Wednesday, 25 April 2012

Mulitple Personality Disorder

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Multiple Personality Disorder (MPD) is an affliction which affects an average of five to fifteen of all mentally ill patients and one percent of the population. MPD is a controversial subject, being disputed among many psychiatrists; some say it exists, and others say it is implemented by patients’ psychiatrists and is a cultural construct. MPD has now been changed to Dissociative Identity Disorder (DID) in light of new professional understanding, which resulted largely in part from increased empirical research of trauma-based disorders. Eighty to one hundred percent of those diagnosed with DID also have a secondary diagnosis of Post-Traumatic Stress Disorder (PTSD). PTSD is a widely accepted mental illness which is estimated to affect nine to ten percent of the general population. It has been suggested that the suicide rate for people with trauma disorders is even higher than for those who suffer from major depression. Dissociative Identity Disorder is a direct result from childhood trauma, and provides a defense mechanism that allows victims to cope with the effects of these prior stresses.

DID is neuropsychological, where a person has alternative personalities, often referred to as alters or alter egos, which recurrently take over the person’s body. Usually as a result to childhood trauma, DID can take years to develop. Patients who have DID are known to say, “We do not suffer from DID; we survive because of it.” The person suffering from DID, known as the host personality, can be aware that he/she has alter egos. More than often than not, this is not the case.

The alter egos can differ greatly from the host personality and from each other, each having his/her own characteristics. Alters can often speak different languages than the host, be either male of female regardless of the host’s gender, be different ages, be from different countries, like different styles, have different hobbies, and carry themselves differently and in sharp contrast to each other and the host. Each alter within a multiple has his/her own history, a unique personality, particular body movements, distinctive facial expressions, exclusive ways to express verbal communication, voice tone, accents, and pitch. The alters may even differ in physical properties such as allergies, right-or-left handedness, or the need for eyeglass prescriptions. These differences between alters are often quite striking. Another trait that may tip off psychiatrists to DID, is handwriting. The handwriting of each alter ego will be different, and handwriting analysts can determine whether the handwriting seems to have come from the same person or different people. There is no limit to the amount of alternative personalities one can have nor is there an immediate cure. It takes years to get rid of these alters, depending on how many one has.

When one of these alters takes over the host personality’s body, the host often suffers from temporary amnesia, not having any knowledge of what transpired while an alter was in control. Patients have similarly described this as “losing time,” or going into a fugue state. Those suffering from DID may suddenly find themselves wearing clothes they don’t remember purchasing, end up in a place which they don’t remember traveling to, or even find food in their refrigerator which they don’t like. Those hosts which are aware of their alters may be at war with themselves with one alter being quite critical of the others, and the alters may also be destructive. Some alters may harbor aggressive tendencies, directed toward individuals in the persons environment, or toward other alters within the person. For example, one woman’s alter had carved into her forearm “I hate Joan,” which was the host’s name.

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DID and other Dissociative Disorders (DD) are now understood to be fairly common effects of severe trauma in early childhood, most typically extreme, repeated physical, sexual, and/or emotional abuse. When faced with overwhelmingly traumatic situations from which there is no physical escape, a child may resort to going away in his or her head. This ability is typically used by children as an extremely effective defense against acute physical and emotional pain, or anxious anticipation of that pain. By this dissociative technique, thoughts, feelings, memories, and perceptions of the traumatic experiences can be separated off psychologically, allowing the child to behave as if the trauma had not occurred.

DID is regarded as a highly creative survival technique, because it allows individuals enduring hopeless circumstances to preserve some areas of healthy functioning. However, over time, for a child who has been repeatedly physically and sexually assaulted, defensive dissociation becomes reinforced and habituated. Because the dissociative escape is so effective, children who are very accomplished at it may involuntarily use it whenever they feel threatened or anxious, even if the anxiety-producing situation is not harmful.

People with DID may experience depression, mood swings, suicidal tendencies, sleep disorders (insomnia, night terrors, and sleep walking), panic attacks and phobias (flashbacks, reactions to stimuli or triggers), alcohol and drug abuse, compulsions and rituals, psychotic-like symptoms (including auditory and visual hallucinations), and eating disorders. In addition, individuals with DID can experience headaches, amnesias, trances, and out of body experiences. Some people with DID have a tendency toward self-persecution, and even violence.

One of the reasons for the decision by the psychiatric community to change the disorders name from Multiple Personality Disorder to Dissociative Identity Disorder is that multiple personalities is a misleading term. A person diagnosed with DID has within him/her two or more entities, or personality states, each with its own independent way of relating, perceiving, thinking and remembering about herself and her life. If two or more of these entities take control of the persons behavior at any given time, a diagnosis of DID may be made. These entities previously were often called personalities, even though the term did not accurately reflect the common definition of the word as the total aspect of our psychological makeup. Other terms often used by therapists and survivors to describe these entities are alternate personalities, alters, parts, states of consciousness, ego states, and identities. It is important that although these alternate personality states may appear to be very different, they are all manifestations of a single person.

DID survivors often spend years living with misdiagnoses, consequently floundering within the mental health classification. They change from therapist to therapist and from medication to medication, getting treatment for symptoms but making little or no progress. Research has documented that on average, people with DID have spent seven years in the mental health system prior to accurate diagnosis. This is common, because the list of symptoms that cause a person with DID to seek treatment is very similar to those of many other psychiatric diagnoses. In fact, many people who are diagnosed with DID also have secondary diagnoses of depression, anxiety, or panic disorders.

Treatment for DID consists primarily of psychotherapy with hypnosis. The therapist seeks to make contact with as many alters as possible and understand their roles and functions in the patients life. In particular, the therapist seeks to form a meaningful relationship with the alters that are responsible for violent or self-destructive actions, and to end this behavior. The therapist seeks to establish communication among the personality states and to find ones that have memories of traumatic events in the patients past. The therapist tries to introduce the alters to each other and the host and let the host know of the abusive memories which he/she may have blocked from memory. The goal of the therapist is to enable the patient to breakdown his/her separate identities and fuse them into a single personality.

Although rare, DID is a serious ailment affecting numerous people in the world. More DID cases exist than originally thought because of the increase in child abuse. Only individual therapy and time can heal those personalities shattered into fragments. Dissociative Identity Disorder is a direct result from childhood trauma, and provides a defense mechanism that allows victims to cope with the effects of these prior stresses.

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