Dissociative Identity Disorder

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Biology 202
1998 Second Web Reports
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Dissociative Identity Disorder

Rachel Kaplan

Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder (MPD) is considered by the American Psychiatric Association to be one of 4 main kinds of dissociative disorders (DSM-IV): "The essential feature of dissociative disorders is a disturbance or alteration in the normally integrative functions of identity, memory, or consciousness" (8). If identity is the main function affected, the person is said to have DID.

Most non-DID people have one identity comprised of many parts that work harmoniously together. They have only one I-function which consists of a conglomeration of thoughts and feelings formed from connections between many different brain areas. People with MPD, however, have a decentralized, internal network of 2 or more I- functions or "alters," each with its own physiology, behavior, and cognitions.

Dissociation often enables victims to maintain a relatively healthy level of functioning because traumatic memories are disconnected from other information in their minds. A multiple presents her view of DID: "We do not SUFFER FROM MPD. We SURVIVE because of MPD" (6). Living with this disorder is often an extremely lonely, confusing experience. Luckily, there has been much success in treating this disorder thanks to the extensive research conducted into DID etiology.

The etiology may be explained by the diathesis-stress model. There appears to be a biological component given the fact that most people with DID have a family history of the disorder. It has also been found that people who are easily hypnotized are more susceptible to DID (5). The stress is known to come from severe physical, emotional, and/or sexual abuse at a developmentally sensitive stage in childhood (3).

When a person experiences extreme stress "endogenous, stress-responsive neurohormones, such as cortisol, epinephrine and norepinephrine (NE), vasopressin, oxytocin and endogenous opioids" are released (10). These substances induce glucose release and activate the immune system, enabling the organism to effectively deal with the stress. Chronic stress, however, such as repeated sexual abuse, decreases the effectiveness of this system. It has been hypothesized that when the system is bombarded with chronic stress, there is a malfunction in the negative feedback loop which goes from the neurohormones back to the hypothalamus and pituitary gland. As a result, the system begins operating in positive feedback mode; increased cortisol release, for example, leads to increased cortisol production. The desensitization of the system causes the person to have an intense stress reaction in the presence of even the smallest trigger. Abnormalities in the limbic system have also been implicated in this condition.

This desensitized state exacerbates the dissociative process. In order to survive extreme stress, many children psychologically separate "thoughts, feelings, memories, and perceptions of traumatic experiences" (2). This coping method becomes increasingly ingrained the more frequent the abuse. The resulting highly conditioned, hypersensitive survival technique leads to impaired functioning. A person with a young child as one of his alters might bring out that child whenever there is even the slightest threat of an anxiety-provoking situation. In this way, if a traumatic event occurs, the pain gets isolated to one faction, a storage space, of the overall personality.

Memories from traumatic experiences are encoded in a unique way. Pierre Janet has suggested that the emotional impact of the trauma prevents the victim from translating the experience into the words and symbols which would be stored in the semantic memory. Instead, the experience gets stored in a "somatosensory or iconic level" form which makes for vivid and accurate recall (10). For example, 4-5 months after witnessing a murder, subjects showed excellent recall for details about the event (Cutshall 1989) (11). Neuroimaging studies have shown that during the stimulation of traumatic memories, there is decreased activity in Broca's area, the part of the brain most concerned with the translation of experience into words, and increased activity in the right hemisphere areas, parts which are involved in the processing of emotional and visual information. (Rauch et al., 1995) (11). A person with DID has stored these emotional and visual representations of traumatic incidents in a whole identity that is as stunted as the memories themselves.

Storage in semantic memory is easier on the ego because experiences are tempered through their translation. Also, because semantic memory integrates input into existing mental schemata, the information is subject to learning effects (10). When recalled, these memories are subject to distortion because of their emergence in a new context. There is debate, however, about whether traumatic memories can ever be changed. It has been found that with time sensorimotor and iconic memories tend to become restored as words and symbols which can be processed in connection with existing mental schemes (10). LeDoux, on the other hand, has postulated that "once formed, the subcortical traces of the conditioned fear response are indelible, and that 'emotional memory may be forever'" (10). LeDoux's theory does not bode well for the ability of trauma victims to unload their burdensome memories. There is definitive evidence, at least, that memories may be recovered.

Research has shown that memory retrieval is "state dependent (10): "physiological arousal in general can trigger trauma-related memories, while, conversely, trauma-related memories precipitate generalized physiological arousal (10). This phenomenon might explain why the presence of a trigger for a traumatic memory may induce a "switching" of alters. The memory may induce a stress reaction which would ultimately produce a different physiological state. It seems possible, given that alters have been shown to have different physiologies, that a specific physiological state might correspond with a specific alter. The concept of corollary discharge may be used to explain why the actions of one alter may affect the mind-set of others despite the psychological separation of these entities.

People with DID are reluctant to integrate their separate identities because they use them to cope; however, patients' quality of life has been shown to increase following treatment. Therapy should involve a nursing, medical, and primary therapist component. Therapists may direct patients to increase the strength of the entire system through increased internal communication and cooperation, the build up of ego strength, and the increased taking of responsibility for internal actions (7). It is very important that the patient gain a sense of control over his current cognitions and past memories. The multiple may gain control by recognizing the abused child's thoughts and feelings and by altering negative self-images (8). It is also vital that both the therapist and the patient show equal respect to all the alters.

Hypnotherapy and nonverbal therapy are commonly used in the treatment of DID. Hypnotherapy is commonly used in treating DID because of its facilitation of memory retrieval, "calming, soothing, containment, and ego strengthening" qualities (4). It can be used to increase communication between the alters and between the alters and the therapist. This method may also help in "fusion rituals (when previous psychotherapeutic work has cause a particular separateness to no longer serve a meaningful function for the patient's intrapsychic and environmental adaptation and when the patient is no longer narcissistically invested in maintaining the particular separateness)" (4). This is interesting because it indicates that a patient's pride might serve as an obstacle to his convalescence. The danger to hypnotherapy is that it may cause a patient to believe in a fantasy which he creates while under hypnosis.

Nonverbal treatment methods such as art and play therapy have also been proven useful in treating DID. Art therapy seems to be a freer expression of thoughts and feelings than verbal methods. The right side of the brain is more involved with creativity and the imagination; whereas, the left side is more concerned with language. Stimulating the right hemisphere might bring up "sensorimotor and iconic" memories more readily than if the person needed to filter input through the left hemisphere (10).

In general, most people respond fairly well to treatment depending on their baseline comorbidity (9). It has been shown that 60% of patients who undergo treatment maintain stable integration, which is defined by Kluft as "3 stable months of continuity of contemporary memory, with the absence of behaviorally evident separate identities (9).

DID research raises a lot of questions about the nature of the I-function. What are the implications of its being able to be fragmented? Perhaps the other I-functions, or separate identities, are merely different centers of connections with some of the same and some of their own links to other brain areas. Maybe the mechanism of the "fusion rituals" during hypnosis involves the solidification of links between the most dominant I-function and the alters such that when one is activated, the whole system becomes activated. Another possibility is that everyone possesses different centers of connections and somehow after repeated dissociation episodes, some people's links become severed.

Findings from DID research may be helpful for DID and non-DID sufferers alike. Research into this area has shed a lot of light into what kinds of cognitions lead to healthy functioning, among the most important of which are the need for a sense of control and self-love and respect. The research also highlights the interconnectedness of the mind and body: the fact that the psychological has a very real affect on the physiological and vice versa.

 

Works Cited

1) Re: Multiple Personality Disorders "NOSSCR Online"

2) The Effects of DID on Children of Trauma Survivors "Sidran"

3) Dissociative Identity Disorder (Multiple Personality Disorder) "Sidran"

4) Guidelines for Treatment "ISSD"

5) About Multiple Personality Disorder and Dissociation

6) Shelters From the Storm

7) Clinical Case Study #2: "Hardscrabble Communications"

8) An Overview of Diagnosis and Treatment

9) Two-Year Follow-Up of Inpatients With Dissociative Identity Disorder

10) The Body Keeps the Score: Memory and the evolving psychobiology of post traumatic stress

11) Dissociation and the Fragmentary Nature of Traumatic memories: Overview and Exploratory Study

 

 

Continuing conversation
(to contribute your own observations/thoughts, write Serendip)

11/28/2005, from a Reader on the Web

Excellent resource about the topic.

Additional comments made prior to 2007
Hey, I am doing a paper on Multiple Personality Disorder a.k.a (DID) and I had a few questions to ask.

1) What are some of the day-to-day concerns or issues people with the disorder face or people they live with face.

2) also, what are the percentage of cases in the U.S. of the people who have this disorder ... Evan Norrgard, 8 May 2006

 

 

I was diagnosed with DID. I see alot of pictures and visuals in my mind. I take these and work with what I see. If I see a house that has has a storm come throught I talk to myself and the alters about the storm. I also talk to THe Holy Spirit and see his help. I will ask the parts if they want to come an be integrated into me. They ususally do after some talk. I always feel relieve after such a talk.

 

I function well and work and enjoy a full life now, But I know there is more for me and I want travel the world and experience more goodness in life.

 

A hard part of this is that my mother and sisters do not except that anything traumatic ever happened to me and talk as though nothing ever happened. It is really strange.

 

Thank you for you imput. I wish I could come for some treatment, however I do not think that your prices are within my price range ... Lena, 3 December 2006

 

 

I suffer with DID and now after years of therapy, I seem to be going backward instead opf forward. There are so many stressors in my life right now I cant cope...any suggestions to help? ... Sam, 28 April 2007

Comments

Anonymous's picture

join the crowd

I HAVE DID WITH EIGHT ALTERS RANGING IN AGE FROM FOUR TO FIFTY, I AM FORTY THREE
WE ARE NOT ALONE THIS DISORDER GIVES ME HEADACHES AND OTHER DIFFICULTIES.

Tom Grayson's picture

DID and Headaches

I've been wrestling with DID for years but did not know there was a clinical term for it until a few years ago. This has been the strangest journey for me over the last few years and I have had an unbelieveable time with chronic headaches. These have been more than headaches for me, but headaches seems to be the easiest way to describe my suffering. The headaches I get usually last for several days (3 to 5)and are at times debilitating requiring time off from work. The headaches are usually accompanied by pain in my shoulders as well and they come with heart palipitations, shortness of breath and a general feeling of anxiety. I've wanted to converse with another DID victim who has headaches to see if there are similarities.

My belief is that my chronic headaches are the result of inter personality conflicts that I have with my altars and I'd like to talk with someone who has DID and headaches to see if there is some common ground.

Tom

Keith's picture

Headaches are usually a sign

Headaches are usually a sign that there is a part that is upset and if that part is given a chance to express its feelings the headache will go away.

regards

Keith

Moth's picture

Yes, this would appear to be

Yes, this would appear to be the case. I believe headaches occur when an alter is frustrated at a situation and is attempting to be heard without going through a complete switch.

J's picture

hey everyone saying that i

hey everyone
saying that i know what you all are going through would be completely exaggerated
however, my partner suffers from DID
if anyone feels like talking just mail me

Laurence's picture

Hello.. can you help me?

Hi my names Laurence,

Im new to this forum and to DID. I don't have it but my potential partner does (we are yet to start dating because she wants me to know everything before i commit). As someone who needs to take care and support the diagnosed partner, what is it like? how can i be the rock of support she needs? What should i look out for and mostly is it hard to deal with being the outsider

I hope these questions arn't offensive or rude in anyway, i sincerely apologise if they have not sounded right. I just have never known about this disorder before and i do not know if i need to prepare myself or how best to help support her. I care about her so deeply, and all i want is to be there for her.

Please if you could give me any help or knowledge that would be most appreciated.

Serendip Visitor's picture

Hello from a DID sufferer

Hi,
My wife and I have been dealing with DID for about 5 years. I have it and she has stuck by my side. It has been very difficult for her not knowing who she is talking to or if she would come home to find me a bloody mess or full of more tattoos. Accorcing to my Psychiatrist it is not uncommon for people with DID to hurt themselves to bring them out of the dissociation. I used to have 10 alters and am now down to 3. To say it is a difficult living with the disorder is minamalizing it. I have depression which often accompanies it and so I am dealing with the two for one sale. I have had 3 different Psychologists in the past 5 years and 5 different therapists. I have been heavily medicated so I would be a slobbering fool and that was unacceptable. I made my new psychologist accept that I will go on the lower doses because I need to work and live life. Problems.....hmm You didn't say if your partner is a male or female so excuse me for the following information. I also do not know if you are a male or female. As my alters integrated my personality and desires changed. I used to be artistic. I am no longer interested in doing such things. I was always heterosexual and now am bisexual and this has caused quite a stir in my marriage. That is a long story I will not get into.
How am I doing right now? Well I am working at a job that pays just over minimum wage and has no benefits but I am at least helping with the bills a little bit. Last night and tonight have been hell because I have had my one alter trying to convince me to kill myself. I have had several attempts the most recent one when he took over my body and hung us in the truck. I came around and managed to get the noose off my neck before I blacked out.

I am sure not all these things are typical. There are things that I do not tell my wife for fear she will go running into the night. To tell you the truth I am afraid to tell her. I want to stay alive to help take care of my grandson that is only a month old. He is a good boy and my younger alter likes to play with him. All my alters interact with each other and even the one that is doing bad stuff takes care of the young one.

All I can say is to try to be kind and caring to your partner and remember that he/she is not doing this for attention. It is something that we wish we didn't have to deal with. If you would like to contact me I wouldn't mind. I have a private email at timtruck44@yahoo.com.
God Bless you Both
Tim

Anonymous's picture

DID &PARTNERS

hey everyone,i have DID & so does my partner now & the one we were with for 10yrs. we don't want to b intergrated, who do we get rid of? as a partner of someone that suffers from this disorder we have learned to accept each alter for the person they r, whether they r male or female. most times they share but there r times when thet r very secretive for alittle while then they come clean with us. we r the same, if we do not feel that someone will not accept us for who we r at the time we will close down. just b patient they will come around when u show them that u LOVE and SUPPORT them all.we also switch alot when we r under alot of stress.we were diagonesed in 1995 and did well on medication and saw a therapist that specialized in DID. recently we(not with my partner)moved to look after our mother & stepfather in the states. of course the medical is the shits here as opposed to canada so we r unable to seek councelling or medication which has put us in a tailspin.so we r all over the place.our partner is still in canada & we travel a couple times a year to see each other & write & toc on the phone everynite for hours.we try to ground each other and toc to each others alters & try to keep each other from completly losing it. so far its touch & go.your partner will come around but eeryone has to b onboard. TRUST in yourself & your partner they will in turn toc to u & see if they r accepted. GOODLUCK PEACEOUT

kloscheo's picture

My partener has DID and I'm going crazy

My partner of 10 years seems to be involved intimately with another person causing me to feel insecure and uncomfortable about our relationship. Because she either is unable or unwilling to let her others talk with me, I don't feel I am able to address the situation and therefore am unable to rectify this problem. I would appreciate any help and information anyone might offer. Thanks very much.

Anonymous's picture

My boyfriend has DID and I

My boyfriend has DID and I have the same feelings of insecurity as you do about it. I was relieved to read your comment, b/c I was sitting here feeling guilty and self absorbed for feeling "left out" of my lover's life. I get my feelings hurt sometimes when he tells me his alters do not want to talk to me. I feel like if he loves me, then they all should. He's constantly having conversations in his head which sometimes makes me feel lonely. Thanks for sharing.

Anonymous's picture

DID

How can I get help if they won't let me get help?

White Snow's picture

ahhhh

i know exactly! i am a male and in the begining i came across as Psychopathic, but then something changed and i felt depressed and noticed the difference, and my aunt thinks it might be bi polar but its too drawn out. now i feel guilt and whatever etc. and im studying into DID and awaiting to see my psychologist to further investigate it. i do talk to myself in terms of "we" and "lets". the thought controle me sometimes other times it talks to me and is very insightful, other times very aggressive. i often feel i dont know who i am, i feel like sometimes my body is going on automatic and im in the background watching minutes passsssssssss...........white snow isnt my name.. the name as seen above, is thine name of the one who is in thee shadows. his name comes forth rare, the analogy of the red dragon is heard often, who are these spirits in my head? who knows. all i do know is, im at peace, with whatever it is.

cory's picture

OH GOD

im trying to see if im DID, my mother was DID and after reading the post by white snow i have thee EXACT things going on with me, whats even weirder is i heard the name White snow before in my head too, and its the same thing in regards to the red dragon...

Maj's picture

I have recently discovered

I have recently discovered that it is quite plausible that I have DID. I have come to realize that when someone hurts me emotionally or if something traumatic happens my personality completely changes. Usually I am a very compassionate, forgiving person and I love my family to death. But when I faced with something very painful or stressful I become a completely person altogether. My other personality is hateful, self-destructive, and I see everything completely different. I view life as a waste of time instead of being thankful. Normally I am a very religious person and I thank God every day for my life. I am a girl and usually I am very feminine, but my other self is very masculine. I hang out with guys and act like them and I find myself attracted to women. When I am my normal self I am terrified of men, except for the ones I know very well, like my husband and my father. There is a lot more than is wrong with me and a lot more details about my two personalities but I feel that I have written enough. I really would just like someone to talk to and help me figure out what is wrong with me. I don't know what else to do. A response would be greatly appreciated.

Sincerely,
Maj

serendip2's picture

Reponse for Maj: I have the same problem

There is an alter that comes out when I am rejected by someone I consider very important to my life. I hear a diaologue in my head of someone telling me to kill myself to get out of the pain. I have had 8 major suicide attempts and luckily the last one, I had good therapists that recognized DID. I had been fired from my job because an alter came out at work that is not professional. I had been under tremendous stress after my husband burned our house down with him in it. I feel in so many ways I caused his death. My biggest worry is that I will attempt suicide again. I isolate myself alot to put myself away from as many people that I can until I can integrate further. The whole thing is so scarey, but I am working hard to get to a place where I have more control. Since I have started having inner dialogues with the alters and just acknowledging their presence, it has gotten much better. serendip2

Anonymous's picture

relapse

Dear Seendip,
I have experienced what the doctors tell me is an unusual pattern. I waqs diagnosed with (then) MPD in 1985. I was in my early 30's and I was hospitalized due to suicidal ideation and depression. I had been hospitalized one other time in my life, for the same symptoms, in 1970.

After the first hosp, I was sent home with antidepressants (trycychlits (sp))and I never returned to see the psychiatrist and of course stopped taking the medication. i seemed to be relatively ok for 15 years, married, had children, divorced and got a BA degree. Then out of the blue, I was depressed again, began seeing a therapist, decompensated, no obvious new psychosocial stressors.
At that point I was hosp for 3 months time (good insurance back then) and was diagnosed because staff and doctor noticed the alter personalities. I was sent home on anti-depressants again, treated for about 2 years and was integrated.

I went on to get an M.A. in psychology and worked in the field in several capacities, including private practice, for another 18 years, with no symptoms of depression or disassociation.

In 2005, I dicovered that my husband of 12 years had been having an affair. I had a complete breakdown, including my first psychotic episode. I was treated initially with anti-psychotic and antidepressant medication. The anti-psychotic medication was stopped after a few days. This episode has not completely resolved as of 28 months later. Disassociation is less frequent but not gone and depression is better but still not resolved.

Obviously the psycho-social stressor is the main variable in this episode and it has not been resoved completely either, in part due to the disassociative episodes.

I wonder is this an unusual pattern? My 2nd question is, is it more difficult to recover and reintegrate, as one grows older? Lastly, is there any new treatment method or medication that has been effective in recovering from a relapse such as mine?

Thank you for your time. A resonse would be greatly appreciated.

sincerely,

Anon

Anonymous's picture

I am a 54 year old white

I am a 54 year old white female. I have been seeing counselors and shrinks since I can remember. I have been treated for and medicated for: depression, alcoholism - addiction to anything that would change the way I feel, dissociative disorder. I crashed through two marriages, raised my wonderful daughters the hard way, graduated with honors from nursing school right before I crashed and burned ending up in rehab. I am now 16 years sober. About three and a half years ago, Wanda, one of my me's, ratted me out to my current counselor that she was tired of cleaning up after me. She told him that not only was I a multiple, but that I was bi-polar. She explained that as soon as I would get through a depressive phase, I would quit going to the shrink as I rode the high graciously provided by the SSRI's provided by the psychiatrists.

My bi-polar is regulated. I got to tell you I miss my mania, but I love my God, my husband and my family. I am not fully integrated, but I know my family and Wanda has forgiven me. I love all of the little warriers within me that kept my secrets and kept me safe until the dawn. God bless all.

Rose's picture

wow

I have not ben diagnosed with DID...but I know I have it. Also many other things like depression. I have no money, so I can not get help, but want it and need it. I know I am not "crazy", talking to Sara and others, and finely seeing someone who, I thought was only in my head. your input informed more of what I already knew, thankyou.

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