The LIGHT Center, T-90, College of the Redwoods (476-4290) - April 3, 2000

It is likely that most of us have read a book or watched a movie about a character with "multiple personalities". This term is now out-dated and has been replaced with the label of Dissociative Identity Disorder. This term does not reflect a specific disorder, rather a spectrum of disorders. To fully understand the nature of disorders falling within this spectrum, one must first consider the term Dissociation. Dissociation is the disconnection from one’s full awareness of self, time, and/or external circumstances. Dissociation is a continuum, ranging from normal all the way to disorders that interfere with everyday functioning. For example, all of us have got "caught up" or even "lost" in a book or a movie. That is normal dissociation. It is a state in which we are so engrossed by the story being woven that we lose track of our surroundings. Another example of normal dissociation would be when one drives along the highway and fails to notice any of the surroundings they are passing. In fact, one could drive all the way to work without noticing the turns, lights or scenery along the way.

It is thought that normal dissociation is a defense against childhood trauma. This could be emotional, physical or psychological abuse. It is when the dissociation as a defense mechanism persists into adulthood that it becomes disordered and interferes with the integrative functions of identity, memory or consciousness. Along the Dissociative Disorder Spectrum are:

Dissociative Amnesia or Fugue (APA, 1994)

In Dissociative Amnesia, important life events cannot be recalled. This may be the result of war trauma, accident or rape. While the memory appears lost, the individual can experience depression or distress due to colors, sounds, odors or images that dredge up the submerged memory. It is thought that the amnesia is evident by age 12 if not earlier. Fugue involves not only the memory loss but also travel to a new location, and therefore the assumption of a new identity.

When the disturbance is primarily in identity, and involves parts of the self-assuming separate identities it is considered a Dissociative Identity Disorder. This is what used to be referred to as Multiple Personality Disorder. In order to be diagnosed with this disorder, the following criteria must be met:

• The existence of two or more distinct personalities, each of which has its own pattern of relating and thinking,
• At least two of the personality states take full control of the person’s behavior,
• Inability to recall important personal information that is considered beyond normal forgetting,
• Not explained by alcohol or drug use,
• The clinician treating the case must "meet" and observe the "switch process" between at least two personalities.

Comments? mailto:trish-blair@redwoods.edu

While the symptoms of DID are fairly well defined, the diagnosis is not without its critics. This is partially due to the fact that the diagnostic tools are predominantly interview based. There is also the persistent issue of the therapist "planting" a memory in the patient. Even with these criticisms, the following characteristics are typically seen in people with DID.

• Recurrent Depression
• Anxiety, panic and phobias
• Anger and rage
• Low self-esteem
• Somatic Pain Syndromes
• Self-destructive behavior
• Substance abuse or alcoholism
• Eating Disorders
• Relationship/intimacy problems
• Sexual dysfunction
• Time loss, memory gaps
• Flashbacks
• Sleep disturbances, nightmares
• Alternative states of consciousness

Ninety percent (90%) of all diagnosed cases occur in females with a history of childhood abuse.

As with the treatment of many of the psychiatric disorders, a combination of techniques is used. Most often psychotherapy is combined with medication to relieve the symptoms. Medications such as Prozac and/or Zoloft are often chosen by psychiatrists as the primary intervention.

Calvin Coolidge