RUNNING HEAD: SYMPTOMS, CAUSES, IMPLICATIONS, TREATMENT

Exploring Dissociative Identity Disorder

Idil Baysal

Abnormal Psychology Dr. Alan Tjeltveit

AIC_____________________________

RUNNING HEAD: SYMPTOMS, CAUSES, IMPLICATIONS, TREATMENT

Abstract: This paper entails a description and assessment of the factors related to the diagnosis, origins, and treatment of Dissociative Identity Disorder. The conditions cultural implications, degrees of symptomology, the relationship between various personalities, and the types of sexual and psychological childhood abuse are presented, along with various approaches to treatment such as psychotherapy, dream analysis, and the resurfacing of painful memories.

RUNNING HEAD: SYMPTOMS, CAUSES, IMPLICATIONS, TREATMENT

Exploring Dissociative Identity Disorder

Dissociative Identity Disorder, formerly known as Multiple Personality Disorder, is a severe psychological condition in which at least two distinct personalities persist in a patient and take turns controlling the individuals behaviors and cognitive processes (Murray, J. B. pg 234, (1994). Often times, persons with this condition have problems establishing intimacy with other people and have histories of intense, stormy, unstable relationships (Dissociative Identity Disorder, 2004, 1). The various personalities one exhibits consists of divergent speech patterns, beliefs, mannerisms, and even distinct coping mechanisms for a variety of external and internal stimuli that may appear to be disturbing or somehow unacceptable to the person experiencing them (Dissociative Identity Disorder, 2012, 3). Furthermore, the separate identities may even exhibit different physical characteristics such as right to left-handedness or the need for eyeglass prescriptions. The crucial aspect of dissociation functions as a coping technique for the individual, helping them dissociate from the traumatic experience that has most likely lead them to their affliction with the illness. Thus, understanding that dissociation is an exceedingly vital step for psychiatrists and psychologists to diagnose and treat patients in an effective manner.

RUNNING HEAD: SYMPTOMS, CAUSES, IMPLICATIONS, TREATMENT

Throughout the history of Multiple Personality Disorder, the most common explanation for the condition revolved around religious and spiritual phenomena, pertaining mainly to spirit possession and the work of demons in taking over ones soul. Although multiple identity enactments occur in most human societies, each culture develops it own indigenous theory of multiple personality enactments, and in doing so, endorsing them spiritually provides a local explanation for DID and helps to establish motivations and expectations for it perpetuation

(Spanos, 1994). Today, however, with the help of science, psychologists and psychiatrists
have moved away from explanations centering on the spiritual and religious realms, and have instead adopted a more clinical approach to examining Dissociative Identity Disorder. According to the DSM-IV, in order for an individual to be diagnosed with DID, he or she must display two or more distinct identities, these distinct identities must take control over the behavior recurrently, the individual must be unable to recall important personal information, and the disturbance cannot be a mere outcome of substance abuse or a general medical condition (Kennett & Matthews. 2002. Pg.509-526,). An alternate personality may even argue that the other multiples in the individual negotiate for control over the body, hold coherent conversations, attempt to protect the other personalities, and that these alters may

RUNNING HEAD: SYMPTOMS, CAUSES, IMPLICATIONS, TREATMENT

even strive to build relationships with one another (Brown, 2001). Today, in order to garner a clear understanding of an individuals present symptoms, clinicians most often employ the interview method in attempts to diagnose the disorder in patients; this is typically done through informal questioning, known as Structured Clinical Interviews or with the use of Dissociative Experiences Scales (Dissociative Identity Disorder, 2008). Although the diagnosis criterion for this disorder is not complex, a great deal of speculation surrounds the causes of Dissociative Identity Disorder. Despite the fact that to this day the exact causes and triggers of the onset of dissociative disorders remain unknown, clinicians have determined that the condition manifests most commonly from childhood trauma, especially those stemming from childhood abuse or harassment. The degree of symptomatology was related to many factors including the duration of the abuse, the amount of force used, the relationship of the victims to the perpetrators, and the amount of maternal support provided. Because dysfunctional families and childhood abuse often occur together, family dysfunction is sometimes an antecedent to childhood abuse (Briere & Elliot, 1993; Nash, Hulsey, Sexton, Harralson & Lambert, 1993). It is interesting to see, however, that although the vast majority of individuals with Dissociative Identity Disorder have experienced

RUNNING HEAD: SYMPTOMS, CAUSES, IMPLICATIONS, TREATMENT

some degree of childhood abuse, during therapy sessions, they rarely disclose these experiences, most likely due to feelings of shame or guilt. Unfortunately, although a strong correlation is established between Dissociative Identity Disorder and these familial pasts of physical, psychological, and sexual abuse, biological and social factors require further investigation. Mirroring the reattention given to various Dissociative Disorders, a paradigm shift has also taken place regarding their relationship with the field of psychoanalysis and its use for the treatment of DID; a typical characteristic of this subfield of psychology is to bring meaning to the realm of dreams. Dreams can play an important role in uncovering buried trauma or identifying secret alters. Various works and research further demonstrate that an individuals variety of personalities may shape or create dreams separately from other alters (Bob, P., 2004). After all, the different personalities that a person possesses have the ability to organize and formulate dreams for the goal of communicating with the mother personality. Psychologists also argue that the role the ego plays in the distinct depictions of the self in the dream realm, and in the myriad of selves exhibited in daily functioning, are virtually identical (Schwartz, H.L., 1994). Thus, if we can describe dreams as a dissociative process that mirrors

RUNNING HEAD: SYMPTOMS, CAUSES, IMPLICATIONS, TREATMENT

an individuals true state, then, we are open during the therapy to any prospective messages

that can help in the integration of the personality (Bob, P., 2004). This is vital for the
implementation of effective treatment and paves a constructive path to healing since dreams are regarded as vital manifestations of inner conflicts; therefore, by taking the significant role of dreaming and the various personalities one may identify with in this dream realm into careful consideration, we can conclude that direct psychotherapy may provide more than just an emotion-focused experience (Schwartz, H.L., 1994). Regardless of which course of treatment psychologists choose to follow, however, whether that be psychotherapy, dream analysis, group therapy, or even hypnosis, it is crucial to catch the development of the disorder relatively early in order to prevent the emergence of a greater number of personalities (Chu, A. James., 1994, 96). Treatment plans for individuals with Dissociative Identity Disorder fall into three major categories: trust between the individual and his or her therapist, increasing the cooperation between the original identity and the alters, and lastly, integrating alters with one another and the main personality in order to ensure an indestructible bonding of these personalities (Erxleben, J., & Cates, J.A, 1991). Without first formulating a friendship with the alters, the therapist cannot create a safe enough

RUNNING HEAD: SYMPTOMS, CAUSES, IMPLICATIONS, TREATMENT

environment for them to manifest themselves. A myriad of direct treatments have also been employed for the treatment of the disorder, such as behavior modification, pharmacotherapy, and group therapy sessions; without the initiation of trust between the patient and therapist, however, these efforts are futile (Murray, J. B. pg 241, (1994). Furthermore, unless the therapist and patient bring resolution to the roots of the trauma experienced by the patient, it is impossible to prevent a relapse in treatment. In working with more challenging or violent personalities, the therapist must understand the psychological development and role of each personality (Chu, A. James., 1994, 96). Thus, the sum of all the independent alters must strive to overcome the initial trauma; unless all the components of the patients identity are engaged, it is impossible to comprehend the origins of conflict, and therefore employ the most advantageous approach to treatment. Although there still remain countless unanswered questions, the public is becoming more cognizant about the Dissociative Identity Disorders implications in modern society, and to this day, the scientific community continues to explore the phenomena. Clinicians believe that regardless of how many clues to multiplicity the patient shows, DID cannot be diagnosed until the psychologist meets an alternate personality. If even one alter personality appears , the

RUNNING HEAD: SYMPTOMS, CAUSES, IMPLICATIONS, TREATMENT

therapist must search for others: no parts of the self are to be arbitrarily excluded form therapy (Kluft, R.P. 42, 1993). Treatment for DID is rigorous and requires the resurfacing of distressing, traumatic memories. Fortunately, the fact that there is a valid course of therapeutic treatment is a vital step forward for psychologists, enabling them to explore a multitude of methods in order to bring patients to levels of healthy functioning and establish a sense of control. I believe that understanding and identifying the original cause of dissociation helps achieve inner psychological peace and aids these distressed individuals on their journey towards wholeness.

RUNNING HEAD: SYMPTOMS, CAUSES, IMPLICATIONS, TREATMENT

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References Bob, P. (2004). Dissociative Processes, Multiple Personality, and Dream Functions. American Journal of Psychotherapy, 58(2), 139-149 Brown, M. T. (2001). Multiple personality and personal identity. Philosophical Psychology, 435-447. doi:10.1080/09515080120088102 Chu, J. A. (1994). The rational treatment of multiple personality disorder. Psychotherapy: Theory, Research, Practice, Training, 31(1), 94-100. doi:10.1037/0033-3204.31.1.94 Dissociative Identity Disorder. (2004). In new Harvard guide to women's health. https://muhlenberg.idm.oclc.org/login?url=http://www.credoreference.com/entry/hupwh /dissociative_identity_disorder Dissociative identity disorder. (2012). Britannica concise encyclopedia. Retrieved from https://muhlenberg.idm.oclc.org/login?url=http://www.credoreference.com/entry/ebcon cise/dissociative_identity_disorder Dissociative Identity Disorder. (2008). In Encyclopedia of Psychology and Law. Retrieved from: https://muhlenberg.idm.oclc.org/login?url=http://www.credoreference.com/entry/sageps yclaw/dissociative_identity_disorder Erxleben, J., & Cates, J. A. (1991). Systemic treatment of multiple personality: Response to a chronic disorder. American Journal of Psychotherapy, 45, 269. Kennett, J., & Matthews, S. (2002). Identity, control and responsibility: The case of Dissociative Identity Disorder. Philosophical Psychology, 15(4), 509-526. doi:10.1080/0951508021000042??? Kraft R.P. (1993).The initial stages of psychotherapy in the treatment of multiple personality

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disorder patients. Dissociation, 6, 145-161. Murray, J. B. (1994). Dimensions of multiple personality disorder. Journal of Genetic Psychology, 155, 233. Schwartz, H. L. (1994). From dissociation to negotiation: A relational psychoanalytic perspective on multiple personality disorder. Psychoanalytic Psychology, 189-231. doi:10.1037/h0079545 Spanos, N. P. (1994). Multiple identity enactments and multiple personality disorder: A sociocognitive perspective. Psychological Bulletin, 116, 143-165. doi:10.1037/00332909.116.1.143