Multiple Personality Disorder: Causes And Symptoms
Dissociative identity disorder (TID), popularly known as “Multiple personality disorder”, is one of the psychopathologies most frequently represented in fiction.
From The Strange Case of Dr. Jekyll and Mr. Hyde until Psychosis either fight clubpassing through the character of Gollum from The Lord of the Rings and even the character played by Jim Carrey in the comedy Me, myself and Irenethere are dozens of works that have used DID as inspiration due to the striking nature of its symptoms.
It is because of this type of disclosure that multiple personality is one of the best-known psychological disorders, although not one of the best understood, not even within the world of Psychology, in which there is an important controversy regarding its very existence. of this disorder as such.
Symptoms
The fourth edition of Diagnostic and statistical manual of mental disorders (DSM-IV) defines DID as “the presence of two or more identities – rarely more than ten – that take control of a person’s behavior on a recurring basis, each having its own memories, relationships and attitudes». In general, the different identities do not remember what the rest experienced, which is why they are not aware of their existence, although this is not always the case. The change between personalities usually occurs as a result of stress.
The primary personality (or the “real”) tends to be passive and depressive, while the rest are more dominant and hostile. It is the more passive identities that manifest amnesia to a greater extent and, if they are aware of the existence of the more dominant personalities, they can be directed by them, which can even manifest themselves in the form of visual or auditory hallucinations, giving orders to the other identities.
Currently, both in DSM as in the International classification of diseases (ICD-10), DID is categorized within dissociative disorders, that is, those that occur due to failures in the integration of consciousness, perception, movement, memory or identity (in the case of personality multiple, disintegration would occur in all these aspects) as a direct consequence of psychological traumas.
Causes of Dissociative Identity Disorder
It is this relationship with traumatic experiences that links DID with stress disorder posttraumaticwhich is characterized by the presence of anxiety and re-experiencing (through nightmares or flashbacks) after life-threatening events, such as sexual abuse or natural disasters. Of particular interest here is the fact that PTSD can include dissociative symptoms, such as failure to remember important aspects of the traumatic event or the inability to experience emotions.
These symptoms are conceived as a protection against feelings of pain and terror that the person is not able to handle adequately, which is normal in the initial moments of the process of adaptation to the traumatic experience, but which in the case of post-traumatic stress becomes pathological when it becomes chronic and interferes with the person’s life.
Following the same logic, DID would be an extreme version of childhood-onset post-traumatic stress disorder (Kluft, 1984; Putnam, 1997): early, intense and prolonged traumatic experiences, particularly neglect or abuse by parents, would lead to dissociation, that is, the isolation of memories, beliefs, etc., in alternative identities rudimentary, which would develop throughout life, progressively giving rise to a greater number of identities, more complex and separated from the rest.
Adult-onset cases of DID are rarely seen. Thus, DID would not arise from the fragmentation of a core personality, but rather from a failure in normal personality development that would result in the presence of relatively separate mental states that would eventually become alternative identities.
Evaluation and Treatment
The number of DID diagnoses has increased in recent years; while some authors attribute this to greater awareness of the disorder on the part of cliniciansothers consider that it is due to overdiagnosis. It has even been proposed that DID is due to the patient’s suggestion due to the clinician’s questions and the influence of the media. Likewise, there are also those who believe that there is a lack of training on the manifestations of DID and an undervaluation of its prevalence that leads to many cases of DID going undetected, in part due to inadequate examination.
In this sense, it should be kept in mind that, according to Kluft (1991), only 6% of cases of multiple personality are detectable in their pure form: A typical case of DID would be characterized by a combination of dissociative symptoms and post-traumatic stress symptoms with other non-DID-defining symptoms, such as depression, panic attacks, substance abuse, or eating disorders. The presence of this last group of symptoms, much more obvious than the rest of the DID symptoms and very common on their own, would lead clinicians to skip a more in-depth examination that would detect multiple personality. Furthermore, it is obvious that people with DID find it difficult to recognize their disorder due to embarrassment, fear of punishment, or because of the skepticism of others.
Treatment for DID, which typically takes years, is fundamentally directs the integration or fusion of identities or, at least, to coordinate them to achieve the best possible functioning of the person. This is carried out progressively. First of all, the safety of the person is guaranteed, given the tendency of people with DID to self-harm and attempt suicide, and the symptoms that most interfere with daily life, such as depression or drug abuse, are reduced. Subsequently, the confrontation of traumatic memories is worked on, as would be done in the case of post-traumatic stress disorder, for example through exposure in the imagination.
Finally, identities are integrated, for which it is important that the therapist respects and validates the adaptive role of each one to facilitate the person accepting those parts of themselves as their own. For a more detailed description of the treatment of DID, see the text Guidelines for treating dissociative identity disorders in adults, third revisionof the International Society for the Study of Trauma and Dissociation (2011).
