Dissociative Identity Disorder: Overview and Current Research
IN THIS ARTICLE
This paper entails a description of factors related to diagnosis and treatment of Dissociative Identity Disorder. Epidemiology, including risk factors and sociocultural aspects of the disorder are presented, along with recommendations for treatment. Highlights of current research focusing on neurobiological and psychobiological aspects of DID provide additional insight into providing accurate diagnosis and appropriate treatment. Recommendations for future research involve studies that will elaborate on research already completed, and provide a more detailed analysis of the characteristics of this unique and complex disorder.
Introduction to Dissociative Identity Disorder (DID)
Dissociative Identity Disorder (DID) is a fascinating disorder that is probably the least extensively studied and most debated psychiatric disorder in the history of diagnostic classification. There is also notable lack of a consensus among mental health professionals regarding views on diagnosis and treatment. In one study involving 425 doctoral-level clinicians, nearly one-third believed that a diagnosis of Borderline Personality Disorder was more appropriate than DID. While most psychologists demonstrated belief that DID is a valid diagnosis, 38% believed that DID either likely or definitely could be created through the therapist’s influence, and 15% indicated that DID could likely or definitely develop as a result of exposure to various forms of media (Cormier & Thelen, 1998).
Description of DID
Prevalence & Comorbidity
High percentages of individuals with DID have comorbid diagnoses of Post-Traumatic Stress Disorder or Borderline Personality Disorder (Gleaves, May, & Cardeña, 2001). In addition, individuals diagnosed with DID commonly have a previous diagnosis of Schizophrenia. However, this most likely represents a misdiagnosis rather than comorbidity, due to the fact that both disorders involve experiencing Schneiderian symptoms (ibid.). Other possible comorbid disorders involve substance abuse, eating disorders, somatoform disorders, problems of anxiety and mood, personality disorders, psychotic disorders, and organic mental disorders (ISSD, 2005), OCD, or some combination of conversion and somatoform disorder (Kaplan & Sadock, 2008). While the symptoms of DID are complex in themselves, the presence of multiple additional symptoms further complicates diagnosis and treatment.
Client characteristics, course, & prognosis
Studies on genetic factors contributing to DID present mixed findings. However, one study involving dyzogotic and monozygotic twins found that considerable variance in experiences of pathological dissociation could be attributed to both shared and non-shared environmental experiences, but heritability appeared to have no effect (Waller & Ross, 1997). Another study utilizing objective ratings of dissociative behavior found that shared environmental factors had little effect in both adopted siblings and twin pairs (Becker-Blease, et al, 2004). However, dissociative behavioral correlations of r = 0.21 for fraternal twins and r = 0.60 for identical twins suggests the presence of a genetic effect. As this study did not specifically investigate pathological dissociation, more research is needed to determine if the genetic tendency to experience dissociation varies according to type of dissociation (pathological or non-pathological), and whether trauma influences the pathological development of a pre-existing tendency to dissociate.
Treatment of Dissociative Identity Disorder
A study involving 280 outpatient participants (98% DID diagnosis) from five different races (Caucasian, African American, Hispanic, Asian, and Other) demonstrated the effectiveness of a similar five-phase model in reducing symptoms of dissociation. As might be expected from successful treatment, clients in later phases of treatment reported less self-harming behavior, symptom reduction, and more positive behavior than clients in stage 1, as indicated by scores on the Dissociative Experiences Scale II, the Posttraumatic Stress Checklist-Civilian, and the Symptom Checklist-90-Revised (Brand, et al., 2009).
While elements of each phase occur throughout treatment, these phases describe the dominant concerns of therapy during the stages of treatment. Because of the intense feelings experienced as a result of trauma, individuals with DID may behave in ways that facilitate exploitation or are dangerous to themselves or others. Thus, a primary goal for treatment is to manage these behaviors and teach impulse control with some form of cognitive or behavioral therapy. Even when amnesia exists between alters, therapists should hold the client responsible for behaviors of all alters. Therapists should also realize that some clients do not desire fusion or integration of their personalities. In this case, the goal of treatment would involve working towards cooperative functioning of alters. In working with alters, therapists should view alters not as problems to be removed, but as the client’s creative response to trauma. Identifying relationships between alters and communicating with alters directly are strategies useful in treating DID. Requesting that the client listen inwardly to alters may facilitate necessary discussion among alters and between the therapist and client (ISSD, 2005).