Dissociative Identity Disorder: Overview and Current Research

By Sue-Mei Slogar
2011, Vol. 3 No. 05 | pg. 1/2 |

Abstract

Show/Hide

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

Diagnosis
According to the diagnostic criteria outlined in the current edition of the DSM, diagnosis of DID requires the presence of at least two personalities, with a personality being identified as a entity having a unique pattern of perception, thought, and relational style involving the both the self and the environment. These personalities must also display a pattern of exerting control on the individual’s behavior. Extensive and unusual loss of memory pertaining to personal information another feature of DID. Differential diagnosis generally involves ruling out the effects of chemical substances and medical (as opposed to psychological) conditions. When evaluating children, it is also important to ensure that symptoms are distinguishable from imaginary play (American Psychiatric Association, 2000).

Prevalence & Comorbidity
In clinical populations, the estimated prevalence of DID ranges from 0.5 to 1.0% (Maldonado, Butler, & Spiegel, 2002). In the general population, estimates of prevalence are somewhat higher, ranging from 1-5% (Rubin & Zorumski, 2005). Females are more likely to receive a diagnosis of DID, at a ratio of 9:1 (Lewis-Hall, 2002). This author also contends that the disproportionately high number of females diagnosed with DID dispels the notion that incestual abuse is largely responsible for the of DID.

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
The course and prognosis of untreated DID is uncertain, and for individuals with comorbid disorders, prognosis is less favorable. Other factors influencing a poor prognosis include remaining in abusive situations, involvement with criminal activity, substance abuse, eating disorders, or antisocial personality features. Although DID occurs more frequently in the late adolescence or early adult age groups, the average age of diagnosis is thirty, with most diagnoses occurring 5-10 years after the onset of symptoms. A risk factor involves having first-degree relatives who have received diagnoses of DID (Kaplan & Sadock, 2008).

Risk factors
One study found that the risk of developing a dissociative disorder (DD) increased seven times with a child’s exposure to trauma. A later diagnosis of DD was twice as likely when the child’s mother had experienced trauma within two years of the child’s birth (Pasquini, Liotti, Mazzotti, Fassone, & Picardi et al. 2002). Dissociative Identity Disorder is linked to childhood abuse in 95-98% of the cases (Korol, 2008). However, other factors in addition to a history of abuse, such as disorganized or disoriented attachment style and a lack of social or familial support best predict that an individual will develop DID (ibid).

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.

Multicultural considerations
Samples of participants from the United States, , the Netherlands, Norway, and Turkey found a similar prevalence estimates (Kluft & Foot, 1999). However, prevalence in , , and Japan is much lower (Fujii, Suzuki, Sato, Muraka, & Takahashi, 1998). A study conducted with inpatient, outpatient, and the general population in found prevalence rates of 0.5, 0.3, and 0.0%, respectively (Xiao, et al., 2006). Factors related to individualistic and collectivistic cultures may contribute to the prevalence and etiology of DID. According to Fujii et al., not only are reports of DID in Japan are far more scarce than in North America, but other differences also exist. While most North Americans participants with DID were physically or sexually abused in childhood, Japanese participants diagnosed with DID were far less likely to have experienced physical or sexual abuse. The North American participants in this study also had nearly three times as many alter personalities as Japanese participants.

Treatment of Dissociative Identity Disorder

Psychotherapy
Although the ultimate goal of treatment is integrated functioning of the alter personalities (ISSD, 2005), the presence of multiple comorbid disorders, experiences of trauma, and safety concerns make a comprehensive treatment plan necessary. The International Society for the Study of Dissociation (ISSD) published some basic guidelines to aid clinicians in treating DID. Treatment most commonly follows a framework of “1) safety, stabilization and symptom reduction, 2) working directly and in depth with traumatic memories, and 3) identity integration and rehabilitation” (p. 89).

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).

Medication
No randomized trials have been conducted to compare the effectiveness of various theoretical orientations or medications in treating DID. However, a survey of psychiatrists treating DID found that the most favored treatment methods involved individual therapy, anxiolytics, and antidepressants (Sno & Schalken, 1999). In addition to these drugs, carbamazapine for use electroencephalograph abnormalities, prazosin for nightmares, and naltrexone for self-injurious behavior might be helpful (Kaplan & Sadock, 2008). Although research involving pharmacotherapy for DID is scarce, two studies involving diazepam and perospirone seem promising.

Suggested Reading from StudentPulse

Within the cultural framework of America, the systemic structure is characterized by White male patriarchy that allows for Black males to have the ability to negotiate the way in which they have been socialized and institutionalized to think, act, and behave because they are men. However, the reality of race and the lack of diversity in the purest sense,  impedes upon this effort and cripples the black male's ability to truly transition into... MORE»
Autism is a complex neuro-developmental disorder causing deficits in social interaction and language development at an early age. The severity is based on the level of impaired social communication and restricted, repetitive behaviors. The average prevalence of autism in 2013 was reported to be 1%. However, there has been a 600%... MORE»
The individually unique music is now a raucous cacophony. The individually savory flavors are a muddled sludge. All the countries in the world are united under one government and one religion. Communists follow the same rules as those previously under a democracy. Muslims and Christians live by the same religious standards. How would we deal with that? In light of rapidly accelerating globalization and expansion of technology, it becomes relevant... MORE»
Antisocial personality disorder (ASPD), also known as dyssocial personality disorder, is a mental illness that is characterized by a reckless disregard for social norms, impulsive behaviour, an inability to experience guilt, and a low tolerance for frustration. Individuals with ASPD exhibit an inflated sense of self-worth and possess a superficial charm, traits that often aid their attempts to exploit and violate the rights of others. Although the... MORE»
In recent years, violence and ethnicity in South Africa received a substantial amount of media attention through the University of the Free State’s Reitz-video saga, the Brandon Huntley issue on asylum seeking and whether or not whites are specifically targeted by criminals, and Solidariteit Radio’s program on farm attacks... MORE»
Submit to Student Pulse, Get a Decision in 10-Days

Student Pulse provides undergraduate and graduate students around the world a platform for the wide dissemination of academic work over a range of core disciplines.

Representing the work of students from hundreds of institutions around the globe, Student Pulse's large database of academic articles is completely free. Learn more | Blog | Submit

Follow SP