An Insight On Dissociative Identity Disorder

Dissociative Identity Disorder is an uncommon mental disorder characterized by the appearance of two or more distinct personalities/alters. It is an ineffective coping mechanism that appears after a traumatic event. Diagnosis is a long process that often takes years and the only known treatment is integration since there is no medication that has seemed to help reduce the effects of DID. Medication can be used to reduce symptoms associated with the disorder such as depression and anxiety but in regards to limiting the amount of switching alters it is ineffective. Alters are extensions of the core personality but cause gaps in the individuals memory. Accountability of responsibility is a common debate because individuals with DID are not autonomous and do not always have control over their actions.

What is Dissociative Identity Disorder?

Formerly known as Multiple Personality Disorder, Dissociative Identity Disorder is when an individual has interruption in everyday consciousness, emotions, and motor skills,also known as dissociating from reality, leading to two or more distinct personalities. A person can be diagnosed with DID if the individual has suffered a traumatic experience (Biever & Karnich, 2012). It is a default unhealthy coping mechanism that develops to protect the individual from the traumatic experience creating a “personality,” and individuals can have anywhere from 2-100 personalities. The higher the level of trauma the higher the level of dissociation (Barslov & Chu, 2014). DID actually creates a sense of vulnerability and instability which means it is not uncommon for individuals to be hospitalized due to suicidal impulses, attempts, and violent behavior. It is predominantly in females and may to some degree be biologically determined but extensive research has not yet been conducted (Romero-López, 2016).

Dissociation is actually quite common; everyday experiences include out of body experiences, automatic writing, and hallucinations. Furthermore, dissociative experiences can actually be linked to a personality trait. For example, if you are introverted, you may have a tendency to fantasy and daydream more often than other individuals. However, when thoughts get dissociated from feeling it can become dangerous. Further, Dissociative Identity Disorder is a more extreme and constant dissociation that leads to the development of a “personality” (Romero-López, 2016). The term personality is actually quite controversial because when dissociating you are not creating a new personality that has no connection to the original individual, instead you are taking a specific trait and making it an alter. Alters, visualize themselves to be physically and mentally different than the body they are in (Maiese, 2017). For example, John was physically abused by his parents as a child whenever the house was dirty. To protect himself from the physical abuse his mind created an alter, Madison, who is a 26 year old overweight woman with OCD. Madison has a distinctive way of speaking, walking, and doing certain actions. She is not an entire different personality from John, but instead an extension of him.

Maslov’s Hierarchy

The root of dissociation can be found in Maslov’s Hierarchy; a theory of human needs. Abaraham Malov created a pyramid of needs in which one can not progress to the next level unless the previous needs are already met. The needs in the order of bottom to top go as: physiological needs, safety needs, love and belonging, esteem, and self- actualization. As previously mentioned if an individual feels unsafe in their current situation their mind will create an alter to protect them. This goes back to the hierarchy with safety. A person cannot move on to love and belonging which also includes close human connections without the feeling of security and then further to esteem and self-actualization. The alter is created to absorb all negative emotions and hold itself accountable for a certain action and emotion, so that the original personality can experience a sense of happiness and move up the hierarchy (Biever & Karnich, 2012). For example, Sarah was sexually abused at the nine by her father which caused her extreme emotional and physical distress. She didn’t have any close friends and had an incredibly low self-esteem. Her mind created Alex, a 45 year-old retired doctor, who would appear anytime the abuse occurred to protect the core personality, Sarah. After Alex was created Sarah was able to move up to the next level of hierarchy of love and belonging and esteem. She then began to make more friends and had a higher self-esteem.

Diagnosis

However, diagnosing DID is incredibly difficult and usually takes several years to accurately diagnosis. This is because symptoms of DID are extremely similar to other disorders such as depression, anxiety, borderline-personality disorder, etc. which an individual can have including DID (Bhandari, 2012). This can lead to misdiagnosis and/ or overlooking DID.

Physical tests are taken first in order to assure that the memory loss was not caused by a previous physical/ biological injury such as a head injury or a brain tumor (NAMI). Next, a mental health specialist is consulted to fully discover what the specific disorder is which as previously mentioned can take years. The disorder must meet the DSM-5 criteria before formally being diagnosed as DID.

Treatment

Since DID is an uncommon disorder throughout history it has easily be mistaken as a supernatural occurrence, possession, and/ or a reincarnation. The actual first study of dissociation was conducted in 1889 by Pierre Janet. His study proposed the idea that new experiences are integrated into memories through thought, emotions, and behaviors associated with the experience. Janet thought that memories associated with a traumatic experience can separate itself through consciousness can be brought to cousiness if a situation similar to the traumatic experience re-occurs. He proceeded to attempt to use hypnosis to access these subconscious memories (Romero-López, 2016).

Integration

However, DID is incredibly hard to treat and cannot be treated with medication but instead integration. Integration is the process of “combining” the alters to become part of the core personality . This can take years and the mental health of the individual plays a huge part in treatment. If the individual has a strong sense of knowledge, consistent emotional state, ability to sustain relationships, and close relationships it will be easier for them to proceed with treatment. However, if the individual has a weak sense of knowledge, poor expression of emotions, and socially isolates themselves it will be extremely hard for them to try to do well before and after therapy (Biever & Karnich, 2012). In order for integration to be possible the individual must be able to consciously be able to switch from each pre-identified personality. Although, this may lead to an increase in the amount of switches the individual originally had. This is because integration increases the individual's awareness of the alters (Barslov & Chu, 2014). If integration is successful it is unlikely the individual will ever dissociate again unless an extreme traumatic event occurs. Treatment also includes trying to help the individual develop effective coping strategies instead of feeling the need to dissociate from reality (Biever & Karnich, 2012).

Accountability & Responsibility

A huge discussion today is ‘How accountable should individuals with DID be held responsible for their alters actions?’. As previously discussed if someone is dissociating they are unaware of conscious behaviors. Therefore, it is agreed that individuals with DID should not be held as responsible for their actions as a normal, healthy individuals due to the lack of autonomous behavior. In order to be accounted as responsible one’s actions must be voluntary. Agential responsibility requires the actions to be responsible and moral responsibility requires the individual to process reflective behavior (Maiese, 2017).

However, since alters are extensions of the core personality if an alter commits a wrongful action it means a part of the individual wanted to do so to a certain degree. Therefore, the individual should acknowledge that these actions are their own, which will allow them to take steps into integration (Ambivalence).

Conclusion

Dissociative Identity Disorder is an uncommon mental disorder caused by traumatic stress. It is an ineffective coping mechanism characterized by the development of two or more distinct personalities/ alters. It is difficult to diagnose and even harder to treat. The only known treatment known is integration. Without integration, the individual can lead a difficult and complicated life due to the ability of not being able to fully control their actions. DID is a complicated mental disorder that requires delicate and consistent attention.

References

1. Barlow, M. R., & Chu, J. A. (2014). Measuring fragmentation in dissociative identity disorder: the integration measure and relationship to switching and time in therapy. European Journal of Psychotraumatology, 5, 1–N.PAG. https://doi-org.lscsproxy2.lonestar.edu/10.3402/ejpt.v5.22250
2. Biever, J. A., & Karinch, M. (2012). The wandering mind: understanding dissociation, from daydreams to disorders. Lanham, MD: Rowman & Littlefield Publishers.
3. Bhandari, S. (2019, July 22). Dissociative Identity Disorder (Multiple Personality Disorder): Signs, Symptoms, Treatment. Retrieved from https://www.webmd.com/mental-health/dissociative-identity-disorder-multiple-personality-disorder#1.
4. Maiese, M. (2017). Dissociative Identity Disorder, Ambivalence, and Responsibility. European Journal of Philosophy, 25(3), 764–784. https://doi-org.lscsproxy2.lonestar.edu/10.1111/ejop.12171
5. NAMI. (n.d.). Retrieved from https://www.nami.org/learn-more/mental-health-conditions/dissociative-disorders.
6. Romero-López, M. J. (2016). A review of the dissociative disorders: from multiple personality disorder to the posttraumatic stress. Anales de Psicología, 32(2), 448–456. https://doi-org.lscsproxy2.lonestar.edu/10.6018/analesps.32.2.218301