PSY 215 Project Two

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Dec 6, 2023

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DISSOCIATIVE IDENTITY DISORDER Jasmine Lumpkin PSY-215 Project Two Due August 13,2023

INTRODUCTI ON What Is

WHAT IS DISSOCIATIVE IDENTITY DISORDER? • Dissociative Identity Disorder is characterized by:  A. Disruption of identity of two or more distinct personality states. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alternations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory- motor functioning (Hooley et al., 2019) .  B. Recurrent gaps in the recall of everyday events, important personal information, and /or traumatic events that are inconsistent with ordinary forgetting (Hooley et al., 2019).  C. Symptoms cause clinically significant distress or impairment in all important areas of functioning (Hooley et al., 2019). ** These symptoms are not a part of a cultural or religious practice, nor are they attributed to the physiological effects of a substance or medical condition (Hooley et al., 2019). This disorder affects approximately 1% of the general population.

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Prevalence Rates • Dissociative Identity Disorder is a rare disorder to be diagnosed. About 1.5% of the global population is affected. Most often, DID is misdiagnosed, requiring multiple assessments for an accurate diagnosis. • Approximately three to nine times more females than males are diagnosed as having dissociative identity disorder. Females tend to exhibit a larger number of alters than males as well. Experts believe that this pronounced gender discrepancy is due to a larger proportion of childhood sexual abuse occurring among females than it does among males (Hooley et al., 2019).

Part One: Biopsychosocial Considerations

Biologica l Dissociative Identity Disorder is typically associated with long-term childhood trauma. Childhood trauma involved includes severe trauma usually related to exposure to repetitive physical, sexual, and emotional abuse. It would also include neglect, the lack of safe and nurturing resources, and the inability to manage trauma. There has not been significant evidence to support biological factors, however, biologically derived traits and epigenetic mechanisms are likely to exist (Sar et al., 2017). While research supports environmental factors and early- life trauma as the cause, it has been found that people with DID have some alterations in their brain morphology (Gilbert, 2019). Studies have shown a reduction in functioning and blood flow in the orbitofrontal cortex in individuals with DID while also affecting the amygdala and hippocampus. It has also shown that individuals with DID show smaller volumes in the parietal structures and increased white matter tracts (Gilbert, 2019).

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Psychological  Dissociative Identity Disorder usually develops as a psychological response to interpersonal and environmental stresses that includes severe trauma-induced experiences during early childhood. Emotional neglect and abuse interfere with personality development during the developmental stages of childhood and typically individuals who develop DID have personal histories of recurring, overpowering, and often life-threatening disturbances.  As a defense mechanism against the recurring trauma and an attempt to create a survival skill, a child will dissociate themselves as a response. In doing so, detaches feelings and thoughts from themselves and place them onto someone else. That someone else happens to be an alternate version of themselves.  It has also been found that in most cases, individuals diagnosed with dissociative identity disorder experience dissociative amnesia. Which is a limited failure to recall previously stored personal information when that failure cannot be accounted for by ordinary forgetfulness (Hooley et al., 2019) .  The gaps in memory most often occur following intolerable stressful circumstances such as wartime combat conditions, suicide attempts, or traumatic experiences also contributing to the development of DID (Hooley et al., 2019) .

Social  Dissociative identity disorder involves experiencing a disconnection and lack of continuity between thoughts, memories, surroundings, actions, and identity (Palmer, 2020). This is caused by early-life trauma thought to be psychological and environmental.  Most times trauma is caused by things happening children, adolescent, or adult's immediate environment. The psychological responses to severe interpersonal, environmental, or psychological stressors, are to dissociate and detach from any thoughts, feelings, behaviors, and memories related with it.

Cultural Variation DID’s prevalence rates in other countries are truly unknown since most individuals are not diagnosed with having a psychological disorder. Possession-form dissociative Identity Disorder can be distinguished from culturally accepted possession states in that the former is involuntary, distressing, and uncontrollable; involves conflict between the individual and his or her surrounding family, social, or work milieu; and is manifested at times and in places that violate cultural or religious norms. Many features of Dissociative Identity Disorder can be influenced by the individual’s sociocultural background. In rural areas of low-and-middle- income countries, among certain religious groups in the United States and Europe, all or some fragmented identities may take the form of possessing spirits, deities, demons, animals, or mythical figures. Acculturation or prolonged intercultural contact may shape the presentation of the other identities.

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Treatment  Treatment for dissociative identity disorder is psychodynamic and insight- oriented, focused on uncovering and working through the trauma and other conflicts that led to the disorder.  A few effective treatment options include psychotherapy, hypnotherapy, and adjunctive therapy.  Cognitive behavioral therapy is another option as a form of treatment

Community The community play’s an important role in promoting access to treatment for individuals diagnosed with dissociative identity disorder and other psychological disorders.  The community can provide elements that are crucial to mental health such as belonging, support, and purpose. However, the individual living with the disorder has to feel they are in a safe place to involve others and the community has to also provide a sense of security for that individual to want to open up about it.  The community includes the involvement of loved ones, support groups, education programs, and therapy. Having a mental health disorder is not the suffering of just one individual, it’s the suffering of the community and everyone should take a stance and help.

Part Two: Diagnostic/Evaluative Considerations

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Clinical Assessments  Dissociative identity disorder is diagnosed usually by a psychiatrist or psychologist based on the review of symptoms and personal health history. Initial tests conducted are to rule out any physical conditions that could cause symptoms of memory loss or altered reality such as head injuries, brain lesions, intoxication, or sleep deprivation. After which, a psychiatric exam will be conducted, and based on those results, any symptoms or behaviors reported will be compared to the criteria for diagnosis of DID in the DSM-5.  Individuals with dissociative identity disorder typically present with comorbid conditions. Common conditions that co-exist with DID are borderline personality disorder, post-traumatic stress disorder, depression, anxiety, substance abuse, and sometimes schizophrenia.  Symptoms individuals with DID seek treatment for are very common among other psychiatric diagnoses, therefore causing many individuals to be misdiagnosed.  Unfortunately, sometimes an accurate diagnosis can take years, and most times individuals are not diagnosed until adulthood.

Reliability and Validity  Dissociative identity disorder is diagnosed based on clinical features, not on proven mechanisms.  Psychometric scales such as the Dissociative Experiences Scale (DES) and the Structural Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) are used and its been an issue of whether DID can be measured.  Repression and/or dissociation of traumatic memories has never been accepted by memory researchers. Recollections of childhood events in adults are not always reliable and when memories are recalled, they are reconfigured, reprocessed, and modified by suggestion. Making the diagnosis of DID questionable.

Diagnosis by Exclusion  Most individuals who meet the criteria for dissociative identity disorder are treated within the mental health system for 6-12 years prior to being correctly diagnosed.  The common differential diagnosis for dissociative identity disorder includes borderline personality disorder, histrionic personality disorder, primary psychotic disorders such as schizophrenia and schizoaffective disorders. DID often presents with symptoms of dissociation and amnesia which is also common in individuals with borderline personality disorder. Also, when individuals present with symptoms of psychosis as alters, they are mistaken for hallucinations. These conditions must be ruled out prior to DID being considered as a diagnosis.

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Assessments  Assessments help contribute to the process of elimination of other psychiatric disorders when trying to diagnose dissociative identity disorders.  Comprehensive administered interviews used to assess DID are: o Structured Clinical Interview for DSM-IV Dissociative Disorders-Revised (SCID-D-R) o The Dissociative Disorders Interview Schedule o The Dissociative Experience Scale (DES) o Thematic Apperception Test o The Rorschach Inkblot Test o Multidimensional Inventory of Dissociation (MID) o Somatoform Dissociation Questionnaire-20 (SDQ-20) o Office Mental Status Examination for Complex Chronic Dissociative Symptoms and Multiple Personality Disorder (OMSEDD)

Publication Process  The Diagnostic and Statistical Manual of Mental Disorders (DSM) is the authoritative guide to the diagnosis of mental disorders for healthcare professionals around the world. It influences the care that people of all ages receive for mental health issues (American Psychiatric Association, 2013). Clinicians use DSM to accurately and consistently diagnose disorders affecting mood, personality, identity, cognition, and more (American Psychiatric Association, 2013).  The DSM is published by the American Psychiatric Association and has been updated several times since its first release in 1952. It standardizes diagnoses by psychiatrists, psychologists, social workers, nurses, and other health and mental health professionals, but it also informs research, public health policy, education, reimbursement systems, and forensic science (American Psychiatric Association, 2013).

Part Three: Therapeutic Considerations

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Therapeutic Approaches PSYCHOTHERAPY ALSO CALLED “TALK THERAPY” IS DESIGNED TO WORK THROUGH WHAT TRIGGERS DID. THE GOAL IS TO FUSE THE SEPARATE PERSONALITY TRAITS INTO ONE CONSOLIDATED PERSONALITY THAT CAN CONTROL THE TRIGGERS (WEBMD, 2022). HYPNOTHERAPY (HYPNOSIS) USED IN CONJUNCTION WITH PSYCHOTHERAPY, CAN BE USED TO HELP ACCESS REPRESSED MEMORIES, CONTROL SOME OF THE PROBLEMATIC BEHAVIORS WHICH ACCOMPANY DID AS WELL AS HELP INTEGRATE THE PERSONALITIES INTO ONE (WEBMD, 2022). ADJUNCTIVE THERAPY SUCH AS ART OR MOVEMENT THERAPY HAS BEEN SHOWN TO HELP PEOPLE CONNECT WITH PARTS OF THEIR MIND THAT THEY SHUT OFF TO COPE WITH TRAUMA (WEBMD, 2022).

Non-Pharmacological Approaches  Most treatments for dissociative identity disorder are non- pharmacological. Since the disorder premise is trauma-related, psychotherapy or “Talk therapy” is the best course of treatment for the disorder. It allows the individual to talk through their experiences with a therapist that specializes in that form of treatment.  Support- Having family therapy would be a great approach as it includes loved ones in understanding the disorder, identifying and working through past trauma, and helping to manage symptoms.  Eye movement desensitization and reprocessing (EDMR)- can be another approach for the treatment of DID. This form of treatment focuses on specific memories but for shorter periods of time than typically conducted with EDMR. It should be modified specifically for individuals with DID to make it safe and effective.

Duty to Treat  There are 4 fundamental principles of ethics in medicine: Beneficence, nonmaleficence, autonomy, and justice (Varkey, 2021).  The first two- beneficence and nonmaleficence date back to the times of Hippocrates “to help and do not harm” (Varkey, 2021). It is the obligation of any medical physician to act for the benefit of the patient without harm.  It is also the obligation of the medical physician to provide autonomy and confidentiality to patients as well as fair, equitable, and appropriate treatment of all persons. This Photo by Unknown Author is licensed under CC BY

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Conclusion The goals of my presentation are for my audience to understand that: Dissociative identity disorder is not a disorder stemming from malfunctions of the brain but from severe and continuous trauma. Alternate identities are created as a result of the trauma starting in one’s childhood and progressing into adulthood. While these identities are used as a form of protection, in the long term will cause significant distress and impairment in other areas of functioning. Understanding DID is beneficial for everyone (patient, family, mental health provider) as it will allow for proper diagnosis and effective treatment to be implemented. This would include finding a therapist that you can trust, talking through the trauma, identifying symptoms and behaviors, and addressing any co-existing disorders even if that includes taking medication, support groups, and other resources to help manage the disorder. It’s important to communicate openly and honestly with those a part of your support system and never be afraid to ask for help.

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Referenc es Brand, B. L., Sar, V., Stavropoulos, P., Krüger, C., Korzekwa, M., Martínez-Taboas, A., & Middleton, W. (2016). Separating fact from fiction: An empirical examination of six myths about dissociative identity disorder. Harvard Review of Psychiatry , 24 (4), 257–270. https://doi.org/10.1097/hrp.0000000000000100 Jones, H. (2022, February 22). What Are The Symptoms And Causes of Dissociative Identity Disorder? Verywell Health. https://www.verywellhealth.com/what-causes-dissociative-identity-disorder-5215201 Mitra, P., & Jain, A. (2021). Dissociative Identity Disorder . PubMed; StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK568768/#:~:text=Dissociative%20identity%20disorder%20(DID)%20is Paris, J. (2019). Dissociative identity disorder: validity and use in the criminal justice system. BJPsych Advances , 25 (05), 287–293. https://doi.org/10.1192/bja.2019.12 Patel, H., & Pharm, M. (2018, May 23). Dissociative Identity Disorder Causes . News-Medical.net. https://www.news- medical.net/health/Dissociative-Identity-Disorder-Causes.aspx Sar, V., Dorahy, M., & Krüger, C. (2017). Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective. Psychology Research and Behavior Management , Volume 10 (10), 137–146. https://doi.org/10.2147/prbm.s113743 WebMD. (2022, January 22). Dissociative Identity Disorder (Multiple Personality Disorder) . WebMD; WebMD. https://www.webmd.com/mental-health/dissociative-identity-disorder-multiple-personality-disorder Hooley, J. M., Nock, M. K., & Butcher, J. N. (2019). Abnormal Psychology (18th ed.). Pearson Education (US). https://mbsdirect.vitalsource.com/books/9780135191033 Gilbert, S. (2019, November 18). The Importance of Community and Mental Health | NAMI: National Alliance on Mental Illness . Www.nami.org. https://www.nami.org/Blogs/NAMI-Blog/November-2019/The-Importance-of-Community-and-Mental- Health#:~:text=Community%20provides%20a%20sense%20of American Psychiatric Association. (2013). Page Not Found | psychiatry.org . Www.psychiatry.org. https://www.psychiatry.org/File%20Library/Psychiatrists/Practice/DSM/APA_DSM-Development-of-DSM-5.pdf Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice , 30 (1), 17–28. https://doi.org/10.1159/000509119

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PSY 215 Project Two

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