Dissociative Identity Disorder
(Multiple Personality Disorder)
The essential feature of Dissociative Identity Disorders is a disruption in the usually integrated functions of consciousness, memory, identity or perception. This is characterized by the presence of two or more distinct identities or personality states that recurrently take control of the individual’s behavior accompanied by an inability to recall important information that is too extensive to be explained by ordinary forgetfulness. It is a disorder that is characterized by identify fragmentation rather than a proliferation of separate personalities.
Each personality state may be experienced as if it has a distinct personal history, self image and identity, including a separate name. Usually there is a primary identity that carries the individual’s given name and is passive, dependent, guilty and depressed. The alternate identities frequently have different names and characteristics that contrast with the primary identity (e.g. are hostile, controlling and self destructive.). Particular identities may emerge in specific circumstances and may differ in reported age and gender, vocabulary, general knowledge, or predominant affect. Alternate identities are experienced as taking control in sequence, one at the expense of the other, and may deny knowledge of one another, be critical of one another, or appear to be in open conflict. Occasionally, one or more powerful identities allocate time to the others. Aggressive or hostile identities may at times interrupt activities or place the others in uncomfortable situations.
The time to switch from one identity to another is usually a matter of seconds. Behavioral changes that may be associated with identity switches include rapid blinking, facial changes, changes in voice and demeanor, or disruption in the individuals train of thoughts.
Individuals with Dissociated Identity Disorders frequently report having experienced severe sexual or physical abuse during childhood. They may manifest posttraumatic stress symptoms (e.g. nightmares, flashbacks, and startle responses or Posttraumatic Stress Disorder. Self mutilation and suicidal and aggressive behavior may occur. Some individual may have a repetitive pattern of relationships involving physical and sexual abuse. It’s important to address the separate personality directly, help it find its voice and realize a new sense of self is returning that needs to be owned. The person will be stronger once this is done.
Treatment of Dissociative Identity Disorders
Dissociation augments repression and splitting. It is an elaboration of splitting leading to the constellation of mental states that are felt to be alien. It develops as a primitive, adaptive response of the mind to the overstimulation and pain of external trauma and may result in disturbances in awareness, memory and identity. This defense results in a vertical split stimulating corresponding mental states alternately enacted but not integrated. Dissociation exists on a continuum with multiple personality disorders representing the most extreme form of this kind of process.
The dissociated state returns with particular force when it is first recovered. Some accidental occurrence will often trigger this recovery. The person may associate to a dream that will lead to recovery of memories of being raped. Recovery of dissociated states often engenders the experience of flashbacks and somatic memories where the patient relives the childhood sensory experience. This reliving often has a terrifying reality and past can become confused with present. Lack of prior symbolization has deprived the memories of a structure and context in time.
Recovery of the trauma stimulates a pattern of alternating mental states where the person alternately experiences themselves as being molested or unprotected and then denies the events. Treatment then becomes a matter of either helping the patient to put words to and make sense of the trauma, or analyzing their resistance to facing the trauma.
I think of dissociated states as almost akin to separate personalities that have an independent existence within the patient. I advocate speaking directly to the child persona in the adult survivor as the most effective way of recovering all traumatic memories. Furthermore, I maintain that, the establishment of an alliance between the child persona and the analyst has the effect of symbolically changing the original traumatic experience of isolation and despair by bringing about the internalization of a new therapeutic relationship that produces permanent internal change.