Dissociative Identity Disorder


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Dissociative Identity Disorder

  1. 1. Dissociative Identity Disorder (Multiple Personality Disorder) Kernifer Deserve Rosario de Sala Diaz Laisha Jamie Johnson Adalberto Toledo Alton St, Rose
  2. 2. DID: Reality or Fantasy? There exists much skepticism about DID since: 1. DID became diagnosed in large numbers after the release of the movies The Three Faces of Eve starring Joanne Woodward and Sybil starring Sally Field. 2. DID is a uniquely North American phenomenon. Very few European, psychiatrists believe in its existence. 3. There is no way to absolutely prove it exists. 4. The symptoms are relatively easy to fake.
  3. 3. Everyone Dissociates      Daydreaming is the mild end of dissociation. Getting lost in memories is another mild form of dissociation. This is known as short, situation-dependent dissociation. People with personality disorders (eg. borderline personality disorder) may experience some degree of dissociation when triggered. Extremely prolonged and frequent dissociative states result in profound disturbances in self, occasionally leading to the formation of alters.
  4. 4. Disturbances of Identity     Existence of alters take control of the individual’s behaviour The alters express a sense of individuality but they aren’t separate and complete individuals DID is identity fragmentation rather than separate identities Transference between one identity and the other is “switching”
  5. 5. What Are Alters?    Atlers are “alternative identity/ies” within the host personality who may or may not know of each other’s existence. Alters may display markedly different characteristics including opposite genders, differing ages and non-human alters such as animals Alters also serve different purposes and exhibit different memories
  6. 6. Impact of Dissociation on Developmental Processes in Children      Interference in: self-agency (authorship of one’s own behaviour) self-coherence (unified sense of self) self-affectivity (ability to freely express appropriate emotion) self-continuity (integrated self)
  7. 7. Effects of Pathological Dissociation Dissociative symptoms including flashbacks, switching, hallucinations and amnesias disrupt the individual’s self-agency and coherence. The individual cannot consolidate altered states into a unified self. The formation of a stable self fails to materialize and DID occurs.
  8. 8. Dissociative Disorders Dissociative Amnesia and Dissociative Fugue • Fugue: Patient wanders away from home and is unable to recall her/his past, generally following a stressful event. • Amnesia: Patient is unable to remember important aspects of her/his life which are associated with trauma. Depersonalization Disorder • Feelings of detachment or estrangement from oneself. • Patient reports feeling as if she/he lives in a dream and is watching her/his life as if it was onscreen or in a dream. Dissociative Identity Disorder (Multiple Personality Disorder) • Patient must exhibit two or more existing personalities (alters) with differing appearances, functions and memories. • DID is often the result of severe childhood sexual abuse.
  9. 9. Three Primary Relationships in DIDs 1. 2. 3. mutually amnesic relationships – personalities have no awareness of each other mutually cognizant pattern – alters aware of each other and have discussions with one another one-way amnesic relationships where some alters are aware of the others but they are unaware of anyone else
  10. 10. The Case for DID       Awareness of DID may account for increased diagnoses, rather than misdiagnoses Manufacturing false memories has never been proven, particularly those related to sexual trauma. There is no evidence to show that DID can be induced in therapy. DID is more likely to occur in people with first-degree relatives who also have DID Various studies have revealed depersonalization episodes in people who have survived life-threatening experiences, such as concentration camps In the 1920s there was a sharp increase in schizophrenia diagnoses and a marked decline in DID diagnoses, suggesting that DID patients were misdiagnosed as schizophrenics. Consolidation of identity is a normal developmental part of childhood, unless this process is disrupted by severe forms of trauma including abuse, or other developmental issues
  11. 11. Misdiagnosis of DID Average misdiagnosis occurs from a period of 5 – 7 years per patient. Sometimes clinicians refute the existence of DID and DID symptoms may closely mimic the symptoms of schizophrenia and other illnesses Schizophrenia Dissociative Identity Disorder
  12. 12. DID Screening Tools Testing methods for DID include:  Dissociative Experience Scale  Dissociation Questionnaire  Questionnaire of Experiences of Dissociation  Informal office interviews that reveal if a patient is at risk of developing DID
  13. 13. DID and Self-Harm     Sometimes a person diagnosed with DID may have an alter that inflicts self-harm or selfinjury. Not all DID people experience SI. Not all SI’s are DIDs. SI is an expression of torment and self-hatred ,sometimes as a result of abuse and sometimes not.
  14. 14. Causes of Abuse     Adults are capable of abhorrent abuse against children, typically cited as the cause of DID. Many cases of such abuse have been documented and proven beyond a doubt. Some adults have been examined by psychiatrists and found to possess characteristics such as: mental illness such as paranoid schizophrenia. personality disorders such as sociopathic personalities. A sociopath or psychopath is not a mentally ill person. cyclical abuse from learned family experiences.
  15. 15. Popular Portrayals of DID
  16. 16. Sybil (Shirley Ardell Mason)  The strange case of Shirley Ardell Mason (Sybil) has been a topic of debate for decades. Dr. Cornelia Wilbur is accused of manufacturing Sybil`s DID in therapy. A colleague of Dr. Wilbur`s alleged Wilbur admitted that to get Sybil published the publisher insisted Wilbur use the expression ``multiple personality`. Although the sexual and physical abuse Sybil suffered at her mother`s hands to some extent is likely true, a historian named Peter J. Swales, who first identified Mason as Sybil, claimed that ``there is evidence that [the worst abuse] could not have happened."
  17. 17. The Three Faces of Eve  The famous case of ``Eve`` (Christine Sizemore) was released as a book and a movie. Septics question Sybil`s veracity since she read this book during treatment.  Unlike Mason, Sizemore claimed she developed ``alters`` as a result of childhood trauma but not child abuse.  Sizemore`s psychiatrist, Dr. Thigpen, claimed that Sizemore had not three but twenty-one alters, a fact Sizemore herself disputed in a BBC television program.
  18. 18. Reported Incidence of DID Worldwide Prior to and After 1976 (particularly in North America)  The release of the movie Sybil led to significant increases in diagnoses of DID in the world population and in particular in the U.S. after 1976, suggesting a co-relation between the two.
  19. 19. The Argument Against the Authenticity of Sybil and MPD       Dr. Herbert Spiegel, a leading American psychiatrist, worked with Sybil for four years and didn’t believe she had DID. Sybil’s treatment sessions reveal “fraudulent construction of a multiple personality”. Sybil’s documented childhood doesn’t match her actual childhood. Iatrogenesis (patient harm caused by treating physician) is suspected to cause DID symptoms in psychiatric patients. Before Sybil’s publication fewer than 200 DID reported cases existed in world history. After the movie’s release thousands of cases were reported.
  20. 20. Multiple Refutes DID Symptoms A woman named Amorpha claiming to have DID, refutes the media and textbook portrayal of people with DID. Her claims are clinically unsubstantiated.
  21. 21. DID and Visual Arts  A number of DID patients engage in drawings and paintings that frequently reflect early incidents of childhood trauma or expressions of fear and rage. Different alters may create radically different styles of work. Art therapy has long been used with child abuse victims, regardless of whether or not they have a diagnosis of DID.
  22. 22. DID and Visual Arts  Kim Noble is a renowned visual artist with DID. Her work has been displayed in galleries worldwide. The most remarkable feature about the work is the very different artistic styles displayed by her alters and the 14 names listed on the gallery walls. Bonny One of the “others”. The sign around her neck reads I am stupid please kick me Dawn
  23. 23. Integration      DID defines a single person with separately functioning parts of the mind Integrated functioning of the mind is the usual goal of therapy Urging alters to create names when they have none is counterproductive The therapist must avoid choosing “favourites” among the alters An increased sense of connectedness is usually beneficial to the DID patient
  24. 24. Pam: A Case Study 1. 2. 3. 4. 5. 6. 7. At the age of 26 while hospitalized Pam entered therapy with a doctor named Ross. Pam manifested several alters Many of Pam’s alters initially emerged through intravenous sodium amytal. Ultimately Pam revealed 335 alters to Ross. Under Ross’s care Pam was able to function as an outpatient. Pam reported her mother’s suicide but an alter named Bob admitted that he had fabricated the story. Ross stopped treating Pam when an aggressive alter threatened to kill Ross.
  25. 25. Pam’s Treatment and Results
  26. 26. Terry: A Case Study 1. 2. 3. 4. 5. Terry was employed full-time, married, with an advanced university degree. Terry functioned well at work but her marriage was rocky Terry remembered nothing of her childhood before age 10. She displayed 5 different Terrys. Terry didn’t want to uncover her childhood memories since she suspected they were traumatic. Terry maintained a distant but relatively nurturing relationship with her parents, her potential childhood abusers. Terry didn’t want full MPD therapy in case she jeopardized her job and unsatisfactory yet co-dependent marriage. 7. Terry’s therapist agreed with her decision and discharged her without attempting intensive MPD counselling. 6.
  27. 27. Terry’s Treatment and Results
  28. 28. Nora: A Dubious Case Study
  29. 29. Further Diagnostic Procedures
  30. 30. Cases Where Psychiatric Treatment is Not Recommended