Dissociative identity disorder, also known as multiple personality disorder, describes a condition in which different personalities or partial identities control a person’s behavior.
What is dissociative identity disorder?
A characteristic of dissociative identity disorder is that the person is not aware of his or her own different personalities, as usually one personality is unaware of the other identity or identities. For this reason, the person may temporarily not remember certain personal things or actions. These actions are linked to another personality and at that moment are only present in the subconscious. Dissociative identity disorder is not the same as schizophrenia, which can have some of the same symptoms. The clinical picture of multiple personality disorder was described by psychiatrists as early as the end of the 19th century, but was not recognized as a separate disease until the 1970s.
Causes
Multiple personality disorder does not result from alcohol abuse or drug use, but is often due to severe, traumatic experiences in childhood. In this case, dissociation, or breaking up of the person into different subpersonalities, is a protective mechanism of the brain to deal with traumatic events. The person experiencing these traumatic events splits into multiple personalities. Only one personality experienced the terrible, which is erased from memories and buried in the subconscious as long as another personality controls the person’s actions. Childhood sexual abuse, physical violence, neglect and other traumatic events are considered the main causes of multiple personality disorder, which affects women much more often than men. Children who are intimidated under threats and are often helplessly exposed to the events split their own person into different personalities: one personality that experiences the terrible and one or more others that control the actions in normal everyday life and are unaware of the terrible events. Thus, the traumatic experiences and abuses are perceived only by one personality, which lives unrecognized in the subconscious in normal everyday life and does not allow the traumatic experience to come to the surface of consciousness.
Symptoms, complaints and signs
In this disorder, those affected suffer from severe psychological complaints and upsets. These can significantly complicate and limit everyday life, resulting in various social discomforts even with other people. In the worst case, this can also lead to suicidal thoughts or further suicide. First and foremost, those affected show a personality disorder. There are clear memory gaps and also depression. The patients can no longer remember simple events and are therefore extremely restricted in their lives. This can also lead to an anxiety disorder, which can have a very negative effect on contact with other people. Often, those affected break off all contact with other people and suffer from aggression or strong irritability. Eating disorders can also occur if the disease is not treated properly. This leads to weight loss and various deficiency symptoms in the patient. Frequently, those affected also suffer from depression. In some cases, the disease is associated with phobias or with various compulsions. Whether this leads to a reduced life expectancy cannot be predicted in general. However, permanent psychological complaints always have a very negative effect on the patient’s health condition.
Course
Dissociative identity disorder is characterized by at least two distinct personalities that alternately control the person’s actions. The main personality is referred to as the host, while the other or other personalities are called alters (cases have been documented in which up to 100 different personalities are combined in one person). The main symptom is memory lapses about personal matters that cannot be attributed to other mental illnesses, such as dementia.The main personality cannot remember actions and experiences of the other personalities and vice versa. For example, the person may not be able to remember how he or she got to a certain place or may not recognize people from his or her personal environment. The different personalities have different names and often differ from the other personalities by contrary preferences. Secondary symptoms include headaches, aggression against oneself, depression, eating disorders, compulsive behavior, strange voices in the head (usually those of the other personalities), and even suicide attempts.
Complications
Some individuals with dissociative identity disorder avoid medical help unless it is absolutely necessary. This avoidance often stems from trauma – but it may also be due to feelings of shame, low self-worth, or experienced neglect. As a result, medical complications are possible even for physical illnesses that would actually be easily treatable. Other individuals with dissociative identity disorder, however, seek comfort and reassurance in medical treatment and care. Some of these sufferers tend to exaggerate, self-induce (for example, through self-injurious behavior), or simulate actual symptoms. Subsequent examination and treatment thereby increases the likelihood of treatment errors and side effects – for example, medication for symptoms that do not exist. In dissociative identity disorder, however, certain somatic symptoms may also be clustered. These include various types of pain. Abdominal pain and headaches are particularly common. Respiratory problems and neurological complaints may also appear as complications of multiple personality disorder. In addition, other forms of dissociation as well as other psychological disorders are possible. In addition, complications can be triggered by psychotherapy. Especially in trauma therapy and in the integration of personality parts, there is often a temporary enormous psychological burden for the person affected. A stable environment and a good relationship of trust with the therapist are therefore particularly important.
When should one go to the doctor?
As soon as noticeable changes in a person’s behavior and personality become apparent, a doctor must be consulted. Multiple personality disorder often occurs in conjunction with other mental illnesses. An identity disorder can also occur as a result of excessive alcohol or drug consumption, after a severe blow of fate, trauma in childhood or after a brain injury. Anyone who notices these factors in themselves or another person should consult a doctor or therapist. If the person cannot be helped, placement in a clinic may also be ordered by authorities. Before this course of action is taken, however, a comprehensive medical and psychological assessment is necessary. This should be done at the latest when the person concerned carries out irrational acts and thus represents a danger to himself and others. Symptoms such as sleep and eating disorders, alcoholism, depression and behavioral disorders should be clarified immediately. If the affected person expresses suicidal thoughts, he or she must be referred to a therapist or, in the case of dissociative identity disorder, taken to the nearest specialized clinic.
Treatment and therapy
Therapy for dissociative identity disorder involves medication with sedatives and antidepressants, as well as psychotherapy, with the goal of bringing the different personalities closer to or merging with the main personality. In trauma therapy, multiple personality disorder patients learn to psychologically process traumatic experiences from childhood in order to eliminate the causes of dissociative identity disorder. Multiple personality disorder therapy may take several years to complete and consists of several phases. The first phase is focused on stabilizing daily life. The next phase focuses on bringing the individual personalities or partial identities together and concludes with psychological management of the trauma.
Outlook and prognosis
The prognosis of dissociative identity disorder is considered unfavorable in most patients.Often there is a chronic course of the disease, which makes a cure impossible. The triggers of the disease must be found and treated. In the case of traumatic experiences, this can last for several years. The symptoms of the disease can regress within a treatment regardless of the underlying disease. Nevertheless, there is often no permanent cure of the disorder. A relapse is possible at any time. Many patients experience individual phases of several weeks to years of freedom from symptoms. However, as soon as a triggering event occurs or repressed experiences come to the fore, the symptoms reappear. Often the intensity of the symptoms differs with a repeated outbreak. In many patients, no relief of symptoms is achieved. The treatment goal in these cases is to integrate the symptoms into everyday life in order to achieve an improvement in well-being. The prognosis worsens as soon as other mental illnesses occur at the same time. If affective disorders, eating disorders, personality disorders, or dependency disorders are identified, relief as well as cure encompasses several years. In some cases, the disorders remain lifelong. If Dissociative Identity Disorder goes unnoticed for a long time, the prospect of recovery worsens significantly.
Prevention
There are no preventive measures to avoid the development of multiple personality disorder because the triggers are severe traumatic experiences. However, raising awareness of the affected person’s environment could help ensure that therapy is started when symptoms first appear to prevent manifestation and chronic progression of multiple personality disorder.
What you can do yourself
In dissociative identity disorder, distinguishable identities take control of the individual. This mental disorder is usually accompanied by considerable memory lapses and also maneuvers the affected person into situations in social interactions that are regularly perceived as embarrassing or even humiliating and often even stand in the way of pursuing a profession. People who notice the first signs of multiple personality disorder in themselves should seek professional help immediately. The first person to contact may be the family physician. If the disorder is treated promptly, there is a good chance of recovery, even if therapy usually takes several years. If left untreated, dissociative identity disorder can become chronic. Therefore, an important step toward self-help is to interpret the symptoms correctly and seek professional help quickly. Often, family members and friends notice the mental illness long before the patient becomes aware of it. In this case, the affected person should be confronted with the disorder sensitively but consistently. The goal must be to begin treatment quickly. Patients suffering from multiple personality disorder are best off seeking an experienced trauma therapist. Information on appropriately qualified specialists is available from the Medical Board.
