Understanding Multiple Personality Disorder

Steps in the Development of Dissociative Identity
Here are the steps involved in the development of a dissociative identity:

1. A child undergoes severe abuse, inflicted upon him by a trusted caretaker, often a parent or guardian, and separates out the memory of this traumatic event in order to carry on in the relationship.

2. The memory of the event is registered separately into his subconscious mind, only to be later experienced as a separate identity or personality.

3. Repeated occurrence of these unpleasant incidences, at different times, gives rise to different personalities such that each personality is associated with a different experience and performs a set of different functions.

4. Dissociation thus becomes a coping mechanism for the individual when faced with a stressful situation in future.

The existence of a clandestine Mr. Jekyl and Mr Hyde in all of our personalities, symbolizing the good and the evil within us, cannot be ruled out. But if the person’s perception and behavior shifts between two or more identities, of which he is himself often unaware, the issue is definitely one of greater severity.

Several psychiatric researchers opine that about 1 percent of the general population and 5 to 20 percent of patients in psychiatric hospitals worldwide suffer from this perplexing psychological disorder called Multiple Personality Disorder (MPD).

What is MPD
Multiple personality disorder (MPD), also known as dissociative identity disorder (DID), is a psychiatric disturbance in which two or more distinct identities or personalities alternate in taking complete control of the patient's perception and behavior, accompanied by a loss of memory.

These alternate personalities are known as alter states or alter egos.

Each alter tends to have a very distinct way of perceiving and relating to the environment and therefore, the individual is not a single person but a group of personalities residing in one physical body.

What this means is that a person behave as a completely different person in different situations and has no memory of it. The person switches from one state to another and is unaware of the other state. It is as though two to more different people reside in the same body.

What can Cause DID
There has been considerable debate over the exact causative agent of DID, but what most psychologists unanimously agree upon is the fact that DID is an outcome of some kind of a prolonged trauma/abuse - mental, emotional or sexual and especially during the sufferer’s childhood. Such an abuse is often followed by a tremendous amount of stress.

As a way of coping up with the stress and sometimes, shame, the patient develops an intrinsic ability to dissociate the unpleasant memories or experiences from consciousness, thus giving rise to multiple personalities within himself.

Symptoms of DID
The following are the major dissociative identity disorder symptoms:

Amnesia
A DID patient may suffer from a memory loss or amnesia for a long duration of time in the past. Such a period of memory loss indicates that the person was taken over by a different alter during that time gap, due to which the memory of the said time has been completely erased.

Hence, it is not unusual for a DID patient to meet people who seem to know them pretty well but they themselves have no memory of meeting earlier. Such people sometimes have no recollection of their entire childhood. People with DID may also find themselves in places they have no recollection of or doing things they have no memory of.

Depersonalization
This symptom manifests in the patient experiencing or leading his own life as if he was a mere spectator. He constantly feels that his body is unreal or changing.

Identity disturbances
A DID patient is characterized as the one having two or more distinct personalities or alters and their associated memories, which are, in fact, dissociated with each other. It is under a stressful situation that one of these dissociated personalities reemerges, bringing with it an array of inexplicably erratic behaviors.

Patients suffering from DID may also display a wide variety of other symptoms such as epilepsy, schizophrenia, anxiety disorders, mood disorders, post traumatic stress disorder, and eating disorders, making the diagnosis of DID even more difficult. So, the patient may undergo years of treatment for a symptom rather than the underlying problem.

Treatment Options for DID
Treatment for DID should essentially comprise of means and modes to reconnect the various alters with the single identity of the person. It may, in addition, also concentrate upon relieving the patient of his symptoms if these tend to pose a threat to his security, since DID patients tend to have at least one alter which is aggressive or violent in nature.

The alternative modes of treatment might include:

Psychotherapy
Psychotherapy basically entails first and foremost discovering the patient’s alters. This is followed by a series of treatments aimed at equipping the patient to come face to face with his past traumatic experiences so that all his alters can be integrated into one personality state. This is followed by a series of attempts at consolidating this newly integrated personality.

Even once all the personalities have been successfully integrated, psychologists might recommend further treatment aiming at endowing the patient with the social skills which he still might not have acquired, but are of vital importance to survive in a society.

Medications
Most doctors opine that medications such as tranquilizers and antidepressants are best kept at bay for fear of making their patients too dependent on these drugs. Further, most DID patients have at least one alter that’s into drug or alcohol abuse, a mix of these drugs with the medicines can prove to be fatal.

Hypnosis
This happens to be the most widely used method for treating DID patients. It has shown some great results with those who display a tendency for self mutilation or eating disorders. It can also be used as a tool to facilitate a patient in recuperating from his unpleasant memories.

At a later stage, hypnosis is widely used in the process of integrating all his alters.

Family therapy at all stages of treatment is a must since it helps the patient's family to understand DID and help lend the support without which no patient can bounce back.

EMDR
This is a new therapy which is known to help people with resolving issues of trauma and subsequently helping them with DID.

This feature has been reviewed by Dr Parul Tank, consultant psychiatrist, Fortis Hospitals Mulund.