Dissociative Identity Disorder (Did) Term Paper

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Dissociative identity disorder (DID), or as it has previously been known and is still referred to in popular culture, multiple personality disorder (MPD), may be one of the most misunderstood and controversial of all psychiatric diagnoses. DID is characterized by the presence of two or more personality states or identities in a single person (Gentile et al., 2013). These personalities take alternate control of the individual, which can cause the person's behavior to appear erratic and disconnected, given that each identity perceives, related, and thinks about the environment in different ways. DID is also associated with some degree of amnesia between identities, so that a person with DID may be unable to recall engaging in particular behavior and may experience losses of chunks of time, while in an alternate identity state (Gentile et al., 2013).Download full Download Microsoft Word File
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Term Paper on Dissociative Identity Disorder (Did), or Assignment

In order to understand DID, it is critical to understand what psychologists and psychiatrists mean by the term "dissociation." Dissociation refers to the idea that a person is not fully relating to his or her own personality. Dissociation is often described as being spacy, but it is more than daydreaming. Instead, "it is argued that the individual subconsciously cannot tolerate being present emotionally during the trauma but cannot control the situation, and therefore protects him- or herself from experiencing it in the moment via dissociation. Dissociative symptoms are not merely failures of normal neurocognitive functioning, they are also perceived as disruptive, because there is a loss of needed information or as discontinuity of experience" (Gentile et al., 2013). However, dissociation, itself, is not a disorder. On the contrary, most people experience some degree of dissociation in their normal daily lives. Daydreaming or losing track of one's thoughts are two normal examples of dissociation, which can occur in healthy people without having any negative mental health implications. However, the dissociation that exists in a person with a DD, particularly DID is so significant that it impacts and impairs the person's ability to function, to the degree that the person's identity is considered fractured and fragmented.

This fragmentation means that a person with DID actually manifests personality swings that are different enough to suggest the presence of different identities. Furthermore, there can be an apparent lack of cohesion between these identities, in spite of popular references to multiple identities suggesting that the identities work together to conquer different areas of the person's life. Generally, at least one of the identities will be ignorant of the existence of other identities. These personalities can be differentiated in several ways, but may represent different ages, genders, and life roles. Furthermore, the identities can have different affect so that an event that would trigger a mood in a person without DID may trigger an identity shift in a person with DID. In addition to the identities, which may be unknown to the patient, a person with DID will present will additional symptomology. They may have symptoms such as "headaches, conversion, pseudoseizures, and gastrointestinal and genitourinary disturbances" (Gentile et al., 2013). These physical symptoms can co-occur with personality shifts or can occur independent of personality shifts.

While DID gained popularity in modern popular culture, the symptoms associated with the disorder have been discussed as a cluster for over a century. Despite being well established for over 100 years, DID is a relatively recent diagnoses and one that, because it can be impossible to verify through biomedical tests, is questioned by many mental health providers as well as many people outside of the healthcare professions. This was not helped by the explosion in reported DID cases following the famous movie book and movie Sybil, which chronicled the life of a woman with multiple personalities. Following the movie and book, diagnosis rates for MPD soared well beyond what is currently expected by experts in the field, which may have helped create a backlash against the diagnosis. This backlash was probably caused by some misdiagnoses, but also may have been due to a lack of real understanding about the disease. Furthermore, the overlap between popular culture and psychology left many health professionals questioning the genuineness of the disease. As a result, any discussion of DID must begin with the following caveat: "The existence of dissociative disorders is questioned by many in the field of psychiatry, and the diagnosis is not utilized by some clinicians" (Gentile et al., 2013). The reason is it important to understand that the diagnosis is controversial is that any healthcare provider who is presented with a patient that exhibits the symptoms of DID must consider DID as a possible diagnosis, even if the patient has an extensive history of psychiatric care because there is such a high probability of misdiagnosis.

Moreover, it is critical to recognize that the reticence to recognize DID as a disorder appears to be unfounded; in patients with DID, researchers have noted "important differences regarding regional cerebral bloodflow and psychophysiological responses for different types of identity states" which could not be simulated by either high or low fantasy prone controls without DID (Reinders et al., 2012). This suggests, at the very least, that fantasy is not the driving component in patients with DID. It also suggests that there is a biological element to DID. This biological element does not suggest that DID is wholly genetic, though there may be a genetic component, but it does suggest that the pathophysiology of DID impacts brain function in a way that is apparent in brain imaging studies. Documented brain changes may not prove the existence of the symptom cluster associated with DID, but they are enough to substantiate that patients diagnosed with DID have brains that function differently than those of people not diagnosed with DID.

Further complicating the diagnosis of DID is the similarity between the way that DID and borderline personality disorder present, which can make it likely that people with DID would be diagnosed with borderline personality disorder, which is considered far more common, than with DID. In fact, in the early 1990, some researchers concluded that DID and borderline personality disorder were essentially the same, suggesting that DID was merely a subtype of the broader borderline personality disorder diagnosis. This led them to conclude that, because DID was not distinguishable and diagnosable by set standards, it was not a stand-alone diagnosis (Gillig, 2009). However, their conclusions were never the accepted medical standard; DID remained a diagnosis, and more recent research has established medical baselines that appear to differentiate patients with DID from other patients on a biological basis; specifically, the brains of people with DID appear to function differently than the brains of people who do not have DID. Moreover, it does not appear that these differences in function can be faked by people mimicking the behavior patterns that appear in patients diagnosed with DID. What this suggests is that DID is separate and distinct from personality disorders, although there may be some overlap between patients with DID and patients with other disorders.

The reality is that a patient could have both DID and a personality disorder, but that does not mean that DID is merely a subtype of personality disorder. In fact, it is important to understand that while DID may frequently be comorbid with other disorders and may share characteristics with other DD, it presents a greater challenge for patients and therapists. "DID is the most complicated and theoretically challenging dissociative disorder; it embodies the full range of dissociative phenomena" (Gentile et al., 2013). Furthermore, these dissociations are organic to the individual; in other words, they are not brought on by outside substances or symptomatic of other physical or mental problems. However, they are complicated by the fact that they "rarely occur in exclusion of additional psychiatric pathology" (Gentile et al., 2013). Other mental disorders that frequently co-occur with DID include: depressive disorders, somatization disorders, substance abuse, personality disorders, and posttraumatic stress disorders, and the treatment and symptoms for each individual disorder can complicate treatment for the other disorders (Gentile et al., 2013). Unfortunately, comorbidities can contribute to patient instability in patients with DID, making them more treatment-resistant (Lakshmanan et al., 2010). In addition, because one of the goals of treatment for patients with DID is eliminating stressors and triggers, it might be necessary to treat these other comorbidities before attempting to treat DID.

All of the confusion surrounding DDs has led to complexities in the diagnosis and treatment of the disease that have not plagued other diagnoses in the same manner and to the same degree. "Dissociative disorders (DDs) were first recognized as official psychiatric disorders in 1980 with the publication of the Diagnostic and Statistical Manual of Mental Disorders, Third Edition (DSM III) in 1980. Prior to this, the related symptoms were listed under 'hysterical neuroses' in the second edition of the DSM" (Gentile et al., 2013). However, while they may have only recently received official diagnosis, the presence of DDs has been noted since before 1900; they simply have not been well-understood or well-studied. Interestingly, all of the current DDs that… [END OF PREVIEW] . . . READ MORE

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