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.

Multiple Personality: what is it?

From The Strange Case of Dr. Jekyll and Mr. Hyde until Psychosis or Fight club, going through the character of Gollum from The Lord of the Rings and even the character played by Jim Carrey in comedy Me, myself and Irene, there are dozens of works that have used DID as inspiration due to its striking symptoms.

It is because of this type of disclosure that multiple personality is one of the psychological disorders best known, although not one of the best understood, not even within the world of Psychology, in which there is significant controversy regarding the very existence of this disorder as such.

Symptoms

The fourth edition of Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines the TID as «the presence of two or more identities - rarely more than ten - taking control of behavior of a person on a recurring basis, each having memories, relationships and attitudes own

». In general, the different identities do not remember what was experienced by the rest, so they are not aware of its 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 most passive identities that manifest amnesia to a greater extent and, if they are aware of the existence of the most passive personalities dominant, can be directed by these, which can even manifest in the form of visual or auditory hallucinations, giving orders to others identities.

At present, both in the DSM like in the International classification of diseases (ICD-10), DID is categorized within dissociative disorders, that is, those that are produced by failures in the integration of consciousness, perception, movement, memory or identity (in the case of multiple personality, disintegration would occur in all these aspects) as a direct consequence of trauma psychological.

Causes of Dissociative Identity Disorder

It is this relationship with traumatic experiences that links DID with stress disorder post-traumatic, characterized by the presence of anxiety Y re-experimentation (through nightmares or flashbacks) following life-threatening events, such as sexual abuse or natural disasters. An element of particular interest in this case is the fact that PTSD can include symptoms dissociative, such as a lack of recollection of important aspects of the traumatic event or an 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 that in the case of posttraumatic stress it becomes pathological when it becomes chronic and interferes in the life of the person.

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, in particular neglect or abuse by parents, would lead to dissociation, that is, to 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 separate from the rest.

Cases of DID with onset in adulthood are rarely seen. Thus, DID would not arise from the fragmentation of a core personality, but rather from a failure in the normal development of the personality that would result in the presence of relatively separate mental states that would end up becoming identities alternatives.

Evaluation and Treatment

The number of DID diagnoses has increased in recent years; while some authors attribute this to greater awareness of the disorder by clinicians, others consider that it is due to an overdiagnosis. It has even been proposed that DID is due to the suggestion of the patient due to the questions of the clinician and the influence of the media. Likewise, there are also those who believe that there is a lack of training on the manifestations of the TID and a underestimation of its prevalence leading to many cases of DID being undetected, in part by examination inadequate.

In this sense, it should be borne 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 symptoms of stress posttraumatic with other non-defining symptoms of DID, such as depression, panic attack, substance abuse or Eating Disorders. The presence of this last group of symptoms, much more obvious than the rest of the symptoms of DID and very frequent due to if alone, it would lead clinicians to skip a deeper exploration that would allow detecting the personality multiple. In addition, it is obvious that people with DID find it difficult to recognize their disorder because of shame, fear of punishment, or because of the skepticism of others.

Treatment of DID, which generally takes years, is fundamentally directed to the integration or fusion of identities or, at least, to coordinate them to achieve the best possible functioning of the person. This is done progressively. In the first place, the safety of the person is guaranteed, given the tendency of people with DID to self-harm and attempt to commit suicide, and the symptoms most interfering with daily life, such as depression or abuse of drugs Subsequently, the confrontation of traumatic memories is worked, 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 respect and validate the adaptive role of each one to make it easier for the person to accept those parts of themselves as their own herself. For a more detailed description of the treatment of DID you can consult the text Guidelines for treating dissociative identity disorders in adults, third revision, of the International Society for the Study of Trauma and Dissociation (2011).

Bibliographic references:

• Freyd, J. J. (1996). Betrayal trauma: The logic of forgetting childhood abuse. Cambridge, MA: Harvard University Press.
• International Society for the Study of Trauma and Dissociation (2011). Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision. Journal of Trauma & Dissociation, 12: 2, 115-187
• Kluft, R. P. (1984). Treatment of multiple personality disorder: A study of 33 cases. Psychiatric Clinics of North America, 7, 9-29.
• Kluft, R. P. (1991). Multiple personality disorder. In A. Tasman & S. M. Goldfinger (Eds.), American Psychiatric Press review of psychiatry (Vol. 10, pp. 161-188). Washington, DC: American Psychiatric Press.
• Putnam, F. W. (1997). Dissociation in children and adolescents: A developmental perspective. New York, NW: Guilford Press.