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Treatment Guidelines for Dissociative Identity Disorder

Previously known as multiple personality disorder, dissociative identity disorder (DID) is a condition in which a person has more than one distinct identity or personality state. At least two of these personalities repeatedly assert themselves to control the affected person's behavior. Each personality state has a distinct name, past, identity, and self-image.

Psychiatrists and psychologists use a handbook called the Diagnostic and Statistical Manual of Mental Disorders , fourth edition text revision or DSM-IV-TR, to diagnose mental disorders. In this handbook, DID is classified as a dissociative disorder. Other mental disorders in this category include depersonalization disorder, dissociative fugue, and dissociative amnesia. It should be noted, however, that the nature of DID and even its existence is debated by psychiatrists and psychologists.

Symptoms

The individual experiences two or more distinct identities or personality states (each with its own enduring pattern of perceiving, relating to, and thinking about the environment and self).
The reported range of identities is from 2 to more than 100. Half of the reported cases include individuals with 10 or fewer.
At least two of these identities or personality states recurrently take control of the person's behavior. Each may exhibit its own distinct history, self-image, behaviors, and, physical characteristics, as well as possess a separate name.
Particular identities may emerge in specific circumstances. Alternative identities are experienced as taking control in sequence, one at the expense of the other, and may deny knowledge of one another, be critical of one another or appear to be in open conflict. Transitions from one identity to another are often triggered by psychosocial stress.
Frequent gaps are found in memories of personal history, including people, places, and events, for both the distant and recent past. Different alters may remember different events, but passive identities tend to have more limited memories whereas hostile, controlling or protective identities have more complete memories.
Symptoms of depression, anxiety, passivity, dependence and guilt may be present.
In childhood, problem behavior and an inability to focus in school are common.
Self-destructive and/or aggressive behavior may take place.
Visual or auditory hallucinations may occur.
The average time that elapses from the first symptom to diagnosis is six to seven years.
The disturbance is not due to the direct psychological effects of a substance or of a general medical condition.

Causes

It is generally accepted that DID results from extreme and repeated trauma that occurs during important periods of development during childhood. The trauma often involves severe emotional, physical or sexual abuse, but also might be linked to a natural disaster or war. An important early loss, such as the loss of a parent, also might be a factor in the development of DID. In order to survive extreme stress, the person separates the thoughts, feelings and memories associated with traumatic experiences from their usual level of conscious awareness.

The fact that DID seems to run in families also suggests that there might be an inherited tendency to dissociate. DID appears to be more common in women than in men. This might be due to the higher rate of sexual abuse in females.

Treatment

Treatment is mainly psychotherapy with hypnosis. The goal is to deconstruct the different personalities and unite them into one. The therapist attempts to make contact with as many alters as possible and tries to understand their roles and functions in the person's life. The therapist seeks to make a connection with personalities that especially display violent or self-destructive tendencies. Another goal of the therapist is to set up a communication among the personalities to retrieve traumatic memories from the past. Generally treatment is as an outpatientComputer Technology Articles, though inpatient treatment may be used to achieve a specific goal. Behavior analysis has not been demonstrated to be effective.


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