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Dissociative Identity Disorder
Transcript of Dissociative Identity Disorder
History of DiD
Signs & Symptoms
Co-Occurring and Differential Diagnoses
Things to Consider
Dissociative Identity Disorder
GPY 4230 - Psychopathology
What is Dissociative Identity Disorder?
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
of perceiving, relating to, and thinking about the environment and self.)
B. At least two of these identities or personality states recurrently
of the person's behavior
Inability to recall
important personal information that is too extensive to be explained by ordinary forgetfulness
is not due to the direct physiological effects of a substance or a general medical condition.
Note: In children, the symptoms are
to imaginary playmates or other fantasy play.
shapeshifting, possession, etc.
Paracelsus - 1646
Gmelin - 1791
Pierre Janet, Morton Prince, etc.
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
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
lapses in memory of
objects or handwriting
in early childhood
frequently accused of
being addressed as
; being called unfamiliar names
failure of past
Co-Occurring and Differential Diagnoses
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.
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%
Lack of coping techniques
Goal : Integration vs. Co-operation?
No systemic, empirically supported approach
Medication often prescribed for co-occurring disorders
Acceptance of diagnosis
Work through defense mechanisms
Integration (or Co-operation)
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
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:
Often believed to be fake
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
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
DSM V - proposed changes
A. Disruption of identity characterized by two or more distinct personality states
or an experience of possession.
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).
With prominent non-epileptic seizures and/or other sensory-motor (functional neurologic) symptoms
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