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Dissociative Identity Disorder
(formerly known as Multiple Personality Disorder)
See Also:
DID:
Introduction
DID:
Overview
DID:
Symptoms
DID: Causes
DID:
Diagnosis
DID:
Treatment
Dissociative Identity
Disorder Treatment
The
main goal of the treatment for patients with dissociative
identity disorder is to help the individual achieve a
better integrated functioning and increase the degree of
communication and coordination between the alternate
identities. Although most clinicians target the fusion of
all the alternate identities as the most desirable and
stable treatment outcome, some patients only achieve an
optimally integrated and coordinated functioning among
the alternate identities that allows them to function in
good conditions. Unfortunately, these patients are more
vulnerable to decompensate in florid DID and/or
posttraumatic stress disorder when encounter stressful
events than those that gained a stable fusion.
Studies conducted on the
efficiency of treatment revealed that patients with DID
can have a very successful treatment outcome, especially
when the treatment focuses "on the direct work
with alternate identities and trauma material."
The clinician's requirements when treating patients with
DID are: (1) to focus on the patient as a spectrum of
alternate identities which "together make up the
identity or personality of the human being with DID"
and not as the "host" or a collection of
separate people sharing the same body, and (2) to foster
the idea that all alters represent adaptive attempts to
cope or master problems that were faced in the past.
A poor prognostic indicator
is associated with the presence of other mental or
psychotic disorders, substance abuse, eating disorders,
or significant antisocial personality features. (4)
Individuals affected by DID
can be classified in three distinct categories:
1. Individuals with a clinical picture
dominated by dissociative symptoms and posttraumatic
symptoms, who generally function well and can completely
recover with treatment.
2. Individuals
with a clinical picture dominated by dissociative
symptoms combined with other disorder symptoms (mood
disorders, eating disorders, substance abuse disorders,
or personality disorders), who can benefit from treatment
with a slow recovery.
3. Individuals
with a clinical picture dominated by dissociative
symptoms combined with coexistent mental disorders, who
can benefit from long-term type of treatments in
controlling and managing the symptoms, rather than
recovering. (8)
The
main form of treatment for patients with DID is
psychotherapy.
Individual psychotherapy
According to the Guidelines
for treating Dissociative Identity Disorder in adults,
one of the most effective forms of individual
psychotherapy for patients with DID is the phase or stage
orientated approach. The phase orientated approach
focuses on three phases: (1) safety, stabilization, and
symptom reduction, (2) working directly and in depth with
traumatic memories, and (3) identity integration and
rehabilitation. However, this approach requires a range
of psychotherapeutic interventions such as cognitive
cognitive, behavioral therapy, hypnotherapy, and
psychodynamically orientated psychotherapy.
The first phase of the
treatment focuses on (1) establishing a therapeutic
alliance, (2) addressing the self-destructive behaviors
that can jeopardize the physical and psychological safety
of the patient through so called "safety
contracts" or "safety agreements", (3)
manage and control the symptoms, and (4) educate the
patient about the nature of the disorder. Patients with
DID have a rich history of suicide attempts and
self-destructive behaviors and when present for
treatment, they exhibit a wide range of behaviors that
can be dangerous to themselves and others. Such behaviors
include: alcohol and/or substance abuse, enmeshment in
violent or exploitative relationships, eating disorder
symptoms, violent or aggressive behavior toward others,
lack of food, clothing or shelter, fugues or wandering in
dangerous neighborhoods or environments, driving
recklessly, engaging in unsafe sexual practices, and/or
failure to attend medical problems. The treatment success
depends on how efficient the safety problems are
addressed and resolved.
Symptoms management is a
complex task that requires several interventions, such
as: psychoeducation concerning the disorder, techniques
to improve internal communication and co- consciousness
among alternate identities, and strategies for them to
have safe ways of communicating as well as containing
their symptoms. One of the essential components when
learning about the nature of the disorder is addressing
the issue of alternate identities. The patient learns how
to understand, accept, and access these alternate
identities.
The
second phase of the treatment focuses on addressing the
patient's memories of traumatic experiences by
remembering, tolerating, and integrating them in a
unified picture. During this phase, the patient gains a
sense of control over past and present experience and
their reactions to them, and built a better understanding
of their personal history and sense of self. As a result
of the process, alternative identities may start to
experience themselves as less separate and distinct and
can start fusing. The internal coordination, integration,
and fusion continues during the last phase of the
treatment when the patient achieves a more solid and
stable sense of who they are, how to related with other
and to the outside world. During this phase, the
patient's focus shifts from past trauma to how to deal
efficiency with current problems.
Group therapy
Group
therapy is not a viable primary treatment, rather adjunct
to the individual psychotherapy, and patients with DID
seem to benefit only from "certain types of
time-limited groups for selected patients with DID or
complex posttraumatic stress disorder." Task
orientated, educational, and skill building groups can
help educated the patients about trauma and dissociation,
assist them in developing specific strategies and skills,
and reinforce its members that are not alone in their
struggle with the disorder. (9)
Family (or couple)
therapy
Family
therapy addresses pathological family and marital
processes common in families with a member affected by
DID. One of the goals is to educate the family about the
disorder and provide support and strategies to cope more
effectively with the symptoms and manifestations of the
disorder. In some cases, sex therapy can be an important
part of the couple therapy, due to the fact that patients
with DID may become intensively phobic of intimate
contact for periods of time and create marital discomfort
or problems.
Pharmacotherapy
Medication
is not a primary treatment for patients with DID and is
usually prescribed to control and manage specific
symptoms of co-morbid disorders such as posttraumatic
stress disorder and affective disorders. Medication can
cause different responses among alternative identities
(due to their different levels of neuropsychological
activation) and is more effective if the targeted symptom
is present in the hole spectrum of identities rather than
one or few.
Some
of the groups of drugs prescribed in patients with DID
include:
1. Antidepressant
medication (selective serotonin re-uptake inhibitor -
SSRI, monoamine oxidase inhibitors - MAOIs, and the
tricyclic antidepressants - TCAs) is usually prescribed
to treat depressive and/or posttraumatic stress disorder
symptoms.
2. Anxiolytics are
used on a short-term basis to treat anxiety.
3. Atypical neuroleptic or
antipsychotic medication is effectively used to
treat overactivation, thought disorganization, intrusive
posttraumatic stress disorder symptoms (chronic anxiety,
insomnia, irritability).
The
treatment can be carried in outpatient or inpatient
settings and the length can vary. Treatment in an
inpatient setting is usually required when the patient is
at higher risk to harm themselves or others and the
posttraumatic or dissociative symptoms are overwhelming
or out of control. However, hospitalization is usually
brief and only for the purpose of stabilization.
There is little information
regarding those individual with dissociative identity
disorder that are not diagnosed and treated. It is
believed that such individuals get involved in abusive
relationships and/or violent subcultures and die by
suicide or as a result of a risk-taking lifestyle.
See Also:
DID:
Introduction
DID:
Overview
DID:
Symptoms
DID: Causes
DID:
Diagnosis
DID:
Treatment
Article by Alina Morrow,
MS Psychology
OmniMedicalSearch.com
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