Dissociative identity disorder (TID), commonly known as “Multiple personality disorder“, Is one of the most frequently depicted psychopathologies in fiction.
Multiple personality: what is it?
From the strange case of Dr. Jekyll and Mr. Hyde at psychosis O The wrestling club, Through the character of Gollum from The Lord of the Rings and even the character played by Jim Carrey in the comedy Me, me and IreneThere are 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 most well-known psychological disorders, but not one of the best understood, not even in the world of psychology, in which there is significant controversy. on this subject. Phone.
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines TID as “the presence of two or more identities – rarely more than ten – which take control of a person’s behavior on a recurring basis, each of them having their own memories, relationships and attitudes“. In general, different identities do not remember what other people are going through, so they are not aware of their existence, although this is not always the case. The change between personalities usually happens due to stress.
the primary personality (Or the “real”) tends to be passive and depressive, while the others are more dominant and hostile. It is the more passive identities that show the most amnesia, and if they are aware of the existence of the more dominant personalities, they can be ruled by them, which can even manifest as visual or auditory hallucinations. , give orders to other identities.
At present, both in the DSM as in the International Classification of Diseases (ICD-10), IDDs are classified as dissociative disorders, that is, those that arise due to failures in the integration of consciousness, perception, movement, memory, or identity (in the case of multiple personality, disintegration would occur in all of these aspects) as a direct consequence of psychological trauma.
Causes of dissociative identity disorder
It is this relationship with traumatic experiences that connects IDD with stress disorder. Posttraumatic, Which is characterized by the presence of anxiety and re-experimentation (Through nightmares or flashbacks) after 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 feel emotions.
These symptoms are meant to protect against feelings of pain and dread that the person is unable to cope with properly, which is normal in the initial moments of the process of adjusting to the traumatic experience, but this in the process. Post-traumatic stress disorder becomes pathological as it narrates and interferes with a person’s life.
Following the same logic, IDD is an extreme version of the onset of post-traumatic stress in childhood (Kluft, 1984; Putnam, 1997): Early, intense and prolonged traumatic experiences, especially neglect or abuse on the part of parents, would lead to dissociation, i.e. isolation of memories , beliefs, etc., in rudimentary alternative identities, which would develop throughout life, gradually giving rise to a greater number of identities, more complex and separate from the rest.
Cases of TID appearing in adulthood are rarely seen. Thus, TID would not result from the fragmentation of a nuclear personality, but rather from a failure in the normal development of the personality which would result in the presence of relatively separate mental states which would eventually become alternate identities.
Assessment and treatment
The number of TID diagnoses has increased in recent years; while some authors attribute this to increased awareness of the disorder by cliniciansOthers consider this to be due to overdiagnosis. It has even been suggested that TID is due to patient suggestion due to clinician questions and media influence. Likewise, there are those who believe that there is a lack of training on the manifestations of IDD and an underestimation of its prevalence which lead to many undetected cases of IDD, in part due to an underestimation of its prevalence. insufficient exploration.
In this regard, it should be borne in mind that, according to rift (1991), only 6% of multiple personality cases are detectable in their pure form: A typical case of IDD would be characterized by a combination of dissociative symptoms and symptoms of post-traumatic stress disorder with other non-determinative symptoms of IDD, such as depression, panic attacks, substance abuse, or disorder. food. The presence of this latter group of symptoms, which are much more obvious than the other symptoms of TID and very common in themselves, would lead clinicians to overlook a more in-depth examination that would allow detection of multiple personality. Additionally, it is evident that people with IDD find it difficult to recognize their disorder out of shame, fear of punishment, or the skepticism of others.
TID treatment, which usually takes years, is it basically aims at the integration or fusion of identities or, at least, to coordinate them in order to obtain the best possible functioning of the person.. It is done gradually. First, security of the person is guaranteed, given the tendency of people with IDD to attack themselves and attempt suicide, and the symptoms that interfere the most with daily life, such as depression or drug addiction. , are reduced. Subsequently, the confrontation of traumatic memories is worked on, as would be the case in the case of post-traumatic stress syndrome, for example through exposure to the imaginary.
Finally, identities are integrated, so it is important for the therapist to respect and validate the adaptive role of each to allow the person to more easily accept these parts of themselves as theirs. For a more detailed description of TID processing, the text can be consulted Guidelines for the treatment of dissociative identity disorders in adults, third review, of International Society for the Study of Trauma and Dissociation (2011).
- Freyd, JJ (1996). Betrayal Trauma: The Logic of Forgetting Child Abuse. Cambridge, MA: Harvard University Press.
- International Society for the Study of Trauma and Dissociation (2011). Guidelines for the treatment of dissociative identity disorder in adults, third review. Journal of Trauma & Dissociation, 12: 2, 115-187
- Kluft, RP (1984). Treatment of multiple personality disorder: a study of 33 cases. Psychiatric Clinics of North America, 7, 9-29.
- Kluft, RP (1991). Multiple personality disorder. In A. Tasman and SM Goldfinger (Eds.), American Psychiatric Press review of psychiatry (Vol. 10, pp. 161-188). Washington, DC: American Psychiatric Press.
- Putnam, FW (1997). Dissociation in children and adolescents: a developmental perspective. New York, NW: Guilford Press.