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Dissociative Identity Disorder

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Dissociative Identity Disorder

Dissociative Identity Disorder

Dishes with Different Personalities
Picmonic
Dissociative identity disorder (multiple personality disorder) is a medical condition in which two or more identities or personality states alternately take control of an individual. This condition is more common in women and is associated with sexual abuse, depression, substance abuse, PTSD, somatic symptom disorders, and borderline personality disorder.
11 KEY FACTS
CHARACTERISTICS
≥ 2 Personalities
Personalities With Tutu

This condition is characterized by the presence of 2 or more distinct identities or personality states that recurrently take control of behavior.

These identities may have distinct patterns of perception, affect, cognition, and behavior. The alteration in identity is often observed by others or reported by the patient. Transitions may be sudden and triggered by stress.

More Common in Women
Women

Although this disorder is one of the rarer psychiatric diseases, it is much more common in women than in men. Women often present with more dissociative symptoms, while men may present more frequently with violent or criminal behavior under different identities (less often diagnosed).

ASSOCIATIONS
Childhood Onset
Child On-switch

DID usually begins in childhood, but symptoms may not be recognized until later. It is often linked to severe childhood trauma, particularly repetitive sexual or physical abuse before age 9. Often occurs in individuals who lacked a supportive caregiver during or after the trauma.

Sexual Abuse
Physically abused by sex-symbols

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.

Other Psychiatric Diseases
Psychic

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.

SYMPTOMS
Depersonalization and Derealization
Detaching-from-Person and D-reel

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. DID is distinct from depersonalization/derealization disorder, which involves these symptoms without identity fragmentation.

Lapses in Personal Information
'Who am I' Thought Bubble

Lapses in personal information are 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.

These amnesic episodes often relate to trauma and may result in dissociative fugue (sudden travel + identity confusion). This is classified under dissociative amnesia, a specifier of DID or a separate diagnosis.

TREATMENT
Cognitive Behavioral Therapy
Cog Behavioral Therapist

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 (SSRI)
Selective Silver-tonic Reuptake tube with Inhibiting-Chains

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.

Long Term Psychotherapy
Long-ruler Psychic-therapist

Long-term psychotherapy is the cornerstone of treatment for dissociative identity disorder. It focuses on integrating fragmented identities, processing past trauma, and improving emotional regulation and functioning. Therapy often spans several years and may include trauma-focused modalities such as dialectical behavior therapy (DBT), psychodynamic therapy, or cognitive behavioral therapy (CBT). Establishing a strong therapeutic alliance and ensuring patient safety are essential goals.

CONSIDERATIONS
Poor Prognosis
Gravestone

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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