Tuesday, May 17, 2011

Dissociative Identity Disorder

ResearchBlogging.orgDissociative Identity Disorder (DID), or if you go by its common name, multiple personality disorder, is an interesting subject to say the least. It is also a subject with which there is much contention. There are even some that claim it does not even exist.

First I would like to address one of the prime reasons why DID is not accepted as a diagnosis. This goes back to the 1990's when there was the wonderful satanic cult fiasco. The new thing in psychology was regression and hypnosis. Now, hypnosis is a viable means of therapy, as it calms the person and makes them feel more safe and reduces stress. But it also opens the patient to suggestion. In the right setting, the patient will be able to open up and reveal things on their own. But in this state, if pressed for answers, the mind will create false answers that fit to the best of its knowledge, and this is where the trouble began.

The patients were asked things they did not have answer for and, in the suggestible state their minds would create scenarios that would fit with the requested information. Add in a little guiding from those determined to find the 'truth' of the satanic rituals and you have the beginnings of a very bad situation.

The most common questions pressured for were those of abuse. If a mind had not experienced any then there was no problem, but in this state of suggestibility and being pressured by their therapists, the patients began creating scenarios to satisfy those who were looking.

It is unsure when DID (then, MPD) was drawn into it, but a connection between severe abuse and DID is what made some convinced that the satanic attacks were occurring. Eventually it was revealed that some therapists were leading on their patients as well as a few manipulative patients who were eager for attention were twisting words around to satisfy credulous therapists. Some of the patients would fake signs of DID for attention, some therapists would poke and prod hoping to find another alter (the term for the differing personalities) until their patient's mind created something from all the suggestion. These weren't true cases of DID, but people who were deluded into thinking they were. Unfortunately as more media attention was shone on the situation, the fake multiples were put in the light as much as the satanist seeking therapists. Which led to a connection between the two in far to many people's eyes.

As one case closed after the other and all the hype and hysteria washed away, the psychology world looked in on itself to try and figure out what went wrong and how not to have a repeat. During this, many saw DID as having been a part of the problem and, as such, should be dismissed as fraudulent as well.  They thought it was simply signs of attention seeking. While many fake cases did arise during the situation, this did not have any bearing on cases of DID that have been known long before this.

And there have been many, DID cases have been potentially written about as far back as 1791 (see link for a more thorough history of DID). It has always been exceedingly rare and while its prevalence has never been accurately noted, it is believed to form in around .05% of the population.

The reason for the splitting comes down to survival in most cases. While not always the case, DID generally forms in cases of severe childhood abuse. The torment the individual goes through becomes more than they can bear so the mind attempts to wipe it out, pressing it down and creating a new 'person' to deal with the new situation. This way the alters (the other personalities) can take the abuse in pieces so that they are not overwhelmed by so much trauma. When the splitting occurs, parts of the whole are often separated, leaving the alters to perform different roles. One may be a protector, another may overly mature to take care of themselves, while yet another may have been solely there to absorb the abuse (this often leads to alters who become suicidal, unable to cope with what they know).

Most of the time, a person with DID is so good at acting 'normal' that nothing seems wrong with them at all. This is all part of the survival, acting normal, in abusive situations is the best way to avoid furthering the situation. Acting abnormal in any way only singles out the person for further abuse. So the person hides it, often from themselves (as the memories are divided just as the personalities are). It is only after self examination (sometimes with the help of a therapist, the good kind now) can the person realize they are part of a collective mind. This obviously is a conclusion not easily accepted and is often flat out denied even with the evidence put before them.

Once it is accepted, communication between the alters may commence. In some cases the barriers of the mind are thin enough that they may communicate with one another freely. Other times, they are trapped separately and only a few can talk to one another with each having their own place. Some may remain in hiding from the others, still too terrified or feeling too alone to be able to contact the others. In some instances a reunification may occur, but only if all personalities are willing. Often, they have developed enough on their own that it would not feel right to merge together completely, some instead just move to the point where the barriers can be dropped between the personalities and each may communicate with the other freely. This creates a more free flowing situation while still having the individual space.

An unusual occurrence can occur where an alter of the alternate gender, for whatever reason, forms. Some alters may not even be quite human if the need arises. If the condition calls for a more animalistic being to survive the situation, cope with the emotions, or because something occurs that cannot be understood, these may also form.

While the debate about the condition has gone on for years, there has been a study that gives physical evidence for multiples. It is known that those with stress related psychiatric conditions such as PTSD have smaller hypocampal volumes. This is also noted in clinical depression with childhood abuse and borderline personality disorder with childhood abuse. It is also noted that in borderline patients with noted childhood trauma a decreased amygdalar volumes as well. When a small study of fifteen noted cases of DID were given MRIs, all showed reduced hypocampal volumes and decreased amygdalar volumes. While all control patients did not show this anomaly. This evidence lends credence to those with DID. DID is still a stigmatized and misunderstood condition and any evidence to get those who deny the existence of this condition to accept will be a boon for both current and future DID patients.
Vermetten E, Schmahl C, Lindner S, Loewenstein RJ, & Bremner JD (2006). Hippocampal and amygdalar volumes in dissociative identity disorder. The American journal of psychiatry, 163 (4), 630-6 PMID: 16585437
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