Dissociative identity disorder, DID

Other pathologies and difficulties that are frequently associated would be depression, anxiety, low self-esteem, social difficulties, self-destructive behaviors, alcohol and drug abuse, eating disorders, somatization, etc.

How is it formed?

The Dissociative identity disorder o DID is part of trauma-based psychopathologies and usually begins in childhood. A series of events occur so destabilizing and repeated that the child feels emotionally overwhelmed. He can neither flee from the situation nor fight against it, so the only way he has to react is to divide internally, to distance himself from himself, as if he were not living what he is living. We call this dissociation. It is important to note that 80-99% of people with DID score for a secondary diagnosis of post-traumatic stress disorder (PTSD). Between 85-90% have suffered sexual abuse. Dissociation is thus a way of defending against trauma, and over time it becomes the only way to handle any type of stress. However, trauma alone is not a sufficient factor to develop dissociative disorder. Some people get through devastating situations without presenting too many problems. What is going to make the difference will be the attachment, the child's way of bonding emotionally. By having a positive reference figure that provides secure attachment experiences (protection, attention, emotional modulation, etc.), the child learns that adversity can be endured and overcome, minimizing the risk of psychological fragmentation and enabling future emotional well-being. .

Types of dissociation?

Not all dissociation is problematic:

• Non-pathological dissociation: It occurs in all people (with and without TID). They are normal changes in the state of consciousness. E.g. becoming engrossed in daily activities, daydreaming, etc.
• Pathological dissociation: It has to do with the disconnection of fundamental aspects of the self, such as consciousness, identity, sensations, body movements, memory or perception of the environment.

There are three main types of dissociative symptoms:

• Amnesia: forgetting the traumatic information, to continue living "as if that had not happened."
• Derealization: reality is not perceived in its entirety, but as isolated elements, a sensation of feeling disconnected from the environment, “this is not happening”, or depersonalization (disconnection from one's own body, mind and one's own feelings or sensations, “one is not there ”).
• Confusion and alteration of identity.

Treatment of dissociative identity disorder

The fragmentation of the personality generates a very important expenditure of mental energy since the person constantly struggles to try to maintain order between the different parts, which generates a high degree of tension. This leaves very little mental energy left for everything else. It is necessary to promote the integration of the personality, making the parts overlap with each other, reconciling and merging. In this way, energy will no longer be wasted internally and can be turned externally, allowing the person to adaptively cope with their present life and functioning in a unified way. You will stop living in the past and start living in the present. So integration is the opposite of dissociation.

The treatment of DID addresses different aspects:

• Stabilization: strengthen and consolidate the person.
• I work with the different parts.
• I work with trauma.
• Integration of personality and recovery of interpersonal functions.

It is important to note that the therapeutic objective is not only to integrate the different mental states. We must work to improve the overall functionality of the person, improve their quality of life, their autonomy, their interpersonal relationships, etc.

Forecast?

Dissociative disorders are treatableYes, but they need a specific approach. That is why it is important that there is a good diagnosis, to be able to detect and treat them properly. There may be varying degrees of advancement. Some patients will reach integration between the parts, others will stabilize and improve their adaptation, others will continue to have parts, but there will be less conflict and negativity between them. Be that as it may, improvement is not a possibility, it is a reality as long as the appropriate help is available.

• Disorder that is characterized by the existence of two or more very different identities, which control the behavior of the person in an alternating way.
• Trauma alone is not a sufficient factor for developing dissociative disorder. What is going to make the difference will be the attachment, how the child bonds affectively.
• The therapeutic objective is to integrate the different mental states, but also to work to improve the overall functionality, quality of life, autonomy, relationships ... of the person.

Cristina Agud

Specialist in Clinical Psychology