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Dissociative Identity Disorder: Difference between revisions
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Similarly, if a person comes to you claiming to have DID, treat them with respect. You are not a doctor, and you don't know what the label means. However, anyone diagnosed with DID has a lot more going on than multiple personalities. According to all professional standards, having multiple personalities is not sufficient reason to apply any diagnosis whatsoever in and of itself. Respect that they may have additional concerns and needs.
== Diagnosis ==
The Diagnostic Standards Manual is the de facto standard for the diagnosis of this condition. However, in practise, diagnostics often diverge from the standards.
With the DSM, revision 5, has five criteria for DID, all of which must be met. Several other dissociative disorders use the same criteria, but need fewer of them to be met.
# Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.
# Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.
# The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning
# The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play.
# The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).
The DSM goes on to clarify some of these points briefly.
:"When alternate personality states are not directly observed, the disorder can be identified by two clusters of symptoms: 1) sudden alterations or discontinuities in sense of self and sense οί agency (Criterion A), and 2) recurrent dissociative amnesias (Criterion B)."
:"Individuals with dissociative identity disorder may report the feeling that they have suddenly become depersonalized observers of their "own" speech and actions, which they may feel powerless to stop (sense of self). Such individuals may also report perceptions of voices (e.g., a child's voice; crying; the voice of a spiritual being). In some cases, voices are experienced as multiple, perplexing, independent thought streams over which the individual experiences no control. Strong emotions, impulses, and even speech or other actions may suddenly emerge, without a sense of personal ownership or control (sense of agency)."
:"Although most Criterion A symptoms are subjective, many of these sudden discontinuities in speech, affect, and behavior can be witnessed by family, friends, or the clinician."
:"The dissociative amnesia of individuals with dissociative identity disorder manifests in three primary ways: as 1) gaps in remote memory of personal life events (e.g., periods of childhood or adolescence; some important life events, such as the death of a grandparent, getting married, giving birth); 2) lapses in dependable memory (e.g., of what happened today, of well-learned skills such as how to do their job, use a computer, read, drive); and 3) discovery of evidence of their everyday actions and tasks that they do not recollect doing (e.g., finding unexplained objects in their shopping bags or among their possessions; finding perplexing writings or drawings that they must have created; discovering injuries; "coming to" in the midst of doing something)."
:"Possession-form identities in dissociative identity disorder typically manifest as behaviors that appear as if a "spirit," supernatural being, or outside person has taken control, such that the individual begins speaking or acting in a distinctly different manner. For example, an individual's behavior may give the appearance that her identity has been replaced by the "ghost" of a girl who committed suicide in the same community years
before, speaking and acting as though she were still alive. Or an individual may be "taken over" by a demon or deity, resulting in profound impairment, and demanding that the individual or a relative be punished for a past act, followed by more subtle periods of identity alteration. However, the majority of possession states around the world are normal, usually part of spiritual practice, and do not meet criteria for dissociative identity disorder."
:"Many features of dissociative identity disorder can be influenced by the individual's cultural
background.:
The DID further discusses comorbidity, suggesting depression, anxiety, substance abuse, self-injury and non-epileptic seasures are all possible signs of DID. It suggests that those with DID are often unaware, or conceal their symptoms at first. It says that disorienting flashbacks can occur. The DSM discusses the reporting of maltreatment and other trauma, but as you see, it's not part of the diagnostic criteria. The DSM lists higher than average hypnotizability and dissociativity, and transient psychotic events as further signs. And attempted suicide is ridiculously common, at 70%
Prevalence is estimated, roughly, at 1.5% of the population, based on the study of a U.S. town.
=== Differential Diagnosis ===
Other Specified Dissociative Disorder: The division of identity (aka plurality) is shared with one variant of OSDD. OSDD does not require amnesia symptoms, and it can be supported by dissociative symptoms not strong enough to meet the first criteria of DID.
Major Depressive Disorder: Most people with DID are also depressed, and this can disguise symptoms.
Bipolar: Personality changes can easily be misinterpreted as mood swings.
Post Traumatic Stress Disorder: Has heavy overlap of symptoms with DID. This can mean the presence of PTSD can hide further evidence of DID. Dissociation unrelated to trauma is a sign it's not PTSD.
Psychotic disorders: Personified voices can be mistaken for hallucinations, one of the criteria for various psychotic disorders. Furthermore, possession events can be confused for formal thought disorder, thought insertion, and thought withdrawal, other symptoms. People with DID may also experience trauma related hallucinations. However, people with DID do not have delusional explanations for their symptoms.
== Alters ==
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In practise, most alters experience communication difficulties. This means they cannot read each others thoughts, they cannot watch each other, and they cannot both be active in order to talk to each other at the same time. This leads to amnesia, where one personality fails to remember what happened while another one was active. They also usually experience control difficulties, where they cannot control who is out in front, and can be pushed to the front through the use of trigger words. A side effect of this is they can almost always switch.
Due to recent changes, "experiences of possession" may now also count as alters.
== History ==
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The diagnosis was largely created in the eighteen hundreds, at a time when efforts to standardise psychological diagnosis were underway. The subject of multiple personalities were discussed amongst psychologists as a topic of fascination. Around this time, it became recognised that traumatic events could indeed cause long lasting mental harm.
Around the start of the nineteen hundreds, interest in this topic began to wane. This is most likely because the condition was seen as very rare, though accusations of fraud also factored in. Around this time, the diagnosis of Schizophrenia was broadened to be more inclusive, capturing much of what dissociative identity disorder was. This overbroadening of Schizophrenia persisted and got worse, mainly in the united states, but has since been largely rectified, with the creation of a new category of dissociative disorders, one that contains DID, as well as other categories for PTSD and similar, and stricter diagnostic standards for Schizophrenia.
In 1957, a book called The Three Faces of Eve, was published, and created a resurgence in the popularity of the diagnosis. In it, in dramatic fashion, was the depiction of "eve", a person with three personalities. This was further strengthened by the story of "Sybil" (real name Shirly Ardell Mason). Despite a sudden jump in the number of people with this diagnosis, more books, and more research, the diagnosis again died amongst rumours of fraud and fakery.
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