Dissociative identity disorder (DID), popularly known as ” Multiple personality disorder “, is one of the most frequently depicted psychopathologies in fiction.

Multiple Personality: what is it?

Since The Strange Case of Dr. Jekyll and Mr. Hyde to Psycho or The Fighting Club , through the character of Gollum in The Lord of the Rings and even the character played by Jim Carrey in the comedy , I, myself and Irene , are counted by dozens of works that have used TID as inspiration due to the striking nature of its symptoms.

It is because of this type of disclosure that multiple personality is one of the best known psychological disorders, although not one of the best understood, even within the world of Psychology, where there is significant controversy regarding the very existence of this disorder as such.

Symptoms

The fourth edition of the Diagnostic and statistical manual of mental disorders (DSM-IV) defines DID as ” the presence of two or more identities – rarely more than ten – that take control of a person’s behaviour on a recurring basis, each having memories, relationships and attitudes of its own “. In general, the different identities do not remember what is experienced by the rest, so they are not aware of their existence, although this is not always the case. The change between personalities usually occurs as a result of stress.

The primary personality (or the “real” one) tends to be passive and depressive, while the rest are more dominant and hostile. It is the more passive identities that manifest amnesia to a greater extent and, if they are aware of the existence of the more dominant personalities, they may be directed by these, which may even manifest themselves in the form of visual or auditory hallucinations, giving orders to the other identities.

Currently, in both the DSM and the International Classification of Diseases (ICD-10), TID is categorised within dissociative disorders, i.e, those that are produced by failures in the integration of consciousness, perception, movement, memory or identity (in the case of the multiple personality, disintegration would occur in all these aspects) as a direct consequence of psychological trauma.

Causes of Dissociative Identity Disorder

It is this relationship with traumatic experiences that links DID to post-traumatic stress disorder , which is characterized by the presence of anxiety and re-experimentation (through nightmares or flashbacks) following life-threatening events, such as sexual abuse or natural disasters. Of particular interest in this case is the fact that post-traumatic stress disorder can include dissociative symptoms, such as a lack of memory of important aspects of the traumatic event or an inability to experience emotions.

These symptoms are conceived as protection against feelings of pain and terror that the person is not able to handle adequately, which is normal in the initial moments of the process of adaptation to the traumatic experience, but which in the case of post-traumatic stress becomes pathological when it becomes chronic and interferes with the person’s life.

Following the same logic, DID would be an extreme version of post-traumatic stress starting in childhood (Kluft, 1984; Putnam, 1997): early, intense and prolonged traumatic experiences, particularly parental neglect or abuse, would lead to dissociation, i.e., isolation from memories, beliefs, etc, into rudimentary alternative identities, which would develop over the course of a lifetime, progressively leading to a greater number of identities, which are more complex and separate from the rest. Cases of DID are rarely observed in adulthood. Thus, DID 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 end up becoming alternative identities.

Evaluation and Treatment

The number of diagnoses of DID has increased in recent years; while some authors attribute this to a greater awareness of the disorder on the part of clinicians , others consider that it is due to an overdiagnosis. It has even been proposed that DID is due to patient suggestion by the clinician’s questions and the influence of the media. There are also those who believe that there is a lack of training in the manifestations of DID and an underestimation of its prevalence that leads to many cases of DID going undetected, partly because of inadequate screening.

In this regard, it should be kept in mind that, according to Kluft (1991), only 6% of cases of multiple personality are detectable in their pure form : a typical case of DID would be characterized by a combination of dissociative symptoms and post-traumatic stress symptoms with other non-defining symptoms of DID, such as depression, panic attacks, substance abuse, or eating disorders. The presence of this last group of symptoms, which are much more obvious than the other symptoms of DID and very common on their own, would lead clinicians to disregard a more in-depth examination for multiple personality. In addition, it is obvious that people with DID find it difficult to recognize their disorder because of shame, fear of punishment, or skepticism from others.

The treatment of TID, which usually takes years, is directed primarily at the integration or merging of identities or at least coordinating them to achieve the best possible functioning of the person . This is carried out progressively. Firstly, the safety of the person is guaranteed, given the tendency of people with DID to self-harm and attempt suicide, and the symptoms that most interfere with daily life, such as depression or drug abuse, are reduced. Later, the confrontation of traumatic memories is worked on, as would be done in the case of post-traumatic stress disorder, for example through exposure in the imagination.

Finally, identities are integrated, for which it is important that the therapist respects and validates the adaptive role of each one to facilitate the person’s acceptance of those parts of him or herself as his or her own. For a more detailed description of the treatment of DID, please consult the text Guidelines for treating dissociative identity disorders in adults, third revision , of the International Society for the Study of Trauma and Dissociation (2011).

Bibliographic references:

  • Freyd, J. J. (1996). Betrayal trauma: The logic of forgetting childhood abuse. Cambridge, MA: Harvard University Press.
  • Sociedad Internacional para el Estudio del Trauma y la Disociación (2011). Directrices para el tratamiento del trastorno de identidad disociativo en adultos, tercera revisión. Journal of Trauma & Dissociation, 12:2, 115-187
  • Kluft, R. P. (1984). Tratamiento del trastorno de personalidad múltiple: Un estudio de 33 casos. Clínicas Psiquiátricas de América del Norte, 7, 9-29.
  • Kluft, R. P. (1991). Trastorno de personalidad múltiple. En A. Tasman & S. M. Goldfinger (Eds.), American Psychiatric Press review of psychiatry (Vol. 10, págs. 161-188). Washington, D.C: American Psychiatric Press.
  • Putnam, F. W. (1997). Disociación en niños y adolescentes: Una perspectiva de desarrollo. Nueva York, NW: Guilford Press.