The growing recognition of psychiatric conditions resulting from traumatic influences is a significant mental health issue of the 1990s. Until recently considered rare and mysterious psychiatric curiosities, Dissociative Identity Disorder (DID) (until very recently known as Multiple Personality Disorder - MPD) and other Dissociative Disorders (DD) are now understood to be fairly common effects of severe trauma in early childhood, most typically extreme, repeated physical, sexual, and/or emotional abuse.
In 1994, with the publication of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders-IV, Multiple Personality Disorder (MPD) was changed to Dissociative Identity Disorder (DID), reflecting changes in professional understanding of the disorder, which resulted largely from increased empirical research of trauma- based dissociative disorders.
Post-Traumatic Stress Disorder (PTSD), widely accepted as a major mental illness affecting 9-10% of the general population, is closely related to Dissociative Identity Disorder (MPD) and other Dissociative Disorders (DD). In fact, as many as 80-100% of people diagnosed with DID (MPD) also have a secondary diagnosis of PTSD. The personal and societal cost of trauma disorders [including DID (MPD), DD, and PTSD] is extremely high. For example, recent research suggests the risk of suicide attempts among people with trauma disorders may be even higher than among people who have major depression. In addition, there is evidence that people with trauma disorders have higher rates of alcoholism, chronic medical illnesses, and abusiveness in succeeding generations.
What Is Dissociation?
Dissociation is a mental process which produces a lack of connection in
a person's thoughts, memories, feelings, actions, or sense of identity.
During the period of time when a person is dissociating, certain
information is not associated with other information as it normally
would be. For example, during a traumatic experience, a person may
dissociate the memory of the place and circumstances of the trauma from
his ongoing memory, resulting in a temporary mental escape from the fear
and pain of the trauma and, in some cases, a memory gap surrounding the
experience. Because this process can produce changes in memory, people
who frequently dissociate often find their senses of personal history
and identity are affected.
Most clinicians believe that dissociation exists on a continuum of severity. This continuum reflects a wide range of experiences and/or symptoms. At one end are mild dissociative experiences common to most people, such as daydreaming, highway hypnosis, or "getting lost" in a book or movie, all of which involve "losing touch" with conscious awareness of one's immediate surroundings. At the other extreme is complex, chronic dissociation, such as in cases of Dissociative Identity Disorder (MPD) and other Dissociative Disorders, which may result in serious impairment or inability to function. Some people with DID(MPD)/DD can hold highly responsible jobs, contributing to society in a variety of professions, the arts, and public service. To co-workers, neighbors, and others with whom they interact daily, they apparently function normally.
There is a great deal of overlap of symptoms and experiences among the various Dissociative Disorders, including DID (MPD).Individuals should seek help from qualified mental health providers to answer questions about their own particular circumstances and diagnoses.
How Does DID(MPD)/DD Develop?
When faced with overwhelmingly traumatic situations from which there is
no physical escape, a child may resort to "going away" in his or her
head. This ability is typically used by children as an extremely
effective defense against acute physical and emotional pain, or anxious
anticipation of that pain. By this dissociative process, thoughts,
feelings, memories, and perceptions of the traumatic experiences can be
separated off psychologically, allowing the child to function as if the
trauma had not occurred. The different roles develop around personal conflicts; one might be shy, the other outgoing.
DID(MPD)/DD is often referred to as a highly creative survival technique, because it allows individuals enduring "hopeless" circumstances to preserve some areas of healthy functioning. Over time, however, for a child who has been repeatedly physically and sexually assaulted, defensive dissociation becomes reinforced and conditioned. Because the dissociative escape is so effective, children who are very practiced at it may automatically use it whenever they feel threatened or anxious -- even if the anxiety-producing situation is not abusive.
Often, even after the traumatic circumstances are long past, the left-over pattern of defensive dissociation remains. Chronic defensive dissociation may lead to serious dysfunction in work, social, and daily activities. Repeated dissociation may result in a series of separate entities, or mental states, which may eventually take on identities of their own. These entities may become the internal "personality states," of a DID(MPD) system. Changing between these states of consciousness is described as "switching."
What Are The Symptoms Of DID(MPD)/DD?
People with DID(MPD) may experience any of the following: depression,
mood swings, suicidal tendencies, sleep disorders (insomnia, night
terrors, and sleep walking), panic attacks and phobias (flashbacks,
reactions to stimuli or "triggers"), alcohol and drug abuse, compulsions
and rituals, psychotic-like symptoms (including auditory and visual
hallucinations), and eating disorders. In addition, individuals with
DID(MPD)/DD can experience headaches, amnesias, time loss, trances, and
"out of body experiences." Some people with DID(MPD)/DD have a tendency
toward self-persecution, self-sabotage, and even violence (both
self-inflicted and outwardly directed).
Who Gets DID(MPD)/DD?
The vast majority (as many as 98 to 99%) of individuals who develop
DID(MPD)/DD have documented histories of repetitive, overwhelming, and
often life-threatening trauma at a sensitive developmental stage of
childhood (usually before the age of nine), and they may possess an
inherited biological predisposition for dissociation. In our culture the
most frequent precursor to DID(MPD)/DD is extreme physical, emotional,
and sexual abuse in childhood, but survivors of other kinds of trauma in
childhood (such as natural disasters, invasive medical procedures, war,
and torture) have also reacted by developing DID(MPD)/DD. They create stronger internal characters to numb the dominant personality to abuse or cope with the trauma.Though the age varies, typically there are groups within who are of the same age group (2 or more) (i.e. young) Often, the people who have been abused who become dissociative have had parents who intersperse abuse with messages of love, and they receive double bind messages-those on whom they were so dependent that they could neither fight them or leave them or even hate them.
Current research shows that DID(MPD) may affect 1% of the general population and perhaps as many as 5-20% of people in psychiatric hospitals, many of whom have received other diagnoses. The incidence rates are even higher among sexual abuse survivors and individuals with chemical dependencies. These statistics put DID(MPD)/DD in the same category as schizophrenia, depression, and anxiety, as one of the four major mental health problems today.
Most current literature shows that DID(MPD)/DD is recognized primarily among females. The latest research, however, indicates that the disorders may be equally prevalent (but less frequently diagnosed) among the male population. Men with DID(MPD)/DD are most likely to be in treatment for other mental illnesses, for drug and alcohol abuse, or incarcerated.
Why Are Dissociative Disorders Often Misdiagnosed?
DID(MPD)/DD survivors often spend years living with misdiagnoses,
consequently floundering within the mental health system. They change
from therapist to therapist and from medication to medication, getting
treatment for symptoms but making little or no actual progress. Research
has documented that on average, people with DID(MPD)/DD have spent seven
years in the mental health system prior to accurate diagnosis.
This is common, because the list of symptoms that cause a person with DID(MPD)/DD to seek treatment is very similar to those of many other psychiatric diagnoses. In fact, many people who are diagnosed with DID(MPD)/DD also have secondary diagnoses of depression, anxiety, or panic disorders.
Do People Actually Have Multiple Personalities?
Yes, and no. One of the reasons for the decision by the psychiatric community to change the disorder's name from Multiple Personality Disorder to Dissociative Identity Disorder is that "multiple personalities" is somewhat of a misleading term. A person diagnosed with DID(MPD) has within her two or more entities, or personality states, each with its own independent way of relating, perceiving, thinking and remembering about herself and her life. The personalities may be an exaggeration or an escalation of the normal conflicts and role variations that all of us experience; It's as if the person gradually separates two or more kinds of conflicting desires, develops complex roles around each one, and engages them separately, so that they do not conflict. Though, sometimes dozens appear to deal with a tough situation. Each personality contrasts with the original in a noticeable way. Each persona has a unique: identity, name, behavior pattern, and brain wave activity. The personalities may also represent incompletely integrated identifications with people who have been important in the person's life (i.e. the living image of a cherished childhood friend) If two or more of these entities take control of the person's behavior at a given time. When two or more entities exist at a given time, a diagnosis of MPD can be made. These entities previously were often called "personalities," even though the term did not accurately reflect the common definition of the word as the total aspect of our psychological makeup. Other terms often used by therapists and survivors to describe these entities are: "alternate personalities", "alters," "parts," "states of consciousness," "ego states," and "identities." It is important to keep in mind that although these alternate personality states may appear to be very different, they are all manifestations of a single person. There are 2 types of DID: 1.) each personality is unaware of the others, and the personality that dominates consciousness has amnesia for the events that occurred while each of the other personalities were in command 2.) the principle personality is amnesic for the periods in which the secondary personalities are in command, but at least one of the secondary personalities is fully conscious of all the others.
Can DID(MPD)/DD Be Cured?
Yes. Dissociative disorders are highly responsive to individual psychotherapy, or "talk therapy," as well as to a range of other treatment modalities, including medications, hypnotherapy, and adjunctive therapies such as art or movement therapy. Family therapy sessions may help to end the cycle of abuse. In fact, among comparably severe psychiatric disorders, DID(MPD) may be the condition that carries the best prognosis, if proper treatment is undertaken and completed. The course of treatment is long-term, intensive, and invariably painful, as it generally involves remembering and reclaiming the dissociated traumatic experiences. After the amnesia is broken down and the patient is conscious of the others, the patient consciously becomes aware of the painful memories and unacceptable desires that previously have been dissociated. This is brought about in part by helping the patient to be less self critical and more tolerant of his human needs, drives, and desires. When this has been achieved, there is no further need for the alternate personas, and the person is whole again. Individuals with DID(MPD)/DD have been successfully treated by therapists of all professional backgrounds working in a variety of settings. Howver, pacing is critical; the material must be allowed to sink in.
Where Can I Get More Information?
The Sidran Foundation is a publicly-supported, non-profit organization devoted to advocacy, education, and research on behalf of people with psychiatric disabilities. The foundation is particularly interested in providing support and advocating empowerment for people who have survived psychological trauma, and has developed resources in this area.