Dissociative Identity DisorderMax Denis
April 28, 2000
From the Diagnosis and Statistical Manual of Mental Disorders, dissociative identity disorder (DID) is recognized as the presence of two or more distinct identities or personality states that recurrently take control of the behavior. There is an inability to recall important personal information, the extent of which is too great to be explained by ordinary forgetfulness (1994). It is a kind of amnesia that repressed all the traumatic memories most of the time lived during childhood. The most frequent traumatisms that cause this disorder are the sexual abuse. The alter personalities are created to cope with intolerable abuse. They are characterized as sometimes having different age and gender. Some alters may be right-handed, others left-handed. Some alters may need different prescription glasses, have a specific food allergies, or show different responses to alcohol or medications (cited in the Wolrd of Psychology, Putnam et al.1986). The DIDSome of them could be really violent and inflict self-mutilation.
Problems sometimes occur in the diagnosis of the disorder. There are psychologists who incorrectly diagnosed the patients as depressed, epileptic or schizophrenic. These persons’ therapies are not efficient so their lives continue on as before, unchanged. There are different treatments that have been created to heal the DID. The treatment used by Colin A. Ross relates a therapy which consists in current techniques that are used by many psychotherapists to cope with DID as the cognitive and the psychodynamic therapy.
The therapy instored to treat the DID is divided in four stages. The first step of the theory consists on establishing rules and limits to create a specific relationship between the therapist and the client. The therapist must placed himself in a neutral position, he acts only as a consultant to avoid to become emotionaly involved in the therapy. This kind of therapy should be no longer than three hours a week, therapies that have a length than five hours a week and more are likely to be regressive and to increase dependency on the therapist. The purpose of the fist stage is also to evaluate if the client has another disorder and treat this before beginning the therapy. A client who has another disorder at the same time could be unable to progress in the treatment and succeed in his/her healing process. An example of this disorder could be a dependency to drugs or alcohol, an eating disorder or merely a depression.
The second stage of the treatment is the most difficult one. The middle phase involves establishing interpersonality communication and cooperation, negotiating adaptive solutions to system problems, correcting cognitive errors, processing traumatic memories, and devising nondissociative coping strategies (Colin A. Ross, 1995). The essential of this phase consists of a rational, adult conversation. The patient has to recognize that he/she has more than one personality and what is the cause of having this disorder. It is conducted in a problem-soving mode, involving cognitive and psychodynamic techniques. Cognitive therapies assume that maladaptive behaviour can result from irrational thoughts, beliefs, and ideas, which the therapist tries to change (Wood, Wood, Wood ; Desmarais, 1999). The cognitive therapy emphasises on present behaviors rather than what happened in the past as the psychodynamic therapy does. It is also based on the consciousness as opposed to the analysis of the unconscious and repressed memories.
The psychodynamic therapy is also well explained by Wood, Wood, Wood ; Desmarais, this kind of therapy is a psychoanalysis which goals are to uncover repressed memories and to bring to consciousness the buried, unresolved conflits believed to lie at the root of the person’s problem. These psychodynamic therapies consit of exploring the unconscious, analysing things the patient tries to avoid talking or feel upset about. After having used this psychoanalysis, the healing stage does not occur when the patient recognizes the memories but it occurs as the result of correcting cognitive errors, processing traumatic affect, and developing more adaptive coping skills (Collin A. Ross). There is no scientific evidence that medication affects the symptoms of the disorder; it has not been proved that any medication had a stabilizing effect.
The next stage of the therapy is named the postintegration. This phase involves learning to cope with the loneliness, innability to “switch” when stress becomes too high. Many people realized the lost years and, depending on their position in the life cycle, can find it very painful. The patient at that time needs help and psychoeducation to learn how to have normal relationships, sexuality, and time sense.
The last phase of the treatment still requires attention over the patient. It is a phase in which personality disorder may be persistent. Antidepressants or cognitive-behavioral treatment for an anxiety disorder may also be required at the end of the therapy. At this phase of the therapy, the clinical syndromes as the degree of insomnia and the frequent headaches are usually reduced.
The cognitive and psychodynamic therapies had good results on the progress of Dissociative Identity Disorder treatment. They are the most common therapies used and have the more efficient results. Studies have been done to determine the effectiveness of these therapies. The results of a research study conducted by Russell A. Powel and Andrew J. Howell mentionned that only a minority of patients had become integrated, but most were judge by their therapists and themselves to be moderately or greatly improved. It has been also conclude that patient who are more likely to be reintegrated were the ones with the less severe symptoms.