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Dissociative Identity Disorder

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K Bender

on 27 February 2014

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Transcript of Dissociative Identity Disorder

What is DiD?
History of DiD
Common Misconceptions
Signs & Symptoms
Co-Occurring and Differential Diagnoses
Things to Consider
Art Therapy
Kim Noble
Clinical Application
Dissociative Identity Disorder
Katie Bender
GPY 4230 - Psychopathology
Spring 2013
What is Dissociative Identity Disorder?
The "lingo"
DSM IV-TR Criteria
300.14 - Dissociative Identity Disorder
A. 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.)
B. At least two of these identities 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
D. The
is not due to the direct physiological effects of a substance or a general medical condition.
Note: In children, the symptoms are
not attributable
to imaginary playmates or other fantasy play.
shapeshifting, possession, etc.
Paracelsus - 1646
Gmelin - 1791
Pierre Janet, Morton Prince, etc.
Public Attention
DSM Changes
DSM II - 1968-1980
"Hysterical Neurosis, Dissociative Type"
"In the dissociative type, alterations may occur in the patient's state of consciousness or in his identity, to produce such symptoms as amnesia, somnambulism, fugue, and multiple personality.
DSM III & III-R - 1980-1994
"Multiple Personality Disorder"
Removed the interpersonality amnesia criteria
Increase in diagnosis
DSM IV & DSM IV-TR - 1994-2000, 2000-present
"Dissociative Identity Disorder"
emphasized a change in consciousness/identity instead of personality
includes interpersonality amnesia criteria
Common Misconceptions
Also known as "Schizophrenia"

Multiples are many people living in one body

Multiples are always aware of their disorder

Medication can cure DID

Multiples switch dramatically and are easy to identify
signs & symptoms
of functioning
lapses in memory of
significant events
not recognizing
in mirror
possession of
objects or handwriting
multiple prior
history of
severe abuse
in early childhood
frequently accused of
inside head
being addressed as
someone else
; being called unfamiliar names
failure of past
Co-Occurring and Differential Diagnoses
Substance Abuse
Suicidal Ideation/attempts
Personality Disorders
Conversion/Somatic Symptoms
DSM-V adding specifiers
~3% of psychiatric inpatients - no rarer than schizophrenia, bipolar disorder, etc.

More than 75% of Multiples are female

Diagnosis usually given in late adolescence and early middle age

Alters can even have different physiological symptoms, i.e., menstrual cycle, allergies, etc.

Familial Patterns:
Can affect multiple generations and siblings in same generation
Trauma/Abuse often transmitted generationally
Congenital predisposition to dissociate
Lack of adequate social and environmental supports, defenses, and coping mechanisms
No empirical evidence
No neurological findings
Strong correlation to history of severe abuse/trauma in early childhood - up to 98%
Disorganized attachment
Lack of coping techniques
Treating DiD
Goal : Integration vs. Co-operation?
No systemic, empirically supported approach
Medication often prescribed for co-occurring disorders
Most common
Phased, Steps
Acceptance of diagnosis
Work through defense mechanisms
Repression, denial
Processing trauma
Integration (or Co-operation)
Other Techniques
Cognitive Behavioral Therapy (CBT)
Dialectical Behavior Therapy (DBT)
Eye Movement Desensitization and Reprocessing (EMDR)

May be beneficial to use a "team" approach using multiple specialties
Art Therapy
Brings up dissociated and repressed imagery
Helps externalize and reframe trauma
Allows an outlet for alters that are sworn to secrecy
Facilitate communication among alters
Barry Cohen & Carol Thayer Cox
Ten Category Model:
Kim Noble
Often believed to be fake
Iatrogenically induced?
Regression techniques
False Memory Syndrome
Repression - does it exist?
Rare before 1980s
Popular culture's influence
Lack of empirical evidence
Definition of "identity" subjective
Very little known

Rarely goes away without treatment

Symptoms tend to wax and wane

Patients without co-occurring disorders tend to be more successful
Clinical Application
You have one client, personifying different fragments.
Work within the system
Client has ongoing internal struggle for control, guide client cautiously, providing structure, without overpowering client's sense of control
May be helpful to work with ISH alter
Not all clients may want to integrate
Presentation Outline
DSM V - proposed changes
A. Disruption of identity characterized by two or more distinct personality states
or an experience of possession.
This involves
marked discontinuity in sense of self and sense of agency, accompanied by related alterations
in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.

Recurrent gaps in the recall
of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.

C. The symptoms cause
clinically significant distress or impairment
in social, occupational, or other important areas of functioning

D. The disturbance is
not a normal part of a broadly accepted cultural or religious practice.
(Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.)

E. The symptoms are not attributable to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or another medical condition (e.g., complex partial seizures).

Specify if:
With prominent non-epileptic seizures and/or other sensory-motor (functional neurologic) symptoms
American Psychiatric Association. (1968). Diagnostic and statistical manual of mental disorders second edition. Washington, D.C.

American Psychiatric Association. (1987). Diagnostic and statistical manual of mental disorders, third edition, revised. Washington, D.C.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, fourth edition, text rev. Washington, D.C.

Cohen, B., & Cox, C. (1995). Telling without talking: Art as a window into the world of multiple personality. New York: W.W. Norton & Company.

Comstock, C. (1991). The inner self helperand concepts ofinner guidance: Historical antecedents, its role within dissociation, and clinical utilization.Dissociation, IV(3), 165-177. Retrieved from https://scholarsbank.uoregon.edu/xmlui/bitstream/handle/1794/1454/Diss_4_3_8_OCR_rev.pdf?

Coons, P. (1986). Treatment progress in 20 patients with multiple personality disorder. The Journal of Nervous and Mental Disease, 174(12), 715-721. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/3783138

Fortea, J. A. (n.d.). A history of Dissociative Identity Disorder. Retrieved from http://www.fortea.us/english/psiquiatria/history.htm

Gluck, S. (2013, January 30). Signs and symptoms of Dissociative Identity Disorder (DID). Retrieved from http://www.healthyplace.com/abuse/dissociative-identity-disorder/signs-symptoms-of-dissociative-identity-disorder-did/

Gray, H. (2012). [Web log message]. Retrieved from http://www.healthyplace.com/blogs/dissociativeliving/

Howell, E. F. (2012, November 12). Dsm-5 dissociative identity disorder. Retrieved from http://www.dissociative-identity-disorder.org/DSM-5.html

Howell, E. F. (2012, October 1). Commonly used terms as they apply to Dissociative Identity Disorder. Retrieved from http://www.dissociative-identity-disorder.org/terminology.html

Kluft, E. (1993). Expressive and functional therapies in the treatment of multiple personality disorder. Springfield, Illinois: Charles C Thomas.

Lyon, S. (2007, November 12). Treatments for dissociation. Retrieved from http://voices.yahoo.com/treatments-dissociation-649108.html?cat=70

Merskey, H. (1995). "Multiple personality disorder and false memory syndrome".The British journal of psychiatry : the journal of mental science 166 (3): 281–283
Recent updates to proposed revisions for dsm-5. (1012). Retrieved from http://www.dsm5.org/Pages/RecentUpdates.aspx

Spiegel, D., Lowenstein, R., Lewis-Fernandez, R., Sar, V., Simeon, D., Vermetten, E., Cardena, E., & Dell, P. (2011). Dissociative disorders in dsm-5.DEPRESSION AND ANXIETY, 28, 824-852. Retrieved from http://www.dsm5.org/Documents/Anxiety, OC Spectrum, PTSD, and DD Group/PTSD and DD/Spiegel et al_Dissociative Disorders.pdf

Tartakovsky, M. (2011). Dispelling Myths about Dissociative Identity Disorder. Psych Central. Retrieved from http://psychcentral.com/lib/2011/dispelling-myths-about-dissociative-identity-disorder

Waldinger, R. (1997). Psychiatry for medical students. (3 ed.). Washington, D.C.: American Psychiatric Press.
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