This condition is characterized by the presence of 2 or more distinct identities or personality states that recurrently take control of behavior.
Although this disorder is one of the rarer psychiatric diseases, it is much more common in women than in men.
DID is associated with a history of sexual abuse. Sexual abuse is abusive sexual behavior by one person upon another. It is often perpetrated using force.
DID may be a psychological response to interpersonal and environmental stresses, particularly during early childhood years when emotional neglect may interfere with personality development. Posttraumatic stress disorder (PTSD), major depressive disorder (MDD), and borderline personality disorder are all closely linked with DID.
Depersonalization is characterized by feelings of detachment or estrangement from one’s own body, thoughts, perceptions, and actions. Derealization is characterized by feelings of detachment from one’s environment. Intact reality testing helps clinicians differentiate depersonalization and derealization from psychosis. Patients with dissociative identity disorder frequently experience depersonalization and derealization.
Lapses in personal information is a common manifestation of dissociative identity disorder. Patients may develop an inability to recall important personal information (e.g., personal identity, memories), usually following severe emotional stress or trauma; this is known as dissociative amnesia. Dissociative amnesia may be accompanied by dissociative fugue, which is characterized by unexpected travel to unfamiliar environments.
Cognitive behavioral therapy is a type of psychotherapy based on analyzing and reforming maladaptive thoughts that are contributing to emotional and behavioral distress. It is indicated in a wide variety of behavioral health disorders and has demonstrated benefit in patients with dissociative identity disorder.
Selective Serotonin Reuptake Inhibitors are antidepressants that work by selectively inhibiting serotonin reuptake into presynaptic cells, increasing the neurotransmitter's availability in the synaptic cleft. Selective serotonin reuptake inhibitors are frequently used in patients with dissociative identity disorder, usually in combination with cognitive behavioral therapy.
Unfortunately, patients with dissociative identity disorder tend to have a poor prognosis due to high morbidity and mortality associated with comorbid conditions (e.g., PTSD, depression) and high rates of suicide.
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