Until 1994, dissociative identity disorder was commonly referred to as multiple personality disorder. This seemed like an apt term at the time, but as doctors continue to better understand the condition, they are shying away from this terminology. Research has expanded and refined the definition of dissociative identity disorder.
Only 1% of the general population has been diagnosed with the condition, but experts believe far more people have dissociative identity disorder and simply lack an official diagnosis.
Someone with dissociative identity disorder cannot integrate the individual parts of their personality into a single identity. Usually, a primary personality emerges that identifies with the person's given name and commonly demonstrates signs of guilt, passivity, and depression. Other personality states are referred to as "alters." These personalities can have different ages, genders, knowledge, and moods than the primary personality. They may or may not know the other alters.
For someone to receive a diagnosis of dissociative identity disorder, he must meet several criteria. He must experience two or more personalities and there must be an identifiable change in behavior, memory, cognition, and motor function between the two. Most people experience long or short-term memory gaps much more severe than typical forgetfulness. The symptoms must also prevent the person from functioning normally in various aspects of their life.
Often, specific personalities take over, depending on the situation. Stress is a common trigger for a dissociative episode. The individual may feel like she is observing her alters and that she has no control over her words or actions. It is also common to hear voices or experience multiple thoughts at once. Dissociative fugues, when the person discovers that they have traveled or had some other significant experience of which she has no recollection, are also possible.
It is not clear why people develop dissociative identity disorder, though there may be a connection to severe sexual or physical childhood abuse. The onset can occur at any age, and there seems to be a genetic link. People with close blood relatives with dissociative identity disorder have a greater chance of developing it than those without this connection. Some experts consider diagnosis questionable, as it is difficult to determine how much the patient is open to suggestion from medical professionals. That said, imaging studies show changes in brain activity when a person with dissociative identity disorder transitions from one alter to another.
Diagnosis commonly involves ruling out other possible causes of memory loss or an altered state of mind, including tumors, drug use, or head injury. Once these physical causes are ruled out, a doctor specializing in mental health is brought in to evaluate the patient. Personal history and symptoms are reviewed before making an official diagnosis.
When doctors started to understand dissociative identity disorder, they shied away from the term "multiple personality disorder" and focused on defining forms of dissociation. Dissociative amnesia occurs when a person cannot remember a significant event, like sexual abuse, combat, or a traumatic accident. These episodes can happen at any time and can last anywhere from minutes to decades.
Depersonalization disorder is another form of dissociative identity disorder, defined as detachment from reality; the individual experiences emotions, thoughts, and actions as if he is playing a role in a movie. He may sincerely believe that what is going on in real life is not really occurring and that everything around him is fake. The average onset for this form of dissociative identity disorder is 16. Most cases occur in childhood, with fewer than 20% of people experiencing their first episode after age 20.
The main treatment for dissociative identity disorder is psychotherapy, with the primary goal of decreasing episode frequency. Cognitive behavioral therapy can help combat negative thinking by teaching coping mechanisms. Dialectical behavioral therapy may help the patient regulate emotions and work through urges in individual and group therapy sessions.
No medication specifically targets dissociative identity disorder, though there are options to treat issues associated with it. For example, an individual may be prescribed anti-anxiety medication or anti-depressants to help her cope with these symptoms, caused by the disorder. In some cases, doctors may prescribe antipsychotic medication.
A lot of people with dissociative identity disorder respond well to psychotherapy, but success depends on whether or not the person can integrate all of his alters back into a single personality. Treatment can make a big difference in the quality of life for someone experiencing this disorder, but psychotherapy is usually a very long, challenging process.
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