Treating Dissociative Identity Disorder Essay
Treating Dissociative Identity Disorder
According to Dr Ralph Allison (1998), decades of studies show that Multiple Personality Disorder was associated to patients whose dissociation occurred before the age of seven while Dissociative Identity Disorder after age seven.(p.125) The change came about in 1994 when the Diagnostic and Statistical Manual of Mental Disorder-IV (DSM-IV) replaced DSM-III-R. According to WebMD.com (2008), this disorder is triggered by something traumatic during a patient’s childhood days. Such trauma is said to be “extreme, repetitive physical, sexual, and/or emotional abuse.” (par. 1)
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What is Dissociative Identity Disorder?
Dissociation may be experienced by any normal person. In cases where one daydreams or loses track of some thought for something else is considered slight dissociation. WebMD.com (2008) defines Dissociative Identity Disorder as “a severe form of dissociation, a mental process, which produces a lack of connection in a person’s thoughts, memories, feelings, actions, or sense of identity.” (par. 2) This means that the person tends to act completely different from his usual or known self. Furthermore, this disorder is seen as a mechanism to cope with traumatic events that transpired during the patient’s early childhood years. As Allison (1998) states: “Dissociation is a life saving mental mechanism which very highly hypnotizable abused patients used to stay alive, by creating alter-personalities.”
Characteristics, Symptoms of Dissociative Identity Disorder
Dissociative Identity Disorder was more popularly known as the Multiple Personality Disorder, characterized by the patient having split or dual, or even multiple personalities. According to the website, “the alters or different identities have their own age, sex, or race.” (WebMD, 2008, par. 6) This means that a child may have an alter personality of an adult and vice versa or a male can have female alters, and vice versa. Alters can be one to a hundred personalities. Furthermore, there are cases where the alter exhibits different handedness from that of the original personality. According to the Gale Encyclopedia of Childhood & Adolescence (2008), there are instances when one personality demonstrates an entirely different posture or voice. Such phenomena further complicate the study and understanding of this disorder among psychiatrists. (par. 5)
As also mentioned in the Gale Encyclopedia, the Diagnostic and Statistical Manual of Mental Disorder-IV (DSM-IV) sets criteria for the diagnosis of Dissociative Identity Disorder, as follows: (a) the patient has two or several different “personality trait;” (par. 2) (b) very often, there are “at least two personalities that take over the person’s identity;” (par. 2) (c) presence of amnesia manifested through forgetfulness of basic self information; and, (d) physiological implications have already been ruled out as a cause of the symptoms.
In addition, a patient diagnosed with Dissociative Identity Disorder has one dominant personality that rules or controls that person’s actions called by doctors as “host.” (Gale Encyclopedia, 2008, par.3) The personality which the person has been born with is called the “original personality.” Psychiatrists say that the original or birth personality does not always act as the “host” in a patient. Significantly, psychiatry experts operationalized the terms used in the diagnosis and treatment of this disorder. As stated by the DSM-IV, in order to consider something as an “alter” or “personality state,” it should be characterized by the following:
(a) a consistent and ongoing set of response patterns to given stimuli; (b) a significant confluent history; (c) a range of emotions available (anger, sadness, joy, and so on); and, (d) a range of intensity of affect for each emotion (for example, anger ranging from neutrality to frustration and irritation to anger and rage). (cited in Braun, 1985, p. xxi)
Psychiatrists use the term “switch” to mean transition from one personality to another. However, there are cases when two or more personalities simultaneously manifest and the “host” may not be aware of these alter personalities’ existence. (Gale Encyclopedia of Childhood & Adolescence, 2008, par. 3)
Treatment of Dissociative Identity Disorder
Dissociative Identity Disorder is treated with long-term psychotherapy. The aim of therapies is to help the patient restore his/her original personality by merging the alters into one. Psychotherapy involves exploration of the deep-seated issues brought about by trauma and abuses that were likely to have occurred during the patient’s childhood.
John Grohol (2006) states that the disorder can indeed be treated with Psychotherapy. (par.1) As the disorder is rooted from a traumatic occurrence in the patient’s life, Dr Muhammad Waseem (2007) suggests that “the initial task of therapy is to detoxify the patient’s environment by stopping all forms of abuse.” (sec. 6) Waseem outlines three specific tasks in the treatment of Dissociative Identity Disorder, as follows: “Encouraging healthy coping behaviours, logging and monitoring emotions, and developing a crisis plan.” (Waseem, 2007, sec. 6) He says that it is important that the therapist establishes affect towards the patient’s view of him/herself and that the treatment focuses on trust. Since dissociation and the switch are triggered by traumatic flashbacks, Waseem stresses out that therapists should help these patients rise above these negative emotions. Before the start of the treatment, it is imperative that the patient develop measures on how to deal with emotional episodes that may occur as the therapy progresses. The patient should “learn healthy alternatives to tolerate feelings and control behaviors” (Waseem, 2007, sec. 6) for him/her to safely and effectively go through the process of discussing the trauma/ abuse experienced in life. Control is said to be very important and when the patient regains this over him/herself, he/she begins to take charge of him/herself, thus able to handle helplessness. Additionally, patients should learn to monitor what they feel. As feelings of sadness or rage usually precede dissociation, Waseem (2007) deems it important that the patient identifies and monitors these emotions. In so doing, the patients can be taught by the therapists “on how to intervene long before anxiety rises to a critical level.” (sec. 6) Patients also ought to learn, practice and master “new and effective coping skills.” They should do simple to complex activities for once they enthuse and get engaged in doing these, they develop some sense of control. “This reconnects them to personal strengths and the choices that can be exercised.” (Waseem, 2007, sec. 6)
James Chu is coherent with Waseem in the significance of starting from trauma and abuse. Chu (1998) emphasized on the importance of “society’s rediscovery of child abuse and other forms of trauma along with the gains that have been made in documenting their effects and in forming new diagnostic conceptualizations.” (p. xxi) He believes that it is important to acknowledge traumatic childhood experience. To unrecognize this can cause damage to the person’s mind posing grave effects such as “posttraumatic responses and alterations in personality development.” (Chu, 1998, p. 8 ) Chu points out however, that clinicians should be cautious in falling to that trap of focusing on the trauma and how to reconstruct it, for he claims this could lead to a regression and further damage.
Frank Putnam (1989) designed eight stages in treating Dissociative Identity Disorder, as follows: “making the diagnosis, initial interventions, initial stabilizations, acceptance of the diagnosis, development of communication and cooperation, metabolism of trauma, resolution and integration, and post resolution coping skills.” (p.116) A number of reviews from experts of the same field see Putnam’s study as a great contribution to understanding and treating dissociation disorders in general. The methodology of treatment he advocated, according to Andrea Moskowitz, (1999) has provided an “excellent framework for organizing research including work on the effects of trauma and maltreatment, the phenomenology and genesis of dissociation, memory functions, and the effects of stress.” (274).
Allison, R. (1998). Multiple personality disorder, dissociative identity disorder and
Internalized imaginary companions. Hypnos , 25 (3), 125-133.
Braun, B. (1985).Treatment of multiple personality disorder. Virginia:American Psychiatric Publishing.
Chu, J. (1998). Rebuilding shattered lives: The responsible treatment of complex post-traumatic and dissociative disorders. New Jersey: John Wiley and Sons.
Encyclopedia of Childhood and Adolescence.(2008). Findarticles.com. Dissociative identity disorder/multiple personality disorder. Retrieved November 13, 2008, from
Putnam, F. (1989) Diagnosis and treatment of multiple personality disorder. New York: Guilford Press.
Waseem, M. (2007). Child abuse & neglect: Dissociative identity disorder.Emedicine.com. Retrieved November 14, 2008 from http://www.emedicine.com/ped/topic2651.htm.
WebMD.(2008). Dissociative identity disorder (multiple personality disorder).WebMD.Com. Retrieved November 13, 2008, from http://www.webmd.com/mental-health/dissociative-identity-disorder-multiple-personality-disorder