The term multiple personality disorder is the common term for one type of dissociative disorder, now referred to in clinical settings as dissociative identity disorder. This term came into use around 1994, in the DSM-IV, to describe a better understanding of multiple personality disorder and other, similar disorders.
Types of Dissociative Identity Disorder
- Dissociative Amnesia
- Depersonalization/Derealization Disorder
- Dissociative Identity Disorder (DID)
A dissociative disorder is a mental disturbance believed to be caused by severe, repeated early childhood trauma, which has led the individual to disconnect, or dissociate, from reality in certain specific ways. The dissociation events lead to “blackouts,” or periods of time that the individual cannot remember. This causes lack of continuity in personality traits, actions, sense of identity, and thoughts.
The current psychological theory about the cause of dissociative disorders involves extensive experience of trauma, typically as a child, before the individual’s personality has been solidified. Some type of dissociation is common among all adults, including neurotypical adults, and it is believed to be a mental coping mechanism to divide traumatic events and normal mental functioning. However, with extensive trauma, the brain dissociates a good deal of the individual’s life from “normal” brain functioning, and any level of real or perceived trauma, including highly emotional events or minor traffic accidents, can trigger a dissociating event.
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Dissociative disorders are misrepresented in popular culture and difficult to diagnose in a clinical setting. In media, multiple personality disorder is often mixed up with schizophrenia, but the clinical criteria for these two disorders are very different. In a therapy setting, people with any dissociative disorder, including dissociative identity disorder, are typically misdiagnosed with several comorbid conditions, including bipolar disorder, panic disorder, somatic disorder, substance abuse, eating disorders, antisocial personality disorder, and more. Although these disorders can co-occur with dissociative disorder, the root causes are the problems with dissociation.
Dissociative disorders are not uncommon among the general population, particularly in the United States and Canada. These are believed to occur in 1-7 percent of the population, and they occur more often in women than men.
The Mayo Clinic’s website reports that the DSM-5 and the American Psychiatric Association recognize three major dissociative disorders.
Types of Dissociative Disorders
There are three primary types of dissociative disorders currently recognized by medical professionals.
- Dissociative Amnesia:
This is the most common type of dissociative disorder. The primary symptoms are extensive forgetfulness and loss of time, which cannot be explained by general forgetfulness, substance abuse, or a medical condition. This is a blank spot in the individual’s memory, during which they cannot remember events that occurred or conversations they had.
This condition can occur due to specific traumatic events like intense combat or sexual abuse. An amnesic episode can last for minutes or hours, although less typically, the period can last for days, weeks, or months. Some instances have occurred over years, but this is extremely rare. Longer periods of dissociative amnesia can be accompanied by dissociative fugue, which involves wandering away from the individual’s current life and participating in other experiences.
- Depersonalization/Derealization Disorder:
This condition is characterized by consistent, ongoing, or episodic emotional and experiential detachment from events in a person’s life. People who struggle with this disorder describe the sensation as watching their feelings, thoughts, and actions from outside themselves, as though watching a movie. Other people describe the experience as feeling like they were in a foggy, dreamlike state and that the world around them was not real. Symptoms can last anywhere from minutes to years.
- Dissociative Identity Disorder (DID):
Although all dissociative conditions were at one time lumped together as multiple personality disorder (MPD) and can be part of MPD, dissociative identity disorder is the current term used when referring to classic symptoms of multiple personality disorder. Dissociative identify disorder involves the formation of at least one other personality, originally referred to as split personality disorder, but involves on average of 3-16 “alters.” Some documented cases have involved over 100 alternate personalities.
Individuals describe their experience with DID as feeling like they have multiple voices in their mind, which may have caused the confusion with schizophrenia, or sometimes, the individual feels “possessed” by these personalities. With DID, the alternate personality or personalities will appear at different times, leading the main personality to experience dissociative amnesia and fugue. Some therapists have reported that DID alters not only have unique names and personalities but also physiological needs and characteristics, including eye glasses, distinct heart and breathing rates, different skin temperatures, varied brain patterns on CT scans, and even allergies.
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Treatment for Dissociative Identity Disorder and Substance Abuse
People who suffer from DID or other dissociative disorders are at a higher risk, compared to the general population, for struggling with substance abuse, including alcoholism. In some cases, dissociative amnesia is misdiagnosed as being caused by heavy substance abuse, so the underlying cause of DID can go untreated for years. However, when substance abuse is treated without the appropriate therapy to address an underlying mental health disorder, symptoms believed to be caused by substance abuse will not go away and could get worse.
Self-harm is common among people suffering dissociative disorders like DID. This includes substance abuse and polydrug abuse, as well as physical self-harm and suicide attempts. One report shows that 70 percent of outpatient individuals diagnosed with DID had attempted suicide at least once. Substance abuse is a common form of both self-medication and self-harm among this group. For example, headaches and other forms of physical pain can be a common symptom of DID, so analgesic abuse is common among people who suffer from DID. A Canadian study found that, in a group of 100 individuals undergoing treatment for substance abuse, 43 percent met the criteria for dissociative disorders, and 14 were diagnosed with DID. The Journal of Trauma and Dissociation published “Guidelines for Treating Dissociative Identity Disorder in Adults,” with a mention that some people suffering DID take large amounts of narcotic painkillers due to somatic experiences of intense pain, which may not have a physical cause like injury or illness.
This self-harming behavior is seen as a manifestation of the individual reenacting their past trauma, so substance abuse among this group should be integrated into treatment for DID. It is important to find a program that can offer both substance abuse and DID treatment. Although detox is an important first step in the treatment process, it does not constitute treatment; therapy for addictive behaviors should occur alongside therapy for DID.