DISSOCIATIVE IDENTITY

DISORDER

M.REETHUSHA
PHARM D 2ND YEAR
GEETANJALI COLLEGE OF PHARMACY
 INTRODUCTION
• Dissociative Identity Disorder (DID) also known as Multiple
personality disorder (MPD) is a complex and rare mental disorder of
‘multiple selves in a single body’.
• It is a psychological condition that involves the fragmentation of one’s
identity, awareness, perception, and memory into different personality
states known as ‘alters’.
What is Dissociative Identity Disorder(DID)?
• Dissociative identity disorder (DID) refers to a mental condition when a
person develops two or more noticeable identities or personalities. The
individual often has a main or primary personality along with one or more
alternate personalities.
• The primary identity of the person may be depressed, dependent or
passive. The alternate personalities often ‘take control‘ of the individual
and function with or without the main personality’s knowledge.
• Although the primary identity carries the given name of the person, it fails
to incorporate different aspects of the individual into a multidimensional,
yet single self.
• The alternative personalities or identities are referred to as alters. The
names, gender, age, vocabulary and general knowledge of an alter may
be completely different from the primary personality.
• Moreover, the alters also show distinct characteristics, preferences,
attitudes, behaviours, moods, mannerisms, and ways of talking. It is
believed that these alternative personalities take turns to be in control
of the individual.
• However, when an ‘alter’ or even the main personality is not in charge,
it completely detaches and dissociates. Hence, it can be completely
unaware of the latest occurrences in the individual’s life.
• Research has found that specific triggers can cause different
personalities (alters) to take control. These alters might not know
about each other or the main identity, or they might be aware and even
conflict with each other. However, these alters are not fully developed
identities but parts of a fragmented personality.
Causes of Dissociative Identity Disorder
(DID)
- Individuals with DID are usually victims of severe and repetitive abuse and trauma
during early childhood, which the disorder acts as a coping mechanism against the
trauma.
- The transition to alternate personalities is involuntary, usually the person with the
disorder is “not aware of the transition or has any memory of the event.” This means
that people with DID may not consciously develop alternate personalities.
- DID may also be related to large-scale trauma, such as natural disasters or war.
- Familial, societal, and cultural factors can also contribute to trauma and influence the
expression of DID.
- DID may result from significant disruptions to self-consciousness and internal
conflict within a single self.
How DID can affect a person?
• Dissociative identity disorder can significantly change how an individual lives
their lives. Here are some of the common ways to know how this psychological
process affects a person:
• 1. Depersonalization- The sufferer feels a recurring sensation of being outside
their body. Similar to an out-of-body experience, they have a sense of getting
detached from their own physical body.
• 2. Derealization- The person gets a strong feeling that their surroundings or even
the world around them is not real. They believe that whatever is happening with
them or around them is fake or imaginary.
• 3. Dissociative amnesia- The person experiences a deficit in memory or memory
loss, which is not a result of a medical condition or injury. This is not similar to
general forgetfulness.
• 4. Dissociative fugue- It is a certain episode of amnesia or memory
loss. The person is unable to remember specific events or personal
information for a period of time. They can also experience micro-
amnesias and forget about a discussion or parts of a conversation
immediately afterward. They may also detach from certain emotions.
• 5. Identity alteration/identity confusion-The person is generally
confused about their own selves and their identity. They may suddenly
become confused about their interests, career goals, sexual orientation,
and perceptions about politics, religion, and society. They may also be
confused about a particular situation, location and may even
experience time distortions.
• 6. Blurred identities- The person feels like multiple people are living
inside them or multiple voices talking inside their head. They might
even feel that they have been ‘possessed’ by one or more entities or
identities.
SYMPTOMS
• People with dissociative identity disorder show various noticeable
symptoms when they switch between alters at different times. DID shares
several symptoms found in other mental conditions and disorders like
trauma and PTSD. Some of the common symptoms of DID in adults
include:

-Exhibition of multiple personalities or alters

-Feelings of dissociation & detachment
-Behaviour inconsistent with character (primary identity)
-Anxiety, depression, panic attacks and mood swings
-Sense of lost time
-Confusion and disorientation
-Severe headaches
-Pain in different parts of the body
-Amnesia and gaps in memory
-Depersonalization
-Derealization
-Hallucinations & delusions
-Obsessive-compulsive symptoms
-Psychotic symptoms
-Different levels of functioning
-Changes in appetite and sleeping problems
-Out of body experiences
-Self-persecution and self-sabotage
-Issues with sexual performance
-Substance abuse
-Self-injury related behaviours
-Suicidal thoughts
• However, the symptoms of DID may vary between adults and
children. Symptoms of DID in children may include:

-Dissociating or becoming unresponsive (zoning out).

-Having recurring nightmares, frightening dreams & memories.
-Triggering or mental distress to reminders of abuse & trauma.
-Sudden physical reactions to memories related to trauma & abuse.
-Sudden unexpected and unparalleled changes in appetite, preferences,
interests & activities.
DIAGNOSIS
• Diagnosis of dissociative identity disorder can be a complex and time-
consuming procedure. DID is diagnosed in a very similar way as most
other psychiatric diagnoses. The following criteria, laid down by the
DSM-5, must be met by a person to be effectively diagnosed with this
mental disorder:

-The person must exhibit two or more distinct alters or personality

states or identities. Each alter must have their own separate pattern of
“perceiving, relating to, and thinking about the environment and self.”
 -There should be noticeable changes in self-identity and control,
affecting thoughts, consciousness, memory, movement, behavior, and
perception.
-The condition should cause significant distress or problems in
important life areas like social, personal, or work-related activities.
-The individual should experience recurring memory gaps, making it
difficult to recall daily events, personal information, or traumatic
experiences.
-The experience or distress should not be a part of the religious or
cultural practices, like spiritual possession.
- The symptoms of DID should not be due to the direct impact of
substance abuse, like alcohol or drugs, or a medical condition.
Treatment options for DID
• Although there is no cure for dissociative identity disorder in the
traditional sense, effective & dedicated treatment over a period of time
can help the patient recover and get better. The objective of treatment
is not to eliminate or get rid of the ‘alters’ or extra personalities, but to
help the person identify the triggers for ‘switching’ and be prepared.
• This will help them live harmoniously with all the personalities,
including the primary one. A mental health professional with
significant experience with dissociative disorders can help an
individual to integrate separate personalities into a single identity.
Doctors usually take a multiple stage approach for the treatment of DID:
• Stage 1 involves managing the symptoms and making the patient feel
safe & secure.
• Stage 2 focuses on processing memories of abuse and trauma in a
supportive & safe environment.
• Stage 3 focuses on integrating the different alters into a unified
personality.
• Effective treatment options for dissociative identity disorder include
the following:

1. Psychotherapy: Involves talking with a mental health professional

to understand triggers and different personalities, aiming to combine
the alters into one and reduce the impact of triggers.
2. Adjunctive Therapy: Includes creative and cognitive therapies to help individuals
connect with dissociated aspects of their identities and minds.
3. Hypnotherapy: Used alongside psychotherapy, it helps access repressed memories and
integrate all alters into one.
4. Medications : Currently, no medications are available that can be specifically
recommended for treating DID.
• However, a therapist might suggest some medications for associated and co-occurring
mental disorders, like anxiety and depression. These medications are used along with
psychotherapy.
Some commonly suggested medications to help psychological symptoms associated
with DID are:
 -Antidepressants: Imipramine, fluoxetine, desipramine.
 -Anti-anxiety drugs: Alprazolam, diazepam, chlordiazepoxide.
 -Antipsychotic medications: Chlorpromazine, aripiprazole, haloperidol.
 -Tranquilizers: Iproniazid, diazepam.

• Studies have found that effective treatment over a long period of time has been known to
help people with DID. Treatment can significantly improve their functional ability in
their personal and professional lives.
 SUMMARY
• Dissociative Identity Disorder (DID), formerly known
as Multiple Personality Disorder, is a severe form of
dissociation, a mental process where a person
disconnects from their thoughts, feelings, memories,
or sense of identity. DID is characterized by the
presence of two or more distinct personality states or
identities, each with its own pattern of perceiving and
interacting with the world. These identities may have
unique names, ages, histories, and characteristics.
DID often arises as a response to severe trauma or
abuse during early childhood, as a coping mechanism.
REFERENCES
• themindsjournal.com
• www.clevelandclinic.org
• www.mayoclinic.com
THA
NK
YOU