Multiple Personality Disorder: causes and symptoms
Dissociative identity disorder (TID), popularly known as "Multiple personality disorder ", Is one of the psychopathologies most frequently represented in fiction.
Multiple Personality: what is it?
From The strange case of Dr. Jekyll and Mr. Hyde until Psychosis or Fight club , going through the character of Gollum of The Lord of the Rings and even the character played by Jim Carrey in the comedy Me, myself and Irene , there are dozens of works that have used the TID as inspiration due to the striking of its symptomatology.
It is by this type of disclosure that the multiple personality is one of the most well-known psychological disorders, although not one of the best understood, not even within the world of Psychology, in which there is an important controversy regarding the same existence of this disorder as such.
The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV) defines the TID as «the presence of two or more identities - sometimes more than ten - that take control of a person's behavior in a recurrent manner, each one having its own memories, relationships and attitudes » In general, the different identities do not remember what is experienced by the rest, for which reason they are not aware of its existence, although this is not always the case. The change between personalities usually occurs as a result of stress.
The primary personality (or the "real") tends to be passive and depressive, while the rest are more dominant and hostile. It is the most passive identities that manifest amnesia to a greater extent and, in case they are aware of the existence of the most dominant personalities, they can be directed by these, which can even manifest themselves in the form of visual or auditory hallucinations, giving orders to the other identities.
Currently, both in the DSM like in the International classification of diseases (ICD-10), DID is categorized within dissociative disorders, that is, those that occur due to failures in the integration of consciousness, perception, movement, memory or identity (in the case of personality). multiple, disintegration would occur in all these aspects) as a direct consequence of psychological trauma.
Causes of Dissociative Identity Disorder
It is this relationship with traumatic experiences that links DID with stress disorder post-traumatic , which is characterized by the presence of anxiety and reexperiencing (through nightmares or flashbacks) after life-threatening events, such as sexual abuse or natural catastrophes. An element of particular interest in this case is the fact that post-traumatic stress disorder can include dissociative symptoms, such as the lack of memory of important aspects of the traumatic event or the inability to experience emotions.
These symptoms are conceived as a protection against feelings of pain and terror that the person is not able to handle properly, which is normal in the initial moments of the process of adaptation to the traumatic experience, but which in the case of post-traumatic stress becomes pathological by becoming chronic and interfering in the life of the person.
Following the same logic, DID would be an extreme version of post-traumatic stress in childhood (Kluft, 1984, Putnam, 1997): early, intense and prolonged traumatic experiences, in particular negligence or abuse by parents, would lead to dissociation, that is, the isolation of memories, beliefs, etc., in alternative identities rudimentary, that would develop over the course of life, progressively giving rise to a greater number of identities, more complex and separated from the rest. There are rarely cases of DID with onset in adulthood. Thus, the TID would not arise from the fragmentation of a nuclear personality, but rather from a failure in the normal development of the personality that would result in the presence of relatively separate mental states that would end up becoming alternative identities.
Evaluation and Treatment
The number of TID diagnoses has increased in recent years; while some authors attribute this to a greater awareness of the disorder by clinicians , others consider that it is due to an overdiagnosis. It has even been proposed that DID is due to the suggestion of the patient due to the clinician's questions and the influence of the media.Likewise, there are also those who believe that there is a lack of training on the manifestations of IDD and an underestimation of its prevalence, leading to many cases of IDD not being detected, partly due to inadequate exploration.
In this regard, it should be kept in mind that, according to Kluft (1991), only 6% of multiple personality cases are detectable in their pure form : a typical case of DID would be characterized by a combination of dissociative symptoms and symptoms of post-traumatic stress with other non-defining symptoms of DID, such as depression, panic attacks, substance abuse or eating disorders. The presence of this last group of symptoms, much more obvious than the other symptoms of DID and very frequent by themselves, would lead clinicians to ignore a deeper exploration that would allow the detection of multiple personality. In addition, it is obvious that people with IDD find it difficult to recognize their disorder by shame, fear of punishment or because of skepticism from others.
The treatment of DID, which usually requires years, is directs fundamentally to the integration or fusion of the identities or, at least, to coordinate them to achieve the best possible functioning of the person . This is carried out progressively. In the first place, the safety of the person is guaranteed, given the tendency of people with DID to self-aggravate and attempt suicide, and the most interfering symptoms are reduced with daily life, such as depression or drug abuse. Subsequently, the confrontation of traumatic memories is worked on, as would be the case in post-traumatic stress disorder, for example through exposure in the imagination.
Finally, identities are integrated, for which it is important that the therapist respect and validate the adaptive role of each one in order to facilitate that the person accepts those parts of herself as their own. For a more detailed description of the TID treatment, see the text Guidelines for treating dissociative disorders in adults, third revision , of the International Society for the Study of Trauma and Dissociation (2011).
- Freyd, J. J. (1996). Betrayal trauma: The logic of forgetting childhood abuse. Cambridge, MA: Harvard University Press.
- International Society for the Study of Trauma and Dissociation (2011). Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision. Journal of Trauma & Dissociation, 12: 2, 115-187
- Kluft, R. P. (1984). Treatment of multiple personality disorders: A study of 33 cases. Psychiatric Clinics of North America, 7, 9-29.
- Kluft, R. P. (1991). Multiple personality disorder. In A. Tasman & S.M. Goldfinger (Eds.), American Psychiatric Press review of psychiatry (Vol. 10, pp. 161-188). Washington, DC: American Psychiatric Press.
- Putnam, F. W. (1997). Dissociation in children and adolescents: A developmental perspective. New York, NW: Guilford Press.