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Dissociative Identity Disorder


DID is usually the result of sexual or physical abuse during childhood. Sometimes it develops in response to a natural disaster or other traumatic events like combat. The disorder is a way for someone to distance or detach themselves from trauma.




Dissociative Identity Disorder



Some medications may help with certain symptoms of DID, such as depression or anxiety. But the most effective treatment is psychotherapy. A healthcare provider with specialized training in mental health disorders, such as a psychologist or psychiatrist, can guide you toward the right treatment. You may benefit from individual, group or family therapy.


Treatment can also help identify triggers that cause personality or identity changes. Common triggers include stress or substance abuse. Managing stress and avoiding drugs and alcohol may help reduce the frequency of different alters controlling your behavior.


There is no cure for DID. Most people will manage the disorder for the rest of their lives. But a combination of treatments can help reduce symptoms. You can learn to have more control over your behavior. Over time, you can function better at work, at home or in your community.


Dissociative identity disorder (DID), previously named multiple personality disorder and commonly referred to as split personality disorder or dissociative personality disorder, is a member of the family of dissociative disorders classified by the DSM-V, DSM-V-TR, ICD 10, ICD 11, and Merck Manual for diagnosis. Dissociative identity disorder is characterized by primarily dissociative disorder symptoms, secondary key symptoms are shared with complex PTSD, borderline and schizotypal personality disorders and tertiary key symptoms are shared with fibromyalgia, sleep disturbances, eating disorders, and body dysmorphic symptoms. Personality states alternately show in a person's behavior; however, presentations of the disorder vary. Dissociative identity disorder is usually caused by excessive and unendurable stress and or trauma, which commonly happens in childhood. The sense of a unified Identity develops from a variety of experiences and sources. In a child who is overwhelmed, the factors that should have blended together or become integrated overtime instead remain separate. Childhood adversity and abuse often leads to the development of dissociative identity disorder, but not exclusively.


Dissociative identity disorder (DID) is a member of the family of dissociative disorders classified by the DSM-IV, DSM-V-TR, ICD 10, ICD 11, and Merck Manual. There are sources claiming DID can't form after childhood, and that Dissociative Identity Disorder is childhood trauma exclusive but there is disagreement about that.


The DSM, ICD and Merck Manual do not state that Dissociative Identity Disorder is trauma exclusive or childhood trauma exclusive. DID commonly arises due to childhood trauma but not exclusively. "The disorder may begin at any age, from early childhood to late life."- Merck Manual[23][24]


Dissociative Identity Disorder is more difficult to develop in someone older. It is more likely for adults to develop CPTSD, adjustment disorders, BPD and/or StPD because the mind is less fragile, they have a better integrated self-perception and identity, and their attachment style is more stable, as it is claimed. It is still largely unclear why the brain processes trauma into dissociative disorders, trauma disorders, [adjustment disorders], and personality disorders.[25] People are more likely to develop DID because of factors such as stressors, attachment disturbances, and trauma, especially when they occur during early development, which is why childhood trauma is so common among DID patients.


DID requires an unintegrated mind to form. Genetic and biological factors are also believed to play a role.[15][31][a] The diagnosis should not be made if the person's condition is better accounted for by substance use disorder, seizures, other mental health problems, imaginative play in children, or religious practices.[6]


Dissociative identity disorder (DID), formerly known as multiple personality disorder or multiple personality syndrome,[32] is a mental disorder characterized by the presence of at least two distinct and relatively enduring personality states.[6]


There is no medication to treat DID as there are for other mental disorders.[37] Treatment generally involves supportive care and psychotherapy.[14] The condition usually persists without treatment.[14][38] It is believed to affect about 1.5% of the general population (based on a small US community sample) and 3% of those admitted to hospitals with mental health issues in Europe and North America.[6][22] DID is diagnosed about six times more often in women than in men.[15] The number of recorded cases increased significantly in the latter half of the 20th century, along with the number of identities reported by those affected.[15]


Hypnosis should be carefully considered when choosing both treatment and provider practitioners because of its dangers. For example, hypnosis can sometimes lead to false memories and false accusations of abuse by family, loved ones, friends, providers, and community members. Those who suffer from dissociative identity disorder have commonly been subject to actual abuse (sexual, physical, emotional, financial) by therapists, family, friends, loved ones, and community members.[39][40]


A large number of diverse experiences have been termed dissociative, ranging from normal failures in attention to the breakdowns in memory processes characterized by the dissociative disorders. It is therefore unknown if there is a commonality between all dissociative experiences, or if the range of mild to severe symptoms is a result of different etiologies and biological structures.[41] Other terms used in the literature, including personality, personality state, identity, ego state, and amnesia, also have no agreed upon definitions.[42][43] Multiple competing models exist that incorporate some non-dissociative symptoms while excluding dissociative ones.[42]


According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), symptoms of DID include "the presence of two or more distinct personality states" accompanied by the inability to recall personal information beyond what is expected through normal memory issues. Other DSM-5 symptoms include a loss of identity as related to individual distinct personality states, loss of one's subjective experience of the passage of time, and degradation of a sense of self and consciousness.[47] In each individual, the clinical presentation varies and the level of functioning can change from severe impairment to minimal impairment.[48][14] The symptoms of dissociative amnesia are subsumed under a DID diagnosis, and thus should not be diagnosed separately if DID criteria are met.[6] Individuals with DID may experience distress from both the symptoms of DID (intrusive thoughts or emotions) and the consequences of the accompanying symptoms (dissociation rendering them unable to remember specific information).[49] The majority of patients with DID report childhood sexual or physical abuse.[50][51] Amnesia between identities may be asymmetrical; identities may or may not be aware of what is known by another.[14] Individuals with DID may be reluctant to discuss symptoms due to associations with abuse, shame, and fear.[50] DID patients may also frequently and intensely experience time disturbances.[52]


The psychiatric history frequently contains multiple previous diagnoses of various disorders and treatment failures.[53] The most common presenting complaint of DID is depression, with headaches being a common neurological symptom. Comorbid disorders can include substance use disorder, eating disorders, anxiety disorders, bipolar disorder, and personality disorders.[36][54][55][56] A significant percentage of those diagnosed with DID have histories of borderline personality disorder and post-traumatic stress disorder (PTSD).[57] Presentations of dissociation in people with schizophrenia differ from those with DID as not being rooted in trauma, and this distinction can be effectively tested, although both conditions share a high rate of dissociative auditory hallucinations.[58][59] Other disorders that have been found to be comorbid with DID are somatization disorders, major depressive disorder, as well as history of a past suicide attempt, in comparison to those without a DID diagnosis.[60] Individuals diagnosed with DID demonstrate the highest hypnotizability of any clinical population.[49] Although DID has high comorbidity and its development is related to trauma, there exists evidence to suggest that DID merits a separate diagnosis from other conditions like PTSD.[61]


DID is etiologically complex.[63][64] Şar et al. state, "Dissociative identity disorder (DID) is multifactorial in its etiology. Whereas psychosocial etiologies of DID include developmental traumatization and sociocognitive sequelae, biological factors include trauma-generated neurobiological responses. Biologically derived traits and epigenetic mechanisms are also likely to be at play. At this point, no direct examination of genetics has occurred in DID. However, it is likely to exist, given the genetic link to dissociation in general and in relation to childhood adversity in particular."[31] Stating that there is "a lack of understanding regarding the etiopathology of DID", Blihar adds that "many researchers and psychiatrists regard DID as the most severe form of a childhood onset post-traumatic stress disorder (PTSD) because it is virtually impossible to find a DID patient without a history of PTSD. ... There are currently two competing theories regarding the relationship between trauma and dissociation: the trauma-related model and the fantasy-prone model."[64]


Severe sexual, physical, or psychological trauma in childhood has been proposed as an explanation for its development; awareness, memories and emotions of harmful actions or events caused by the trauma are removed from consciousness, and alternate personalities or subpersonalities form with differing memories, emotions and behavior.[67] DID is attributed to extremes of stress or disorders of attachment. What may be expressed as post-traumatic stress disorder (PTSD) in adults may become DID when occurring in children, possibly due to their greater use of imagination as a form of coping.[49] 041b061a72


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