Disociative Identity Disorder (TID)

DISOCIATIVE IDENTITY DISORDER:

The (TID) is popularly known as "Multiple Personality Disorder", one of the most frequently depicted psychopathologies in fiction.

Multiple Personality: Realities and Fictions:

Personality From The Strange Case of Dr. Jekyll and Mr. Hyde to the Psychosis or The Fight Club, through the character of  Gollum from The Lord of the Rings and even the character played by Jim Carrey in the comedy Yo, myself and Irene, are told by dozens of works that have used this disorder as inspiration.

It is by this type of disclosure that the multiple personality is one of the most known psychological disorders, although not one of the best understood, nor even within the world of the Psychology, in which there is an important controversy with respect to the same existence Of this disorder as such.d Multiple: Realities and Fictions.

Symptoms:

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders defines TID as "the presence of two or more identities - often more than ten - that take control of a person's behavior on a recurring basis, each having Memories, relationships and attitudes ". Generally, the different identities do not remember what experienced by the rest, for which they are not aware of its existence, this is not always so. The change between personalities usually occurs as a result of stress.

The primary personality (the "real")  tends to be passive and depressive, while the rest are more dominant and hostile. The  passive identities are manifested by amnesia to a greater extent and, if they are aware of the existence of the most dominant personalities, they can be directed by them, which may even manifest in the form of visual or auditory hallucinations, giving orders to the other identities.

At present, in both the DSM and the International Classification of Diseases (ICD-10), the  TID is categorized into dissociative disorders,  those that occur due to failures in the integration of consciousness, perception, Movement, memory or identity (in the case of multiple personality, disintegration would occur in all these aspects) as a direct consequence of psychological traumas.

Causes of Dissociative Identity Disorder:

It is this relationship with traumatic experiences that links TID with post-traumatic stress disorder, which is characterized by the presence of anxiety and re-experiencing (through nightmares or flashbacks) after life-threatening events such as sexual abuse or natural catastrophes. An element of particular interest in this case is the fact that PTSD may include dissociative symptoms such as lack of memory of important aspects of the traumatic event or inability to experience emotions.

These symptoms are conceived as a protection against feelings of pain and terror that the person is not able to handle properly, which is normal in the initial moments of the process of adaptation to the traumatic experience, but that in the case of the post-traumatic stress becomes Pathological by interfering in the life of the person.

Following the same logic, TID would be an extreme version of early childhood post-traumatic stress (Kluft, 1984; Putnam, 1997): early, intense and prolonged traumatic experiences, in particular neglect or abuse on the part of the parents, would lead to Isolation of memories, beliefs, etc., in rudimentary alternative identities, which would be developed throughout life, gradually giving rise to a greater number of identities, more complex and separate from the rest.

Thus, TID would not arise from the fragmentation of a nuclear personality, but rather from a failure in the normal development of the personality that would result in the presence of relatively separate mental states that would eventually become alternative identities.

Evaluation and Treatment:

The number of diagnoses of TID has increased in recent years; While some authors attribute this to a greater awareness of the disorder by clinicians, others believe that it is due to an overdiagnosis.

It has even been proposed that the TID is due to the patient's suggestion due to clinician questions and the influence of the media. Likewise, there are also those who believe that there is a lack of training on the manifestations of TID and an underestimation of their prevalence that lead to many cases of TID not being detected, in part due to inadequate exploration.

According to Kluft (1991), only 6% of cases of multiple personality are detectable in their pure form: a typical case of TID would be characterized by a combination of dissociative symptoms and symptoms of stress Posttraumatic disorder with other non-defining symptoms of TID, such as depression, panic attacks, substance abuse, or eating disorders.

The presence of this latter group of symptoms, much more obvious than the other symptoms of TID and very frequent on their own, would lead the clinicians to avoid a deeper exploration that allowed to detect the multiple personality. To the people with TID results Difficult to recognize their upset by shame, fear of punishment or the skepticism of others.

The treatment of TID, which generally requires years, is fundamentally aimed at integrating or merging identities or, at least, coordinating them to achieve the best possible functioning of the person.

This is done progressively. First, the person's safety is guaranteed, given the tendency of people with TID to self-harm and suicide, and reduce symptoms that are more interfering with daily life, such as depression or drug abuse. Later the confrontation of the traumatic memories is worked, for example through exhibition in the imagination.

Finally, the identities are integrated, for which it is important that the therapist respect and validate the adaptive role of each one to facilitate that the person accepts as its own those parts of itself.

By: Carlos Cestelo Garrido.