Multiple Personality Disorder (MPD) has been a highly controversial disorder throughout the years shrouded in mystery and misunderstanding. It has been sensationalised by the media creating misconceptions and confusion. MPD is now known as Dissociative Identity Disorder (DID) and is a real disorder affecting approximately 1-5% of the general population, although the prevalence is somewhat disputed.
DID is a disorder that has fascinated, shocked, horrified and intrigued the world. There are five criteria according to the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5) that signify a diagnosis of DID. These criteria include:
- Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to and thinking about the environment and self.
- Amnesia must occur, defined as gaps in the recall of everyday events. Memories relating to the trauma tend to be forgotten.
- The person must be distressed by the disorder or have trouble functioning in one or more major life areas because of the disorder.
- The disturbance is not part of normal cultural or religious practices.
- The symptoms are not due to the direct physiological effects of a substance (such as blackouts or chaotic behaviour during alcohol intoxication) or a general medical condition (such as complex partial seizures).
Many people who suffer from DID have experienced trauma early in their life. It is uncertain whether the trauma causes the dissociation or merely correlates with it; nonetheless, neglect early in life, physical or sexual abuse tend to be reoccurring themes in the accounts of people diagnosed with DID. It is believed that dissociating and creating another, separate identity could be a form of coping with a traumatic situation. By having an alternate identity, the person is creating a protective shield around themselves whilst also creating emotional and psychological distance from the situation. The traumatic memories would then remain with the dissociated identity and will be forgotten by the individual as those diagnosed with DID tend to suffer from amnesia.
Dissociation happens when there is a lack of integration in one’s mental processes such as memory, emotion, consciousness and identity. Experiences then become compartmentalised and separated. Although this is not a conscious process, dissociative memories still have an influence over the person’s thoughts and actions. People who experience this dissociation tend to feel very detached physically from their own body as well as mentally. They experience what is called depersonalisation, a sense of feeling separate from oneself. They also experience derealisation which is when an individual feels as if he/she is in a trance or dreamlike state. Another symptom would be experiencing perceptual alterations such as hallucinations.
There are several reasons why this disorder has been so highly debated in the past. To begin with, it takes time to diagnose. DID has high comorbidity rates with many disorders such as depression, substance abuse, anxiety disorders, psychotic disorders, eating disorders, sleep disorders and obsessive compulsive behaviour. It also shares similarities with schizophrenia and bipolar personality disorder. Another recurrent issue is that people with DID tend to be highly suggestible and hypnotizable. This may lead people to believe that since they are highly suggestible the therapist may be encouraging false memories since the patient may be more likely to exhibit behaviours they think the therapist would want to see. There are also methodological issues since recollections of abuse are based on self-reporting and retrospective data which may not be accurate. Furthermore, there are a myriad of ethical issues when conducting research in this area.
Although there are not any treatments that can cure DID, there are treatment options. Several options include psychotherapy, medication, and hypnotherapy. The ultimate goal of treating someone with DID would be to integrate all the separate identities the person has created and have the person function as a whole. This can be done through the use of medication to reduce the anxiety and depressive symptoms. Behavioural therapies could also be useful at this point to decrease intrusive thoughts and harmful behaviours. Psychotherapy could also be an option whereby the therapist would work with the individual to bring the traumatic memories to conscious awareness and focus on working through the thoughts and feelings they bring up in the individual. In order to integrate the alternate personalities it may be helpful to engage and communicate with each of them. It is important for the therapist to be flexible and see what works with the patient. The treatment package would have to be complex and all-encompassing in order to be effective.
In conclusion, there is still much research to be done in this field. Future research could focus on developing a better understanding of the risk factors, genetic predispositions and environmental factors that could impact upon this disorder. Once more is known about the disorder, there could be better treatment packages set up, more understanding and awareness and less sensationalised stories about DID.
References
Criteria for Dissociative Identity Disorder in the DSM-5. (n.d.). Healthy Place. Retrieved January 17 2017, from http://www.healthyplace.com/abuse/dissociative-identity-disorder/dissociative-identity-disorder-did-dsm-5-criteria/
Goldberg, J. (2016). Dissociative Identity Disorder (Multiple Personality Disorder). WebMD. Retrieved January 17 2017, from http://www.webmd.com/mental-health/dissociative-identity-disorder-multiple-personality-disorder?page=5
Slogar, S. (2011). “Dissociative Identity Disorder: Overview and Current Research.” Inquiries Journal/Student Pulse, 3(05). Retrieved from http://www.inquiriesjournal.com/a?id=525
Spiegel, D., & Cardeña L. (1991). Disintegrated Experience: The Dissociative Disorders Revisited. Journal of Abnormal Psychology, 100, 3(366-378). DOI: 10.1037//0021-843X.100.3.366
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