We speak of the disorder previously known as ‘multiple personality’.
Despite this, sometimes it becomes a phenomenon that causes a profound impact on daily life; describing an alteration of memory, personality and other processes (such as perception).
Dissociative identity disorder is one of those cases , since it is associated with the rupture in the ability to integrate processes whose objective is to provide coherence to what we are.
In the next few lines we will delve into this intriguing (and rare) mental health problem; emphasizing its clinical expression, its causes and the treatment strategies that are currently used.
- Recommended article: “8 symptoms that indicate when to go to the psychologist”
Symptoms of dissociative identity disorder
Dissociative identity disorder (previously multiple personality) is expressed through substantial changes in the way of acting and feeling , as well as in the ability to evoke recent events (or episodic memory), which is not explained by the basic mechanisms of the disorder. ordinary forgetfulness.
Three of its main symptoms are delved into below.
1. Presence of two or more personalities in one individual
The central symptom of dissociative identity disorder is the alternating presence of two personalities (or more) that concur in the same individual; counting each of them with differential aspects in the way they think, feel and/or act.
The fluctuations between one and the other generate notable changes in the expression of individuality, in such a way that each of these identities would be built by a stable configuration of personality and thought, independent of the rest.
They can be similar or different expressions with respect to the basic personality (before the appearance of the disorder) , and they may or may not have knowledge of what each of the others does. Sometimes one of these identities is aware of what the rest is thinking, despite the fact that they are not present at the same moment, while the others do not know any of their companions.
The subject with dissociative identity disorder becomes the repository of an amalgam of ways of being and acting that can lead to friction in coexistence. Thus, while some generate situations of great conflict, others can try to solve them; therefore, evident divergences are observed in their goals, desires and main motivations (depending on the state in which the individual finds himself).
It is possible that one of the identities adopts a dominant position with respect to the others; over which it exerts a relationship of pressure or dominance. This frequently constitutes the antagonistic perspective of what the person was before suffering from the disorder, which is why many theories have explained this phenomenon (from dynamic models) as the expression of impulses that the person represses in their daily life.
2. Alternate personalities take over behavior
One of the experiences most often reported by people with dissociative identity disorder is the feeling of loss of control , as it is difficult for them to predict when the transition to another of their states will occur (despite the fact that it is usually accentuated under stress). ). In this case, the discomfort is aggravated when the period is followed by lacunar amnesia (limited to that period of time), since it is unknown what the consequences of his behavior during the “absence” could be.
In this way, for example, the person may appear distant from relatives with whom they maintain a close bond of trust, which is an unexpected and very distressing reaction for them. This abrupt change in attitude is often the main reason why a mental health professional is consulted. It has even been described how an alternative personality can fake the behavior of the original, in order to deceive and/or obtain a specific benefit.
The dominant personality can prioritize the relationship established with the others , interrupting them or interacting with them directly according to their criteria. In any case, it is the personalities with the greatest control who are most frequently aware of the rest, of their fears and even of their will.
3. Daily memory gaps, not explained by the ordinary mechanisms of forgetting
As in other dissociative disorders, such as amnesia or fugue, many people are unable to remember what happened during the episodes in which the symptoms were in the acute phase. Thus, for example, it is common for the patient to feel confused when “appearing” in a place other than the last one he remembered, or if he is reproached for having said or done things that he does not recognize as his own.
It is important to bear in mind that the state of memory cannot be generalized for all cases of dissociative identity disorder , since a symmetrical memory network can be established (all personalities perfectly remember what others were doing, despite the lack of memory). control over their actions) or asymmetric (personalities with less extensive knowledge about what the others do).
Causes
Both psychological and neurological causes have been described for dissociative identity disorder.
Next, we will explore each one of them, also stopping at the cultural dimensions that could underlie this phenomenon.
1. Chronic and severe trauma in childhood
One of the causes that has been most frequently detected in the literature is the experience of deeply stressful adverse events (traumas) in childhood , especially when they lasted for many years. Although vital events of all kinds have been described (economic, organic, relational, etc.), those with a sexual content stand out. This form of abuse is a key risk factor for the onset of the problem in adulthood.
In addition to dissociative disorders, it has been observed that being a victim of sexual abuse increases the risk of isolated dissociative symptoms in mental health problems of another order. Some examples would be panic disorders (in which they would be expressed in the form of depersonalization and/or derealization) and borderline personality disorder (sensation of strangeness regarding internal processes, which is experienced with affective distance).
2. Neurological alterations
Neuroimaging techniques, structural or functional, have allowed the projection of various explanatory hypotheses from the cerebral point of view , which are not exclusive: the orbitofrontal, the cortico-limbic and the temporal. They are organic components that do not eliminate the role of childhood experiences, since they could also describe neurological consequences that arise from having gone through them.
Along these lines, there are suggestive hypotheses that traumatic events can affect the orbitofrontal region (reasoning and way of thinking). In people with dissociative identity disorder, a hypoactivation of this structure has been observed in contrast to control subjects. However, the studies that have focused on this finding have not found changes in this area as a result of fluctuations from one personality to another.
Regarding the cortico-limbic hypothesis, often contemplated in studies on post-traumatic stress, it has been observed that in dissociative identity disorder there is a reduced volume in the gray matter of the hippocampus and the amygdala . These brain regions are essential for the management of emotion and memory, two of the areas that tend to be compromised during the evolution of this health problem.
The temporal hypothesis (based on electroencephalographic studies) suggests that the variability between the different states of identity may be associated with an increase in the activity of beta brain waves in the frontal and temporal lobes. These are the most frequent, associated with wakefulness and active consciousness (low levels induce states of calm or relaxation and high levels are typical of anxiety or stress).
3. Cultural aspects
Certain cultures support the possibility that a person shows an altered state of consciousness as a result of some religious or mystical practice. This has been the case since the very dawn of humanity, generally serving as a mediating factor between mortals and divinities. These traditions, transmitted in the form of rituals, have often included the consumption of substances with hallucinogenic properties.
Diagnostic manuals (such as the DSM-5) indicate that dissociative experiences that occur in the context of substance intoxication , or within ethnographic multiplicity, do not allow their coding as a dissociative identity disorder. This group may include experiences of trance or possession, which are of particular interest from a sociocultural perspective, but which do not meet the criteria of the problem at hand.
Treatment
Next we will describe the phasic model for dissociative identity disorder. However, this is not the only one that has shown to be interesting for its therapeutic approach; Psychoeducation, reinforcement of self-awareness and emotional tolerance, impulse control, stress management and the development of skills for effective coping with the causes and consequences of the disorder are also recommended.
The phase model has three well-differentiated stages: security and stability, confrontation and overcoming, and integration and rehabilitation .
1. Security and stability
At this point in the therapeutic process, the goal is limited to meeting the immediate needs of the person , reducing the probability of harm to the person or third parties. This is a phase in which information about the past history is collected, quality psychoeducation is provided and the therapeutic alliance is forged (which will be essential throughout the entire process).
2. Confrontation and overcoming
Once the vital episodes that could be considered as a distal cause (sexual abuse, mistreatment, etc.) have been detected, strategies aimed at confronting the past and resolving the underlying emotional conflict are deployed . This process is similar to that often used in post-traumatic stress disorder (PTSD); including a cognitive approach (restructuring), eye movement desensitization and reprocessing (EMDR) and exposure (among others).
3. Integration and rehabilitation
The final objective is to develop strategies to integrate the different identities in a congruent way , thereby minimizing the negative impact on the different areas of life and reducing the affective correlate that is associated with the experience of dissociative episodes. The variety of strategies that have been described for this phase is multiple, but all of them seek to reduce the consequences on quality of life and autonomy.
Bibliographic references
- Brand, B.L. (2014). Dissociative Identity Disorder. In Gabbard, G.O. (Ed.). Gabbard’s Treatments of Psychiatric Disorders (Fifth Edition). American Psychiatric Publishing: Washington, D.C.
- Dorahy, M.J., Brand, B.L., Sar, V. y Krüger, C. (2014). Dissociative identity disorder: An empirical overview. Australian and New Zealand Journal of Psychiatry, 48(5), 402-417.
To the classic question “what do you do?” I always answer “basically I am a psychologist”. In fact, my academic training has revolved around the psychology of development, education and community, a field of study influenced my volunteer activities, as well as my first work experiences in personal services.