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Dissociative Identity Disorder (DID) Brianna Cole

Introduction ❖ What is dissociative Identity Disorder? ❖ Prevalence

● What is Dissociative Personality Disorder? ❖ Dissociative identity disorder,(D.I.D) is a dissociative disorder characterized by: ❖ Having two or more separate personalities and the capacity to manipulate the individual with D.I.D. (Murray, 1994;Kluft 1999) ❖ Amnesia

Dissociative Identity Disorder is a rare condition in which individuals experience two or more different personalities that live inside of them. Some people actually describe this illness as being possed. Most of these individuals experiencing DID often have memory loss that causes them to not remember any other personality taken control over them. When in control, each personality state, or alter, may be experienced as if it has a distinct history, self-image and identity.

Prevalence Women are five times more likely than males to show symptoms of D.I.D., according to most experts. This is due to the fact that women are sexually assaulted at a higher rate than males. A DSM-III-R dissociative disorder of some type affects about 10% of the adult population. Pathologic dissociation appears to be a substantial cause of emotional distress in North America, with rates comparable to anxiety, mood, and substance abuse disorders. Dissociative disorders can no longer be classified as uncommon.

Part One: Biopsychosocial Considerations

Biological ❖ Most mental health professionals believe that the underlying cause of dissociative disorders is chronic trauma in childhood.

❖ A person experiencing DID, most likely had dissociative amnesia as well

❖ Dissociative amnesia is when a person can't remember the details of traumatizing events that they have gone through.

Dissociative Identity Disorder does not result from a chemical imbalance in the brain, and is not caused by faulty genes. It is simply caused by the traumatic events that happen to an individual throughout their childhood. Trauma in ones adulthood may also lead to DID, for example, PTSD.. An individual may be traumatized from a war, causing them to develop Dissociative Identity Disorder.

Psychological Dissociative Identity Disorder is caused by psychological/physical trauma with in children. Children will experience trauma throughout their entire childhood and not know what to do or are silenced by the abuse taken place that it makes them want to shut off everything causing them to experience DID. Dissociative Identity Disorder is known to affect the way in which we remember things. People with DID experience Distorted perception and anxiety.

The severity of the dissociative disorder in adulthood is directly related to the severity of the childhood trauma. Oftentimes children will go through so much trauma and pain throughout their short time on earth that it causes them to want to shut off their mind. Causing them to experience multiple personalities. When these children go through such pain and the abusers tell them what is right in the children's eyes isn't actually right, making it as though their reality isn't really what is right in front of them. These individuals start feeling that they are having partial control over their actions. These types of feelings can cause them to get detached from lives.

Social ❖ Dissociative identity disorder (DID) causes are virtually always thought to be environmental and, specifically, related to early-life trauma.( Tracy N.) ❖

the surroundings you grew up in, events that occurred, and relationships with family members and others. Dissociative identity disorders are thought to be caused by environmental influences.

Dissociative Identity Disorder stems from a psychological response to extreme environmental and interpersonal stressors, like the environment or people around that the individual grew up with. In order to survive and manage these stressors, the individual separates his or her thoughts, feelings, actions and memories associated with the traumatic experience from his or her usual level of consciousness.

Cultural Variation ❖ Dissociative Personality Disorder varies with the different cultures

the individual was raised in.

❖ It also depends on the different beliefs the individual and their family believes in.

❖ These different things can cause various outcomes when it comes to treatment and the different resources to use.

DID has been found in all of the countries that have studied different mental disorders. However DID has been known to be diagnosed at lower rates in countries that don't really diagnose mental illnesses. There has also been evidence found that possession disorders around the world are actually different manifestations of dissociative identity disorder. Another study has been found that possession experiences closely match DID in the DSM-5 through different symptoms such as, hearing voices, and talking in a voice attributed to “spirits”. So it really varies on the different cultures and how they handle this mental illness and the different reactions and ways of explaining the illness.

Treatment ❖ Most Treatment for DID involves: Talk therapy(Psychotherapy) to help the individual better understand their illness and how to cope with it. ❖ The different treatment plans should also aim to help with the co-occurring symptoms of DID like, PTSD, Anxiety & depression, suicidal thoughts and eating disorders.

When it comes to DID, there are no known medications that help with DID directly, but rather there are medications that help with the co-occurring illness that go hand and hand with DID. The few medications include: fluoxetine (Prozac) sertraline (Zoloft). However the main treatment known for DID, is Talk Therapy. which is talking with your therapist and gaining a better understanding the your illness and better ways to manage it in hopes to decrease the symptoms that go along with DID.

Community ❖ When an individual dealing with DID has the support of family, it is best that these family members and friends really take the time to study the illness and the ways of help that individual.

❖ Oftentimes a loved one will attend the support group and therapy meetings with the individual that has the illness, to make sure that they know they are supported and loved.

Making sure the individual has a safe and loving environment to turn to each day is crucial, and making sure you as a loved one knows all about the illness and how to help when a episode occurs. In order to really care for someone who has DID, you have to be patient and understand that the way the individual is reaction and the feelings they have is not being directed at you as a loved one. Although you can't shorten a episode, one way of treatment is to intervene immediately following a traumatic event.

Part Two: Diagnostic/Evaluative Considerations

Clinical Assessments ❖ DID is diagnosed by clinical observation ❖ DID consist of psychiatric symptoms some that are more severe than others. Causing personal suffering. ❖ Similarities between other mental illnesses causes for misdiagnosis.

Many times the signs and symptoms of Dissociative Identity Disorder are overlapped and thought to be another mental illness that is similar. For example, Hallucinations are expected to be experienced in both schizophrenia and DID. So one of the main challenges for DID is that it is commonly misdiagnosed especially for a clinician who isn't as experienced as the next. The good thing about Diagnosing DID, is all of the different assessments. The Different assessments can determine how severe your illness is and the different steps to take to treat it and help the individual feel better.

Reliability and Validity ❖ DID is based off of clinical features and not on standard approaches. ❖ 8 out of 9 cases of DID are reported to have been abused as children.

DID is based off of Clinical features, this happens to be a problem for other mental illnesses because some are based off of suggestion. One major support for DID as a traumagenic disorder is the strong association between DID and childhood trauma. DID patients have smaller hippocampal and amygdalar glands, something seen in those who were abused as children.

Diagnosis by Exclusion ❖ Ruling out other mental illness ❖ Other mental illnesses must be considered first before even putting in to question DID. ❖ Patients are estimated to spend up to 7 years getting tested and treated for other disorders before receiving the correct diagnosis.

Unlike other disorders, Dissociative Identity Disorder gets misdiagnosed quite often. This is because many other disorders coincide with DID. Schizophrenia being the main one. These two disorders share lots of the same symptoms, so it becomes really difficult to get a correct diagnosis on the first couple of times being tested for different disorders. When symptoms aren't as severe clinicians often miss it mistaking it for a disorder not as severe.

Assessments ❖ Assessments contribute to the process of exclusion by the different test run to make sure the diagnosis of DID is accurate. ❖ Schizophrenia needs to be ruled out. ❖ Borderline Personality disorder is another main one that has to be similar. ❖ Both of these Disorders experience the same symptoms as Dissociative Identity Disorder so it is crucial for these to be eliminated first.

A major difference between DID and Schizophrenia is that with Schizophrenia, individuals tend to hear voices from outside of the body whereas with DID you hear the voices within yourself as different personalities come out. This makes it easy to rule out Schizophrenia due to this major difference. However individuals that experience DID can also have borderline personality disorder. Not all individuals do but those who deal with both get treated for DID first due to the alternate personalities because it provides an avenue of therapy that is not available when treating the individual only as a whole.

Publication Process ❖ Improvements in assessments ❖ Understanding all of the different Disorders within the DSM

The DSM was designed as a way to gather information to help better understand Mental illness there have been many improvements in the different test run for all of the different mental illnesses and the DSM gives a good explanation of all the different disorders and they ways you can get the disorder, and the ways to treat and diagnose the disorder.

Part Three: Therapeutic Considerations

Therapeutic Approaches ❖ Talk therapy also known as (Psychotherapy)

❖ Therapists take the time to really understand you and the challenges that you face by paying attention to the words you use and the body language that you may have.

Psychotherapy is a professional relationship between a therapist and a client that is based on therapeutic principles, structure and technique. It differs from other relationships in several ways. This is a professional relationship and the only thing the therapist cares about is making sure that the individual is cared for and that someone is taking the time to listen. This therapy helps the individuals learn more about their disorder and the symptoms that happen along with it.

Non-Pharmacological Approaches ❖ Talk therapy

❖ Reassurance

❖ support

❖

A good resource that therapist go to is Hypnotherapy.

Most of the treatment for Dissociative identity disorder is non-pharmacological, as it deals with the mind and helping the individual cope with his illness and talking them through an episode or even just reassuring them that they are loved and supported even with having a severe illness like this one. Although hypnotherapy isn't a good source, it was successfully done once and cured a patient suffering from DID.

Duty to Treat ❖ Ethical obligation to treat each patient the same regardless of race, gender, disorder ❖ Respect to all of the patients privacy

Duty to treat and do no harm, means taking care each patients and respecting their wishes, being supportive and making sure that each individual gets the right care and equal care as any other patient should get regardless of race gender or the severity of their illness.

Conclusion ❖ its okay to ask for help when you notice changes within yourself. ❖ making sure the individual knows they are loved and support through every challenge dealing with their illnesses. ❖ Seeking the proper treatment and gaining an accurate diagnosis.

The main information that i want my audience to gain from my powerpoint is, when it comes to Dissociative Identity Disorder, making sure you are getting the best care and the right diagnosis is crucial for the patients overall wellbeing. It is also important to understand DID and all of the symptoms that can occur with it. Making sure that the individual takes care of themselves and knows when they need to ask for help is also important.

References ❖ Ross CA. Epidemiology of multiple personality disorder and dissociation. Psychiatr Clin North Am. 1991 Sep;14(3):503-17. PMID: 1946021.

❖ Şar V. (2014). The many faces of dissociation: opportunities for innovative research in psychiatry. Clinical psychopharmacology and neuroscience : the official scientific journal of the Korean College of Neuropsychopharmacology, 12(3), 171–179. https://doi.org/10.9758/cpn.2014.12.3.171

❖ Tracy, N. (2015, May 14). Causes of Dissociative Identity Disorder (DID). HealthyPlace. https://www.healthyplace.com/abuse/dissociative-identity-disorder/did-causes.

❖ Dissociative Identity Disorder Globally. DID Research. (n.d.). https://did-research.org/controversy/international.

Lebow, H. (2021, May 29). Dissociative Identity Disorder: Treatment and Recovery. Psych Central. https://psychcentral.com/disorders/dissociative-identity-disorder/treatment#psychotherapy. ❖ Gentile, J. P., Dillon, K. S., & Gillig, P. M. (2013). Psychotherapy and pharmacotherapy for patients with dissociative identity disorder. Innovations in clinical neuroscience, 10(2), 22–29.

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