Behind the Masks – The Mysteries of Dissociative Identity Disorder

While Toni Collette may have pulled off making dissociative identity disorder (DID) look glamorous and sexy in the recently cancelled Showtime series United States of Tara, the reality of this disorder is much more complex. As fun as it is to watch an actress play five different parts in one show, for people with DID, the shifting is no fun at all.

One thing the show did get right is the fact that most people with DID develop it as a response to trauma, especially early childhood abuse from a parent or caregiver; studies have consistently reported this in 95-98% of the cases. People develop this disorder in order to distance themselves from the traumatic experience, by way of creating other personalities. While momentary dissociation is a technique that normal people use to cope with traumatic situations; in the case of people with DID, this dissociation goes beyond the moment, creating a whole new persona that has not been affected by the abuse, as an escape mechanism.

The prevalence of DID in the general population has been established at 1%, making it far more common than popular belief would have it. Nevertheless, the allure of the “exotic” continues to surround this condition, for example, because hypnosis is commonly used to gain access to the alters, as the different personalities are called. A scientifically accepted technique, hypnosis still remains, in the public mind, a practice bordering the world of the occult, found more at home in magic show than in the therapist´s office.

Perhaps because of its assumed rarity, it is the diagnosis of DID that poses one of the biggest problems. In 1993, a Dutch study of 71 DID patients established that:

Patients had spent an average of 8.2 years in the mental health system prior to correct diagnosis. Patients presented with many different symptoms and frequently received other psychiatric or neurological diagnoses.

Over the years, studies carried out in other parts of the world have yielded similar results, raising awareness about DID and the methods that could be used to identify it, separating it from other disorders, some of which can sometimes be comorbid with it, thus further complicating an effective diagnosis.

According to DSM IV, DID can be diagnosed whenever there is a coexistence of:

• The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
• At least two of these identity or personality states recurrently take control of the person’s behavior.
• Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness and not due to the direct effects of a substance (e.g. blackouts or chaotic behaviour during alcohol intoxication) or a general medical condition (e.g. complex partial seizures).

While some alters can be harmless, a study on DID and suicidality found a strong correlation between the disorder and repeated suicide attempts, as well as the risk of causing harm to others. As the DID patient does not control the alters, this presents a great danger. In fact, DID patients have often been involved in crime investigations, and North American law has even recognized the right of the different personalities to have different attorneys, outlining a plot fit for the ultimate trial film from Hollywood. Courts have also been known to take the testimonies of the different alters as if they were actually different people, especially in cases in which one of the “bad” alters has committed a crime that neither the patient´s main personality nor the other alters have a recollection of.

Many times, people have ended up going to jail for crimes committed by one of their alters. Even today, with all the developments and research carried out by the scientific community, it seems that DID remains as mysterious as ever, and people continue to suffer from this disorder without even being aware of it, all over the world.

For those who have been successfully diagnosed, the International Society for the Study of Dissociation (ISSD) has developed a phasic treatment framework for dissociation disorders, including DID. The three phases are:

• safety, stabilization and symptom reduction
• working directly and in depth with traumatic memories
• identity integration and rehabilitation

A recent study by DID expert Bethany Brand and some of her colleagues concluded, after analyzing most of the current literature and research pertaining to DID treatment results, that the three-phase treatment has been widely effective, bringing about a reduction of “symptoms of dissociation, depression, general distress, anxiety and PTSD.”

References

Korol S (2008). Familial and social support as protective factors against the development of dissociative identity disorder. Journal of trauma & dissociation : the official journal of the International Society for the Study of Dissociation (ISSD), 9 (2), 249-67 PMID: 19042777

Koopmans, C. (1994). Multiple Personality Disorder in The Netherlands Tijdschrift voor Psychotherapie, 20 (4), 169-171 DOI: 10.1007/BF03079185

James, D.V. Multiple personality disorder in the courts: a review of the North American experience. Journal of Forensic Psychiatry 1998, 9: 339-361.

Foote B, Smolin Y, Neft DI, & Lipschitz D (2008). Dissociative disorders and suicidality in psychiatric outpatients. The Journal of nervous and mental disease, 196 (1), 29-36 PMID: 18195639

Sinason, V. Attachment, Trauma and Multiplicity: Working with Dissociative Identity Disorder. New York, 2011: Routledge.

Brand, B & Loewenstein, RJ. Dissociative disorders: an overview of assessment, phenomenology and treatment. Psychiatric Times. October, 2010.