Dissociative identity disorder (previously referred as “split personality disorder” or “multiple personality disorder”) is a complex psychiatric condition described by fragmentation of a person’s identity into multiple unique personalities.
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Individuals with this condition are likely to have gone through repeated severe physical, emotional, and/or sexual abuse at an early age. Researchers suggest that dissociative disorders often begin as the body’s way of dealing with traumatic experiences.
Various treatment approaches such as psychotherapies (including cognitive behavioral therapy [CBT] and dialectal behavioral therapy [DBT]), antidepressants, and anxiolytics are usually employed. Hypnosis therapy is also used by some of the psychiatrists to manage this condition.
As the patients with dissociative identity disorder behave quite similar to the patients with other similar psychiatric conditions (such as post-traumatic stress disorder [PTSD], depression, and anxiety) in general, it becomes quite important to accurately diagnose the disorder in order to be able to treat it effectively.
Symptoms and Diagnosis
Patients with this condition dissociate themselves from the situation and become someone else during the episodes. The manifested secondary personality is usually very different from their own personality. The secondary personality is often stronger or in some ways capable of doing things which the person cannot do while being their normal self. For example, a person who is quite an introvert in routine life may become outrageously uninhibited during the episodes. The personal preferences, mannerisms, and even the voice of the secondary personality may be substantially different than usual.
The emergence of specific personalities is largely dependent on social circumstances around the patient. In milder cases, dissociation may not be very evident in the behavior of patients. Usually, expression of the secondary identity is accompanied by sudden changes in the physical behavior as well as perception about self and the surroundings. Some tribes often correlate this behavior with their religious beliefs, and describe this phenomenon as an experience of “possession”. Hysterical behavior (also known as “fugue”) is common during the phases of possession and is often confused with an epileptic episode. The person loses the sense of space and time and often recovers puzzled from the episode.
Patients normally forget everything that occurs during that particular episode. There are frequent gaps in the memories, both long-term as well as short-term, which are different from usual forgetfulness. These symptoms make the patient feel distressed and socially awkward, and also affect their day-to-day affairs including occupational as well as personal.
Patients often report of having heard voices, such as spiritual voice or a child’s cry, which they cannot consciously control. These are usually accompanied by strong emotional impulse and detachment from their actual personality. Some patients go into a semi-conscious state of being (often termed as “trance”), while some feel biologically different (e.g. of a different age or gender than theirs) during the episodes. Those with partial memories of such “out of body” experiences, sometimes yearn to feel the same way again.
Depression and anxiety are particularly common in these patients. Post-traumatic flashbacks and nightmares are also frequently reported. After becoming aware of their condition, many patients suffer from identity crisis. More violent behavior is observed in male patients with this ailment. Attempts of suicide and self-destructive behavior are reported in approximately 70% of the patients.
In addition to psychological symptoms, the patients with dissociative identity disorder also suffer from somatoform symptoms such as physical hyperactivity, exaggerated startle response, idiopathic gastrointestinal pain, and high occurrence of auto-immune disorders such as rheumatoid arthritis and fibromyalgia.
Reviewed by Amrita Roy, MSc