Category: Dissociative Identity Disorder


Just some thoughts


Like any other psychological disorder, suffering from DID is not an easy or enjoyable lifestyle. Yes it may be manageable but it’s certainly takes time along with therapy and or medications not to mention support from either friends or family. I think with DID because these individuals are usually traumatized at such an early age and because those feelings are never dealt with, as their life progresses so does the psychological issue. Even some issues that happen in everyday life need some type of mending. Take for instance someone having an extremely stressful day and eventually the stress builds up and then affects other aspects of their life, the person begins to “deteriorate” in a sense or fall apart. However, usually we have friends or family to vent to and get it all out of our systems, maybe not fully but in a healthy way it’s released.

For those who suffer from psychological disorders such at DID or even other ones such as Depression or Anxiety, normal day-to-day events are seemed to be taken to the extreme and having a friend to talk to about it doesn’t necessarily do the trip. As time goes on the symptoms and prognosis tend to build up and cause for a greater distress.

As for cognitive behavior therapy, I believe that it truly does help and benefit the individual suffering from DID or other psychological disorders. Clearly, something is wrong in their life and because of that, daily normal functioning is impaired which causes distress and an impossibility to live enjoyably.

What excites me about these psychological disorders is it origin and how nothing is a guaranteed fix. No one knows why the brain functions the way it does during psychological issues. Yes there may be theories with some proofs but nothing is definite. As for psychological medications like any other general medication, what’s good for one may not be good for another. General these psychotic medications have negative symptoms and because of those side affects people wonder, “well why even take them?” However, if you think of these medications as a means of harm reduction you could see that some good does come from it. Nothing is guaranteed but if it helps the individual somewhat get back to a normal functional lifestyle then its a plus.

In healthcare, nothing is black and white. As for our brain it even goes to show for a bigger mystery.

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Alleged Abuse in DID
Otnow-Lewis, Yeager, Swica, Pincus, and Lewis,M. (1997) conducted research which sought to verify dissociative symptoms and alleged abuse of a group of individuals diagnosed with DID.Their study included 11 men and one woman who had been previously convicted on murder charges.The study included an objective verification of childhood abuse and dissociative symptoms.Family and childhood friends were interviewed and the various records were reviewed (police, social service, psychiatric, etc.) in an attempt to verify that the symptoms were present before the murders and that childhood abuse did actually occur (Otnow-Lewis et al., 1997).
After Otnow-Lewis and colleagues (1997) completed the various interviews and review of the records, the researchers were able to objectively verify dissociative symptoms in all 12 of the participants, as well as extreme childhood abuse in 11 of the 12 participants.A common belief about dissociative identity disorder is that people “fake” the symptoms or false memories are produced during the course of therapy.However, with these 12 participants, this was not the case.None of the murderers that took part in this study were even aware of their psychiatric condition and remembered very little, if anything of their childhood. The participants either had total or partial amnesia for the abuse that had occurred during their childhood.These individuals either claimed that the abuse never occurred or minimized the abuse.There was not one individual in this study that produced a memory concerning abuse that the researchers were not able to objectively verify (Otnow-Lewis et al., 1997).Another controversy concerning DID is the high prevalence of the disorder in North America.

http://www.fortea.us/english/psiquiatria/dissociative.htm


Patient “Kathy” is a 32 year old female who has had 17 prior admissions to acute care psychiatric facilities for suicide attempts and self-mutilation. She reported hearing voices and losing periods of time for which she could not account.
Diagnosis Dissociative Identity Disorder, Post Traumatic Stress Disorder, Depression.
Referral Kathy was referred by her therapist for immediate admission for treatment of her self-mutilation, dissociative identity disorder and post traumatic symptoms.
Barriers to Treatment Kathy has been repeatedly self abusive by cutting her arms with razor blades, burning herself with cigarettes and masturbating with sharp objects.
History According to her account, Kathy’s childhood was characterized by two alcoholic parents who exhibited violence toward each other and Kathy. They divorced when Kathy was 5 and Kathy lived with her mother and a series of “stepfathers” who physically and sexually abused her. Kathy’s mother confirmed much of this abuse in sessions with Kathy’s therapist. Kathy was first hospitalized at age 13 following a Tylenol overdose. Shortly thereafter she refused to go to school and lived on the streets where she traded sex for food and shelter. Kathy was picked up by the juvenile authorities and spent the next 4 years in a residential program as a ward of the state.
Kathy’s behavior improved with the structure; she completed high school and got a secretarial job. She married at age 20, but soon after began to have problems. Kathy’s husband reported that she was extremely moody and would often become hysterical during sex. Kathy began having “flashbacks” of sexual abuse and became extremely depressed. She was hospitalized repeatedly during the next 10 years receiving diagnoses of schizo-affective disorder, bipolar mood disorder and borderline personality disorder.
Kathy had seen her current therapist for six months at the time of admission. A clinical interview conducted by this therapist revealed that Kathy often heard “mean voices in her head” and “children crying.” Kathy reported that she cut on her arms and abdomen to “relieve the internal pressure and stop the bad feelings.” Kathy said she frequently lost periods of time and would find herself in strange places not remembering how she got there. Upon request, the therapist was able to talk to an alter personality, Julie, who said that she helped Kathy during times of stress. Kathy’s therapist requested admission to a Ross Institute program following an excerbation of self mutilatory behavior and threats of suicide.
Course of Treatment An integrated team approach, consisting of psychiatrists, masters level therapists, case managers, direct care staff and Kathy, developed a master treatment plan which included individual and group psychotherapy. In individual therapy, Kathy and her therapist worked on identifying the alter personalities who were suicidal or self injurious, orienting them to the present, encouraging them to talk about their feelings and reframing them as positive and helpful. Kathy also worked with her therapist on problem solving and coping skills and practiced these new behaviors with peers on the unit. Kathy received a variety of specialized group therapies designed to address her defenses, anger and cognitive distortions. With these new skills she learned in the Trauma Program, she would not have to rely so much on dissociation as a coping strategy.
In groups, Kathy found safe ways to manage and discharge her anger and was able to talk openly about the difficulties her dissociative disorder created in her daily life. Cognitive distortions such as “I can hurt or kill the body and not die myself” and “It was my fault that I was abused” were recognized and corrected both in groups and in individual therapy. Education groups helped Kathy learn about her disorders and feel less isolated.
Through the course of treatment Kathy began to appreciate the protective role her dissocation played during childhood, and she began to accept her parts as parts of herself. She was able to partly revers her self-blame, and therefore be less depressed, suicidal and hopeless. Kathy was soon able to be discharged to the Trauma Day Program where she could practice her new skills in an outpatient setting.
Discharge Kathy was discharged to the Ross Institute Day Program, a partial program dedicated to the treatment of trauma disorders. Since Kathy was referred from another state, she was assisted in finding safe housing near the hospital. In the Day Program, Kathy was given many opportunities to practice her new coping skills and to learn effective strategies for independent living.
The above patient information is a composite of patients treated in the program.

Intervention and Treatment

Left untreated, DID can last a lifetime. While treatment for DID may take several years, it is effective. Persons with DID may find that they are better able to handle the symptoms in middle adulthood. Stress, substance abuse, and sometimes anger can cause a relapse of symptoms at any time. As a good standard of care, persons with DID should be treated by a mental health professional with specialized training and experience with dissociation. Since physical illness can sometimes mimic or contribute to a psychological disorder, a complete physical examination by a physician is warranted when there are concerns about physical conditions. For significant mood disorders and psychiatric conditions, a psychiatric consult is necessary.

  1. Psychotherapy.Treatment for DID consists primarily of individual psychotherapy and can last for an average of five to seven years in adults. Individual psychotherapy is the most widely used modality as opposed to family, group or couples therapy. The main goal for treatment is the integration of the separate personality states into one cohesive, unified personality, unless the person with DID is not ready or motivated to work with trauma. Psychotherapy for dissociative disorders often involves techniques that help work through the trauma that triggers dissociative symptoms. Treatment may include the following stages: uncovering and “mapping” the alters or parts; treating the traumatic memories and “fusing” the alters; and consolidating the newly integrated personality.
  2. Family Therapyis recommended to help educate the family about DID and its causes, to understand the changes that can take place as the personality is being reintegrated, as well as help family members recognize symptoms of recurrence. Family therapy for a person with DID may produce significant negative and traumatic memories of other family members which can hinder clinical progress.
  3. Group therapymay be beneficial in addition to individual therapy, provided the group is exclusively for people with dissociative disorders. Persons with DID can sometimes have setbacks in mixed therapy groups because others may be bothered or disturbed by the personality switches.
  4. Medications.There is no medication to treat DID since it is not an organic disorder or a chemical imbalance. However, antidepressants and anxiolytics might help with mood disorders.
  5. Clinical Hypnosis. Despite controversy about therapists implanting false memories by suggestion, clinical hypnosis can be used in conjunction with psychotherapy when conducted safely by a trained therapist. Hypnosis can help clients access repressed memories, control problematic behaviors, such as self-mutilation and eating disorders, and help fuse the alters during the integration process.

http://www.aamft.org/imis15/content/Consumer_Updates/Dissociative_Identity_Disorder.aspx


http://www.cnn.com/2008/HEALTH/conditions/04/15/herschel.walker.did/index.html#cnnSTCVideo

http://www.youtube.com/watch?v=YXuG2zI39yA&feature=player_embedded

Vido about Herschel Walker, famous football star. He is someone like you or me who suffers from DID.

(From the article http://www.cnn.com/2008/HEALTH/conditions/04/15/herschel.walker.did/index.html#cnnSTCText

Some of these alters did a lot of good, he said. But others led to some extreme and violent behavior, most of which Walker said he doesn’t remember. As a result, the disorder, or DID, led to the breakup of his marriage. “I lost the person that was like everything to me,” he said. “I lost my wife and that’s totally, totally devastating to me.”

Nobody witnessed his alters surfacing more than Cindy Grossman, now remarried, but who was Mrs. Herschel Walker for 19 years.

For 16 years of her marriage, Grossman said, she didn’t know anything was wrong. That’s because Walker’s various alters were somehow kept in check. He believes during that time, his alters did a lot of good. They helped him train hard to become an outstanding athlete and student, smashing high school football records, graduating at the top of his class and evolving into one of the greatest college football players ever.)

 

When football was out of Walker’s life, his alters were no longer focusing on a common goal. That’s when things started to go wrong. Dr. Jerry Mungadze, Walker’s therapist, said he’s seen at least three of Walker’s alters and believes that after retiring from football, Walker “had to find another way of coping and couldn’t.

DID vs PTSD


Most cases of DID begin in the same fashion as cases of PTSD- exposure to extremely stressful or traumatic events such as sexual or physical abuse. Exposure to trauma manifesting as DID seems to be somewhat different from that of PTSD. DID is said to be an extreme case of PTSD. However, I would think that females would have a higher rate of developing DID over males who would generally develop PTSD. DID gives the mind a sense of relief because it can suppress memories of traumatic events. PTSD is identified by the client having flashbacks or re-experiences of the events and because of this the person developed emotional distress. A male coming back from war is likely to experience PTSD compared to a female who was sexually abused develops DID. Also, DID is defined by the DSM as having “multiple” traumatic events or “multiple” abuse evident in someone’s childhood. In order to get through this event the brain, in a sense, develops an alternate way of coping or otherwise known as alters. Also, PTSD is described as being diagnosed as early as 1 month prior to the experience, DID sort of builds throughout childhood and possibly into adolescents along with more traumatically occurring events that lead up to a later diagnosis but poor prognosis of DID.

I thought it was important to distinguish between these two different disorders because they both develop from the same traumatic events but whats surprising is how males and female differentiate.


Some factors that account for the finding that DID is more common in females than males is the idea that females are more willing to seek treatment over males so statistically; you would see more females present with this diagnosis. Also, females have a higher prevalence of abuse sexually and or physically than males. For males aggression is more prominent while females focus on dependence. This dependence may lead females to be more susceptible to developing dissociative disorders such as DID. The female can longer feel dependent so in return the brain develops “alters” to deal with traumas and or stress.

 


I found a video on DID that displays a woman during an shift in alters. She uses painting and art to represent some of the issues going on in her life present and past.

http://www.oprah.com/oprahshow/Art-Therapy-and-Dissociative-Identity-Disorder-Video

I think its interesting to actually see what is going on when an alter is present. For instance, the alter present in this video is 12 years old and by looking at her drawings and responses you phsycially get a idea about what someone with DID experiences.


NAMI defines

Dissociative Identity Disorder (DID), previously referred to as multiple personality disorder (MPD), is a dissociative disorder involving a disturbance of identity in which two or more separate and distinct personality states (or identities) control the individual’s behavior at different times. When under the control of one identity, the person is usually unable to remember some of the events that occurred while other personalities were in control. The different identities, referred to as alters, may exhibit differences in speech, mannerisms, attitudes, thoughts, and gender orientation. The alters may even differ in “physical” properties such as allergies, right-or-left handedness, or the need for eyeglass prescriptions. These differences between alters are often quite striking.

But what does this really mean? In my opinion and after having lecture on the topic in my Psychopathology class, I understand DID to be a disorder that develops from a previous traumatic event. It seems difficult to understand the disorder in a sense because there are these other alters present in a individual to give some type of relief or a defense mechanism. The average number of alters is about 15 each having their own distinctive characteristics and behaviors.

Dissociative Identity Disorder


Haaaaay! Lori here! So I picked DID because this disorder always seemed to catch my attention. I do not know much about DID but I figured choosing this topic would better my knowledge and understanding of DID. Also, I really enjoy watching the show, United States of Tara, which focuses on the main character who is diagnosed with Dissociative Identity Disorder.