminder notes around the house for the others.

During therapy, the therapist may give the person a journal that is intended for everyone to write in. As time goes by, the different alters write in the journal (the child alters--if any--may color in it), everyone gets to know each other, and continuity within the person can begin because the therapist now has a source of learning why each alter exists.

Sometimes, it's only through an alter that the source of the trauma is discovered. As I mentioned before, alters are usually created as defense mechanisms to avoid being mentally present at a traumatic event. Many times, the original person doesn't have any set memories of whatever happened...but an alter does. 

In reality, a therapist treating one person for DID may actually have anywhere from 2-100 clients all in the same body. Trust has to be established between the therapist and each individual alter in order for therapy to work. That's hard work and any therapist who takes that on deserves a ton of respect for what he/she does.

On the up side

Having alters isn't always a bad thing. There is a case study of a man who wanted to be a cop, but he was absolutely petrified of guns. Because the fear was so intense, he developed an alter who was a sharp-shooter. This alter came out only when the man needed to use his gun (be it only aiming or actually firing). When the gun went back into the holster, the alter went back as well.

For those who have a little more time to read, here's a story of a women with 20 alters who has learned to make the best of her situation. Most of her alters existed by the time she was five years old, so integration into the "original person" is next to impossible; she's been changing personalities since such a young age that experts have a hard time knowing which alter is the "original." Her host alter and currently, the dominant personality, is Patricia. It's mostly from her that the quotes in the article are given. Read about it here.

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