Dissociative Identity Disorder

Dissociative identity disorder (DID) is a disturbance in the normal integrative function of memory, identity and self. (Turkus) Pierre Marie Félix Janet, a genius and researchers who lived during the late 1800's and early 1900's understood there is a connection between past events and present day symptoms of trauma, and he concluded that the personality is a structure comprised of various systems. (van der Hart, 2006, p. 2) Researchers since have struggled to catch up with Janet, and have not always understood how the separate states that make up the personality work like Janet did, but more recently, due to significant contributions from excellent researchers, such as the ones seen on our reference list it is now widely accepted and understood that all humans have multiple aspects to their personality. (Dorahy & van der Hart 2014)

Terminology of

The terms personalties, parts and states are correctly used interchangeably, (Dorahy, 2014) as well as subpersonalities, sides, subselves, internal self states, and ego states. (Noricks, 2011, p.1) These terms are all referring to the same thing, which is the multiple aspects that make up an individuals one personality.

I. Normal part of the personality

A normal personality state maintains a continuous sense of "I, and myself" over time, despite the transition from one state to another, whilst the separate states in individuals with dissociative identity disorder do not. (Gillig,2009)

II. Distinct state of the personality

A distinct personality states is seen in all the dissociative disorders, but only dissociative identity disorder has two or more distinct states. A distinct state is not a normal part of the personality. It's been altered due to trauma and they show up on an fMRI scan as a distinctly lit up area that switches as an individual with dissociative identity disorder switches from one distinct state to another. (Dorahy & van der Hart 2014) This state does not hold trauma memory and it does not usually act child-like. It is the part of an individual that attends to daily life activities such as raising children, having relationships, loving and feeling a normal range of emotions. For those that understand structural dissociation, this state is known as an apparently normal part (ANP). See our page on structural dissociation for more. (van der Hart, Nijenhuis, Kathy Steele 2006)

III. Less than distinct state of the personality

Dissociated parts are found in all of the dissociative disorders, as well as in posttraumatic stress disorder (PTSD), dissociative posttraumatic stress disorder (D-PTSD), and the dissociative aspects of some forms of borderline personality disorder (D-BPD), but none of these disorders have more than one distinct state. This, again is only found in dissociative identity disorder. Lesser distinct states are far more common that distinct states. For those that understand structural dissociation, this state is known as an emotional part (EP). It is often subject to vehement emotion. See our page on structural dissociation for more. (van der Hart, Nijenhuis, Kathy Steele 2006)

IV. Amnesia between distinct states

Not all parts of the personality in individuals with dissociative disorders experience amnesia, and the less than distinct states can and often do have this experience, but the DSM-5 reports that for a diagnosis of dissociative identity disorder there must be amnesia between two or more distinct states, and as has already been explain, only dissociative identity disorder has two or more distinct states. (Dorahy & van der Hart 2014)

V. Etiology

Unfortunately misconceptions, personal bias, media sources, and various forms of denial have worked together to distort the presentation, epidemiology and etiology of dissociative identity disorder, a mental illness often associated with extreme and early child abuse and neglect. (Dorahy, 2014) This spread of misinformation has been going on for decades. Dissociative identity disorder is precipitated by prolonged exposure to overwhelming circumstances during early childhood. (ISSTD, 2011) This is most significantly noted in the formative years of development where the normal integration of parts should occur. Coping by dissociation is an innate ability all children have, but when nurturing and compassion are missing, the infant can rely heavily on dissociation to move their stressful and traumatic memories from consciousness. (Howell, 2011, p. 85-108) The age a child is when they become overwhelmed by trauma is critical to the development of dissociative identity disorder. (Brand, 2014)

VI. Integration

Normal integration can be described as thus. At birth, behavioral states are not linked, but do integrate naturally over the course of normal childhood. (Howell, 2011, p. 89) Parts group into sequences, until a sense of cohesiveness emerges that can fluently shift from one task-focused aspect of the personality to another. (Putnam, 1989, p. 51) The parts share and develop a sense of common identity, and retain the ability to easily transition from one state to another. (Howell, 2011, p. 89)

Lack of normal childhood integration can be due to repeated and extreme instances of neglect, abuse and mental torment or other trauma which inhibit normal linking. (Wilkinson 2012, p. 81-93) Frank W. Putnam brought to light the idea that trauma in childhood causes a "disruption of the developmental tasks of consolidation of self across behavioral states and the acquisition of control over the modulation of states."  (Putnam, 1989, p. 53)

Important points of the DSM-5 criteria for Dissociative identity disorder

Disruption of identity characterized by two or more distinct states.

Amnesia between the distinct states.

The disturbance is not a normal part of broadly accepted cultural, religious practice, or part of the normal fantasy play of children.

The last two points are commonly stressed with any mental illness.

Causes clinically significant distress and impairment in social, occupational, or other important areas of functioning.

The disturbance is not due to the direct physiological effects of a substance.
(APA, DSM-5)

See our page on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

VII. Diagnostic criteria

"Multiple personalities" were not mentioned in the DSM-I, but the term was used as part of the description in the 1968 printing of the DSM-II, under the diagnosis of hysterical neurosis, dissociative type. The DSM-III, which was printed in 1980 moved the idea of "multiple personalities" from a symptom of hysteria to its own diagnosis and called it multiple personality disorder. The DSM-IV, printed in 1994, changed the name to dissociative identity disorder. The Diagnostic and Statistical Manual of Mental Disorders-5 retained the name of dissociative identity disorder. Never has this mental disorder been listed as a personality disorder, and the term personalities, although still used today is only accepted as a term to refer to the multiple parts of an individuals one personality.

Enough diagnostic criteria is included in the Diagnostic and Statistical Manual of Mental Disorders fifth edition for trained mental health professionals to make an accurate diagnosis of dissociative identity disorder. The DSM-5 emphasizes distinct states and amnesia, and adds the disruptive effect of symptoms that affect consciousness. This version of the DSM includes a broader definition of symptoms than previous versions (Spiegel, 2011). Dissociative identity disorder is the most complex and misunderstood of the dissociative disorders, and is listed in the Diagnostic and Statistical Manual of Mental Disorders, fifth edition, (APA DSM-5) as dissociative identity disorder, and in the International Classification of Diseases (ICD-10 WHO, 1992) as multiple personality disorder.

VIII: Physiological and psychophysiological measures

A variety of distinguishing physiological measures have been found in dissociated personality states including: visual acuity, medication response, allergies, plasma glucose levels in diabetic subjects, heart rate, blood pressure, galvanic skin response, muscle tension, immune function, electroencephalography, evoked potential patterns, functional magnetic resonance imaging activation, brain activation and regional blood flow. (ISSTD, 2011) Distinct parts also often have different psychophysiological organizations, such as different allergies, taste preferences, handedness, eyesight and prescriptions for glasses, and responses to medications.  (Howell, 2011, p. 57) z

In addition, the concept of physiological and psychophysiological differences in individuals with dissociative identity disorder is not that there are individual "people" inside a persons head, but that there is neural networks that are so isolated that they function as if the various parts were indeed separate people. Before anyone thinks of taking that quote out of context lets look at the mind and the brain and see how they correlate with each other. The mind is capable of performing an enormous number of tasks while, at the same time the brain can act upon what's happening in the mind. Can you see then how an isolated set of neurons can take on it's own distinct ways? Well, probably not from what we have wrote, so let us explain a bit further. Packages of neurons, in individuals with dissociative identity disorder, stay together and become more distinct over time. A period during which a part of the personality develops more daily just as the over all personality would of a child. This is all happening early in childhood, of course.


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