This presentation is about Dissociative Identity Disorder in relation to the television series Bates Motel.

1. Bates Motel
&
Dissociative Identity Disorder
By: Samantha Stiles

2. Soap Note
Date: 3/5/14
Time: 7:20 PM
Name: Norman Bates
Significant Events: Two days ago Norman Bates murdered his father.
Subjective (S): Patient states he has trouble sleeping and has frequent nightmares. Appetite is normal, concentration/energy have decreased
while anxiety has increased. Patient complains of migraine like headaches. His only request was to have his mother present at all times.
Objective (O): Patients vital signs: Temperature: 98.1, Pulse: 73,
Respiration: 18, Blood Pressure: 140/60. Physical exam was normal, but labs showed a minor electrolyte imbalance. MRI results were negative
as well.
Mental Status Exam: Patient smells of AXE, grooming is clean and clothing is neat. Patient is behaving in a calm manner, not much
movement, and sits with an upright posture. Patient’s speech is slow, clear, and medium toned, while answers are short and delayed.
Patient quotes, “I feel fine”. The patients affect is not congruent with his answers. Patients thought process is tight. Whenever asked
questions, his answers are thought about longer than normal. Patient is experiencing nightmares, extended periods of dissociation, and
amnesia. Patient has a limited amount of insight and has poor decision making skills
Patient Profile: Caucasian 17 year old male. Reports he is single and attends high school.
Diagnosis: Dissociative Identity Disorder
Prognosis: Poor. Patient is resistant to treatment because of denial.

3. Axis 1: Dissociative Identity Disorder
Axis 2: Not Applicable
Axis 3: Migraines
1. Dissociative Identity Disorder
A. Start Prozac for Depression and Buspirone for Anxiety
B. Schedule outpatient appointment with therapist and
psychiatrist.
C. Family Counseling
Plan:
Frances Gray
Samantha Stiles
(300.14)

4. What is dissociative identity disorder?
“A dramatic dissociative disorder in which a patient manifests two or more distinct identities that
alternate in some way in taking control of behavior. An inability to recall important personal
information that cannot be explained by ordinary forgetting. Each identity may appear to have a
different personal history, self-image, and name, although there are some identities that are only
partially distinct and independent from other identities”. (p. 241)
Host Identity: “The one identity that is most frequently encountered and carries the persons real
name.” (p. 241)
Alter Identities: “May differ in striking ways involving gender, age, handedness, handwriting, sexual
orientation, prescription for eyeglasses, predominant affect, foreign languages spoken, and general
knowledge”. (p. 241)

5. Criteria
A. Presence of two or more distinct identities, each with its own relatively enduring pattern of
perceiving, relating to, and thinking about the environment and the self.
B. At least two of the identities recurrently take control of the person’s behavior.
C. Inability to recall important personal information that is too extensive to be explained by
ordinary forgetfulness.

6. History of dissociative identity disorder
Who: “Eberhardt Gmelin is sometimes credited as being the first to report a case of “multiple
personality”.
When: Beginning in the 18th century, during the French Revolution.
“Until relatively recently DID was extremely rare-or at least rarely diagnosed- in clinical practice”.
(pg. 243)

7. Post-traumatic theory
“According to this view, DID starts from the child’s attempt to cope with an overwhelming sense
of hopelessness and powerlessness in the face of repeated traumatic abuse. Lacking other
resources or routes of escape, the child may dissociate and escape into a fantasy, becoming
someone else”. (pg. 246)
Leading Cause: Child abuse (physical, sexual, emotional)

8. Norman Bates
http://www.youtube.com/watch?v=9w5RiWnoRT4

9. Norman Bates
Casual: He is emotionally abused by his mother and witnesses his mom being abused.
Precipitating: Once the abuse occurs, Norman self-hypnosis himself and goes into a blackout.
The blackout is usually silent and lasts a few minutes even after his dissociation.
Maintaining: Norman’s life is maintained because the disorder is sheltered by his mom which
enforces his denial of the disorder.
Contributory: The contributing factor of this disorder is the abuse towards him and his mom.

10. Treatment Options
For
Dissociative Identity
Disorder

11. Psychotherapy
Psychotherapy is the treatment of
choice for individuals suffering from any
type of dissociative disorder.
Approaches vary widely, but generally
take an individual modality (as opposed
to family, group or couples therapy) and
emphasize the integration of the various
personality states into one, cohesive
whole personality.

12. Group Therapy
Group Therapy should be
used to teach client’s new
skills, such as, containment
imagery, progressive muscle
relaxation, and effective
communication. Group
Therapy SHOULD NOT be
used to discuss trauma
because it can be triggering
for the individual and the
individual’s parts.

13. Dialectical Behavioral Therapy
(DBT)

14. Cognitive Behavioral Therapy
(CBT)

15. Self-Help
Reading Materials Online: http://www.soulselfhelp.on.ca/
Journaling: Levels One through Four
Artwork
Healthy Eating Patterns
Healthy Exercise Routine
Self-Care
Sleep Hygiene
Personal Hygiene
Relaxation Techniques

16. Medications
The use of medication, except
for the treatment of acute,
specific concurrent Axis I
disorders, is not
recommended. Maintenance
and effective use of
prescriptions given the
multiple personality states
is difficult to attain. If
medication is prescribed, it
should be carefully monitored.

17. Prognosis
Research indicates that people with dissociative
identity disorder have their best opportunity for
living a well-adjusted life if they receive
comprehensive treatment for their multiple
symptoms. However, differences in how practitioners
diagnose and treat this illness make it difficult to
quantify outcomes.

18. Strengths and Weaknesses of the
Movie’s Portrayal
Strengths Weaknesses
Memory loss Clear cause and effect of the disorder
Pseudo seizures Inaccurate display of the disorder
Headaches before brief episodes of amnesia. Derealization
Mood Shifts Depersonalization
Relationship Instability Identity Alteration
Most importantly, the television series increases the stigma towards
people who suffer from Dissociative Identity Disorder.

19. Works Cited
A History of Dissociative Identity Disorder. History of Dissociative Identity Disorder. Retrieved March 12,
2014, from http://www.fortea.us/English/psiquiatria/history
Bates Motel. YouTube. Retrieved March 12, 2014 from http://www.youtube.com/
Butcher, J. N., Mineka, S., & Hooley, J.M. (2008). Abnormal Psychology: Core Concepts. Boston, MA:
Pearson Allyn and Bacon.
Cuse, C. (Director). (2013). Bates Motel [Motion Picture]. Canada: A&E Television
Diagnostic and Statistical Manual of Mental Disorders: DSM-5. (5th ed.). (2013). Washington, D.C.:
American Psychiatric Association.