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Dissociative identity disorder

In psychiatry, dissociative identity disorder (DID) is the current name of the condition formerly listed in the Diagnostic and Statistical Manual of Mental Disorders as multiple personality disorder (MPD) and multiple personality syndrome. The International Statistical Classification of Diseases and Related Health Problems continues to list it as Multiple Personality Disorder. Multiple Personality Disorder should not be confused with schizophrenia. more...

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Those who recognize dissociative identity disorder as a psychological condition believe that it is characterized by the use of dissociation as a primary defense mechanism. A chronic reliance on dissociation as a means of defending against stressors in the environment causes the individual to experience their psyche/identity as disconnected (from their senses, for example) or split into distinct parts.

Some psychologists and psychiatrists dissent from the manuals and regard the disorder as possibly iatrogenic or factitious. Some will accept it as a disorder, but prefer not to use terms like "defense mechanism", which they regard as an unscientific borrowing from Freudianism. See the article Defense mechanism for further discussion.

It is not clear what percentages of the psychological community accept, accept with reservations, or disagree with the previously noted positions.

Controversy

This diagnosis is controversial. The main points of disagreement are:

Whether MPD/DID is a real disorder, or just a fad.
If it is real, is the appearance of multiple personalities real or delusional?
If it is real, should it be defined in psychoanalytic terms?
Whether it can be cured.
Whether it should be cured.
Who should primarily define the experience -- therapists, or those who believe that they are "multiple" (have multiple personalities)?
Whether it is invariably a disorder or simply a way of being.

In rough terms, believers in DID or MPD argue that children who are stressed or abused (especially sexually abused), split into several independent personalities or ego states as a defense mechanism. How people with DID/MPD perceive their actions varies, but often only one personality (or "alter") can control the body at any given time. Sometimes alters are co-conscious and share all memories. Sometimes each alter reports remembering only the times when he/she/it controlled the body, and claims amnesia for all other periods. People diagnosed with DID may exhibit erratic alterations of personality and may claim to "lose time".

Skeptics claim that people who act as if they have MPD/DID have learned to exhibit the symptoms in return for social reinforcement, either from therapists, from others with DID, from society at large or from any combination thereof.

A third view is that it is normal to experience oneself as multiple and that "multiplicity" is not necessarily a disorder, so that it is possible to be multiple without having MPD or DID. Proponents of this view may generally hold the perhaps controversial belief that mental illness itself generally tends to be a culture-specific syndrome, and that many cultures throughout history have had different models for integrating alternative mentalities into their social fabric, for example, as shamans. Proponents of the "healthy multiple" position are common in online communities.

Definition

Acute stress disorder (ASD) is an anxiety disorder characterized by a cluster of dissociative and anxiety symptoms occurring within one month of a traumatic event. (Dissociation is a psychological reaction to trauma in which the mind tries to cope by "sealing off" some features of the trauma from conscious awareness).

Description

Acute stress disorder is a new diagnostic category that was introduced in 1994 to differentiate time-limited reactions to trauma from post-traumatic stress disorder (PTSD).

Causes & symptoms

Acute stress disorder is caused by exposure to trauma, which is defined as a stressor that causes intense fear and, usually, involves threats to life or serious injury to oneself or others. Examples are rape, mugging, combat, natural disasters, etc.

The symptoms of stress disorder include a combining of one or more dissociative and anxiety symptoms with the avoidance of reminders of the traumatic event. Dissociative symptoms include emotional detachment, temporary loss of memory, depersonalization, and derealization.

Anxiety symptoms connected with acute stress disorder include irritability, physical restlessness, sleep problems, inability to concentrate, and being easily startled.

Diagnosis

Diagnosis of acute stress disorder is based on a combination of the patient's history and a physical examination to rule out diseases that can cause anxiety. The essential feature is a traumatic event within one month of the onset of symptoms. Other diagnostic criteria include:

The symptoms significantly interfere with normal social or vocational functioning
The symptoms last between two days and four weeks.

Treatment

Treatment for acute stress disorder usually includes a combination of antidepressant medications and short-term psychotherapy.

Alternative treatment

Acupuncture has been recommended as a treatment for acute stress disorder. Some other alternative approaches, including meditation, breathing exercises, and yoga, may be helpful when combined with short-term psychotherapy. Homeopathic treatment and the use of herbal medicine and flower essences also can help the person with acute stress disorder rebalance on the physical, mental, and emotional levels.

Prognosis

The prognosis for recovery is influenced by the severity and duration of the trauma, the patient's closeness to it, and the patient's previous level of functioning. Favorable signs include a short time period between the trauma and onset of symptoms, immediate treatment, and appropriate social support. If the patient's symptoms are severe enough to interfere with normal life and have lasted longer than one month, the diagnosis may be changed to PTSD. If the symptoms have lasted longer than one month but are not severe enough to meet the definition of PTSD, the diagnosis may be changed to adjustment disorder.

Patients who do not receive treatment for acute stress disorder are at increased risk for substance abuse or major depressive disorders.

Prevention

Traumatic events cannot usually be foreseen and, thus, cannot be prevented. However, in theory, professional intervention soon after a major trauma might reduce the likelihood or severity of ASD. In addition, some symptoms of acute stress disorder result from biochemical changes in the central nervous system, muscles, and digestive tract that are not subject to conscious control.

Key Terms

Depersonalization: A dissociative symptom in which the patient feels that his or her body is unreal, is changing, or is dissolving.
Derealization: A dissociative symptom in which the external environment is perceived as unreal.
Dissociation: A reaction to trauma in which the mind splits off certain aspects of the trauma from conscious awareness. Dissociation can affect the patient's memory, sense of reality, and sense of identity.
Trauma: In the context of ASD, a disastrous or life-threatening event.

For Your Information

Books

"Acute Stress Disorder." In Diagnostic and Statistical Manual of Mental Disorders, 4th ed. Washington, DC: American Psychiatric Association, 1994.
Corbman, Gene R. "Anxiety Disorders." In Current Diagnosis 9, edited by Rex B. Conn, et al. Philadelphia: W. B. Saunders Company, 1997.
Eisendrath, Stuart J. "Psychiatric Disorders." In Current Medical Diagnosis & Treatment 1998, edited by Lawrence M. Tierney, Jr., et al. Stamford, CT: Appleton & Lange, 1997.
Kabat-Zinn, Jon. Full Catastrophe Living: Using the Wisdom of Your Body and Mind to Face Stress, Pain, and Illness. New York: Bantam Doubleday Dell Publishing Group, Inc., 1990.
"On-Call Problems: Insomnia." In Surgery On Call, edited by Leonard G. Gomella and Alan T. Lefor. Stamford, CT: Appleton & Lange, 1996.

Gale Encyclopedia of Medicine. Gale Research, 1999.

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