Multiple Personality Disorder: Causes and Symptoms

Learn about the disorder that deals with the presence of two or more identities in the person who suffers from it.

Dissociative Identity Disorder (DID), popularly known as "multiple personality disorder.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 Psychosis o Fight Clubthrough the character of Gollum from The Lord of the Rings and even the character played by Jim Carrey in the comedy Me, Myself and IreneIn addition, dozens of works have used DID as an inspiration due to its striking symptomatology.

It is for 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 recurrently take control of a person's behavior, each having memories, relationships, and attitudes of its own.". In general, the different identities do not remember what the others have experienced, so they are not aware of each other's 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, in case they are aware of the existence of the more dominant personalities, they can be directed by these, which can even manifest themselves in the form of visual or auditory hallucinations, giving orders to the other identities.

Currently, both in the DSM and in the International Classification of Diseases (ICD-10), DID is categorized within the dissociative disorders, i.e., those caused by failures in the integration of consciousness, perception, movement, memory or identity (in the case of 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 to traumatic experiences that links DID to post-traumatic stress disorder. post-traumatic stress disorderwhich is characterized by the presence of anxiety and re-experiencing (through nightmares or flashbacks) following life-threatening events such as sexual abuse or natural disasters. Of particular interest here is the fact that post-traumatic stress disorder may include dissociative symptoms, such as a lack of recall of important aspects of the traumatic event or an inability to experience emotions.

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

Following the same logic, DID would be an extreme version of childhood-onset post-traumatic stress (Kluft, 1984; Putnam, 1997). (Kluft, 1984; Putnam, 1997): early, intense and prolonged traumatic experiences, in particular parental neglect or abuse, would lead to dissociation, i.e., isolation of memories, beliefs, etc., into rudimentary alternative identities, which would develop throughout life, progressively giving rise to a larger number of identities, more complex and separate from the rest.

Rarely are cases of adult-onset DID observed. Thus, DID would not arise from the fragmentation of a nuclear personality, but rather from a failure of normal personality development resulting in the presence of relatively separate mental states that would eventually develop into alternative identities.

Assessment and Treatment

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

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

The treatment of DID, which usually takes years, is directed primarily at the The treatment of DID, which usually takes years, is primarily aimed at integrating or merging identities, or at least coordinating them to achieve the best possible functioning of the person.. This is done progressively. First of all, the safety of the person is ensured, given the tendency of people with DID to self-harm and attempt suicide, and the symptoms that interfere with daily life, such as depression or drug abuse, are reduced. Subsequently, work is done on confronting traumatic memories, 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 in order to facilitate the person's acceptance of these parts of him/herself as his/her own. For a more detailed description of the treatment of DID, see the following text Guidelines for treating dissociative identity disorders in adults, third revisionby the International Society for the Study of Trauma and Dissociation. (2011).

Bibliographical references:

• Freyd, J. J. (1996). Betrayal trauma: The logic of forgetting childhood abuse. Cambridge, MA: Harvard University Press.
• International Society for the Study of Trauma and Dissociation (2011). Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision. Journal of Trauma & Dissociation, 12:2, 115-187
• Kluft, R. P. (1984). Treatment of multiple personality disorder: A study of 33 cases. Psychiatric Clinics of North America, 7, 9-29.
• Kluft, R. P. (1991). Multiple personality disorder. In A. Tasman & S. M. Goldfinger (Eds.), American Psychiatric Press review of psychiatry (Vol. 10, pp. 161-188). Washington, DC: American Psychiatric Press.
• Putnam, F. W. (1997). Dissociation in children and adolescents: A developmental perspective. New York, NW: Guilford Press.