Class presentation for Nursing Psychosocial class

1. Dissociative Identity Disorder
(Multiple Personality Disorder)
Kernifer Deserve
Rosario de Sala Diaz
Laisha
Jamie Johnson
Adalberto Toledo
Alton St, Rose

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. Everyone Dissociates


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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.

6. Disturbances of Identity


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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”

7. What Are Alters?


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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

8. Impact of Dissociation on Developmental
Processes in Children



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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)

9. 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.

10. 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.

11. 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

12. The Case for DID

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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

13. 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

14. 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

15. DID and Self-Harm
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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.

16. Causes of Abuse

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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.

17. Popular Portrayals of DID

18. 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."

19. 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.

20. 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.

21. The Argument Against the Authenticity of Sybil
and MPD
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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.

22. 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.

23. 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.

24. 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

25. Integration
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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

26. 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.

27. Pam’s Treatment and Results

28. 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.

29. Terry’s Treatment and Results

30. Nora: A Dubious Case Study

31. Further Diagnostic Procedures

32. Cases Where Psychiatric Treatment is Not
Recommended