Symptoms
Presence of two or more distinct identities or personality states: Each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.
Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting. These memory gaps can include:
Lapses in memory about past events.
Finding oneself in unfamiliar places with no memory of how one got there.
Discovering items among one's possessions that one does not recognize.
Significant distress or impairment in social, occupational, or other important areas of functioning.
Other common symptoms: Depression, anxiety, suicidal ideation, self-harm, substance abuse, eating disorders, panic attacks, phobias, psychotic-like symptoms, and sleep disorders.
Depersonalization: Feeling detached from one's body or mental processes.
Derealization: Feeling that the external world is unreal or distorted.
Causes
DID is overwhelmingly linked to severe and prolonged trauma experienced during early childhood. This trauma often involves:
Physical abuse: Repeated and severe physical harm.
Sexual abuse: Sexual exploitation and violation.
Emotional abuse: Persistent belittling, neglect, and psychological manipulation.
Neglect: Failure to provide basic needs such as food, shelter, and safety. DID is thought to be a coping mechanism developed by the child to dissociate from the overwhelming pain and terror of the trauma. By creating different identities, the child can psychologically escape the abuse and protect their core self. Genetics and other environmental factors may also play a role, but trauma is the primary cause.
Medicine Used
There is no specific medication to "cure" DID. However, medication can be used to manage co-occurring symptoms and mental health conditions often associated with DID, such as:
Antidepressants: To treat depression, anxiety, and related mood disorders (e.g., SSRIs like sertraline, paroxetine, fluoxetine; SNRIs like venlafaxine, duloxetine).
Anti-anxiety medications: To manage anxiety, panic attacks, and phobias (e.g., benzodiazepines like lorazepam, alprazolam, although these are typically prescribed with caution due to potential for dependence; buspirone).
Mood stabilizers: To help regulate mood swings and impulsivity (e.g., lamotrigine, valproic acid).
Antipsychotics: To manage psychotic-like symptoms or severe anxiety (e.g., risperidone, quetiapine, aripiprazole).
Prazosin: to help with trauma related night terrors. Medication is generally used in conjunction with psychotherapy.
Is Communicable
No, Dissociative Identity Disorder is not a communicable disease. It is a mental disorder caused by trauma and is not contagious.
Precautions
Since DID is not communicable, standard precautions against infectious diseases are not relevant. Precautions relate to managing the disorder itself and its associated risks:
For individuals with DID:
Seek professional treatment: Therapy is crucial.
Create a safety plan: If experiencing suicidal thoughts or self-harm urges.
Avoid triggers: Identify and try to minimize exposure to situations or stimuli that trigger dissociation or traumatic memories.
Develop coping skills: Learn techniques to manage distress, anxiety, and dissociation.
Practice self-care: Engage in activities that promote well-being.
Consider a support system: Connect with trusted friends, family members, or support groups.
For those interacting with individuals with DID:
Be patient and understanding: Avoid judgment or disbelief.
Respect their identities: Acknowledge and validate their different personality states.
Communicate clearly and calmly: Avoid triggering language or behavior.
Maintain boundaries: Protect yourself from potentially harmful behaviors.
Encourage professional help: Support their efforts to seek and maintain treatment.
How long does an outbreak last?
DID is not an outbreak illness. It is a chronic mental health condition. Symptoms can fluctuate in intensity and frequency over time, but it does not have a defined "outbreak" period. Without treatment, the symptoms can persist for many years. With effective therapy, individuals can learn to manage their symptoms and improve their functioning.
How is it diagnosed?
DID is diagnosed by a qualified mental health professional (psychiatrist or psychologist) through a comprehensive clinical interview and assessment. The diagnostic process typically involves:
Clinical Interview: Gathering detailed information about the individual's history, symptoms, and functioning.
Mental Status Examination: Assessing the individual's current mental state, including appearance, behavior, mood, thought processes, and cognitive functioning.
Dissociative Experiences Scale (DES): A self-report questionnaire that measures the frequency and severity of dissociative experiences.
Structured Clinical Interview for DSM-5 Dissociative Disorders (SCID-D): A semi-structured interview designed to assess the diagnostic criteria for DID and other dissociative disorders.
Ruling out other conditions: Ensuring that the symptoms are not better explained by another medical or mental disorder, substance use, or cultural factors.
Observation of identity switching: The clinician may observe the individual switching between different personality states during the assessment.
Review of records: Speaking with family members or reviewing previous treatment records (with the individual's consent) to obtain additional information. The diagnostic criteria for DID, as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), must be met for a diagnosis to be made.
Timeline of Symptoms
The onset of DID typically occurs in early childhood, usually before the age of 9. However, the disorder may not be diagnosed until adulthood, as symptoms can be subtle or misattributed to other conditions.
Early Childhood: The individual experiences severe trauma, leading to the development of dissociative defenses and the creation of different identities.
Childhood/Adolescence: Symptoms may include memory gaps, behavioral changes, difficulty with relationships, and increased anxiety or depression.
Adulthood: The disorder becomes more apparent, with clear switches between identities, significant memory loss, and functional impairment. Co-occurring mental health conditions, such as depression, anxiety, and substance abuse, are common.
Throughout Life: Symptoms can fluctuate in intensity and frequency, depending on stress levels, life events, and the presence or absence of treatment. With effective therapy, individuals can learn to manage their symptoms and improve their quality of life. It's important to note that the timeline and presentation of symptoms can vary significantly from person to person.
Important Considerations
Differential Diagnosis: DID can be misdiagnosed as other mental disorders, such as borderline personality disorder, schizophrenia, or bipolar disorder. A thorough assessment is crucial to ensure an accurate diagnosis.
Trauma-Informed Care: Treatment for DID should be trauma-focused, meaning that it addresses the underlying trauma that contributed to the development of the disorder.
Therapeutic Relationship: A strong and trusting therapeutic relationship is essential for successful treatment. The therapist must be able to provide a safe and supportive environment for the individual to explore their trauma and work towards integration.
Integration: While integration of identities is a common goal of treatment, it is not always possible or desired by the individual. In some cases, the focus may be on improving communication and cooperation between identities.
Long-Term Treatment: Treatment for DID is often long-term and requires ongoing support.
Stigma: Individuals with DID may face stigma and discrimination, which can further complicate their recovery. Education and awareness are important to reduce stigma and promote understanding.
Safety: Assessment for suicidality and self-harm is important.
Legal Issues: DID can impact legal proceedings, especially related to competency.