Dissociative Identity Disorder

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A diagnosis of dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}} (multiple personality disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}an old name used for dissociative identity disorder in the DSM manual from 1980-1994, and in the ICD manual for some time.) is given when two or more distinct, highly dissociated states present, alternating control, accompanied by amnesia in the usually presenting part; the part with amnesiaMemory loss. {{See also| amnesia}} has historically been referred to as the host alter, but a more accurate and current term is "apparently normal part" or ANPAn alter who often acts as the host, does not hold trauma memories (has amnesia for trauma). Dissociative identity disorder is the only mental disorder where an individual can have two or more ANP. <ref name=HauntedSelf/> A term used for the part that often acts as the host alter in individuals with dissociative identity disorder according to the model of structural dissociation. {{See also| structural dissociation}}. Symptoms of dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}} often overlap, meaning there is (comorbidity), with other disorders such as posttraumatic stress disorder (PTSD) and other dissociative disorders. These comorbidthe presence of more than one psychiatric diagnosis at once disorders are subsumed under the dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}} diagnosis. Researchers have looked at the many symptoms that go beyond amnesia and distinct states presented in the DSM-5. Experts agree, that this disorder is caused by early and severe childhood traumaThe most fundamental effect of trauma is dissociation, so we define trauma as the event(s) that cause dissociation. <ref name=Howell2011/>{{Rp|75}} The original trauma in those with dissociative identity disorder was failure of secure attachment with a primary attachment figure in early childhood. <ref name=Howell2011/>{{Rp|83}}, abuse"interactions in which one person behaves in a violent, demeaning or invasive manner towards another person (e.g. child or partner)" <ref name=VandenBos2007/>, neglect and a lack of attachmentThe communication of emotion between an infant and their primary caregiver(s) is essential to shaping the developing mind. "Emotion serves as a central organizing process within the brain. In this way, an individual's abilities to organize emotions - a product in part, of early attachment relationships directly shapes the ability of the mind to integrate experience and to adapt to future stressors." <ref name=Siegel/>{{Rp|9}} Interruption in the attachment pattern of young children with their caretaker(s) has been shown to be a primary precursor to Dissociative Disorder pathology. (see etiology) <ref name=Medscape/> <ref name=HauntedSelf/>{{Rp|85}} <ref name=Howell2011/>{{Rp|97}} with a child's primary caregiver. Research in this area understandably focuses on clinical and case study, since no ethical human would isolate infants and or children for years in an experience of constant, severe psychological and physical trauma so they could prove the etiology of a disorder.

The term multiple personality disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}an old name used for dissociative identity disorder in the DSM manual from 1980-1994, and in the ICD manual for some time.[edit]

The term multiple personality disorder (MPDPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}) has been used in the ICD psychiatric manual since its last update in the 1990's, but the draft ICD-11 manual has already made the change from multiple personality disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}an old name used for dissociative identity disorder in the DSM manual from 1980-1994, and in the ICD manual for some time. to dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}}. When seeing the label multiple personality disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}an old name used for dissociative identity disorder in the DSM manual from 1980-1994, and in the ICD manual for some time. it is important to know that the condition has never been categorized as a personality disorder; [4] it is a dissociative disorder in the DSM and a dissociative (conversion"The development of symbolic physical symptoms and distortions involving the voluntary muscles or special sense organs; not under voluntary control and not explained by any physical disorder." (Kaplan & Sadock, 2008). Functional Neurological Symptom Disorder is the new name for Conversion Disorder in the DSM-5 manual, and is part of the Somatic Symptom and Other Related Disorders category. Somatization Disorder was removed during the changes, but is represented in this category. <ref name=DSM5changes/>{{Rp|11}}Conversion symptoms are most common in conversion disorder, but also seen in a variety of mental disorders." <ref name=Sadock2008/>{{Rp|23}}"Conversion disorders" is the ICD-10 category includes somatoform dissociation within dissociative disorders of movement and sensation.<ref name=Nijenhuis2001/> {{Rp|9}}{{See also| Somatoform Disorders}}) disorder in the ICD-10.

The parts of the personalityEvery individual has a personality that is composed of many diverse, fragmentary and generally illusory images of [[Personality|self]]. (see multiples) <ref name=Noricks2011/>The DSM-IV uses the term identity in its definition of dissociation. (see identity) <ref name=Dell2009/>{{Rp|127}}[edit]

The personality is made up of many personality states that work together and communicate easily, but a state in dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}} (Howell, 2011, p. 8) is dissociated, distinct and has developed their own sense of selfNormal sense of self is experienced as alterations in consciousness, but the sense of self remains stable and consistent. In individuals with a Dissociative disorder the sense of self alternates and is inconsistent across time and experience. <ref name=Dell2009/>{{Rp|160}} There is no unified sense of self. that is separate from other states. [5] These states are contained within dissociative boundaries, with the degree of dissociation experienced between parts as defining the dissociative disorder (Howell, 2011, p. 8).

There are many terms used interchangeably for states including; alter identitiesAltered states of consciousnessExchangeable terms include parts, dissociative parts, personality states, self-states, states, identities, selves, or ego states. Alters are present only in those with dissociative identity disorder or similar presentations of other specified dissociative disorder, where the parts of the personality are highly dissociated and isolated. No alter, including the host alter, is a complete personality, even though an alter might feel as if they are. <ref name=Howell2011/>{{Rp|55-67}}Alters are psychodynamically interacting parts, each with their own separate centers of subjectivity, identity, autonomy, and sense of personal history. <ref name=Howell2011/>{{Rp|55}}An individual with dissociative identity disorder may have few or many |alters, which include a variety of ages, cross gender, animal or objects, with coconsciousness (see coconsciousness) at varying degrees, and [[communication]] can be limited to one direction. (one way amnesia) <ref name=Dell2009/>{{Rp|301}} (altersAltered states of consciousnessExchangeable terms include parts, dissociative parts, personality states, self-states, states, identities, selves, or ego states. Alters are present only in those with dissociative identity disorder or similar presentations of other specified dissociative disorder, where the parts of the personality are highly dissociated and isolated. No alter, including the host alter, is a complete personality, even though an alter might feel as if they are. <ref name=Howell2011/>{{Rp|55-67}}Alters are psychodynamically interacting parts, each with their own separate centers of subjectivity, identity, autonomy, and sense of personal history. <ref name=Howell2011/>{{Rp|55}}An individual with dissociative identity disorder may have few or many |alters, which include a variety of ages, cross gender, animal or objects, with coconsciousness (see coconsciousness) at varying degrees, and [[communication]] can be limited to one direction. (one way amnesia) <ref name=Dell2009/>{{Rp|301}}), ego states, parts, parts of the personalityEvery individual has a personality that is composed of many diverse, fragmentary and generally illusory images of [[Personality|self]]. (see multiples) <ref name=Noricks2011/>The DSM-IV uses the term identity in its definition of dissociation. (see identity) <ref name=Dell2009/>{{Rp|127}}, identities, personalities, selves, subselves, sides, subpersonalities, internal self states and all of these terms can be used to define aspects of those with dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}}. In addition, the following terms are used often when referring to those with dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}}; alterAltered states of consciousnessExchangeable terms include parts, dissociative parts, personality states, self-states, states, identities, selves, or ego states. Alters are present only in those with dissociative identity disorder or similar presentations of other specified dissociative disorder, where the parts of the personality are highly dissociated and isolated. No alter, including the host alter, is a complete personality, even though an alter might feel as if they are. <ref name=Howell2011/>{{Rp|55-67}}Alters are psychodynamically interacting parts, each with their own separate centers of subjectivity, identity, autonomy, and sense of personal history. <ref name=Howell2011/>{{Rp|55}}An individual with dissociative identity disorder may have few or many |alters, which include a variety of ages, cross gender, animal or objects, with coconsciousness (see coconsciousness) at varying degrees, and [[communication]] can be limited to one direction. (one way amnesia) <ref name=Dell2009/>{{Rp|301}}, altered state, altered identity, distinct state, distinct part, emotional partAn alter (or identity fragment) whose main job is to hold unintegrated trauma memory. A term used in structural dissociation. <ref name=HauntedSelf/>{{Rp|38-39}} (EPAn alter (or identity fragment) whose main job is to hold unintegrated trauma memory. A term used in structural dissociation. <ref name=HauntedSelf/>{{Rp|38-39}}) and apparently normal part (ANPAn alter who often acts as the host, does not hold trauma memories (has amnesia for trauma). Dissociative identity disorder is the only mental disorder where an individual can have two or more ANP. <ref name=HauntedSelf/> A term used for the part that often acts as the host alter in individuals with dissociative identity disorder according to the model of structural dissociation. {{See also| structural dissociation}}). The terms ANPAn alter who often acts as the host, does not hold trauma memories (has amnesia for trauma). Dissociative identity disorder is the only mental disorder where an individual can have two or more ANP. <ref name=HauntedSelf/> A term used for the part that often acts as the host alter in individuals with dissociative identity disorder according to the model of structural dissociation. {{See also| structural dissociation}} and EPAn alter (or identity fragment) whose main job is to hold unintegrated trauma memory. A term used in structural dissociation. <ref name=HauntedSelf/>{{Rp|38-39}} have been gaining popularity with researchers and authors and are the preferred terms by many these days. The ANP is the part that is usually in charge of a persons actions and the EP came out when an individual was a child for abuse"interactions in which one person behaves in a violent, demeaning or invasive manner towards another person (e.g. child or partner)" <ref name=VandenBos2007/>, and now are the parts holding trauma memories. The EPAn alter (or identity fragment) whose main job is to hold unintegrated trauma memory. A term used in structural dissociation. <ref name=HauntedSelf/>{{Rp|38-39}} can act as the host, but once an individual is an adult it is usually the ANPAn alter who often acts as the host, does not hold trauma memories (has amnesia for trauma). Dissociative identity disorder is the only mental disorder where an individual can have two or more ANP. <ref name=HauntedSelf/> A term used for the part that often acts as the host alter in individuals with dissociative identity disorder according to the model of structural dissociation. {{See also| structural dissociation}} that have that role.

DSMPublished by the American Psychiatric Association as the standard classification of mental disorders used by US mental health professionals. It consists of diagnostic classification, the diagnostic criteria sets, and descriptive text. The DSM-II listed multiple personality disorder as a symptom of hysterical neurosis, dissociative type. The DSM-III (1980) moved Multiple Personality Disorder from a symptom to its own disorder. The DSM-IV changed the name to dissociative identity disorder (1994) and the DSM-5 (May 2013) updated the listing to current standards. <ref name=DSMIV/> <ref name=DSM5/> <ref name=Dell2009/>{{Rp|384}}-5 (Diagnostic and Statistical Manual of Mental DisordersPublished by the American Psychiatric Association as the standard classification of mental disorders used by US mental health professionals. It consists of diagnostic classification, the diagnostic criteria sets, and descriptive text. The DSM-II listed multiple personality disorder as a symptom of hysterical neurosis, dissociative type. The DSM-III (1980) moved Multiple Personality Disorder from a symptom to its own disorder. The DSM-IV changed the name to dissociative identity disorder (1994) and the DSM-5 (May 2013) updated the listing to current standards. <ref name=DSMIV/> <ref name=DSM5/> <ref name=Dell2009/>{{Rp|384}})[edit]

Dsm-5.png

The American Psychiatric AssociationThe APA is a scientific and professional organization that represents psychiatrists in the United States. The American Psychiatric Association publishes the DSM. <ref name=DSMIV/> <ref name=DSM5/> Commonly confused with the American Psychological Association. (APA) publishes the Diagnostic and Statistical Manual of Mental DisordersPublished by the American Psychiatric Association as the standard classification of mental disorders used by US mental health professionals. It consists of diagnostic classification, the diagnostic criteria sets, and descriptive text. The DSM-II listed multiple personality disorder as a symptom of hysterical neurosis, dissociative type. The DSM-III (1980) moved Multiple Personality Disorder from a symptom to its own disorder. The DSM-IV changed the name to dissociative identity disorder (1994) and the DSM-5 (May 2013) updated the listing to current standards. <ref name=DSMIV/> <ref name=DSM5/> <ref name=Dell2009/>{{Rp|384}} DSM, with the most current version the DSM-5 which came out in 2013. [6] Historically, even if common symptoms of dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}} were to be overtly evident, this diagnosis was not given until a switch between the ANP (part most often in control) and another state were observed and the switch resulted in amnesia for the ANP.

In 2013 this was changed in the DSM and now the criteria no longer require that a mental health professionalThe various mental health professionals provide services basked on their training and area of expertise. observe time-loss, but the loss of time must be reported by the patient. [6] Those who do not experience amnesiaMemory loss. {{See also| amnesia}} will still be diagnosed with an unspecified dissociative disorder. See also DSM.


Beyond the psychiatric manuals[edit]

Dissociation-And-The-Dissociative-Disorders-DSM-V-and-Beyond.JPG

There is documented evidence that comprises a pattern of dissociative symptoms unique to dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}} including: self-alteration, derealization, depersonalization, flashbacks, trances, identity confusion, awareness of alters, voices, thought withdrawal and insertion, made impulses, feelings and actions, non psychotic auditory and visual hallucinations and of course state dependent amnesiaMemory loss. {{See also| amnesia}}. [7]

Dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}} is often separated into four categories:

  • Overt: There are distinct states where it is obvious to an individual that there is amnesiaMemory loss. {{See also| amnesia}} between the states. Only this category meets the DSM-5 criteria for dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}}.
  • CovertCovert dissociative identity disorder gives Dissociative experiences scale scores that are lower than those with overt dissociative identity disorder. These individuals are skilled at hiding overt symptoms. The overwhelming majority of individuals with dissociative identity disorder have this version. <ref name=Dell2009/>{{Rp|424}}: DES scores are lower in those with covertCovert dissociative identity disorder gives Dissociative experiences scale scores that are lower than those with overt dissociative identity disorder. These individuals are skilled at hiding overt symptoms. The overwhelming majority of individuals with dissociative identity disorder have this version. <ref name=Dell2009/>{{Rp|424}}, as compared to overt dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}}. The ANP's of these individuals deny and ignore their overt symptoms. The overwhelming majority of individuals with symptoms of this disorder have this version and they don't have any clue of their own pathology. (Dell, 2009, p. 424)
  • Subtle: This group of individuals has less frequent and severe dissociation when compared to individuals with either overt or covertCovert dissociative identity disorder gives Dissociative experiences scale scores that are lower than those with overt dissociative identity disorder. These individuals are skilled at hiding overt symptoms. The overwhelming majority of individuals with dissociative identity disorder have this version. <ref name=Dell2009/>{{Rp|424}} versions. (Dell, 2009, p. 424)
  • Polyfragmented: Most individuals with the disorder have less than a dozen altersAltered states of consciousnessExchangeable terms include parts, dissociative parts, personality states, self-states, states, identities, selves, or ego states. Alters are present only in those with dissociative identity disorder or similar presentations of other specified dissociative disorder, where the parts of the personality are highly dissociated and isolated. No alter, including the host alter, is a complete personality, even though an alter might feel as if they are. <ref name=Howell2011/>{{Rp|55-67}}Alters are psychodynamically interacting parts, each with their own separate centers of subjectivity, identity, autonomy, and sense of personal history. <ref name=Howell2011/>{{Rp|55}}An individual with dissociative identity disorder may have few or many |alters, which include a variety of ages, cross gender, animal or objects, with coconsciousness (see coconsciousness) at varying degrees, and [[communication]] can be limited to one direction. (one way amnesia) <ref name=Dell2009/>{{Rp|301}}, (Howell, 2011) however at the far end of the spectrum are those who are said to be polyfragmentedPolyfragmented dissociative identity disorder. Most individuals with dissociative identity disorder have less than a dozen alters, however the far end of the spectrum is those individuals who are polyfragmented, having many alters which are subdivided into subsystems. <ref name=Howell2011/>{{Rp|57}} "In general, the complexity of dissociative symptoms appears to be consistent with the severity of early traumatization." <ref name=Chu2011/> In a polyfragmented system, the alters are broken into subsystems (see systems) as a method of self-preservation and organization of trauma memories. Polyfragmented dissociative identity disorder often develops in children who suffered very early (as an infant) and extreme abuse, either at home or from ritual abuse.<ref name=Miller2012/> and have many ANP and EP. (Howell, 2011, p. 57) [5] The complexity of dissociative symptoms appear to be consistent with the severity of early tramatization. (Chu, 2011)

    Symptoms[edit]

663px-A picture is worth a thousand words.jpg
Severity differs ranging from an individual that acts and feels normal, or even highly effective to those that are severely impaired. The main symptom, dissociation, reduces distress and acts as a coping mechanism, but at the same time causes its own mental and physical impairments. Individuals may experience all the (generalized, systematized, localized, continuous, selective) known five types of amnesiaMemory loss. {{See also| amnesia}}. With this in mind, it's still understood that amnesiaMemory loss. {{See also| amnesia}} between the parts of the personality are what is looked for when defining dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}}, and the events forgotten can be very mundane. (Dell, 2009, p. 776) DissociationThis explanation refers to pathological dissociation only; which is dissociation which is a symptom of or causes a mental health disorder. For normative dissociation see Dissociation page. Dissociation is a compartmentalization of experience, where elements of a trauma are not integrated into a unified sense of the Self. <ref name=Dell2009/>{{Rp|4-810, 127}}The lay persons idea of [[dissociation]], that which exists in the normal mind, is not what is referred to in this document. True or pathological dissociation requires an experiencing Self. <ref name=Dell2009/>{{Rp|233-234}} can result in stored memories, skills, affects and other knowledge compartmentalized into distinct states. [2]:95Traumatic unprocessed memories are often reveled as nightmares, flashbacks, and conversion"The development of symbolic physical symptoms and distortions involving the voluntary muscles or special sense organs; not under voluntary control and not explained by any physical disorder." (Kaplan & Sadock, 2008). Functional Neurological Symptom Disorder is the new name for Conversion Disorder in the DSM-5 manual, and is part of the Somatic Symptom and Other Related Disorders category. Somatization Disorder was removed during the changes, but is represented in this category. <ref name=DSM5changes/>{{Rp|11}}Conversion symptoms are most common in conversion disorder, but also seen in a variety of mental disorders." <ref name=Sadock2008/>{{Rp|23}}"Conversion disorders" is the ICD-10 category includes somatoform dissociation within dissociative disorders of movement and sensation.<ref name=Nijenhuis2001/> {{Rp|9}}{{See also| Somatoform Disorders}} symptoms. [8] The effects of unprocessed trauma memories held by some states, can intrude on ANPAn alter who often acts as the host, does not hold trauma memories (has amnesia for trauma). Dissociative identity disorder is the only mental disorder where an individual can have two or more ANP. <ref name=HauntedSelf/> A term used for the part that often acts as the host alter in individuals with dissociative identity disorder according to the model of structural dissociation. {{See also| structural dissociation}} (part usually in control) in what is called partial dissociationThis is not limited to those with dissociative identity disorder. Parts of the [[personality]] influence each other, whether they are aware of others or not. Any part may intrude on, and influence the experience of the part that is functioning in daily life, without taking full control of functioning. <ref name=Boon2011/>{{Rp|27}} In dissociative identity disorder dissociative symptoms are felt when one alter intrudes into the experience of another. Intrusions occur in perceptions, ideas, wishes, needs, movements and behaviors. <ref name=Boon2011/>{{Rp|18}} In partial dissociation, amnesia is not present. <ref name=Dell2009/>{{Rp|228}} [[Dissociated|Switching]] is not equivalent to amnesia. <ref name=Dell2009/>{{Rp|228-229}}. [1]:5

Etiology[edit]

There are three etiological models accepted by the International Society for the Study of Trauma and Dissociation (ISSTD), and all three report that this disorder is the result of childhood trauma." [2]:99 When a young child suffers early trauma in life, and that trauma is chronic and severe, it effects personality development. [1]:73 Also a combination of trauma and chronic emotional neglect in early childhood leads to attachmentThe communication of emotion between an infant and their primary caregiver(s) is essential to shaping the developing mind. "Emotion serves as a central organizing process within the brain. In this way, an individual's abilities to organize emotions - a product in part, of early attachment relationships directly shapes the ability of the mind to integrate experience and to adapt to future stressors." <ref name=Siegel/>{{Rp|9}} Interruption in the attachment pattern of young children with their caretaker(s) has been shown to be a primary precursor to Dissociative Disorder pathology. (see etiology) <ref name=Medscape/> <ref name=HauntedSelf/>{{Rp|85}} <ref name=Howell2011/>{{Rp|97}} difficulties, with disorganized attachmentThe communication of emotion between an infant and their primary caregiver(s) is essential to shaping the developing mind. "Emotion serves as a central organizing process within the brain. In this way, an individual's abilities to organize emotions - a product in part, of early attachment relationships directly shapes the ability of the mind to integrate experience and to adapt to future stressors." <ref name=Siegel/>{{Rp|9}} Interruption in the attachment pattern of young children with their caretaker(s) has been shown to be a primary precursor to Dissociative Disorder pathology. (see etiology) <ref name=Medscape/> <ref name=HauntedSelf/>{{Rp|85}} <ref name=Howell2011/>{{Rp|97}} being is a major pathway to the formation of dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}}. [9]:14 [10] Dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}} occurs when a child is unable to develop a unified sense of self, instead the person's sense of selfNormal sense of self is experienced as alterations in consciousness, but the sense of self remains stable and consistent. In individuals with a Dissociative disorder the sense of self alternates and is inconsistent across time and experience. <ref name=Dell2009/>{{Rp|160}} There is no unified sense of self. involves multiple identities.[5]:133 The developmental model of dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}} states this is particularly likely to happen "if the traumatic exposure first occurs before the age of 5".[5]:122
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"The age of the individual at the time of the abuse is a critical component due to the developmental processes that, under other circumstances, would normally occur at that time. In addition, the age at the beginning and the ending of the abuse is significant as it encompasses the sequence of developmental stages spanned by the maltreatment and should influence which developmental tasks are most disrupted. Although there is no conclusive data in this area, it appears as if vulnerability to dissociation increases if the abuse"interactions in which one person behaves in a violent, demeaning or invasive manner towards another person (e.g. child or partner)" <ref name=VandenBos2007/> occurs at earlier developmental stages." [11]

Psychological trauma and dissociation are entwined closely. When early trauma is chronic and severe, it can result in dissociation and profoundly affect"a person's present emotional responsiveness, which can be inferred from facial expressions" including both the degree and range of expressive behavior. This can also be shown in tone of voice, hand and body movements. <ref name=Sadock2008/>{{Rp| 6}} personality development, and even change brainThe brain is a approximately a 1300-gram organ containing 100-billion neurons. It is the control center of the central nervous system. The mind and brain are not the same thing. (see mind) The mind emerges out of interactions between the brain and relationships during the earliest years of childhood. Different child-parent attachment relationships form differing physiological responses, patterns for interpersonal relationship and how an individual views the world. <ref name=Siegel2012/>{{Rp|9}} (see attachment) structure. If this trauma is experienced often enough during the earliest years of life, then states can endure, until they eventually evolve becoming so dissociated and distinct they are then referred to as "altered states of consciousness" or alters. These distinct states are unique in their way of being, and both psychobiological and physiological differences exist between them. [5]

Unified sense of selfAn individual with a unified personality. "Singleton" is a term used by some with dissociative identity disorder to refer to a person that does not have alters. (see multiples)[edit]

Developing a unified sense of selfNormal sense of self is experienced as alterations in consciousness, but the sense of self remains stable and consistent. In individuals with a Dissociative disorder the sense of self alternates and is inconsistent across time and experience. <ref name=Dell2009/>{{Rp|160}} There is no unified sense of self. is not a quick process, and an infant is not born with it; this process takes years of experience to obtain. [12] To survive the type of trauma that causes dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}}, a child detaches from both emotional and physical pain which can change memory encoding and storage. Their memory can then become compartmentalized into different parts of the personality and memory retrieval is impaired resulting in the inability to integrate parts into a unified sense of self. [1]:73 People with dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}} do not have a single, unified sense of self and the different identities may find it difficult to accept that each of them is a part of a whole.

Treatment: memory"Memory is not a static thing, but an active set of processes." <ref name=Siegel/>{{Rp|51}} "Our earliest experiences shape not only what we remember, but also how we remember and how we shape the narrative of our lives. Memory can be seen as the way the mind encodes elements of experience into various forms of representation. As a child develops, the mind begins to create a sense of continuity across time, linking past experiences with present perceptions and anticipations of the future." <ref name=Siegel/>{{Rp|11}} reassociation and integrationIntegration (state of unification) occurs in the minds of all individuals and is a process rather than an end product. "If integration is impaired, the result is chaos, rigidity, or both. Chaos and rigidity can then be seen as the red flags of blocked integration and impaired development of the mind." <ref name=Siegel2012/>{{Rp|9}} The natural process of the mind is to link differential parts (distinct modes of information processing) into a functional and unified self. No child has unified personality when born, in fact, they need years of sufficient nurturing for the parts of their personality to integrate. (see multiple) <ref name=Siegel2012/>{{Rp|394}} "Integration is more like making a fruit salad than like making a smoothie: It requires that elements retain their individual uniqueness while simultaneously linking to other components of the system. The key is balance of differentiation and linkage." <ref name=Siegel2012/>{{Rp|199}} Integration is the normal process that occurs in early childhood, but if interrupted by trauma and disorganized attachment, the child may not be able to integrate, resulting in a dissociative disorder. <ref name=Howell2011/>{{Rp|143}} As an adult, when therapy is sought out, an individual who has unresolved trauma and lacks integration, can finally get the help needed to process the trauma memories, which needs to be done prior, and to finally [integrate the alters making up the ersonality into one unified self. <ref name=Noricks2011/>{{Rp|141-144}}[edit]

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Therapy is the primary treatment method and there are no medications to cure or manage it; the best results are obtained when trauma memories are "processed" (reassociated), allowing dissociative boundaries to abate and a unified sense of self to thrive, thereby reducing dissociative symptoms. Even highly experienced therapists have a substantial number of patients try but do not achieve a unified sense of Self. Not all people choose to integrate, but instead work on cooperation between parts of the personalityEvery individual has a personality that is composed of many diverse, fragmentary and generally illusory images of [[Personality|self]]. (see multiples) <ref name=Noricks2011/>The DSM-IV uses the term identity in its definition of dissociation. (see identity) <ref name=Dell2009/>{{Rp|127}}.

Prognosis[edit]

When untreated, there is chronic and recurrent symptoms varying over time including long-lasting effects such as suicidal tendencies, anxiety, and dissociative symptoms. [13]. Some individuals function at different times in their life with mild disturbance, while at different times they are severely impaired. [9]:14 At least two-years of psychotherapy are usually needed (for adults) to allow time for trauma memory"Memory is not a static thing, but an active set of processes." <ref name=Siegel/>{{Rp|51}} "Our earliest experiences shape not only what we remember, but also how we remember and how we shape the narrative of our lives. Memory can be seen as the way the mind encodes elements of experience into various forms of representation. As a child develops, the mind begins to create a sense of continuity across time, linking past experiences with present perceptions and anticipations of the future." <ref name=Siegel/>{{Rp|11}} processing, elimination of dissociative boundaries and for them to obtain a unified sense of self. [13] [14] Estimates of full integration range from 16.7% to 33%, [13]

Epidemiology[edit]

Did-poster-2.jpg

Tools designed to assess dissociative disorders, yield lifetime prevalence rates around 10% in the clinical population. [15] In children, rates among females and males are the same. In adults, more women are known to have dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}} than men. Dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}} is not rare; it is thought to occur in 1% to 3% of the worlds general population. [5]

History[edit]

Dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}} was not included in the DSM-I, but in the DSM-II it was added as a symptom of NeurosisNeurosis is an emotional disorder. Neurotic refers to a person displaying a symptom of emotional distress, which could range from anxiety, panic attacks depression, and lying, to promiscuity. <ref name=Hook2004/>{{Rp|97}} This historical term referred to a very large group of conditions, which were later divided between Mood Disorders, Dissociative Disorders, Anxiety Disorders, Somatization Disorder and Personality Disorder. Neurosis was removed from the DSM completely because it suggested a "cause" common to the categories under that term, and to "reduce confusion" <ref name=Decker2013/>{{Rp|272}} and called "multiple personalities". It was not added as a disorder in itself until the DSM-III, and at that time it was referred to as multiple personality disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}an old name used for dissociative identity disorder in the DSM manual from 1980-1994, and in the ICD manual for some time.. A lot of myths and misinformation surround this disorder, and popular shows such as SybilSybil is a biography describing the life of a woman with dissociative identity disorder, published as a book in 1973 and released as a TV movie in 1976."It is often the first association that people have when they hear the words MPD or DID. Despite the Hollywood blitz associated with this disorder, however, the diagnosis appears to have begun in the last 1800s with Pierre Janet, a French psychiatrist, and William James, a student of philosophy and psychology." <ref name=Haddock2001/>{{Rp|12-13}} "Sybil" included descriptions of the severe abuse and sexual abuse she suffered during her childhood, and the help she received from her psychiatrist, Dr. Wilbur. <ref name=Schreiber1973/>Nearly 40 years later, after the death of "Sybil", a journalist published the heavily marketed book "Sybil Exposed" claiming Sybil did not have DID, but legal action forced the publishers of Sybil Exposed to remove a false statement on the dust jacket and provided additional evidence of false and fabricated statements in Sybil Exposed.<ref name=Suraci2011/> Coons (2013) later studied the original evidence and stated "the story of Sybil is true, not fraudulent or fiction". <ref name=Coons2013/> {{See also| History of DID}}, Three Faces of Eve and United States of Tara have perpetuated myths.

Related project[edit]

For more information see our other project site on dissociative identity disorder.

References[edit]

  1. ^ Chu, James A. (2011). Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders. ISBN 0470768746. Hoboken, N.J.: John Wiley & Sons
  2. ^ a b c d e Dell, P. (2009). Dissociation and the dissociative disorders : DSM-V and beyond. ISBN 0415957850. London: Routledge
  3. ^ a b c d e f g Howell, Elizabeth F. (2011). Understanding and Treating Dissociative Identity Disorder: A Relational Approach Volume 49 of Relational Perspectives Book Series. ISBN 0415994977. New York: Routledge/Taylor & Francis Group, 2011
  4. ^ American Psychiatric Association, (1994). Diagnostic and statistical manual of mental disorders:DSM-IV. ISBN 0890420629.
  5. ^ a b c d e f International Society for the Study of Trauma and Dissociation. Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision. Journal of Trauma & Dissociation, volume 12, issue 2, 28 February 2011, page 115–187. (doi:10.1080/15299732.2011.537247)
  6. ^ a b Diagnostic and Statistical Manual of Mental Disorders-5.
  7. ^ Dell, P.F.. A new model of dissociative identity disorder. Psychiatric Clinic North America, volume 29, issue 1, page 1-26. (doi:10.1016/j.psc.2005.10.013)
  8. ^ Brand, B.; Richard J. Loewenstein, (2010). Dissociative disorders: An overview of assessment, phenomenology, and treatment. Psychiatric Times.
  9. ^ a b Shusta-Hochberg, Shielagh R.. Therapeutic Hazards of Treating Child Alters as Real Children in Dissociative Identity Disorder. Journal of Trauma & Dissociation, volume 5, issue 1, 28 January 2004, page 13–27. (doi:10.1300/J229v05n01_02)
  10. ^ Ross, Colin A.; Ness, Laura. Symptom Patterns in Dissociative Identity Disorder Patients and the General Population. Journal of Trauma & Dissociation, volume 11, issue 4, 7 October 2010, page 458–468. (doi:10.1080/15299732.2010.495939)
  11. ^ Gentile, JP; Dillon, KS; Gillig, PM (2013). Psychotherapy and Pharmacotherapy for Patients with Dissociative Identity Disorder.. Innovations in clinical neuroscience, volume 10, issue 2, 2013 Feb, page 22-29.
  12. ^ Merck Manual Dissociative Identity Disorder.
  13. ^ a b c Brand, B.; Classen CC, McNary SW, Zaveri P. (2009). A review of dissociative disorders treatment studies. J Nerv MentDis., volume 197, issue 9, page 646-54. (doi:10.1097/NMD.0b013e3181b3afaa)
  14. ^ Bethany L. Brand PhD (2012): What We Know and What We Need to Learn About the Treatment of Dissociative Disorders, Journal of Trauma & Dissociation, 13:4, 387-396 To link to this article: http://dx.doi.org/10.1080/15299732.2012.672550
  15. ^ Sar, Vedat. Epidemiology of Dissociative Disorders: An Overview. Epidemiology Research International, volume 2011, 1 January 2011, page 1–8. (doi:10.1155/2011/404538)