Dissociative Identity Disorder

The dissociative identity disorder, formerly called multiple personality disorder, is a form of dissociative disorder characterized by ? 2 personality states (also called “other people” self-states or identities called). The disorder involves the inability to remember everyday events, important personal information and / or traumatic or stressful events, all of which would go normally lost with ordinary forgetfulness. The cause is almost always an overwhelming childhood trauma. The diagnosis is made by history, sometimes under hypnosis or medically-assisted calls. Treatment consists of long-term psychotherapy, sometimes with a pharmacotherapy for comorbid existing depression and / or anxiety.

As evident, the different identities differ. They tend to be more open when people are under extreme stress. What an identity knows, maybe do another or not, that is, that there may be amnesia for events with an identity that have experienced other identities. Some identities seem to know each other and interact in a sophisticated internal system, some Identiäten interact more strongly than others.

The dissociative identity disorder, formerly called multiple personality disorder, is a form of dissociative disorder characterized by ? 2 personality states (also called “other people” self-states or identities called). The disorder involves the inability to remember everyday events, important personal information and / or traumatic or stressful events, all of which would go normally lost with ordinary forgetfulness. The cause is almost always an overwhelming childhood trauma. The diagnosis is made by history, sometimes under hypnosis or medically-assisted calls. Treatment consists of long-term psychotherapy, sometimes with a pharmacotherapy for comorbid existing depression and / or anxiety. As evident, the different identities differ. They tend to be more open when people are under extreme stress. What an identity knows, maybe do another or not, that is, that there may be amnesia for events with an identity that have experienced other identities. Some identities seem to know each other and interact in a sophisticated internal system, some Identiäten interact more strongly than others. In a small American community study, the 12-month prevalence of dissociative identity disorder 1.5%, with men and women were almost equally affected. The disorder may begin from early childhood to late life at any age. The dissociative identity disorder has a possessive (possession) and non-possessive (nonpossession) form. In the possession of form, the identities manifest usually as if they were an outside observer, usually a supernatural being or spirit (but sometimes another person) that / who has taken control of the person and the person to brings you to speak and act in a completely different way. In such cases, the different identities are very open (easily noticed by others). In many cultures, like possession disorders are a normal part of the cultural or spiritual practice and are not considered as dissociative identity disorder. The ownership form that occurs in dissociative identity disorder, but differs in that the alternative identity is undesirable and involuntarily occurs, it leads to a substantial impact and impairment and manifests itself in times and places where it violates cultural and / or religious norms. The non-holding form (nonpossession form) seems to be less obvious. People can sense a sudden change in their self-esteem, maybe they feel more likely to be observers of their own language, their emotions and actions rather than acting. Many also have a recurring dissociative amnesia. Etiology Dissociative identity disorder occurs usually in people who have experienced the overwhelming stress in childhood. Children are not born with a sense of a closed identity; This develops from many sources and experiences. In overwhelming experiences in childhood many personality traits remain, which would have to be merged, there are isolated. Many patients with dissociative identity disorder report chronic and severe physical, sexual or emotional abuse and neglect during their childhood (in the US, Canada and Europe about 90% of patients). Some patients were not ill-treated, but have suffered a serious loss in early (like the death of a parent) or a serious illness or other experienced overwhelming stressful situations. Unlike most children who acquire a cohesive, complex assessment of themselves and of others, hard abused children can go through phases in which different perceptions, memories and feelings are kept of their life experiences apart. Over time, such children can develop an increasing ability to escape the abuse by “go away” or retreat into himself. Each development phase or any traumatic experience can bring a different identity. In standardized tests persons with this disorder a high susceptibility to hypnosis and dissociation (ability to own memories, perceptions or identity to decouple from the consciousness) symptoms and signs Several symptoms are characteristic of a dissociative identity disorder: Multiple Identities in the possessive form, are the multiple identities of family members and staff readily apparent. Patients speak and act in an obviously different manner, as if another person or entity has taken them. The new identity can be another person (often someone who has died, perhaps in a dramatic way) or a supernatural spirit (often a demon or God) who asks for previous acts of punishment. In the non-owning form, the different identities for the observer are often not so obvious. Instead, patients have the experience of a feeling of depersonalization; z. As they feel unreal, detached from himself and separated from one’s own physical and mental processes. Patients say that they appear as an observer of her own life, as if they would see themselves in a movie. You may think that her body feels different (eg. As like that of a small child or a person of the opposite sex) and not one of them. You suddenly have thoughts, impulses and emotions that do not seem to belong to them and which manifest themselves as more confusing currents of thought or as votes. Some symptoms can be perceived by observers. For example, the attitudes, opinions and preferences of the patient (eg. As in terms of food, clothing, or interests) may change suddenly and then change again. Memory loss patients typically have a dissociative amnesia. It typically manifests as gaps in the memory of past personal events (eg. As periods during childhood or adolescence, death of a relative) memory lapses (z. B. what happened today, well-learned skills, such. As how used a computer) discovery of evidence for things that they have done, but did not recall time can be lost. Patients can discover things in their bag or writing samples, which they can not explain or recognize. You may also be reflected in different places where they remember having been there last, and they have no idea why or how they got there. In contrast to patients with post-traumatic stress disorder, dissociative identity disorder patients forget everyday events as well as stressful or traumatic events. Patients differ in their perception of amnesia. Some try to hide it. The amnesia can be noticed by others, if patients do not remember things they have said and done or important personal information such as their own Namen.Weitere symptoms In addition to hearing voices, patients with dissociative identity disorder and visual, tactile – have smell, and taste hallucinations. This can easily come about the misdiagnosis of a psychotic disorder. These hallucinatory symptoms differ from the typical hallucinations in psychotic disorders such as schizophrenia. Patients with dissociative identity disorder perceive these symptoms as if they were coming from someone else (eg. B. as if someone wanted different with their eyes crying). Depression, anxiety, substance abuse, self-injury, self-mutilation, non-epileptic seizures and suicidal behavior are common, as well as sexual dysfunction. The change of identities and amnestic barrier between them often lead to a chaotic life. In general, patients try their symptoms and the impact they have on others to minimize. Diagnosis Clinical criteria detailed discussions, sometimes under hypnosis or facilitated by drugs, the diagnosis of dissociative identity disorder is clinical based on the criteria in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5): Patients have (? 2 personality states or identities disturbance of identity) with significant discontinuity in their self-esteem and awareness action patients have gaps in her memory for daily events, important personal information and traumatic Events- information that would normally go not lost with ordinary forgetfulness. Symptoms cause significant distress or impair significantly the social or occupational functioning. Also, the symptoms can not be better for another medical condition (eg, complex partial seizures, bipolar disorder, post-traumatic stress disorder, another dissociative disorder.), The effects of alcohol poisoning, largely accepted cultural or religious practices or – for children – for fantasy games are (for example with an imaginary friend). The diagnosis requires both a Verstsändnis of and specific questions about dissociative phenomena. Sometimes extensive interviews, hypnosis or drug-assisted (barbiturates or benzodiazepines) are used calls, and the patient may be asked between sessions to keep a diary. All these measures promote an exchange between the identities during the assessment. The doctor can with the time trying to decipher the different identities and their relationships with each other. Specially developed structured interviews and questionnaires can be very helpful, particularly for doctors who have less experience with this disorder. The doctor may also try to make direct contact with the other identities by asking to be allowed to talk to the identity that was involved in actions to which the patient can not remember or that appear to be committed by someone else , Simulation (the intentional faking of physical or psychological symptoms, motivated by external stimuli) should be taken into consideration when benefits could be a motive (eg. As to evade accountability for actions or responsibilities to it). However malingerers tend known symptoms of the disease play up (z. B. dissociative amnesia) and to belittle others. They tend to create also stereotypical changing identities. In contrast to the patients who are really sick, malingerers usually seem to enjoy the idea of ??having the disease. In contrast, patients often try with dissociative identity disorder to hide this. On suspicion of faking an illness checking of information from different sources can be cover inconsistencies that exclude the diagnosis. The forecast deterioration in dissociative identity disorder is very different. You may be minimal at very functioning patients; in these patients Relations (z. B. with their children, spouses or friends) may be more than the occupational functioning compromised. With treatment, the relational, social and occupational functioning may improve, but some patients respond very slowly to treatment and may require a long-term supportive care. The symptoms come and go spontaneously, but dissociative identity disorder itself does not disappear spontaneously. Patients can be according to their symptoms into groups is share: Symptoms are mainly dissociative and post-traumatic nature, such patients i.. Gen. along well and recover completely during treatment. The dissociative symptoms are combined with significant symptoms of other disorders such as personality disorders, mood disorders, eating disorders and addictions. These patients show a slower recovery, and treatment may be less successful or take longer and be more affected by crises. Patients not only have severe symptoms of comorbid mental disorders, but can also remain emotionally attached to the person who has abused. to treat these patients can be challenging, and often longer treatments are needed, the less aim to achieve integration, rather than to control the symptoms. Treatment Supportive measures, including if necessary. Drug treatment of associated symptoms If possible aims of psychotherapy on long-term integration of identities, the most desirable outcome of the treatment of dissociative identity disorder is the integration of individual identities. Drugs are widely used to support the symptomatic treatment of depression, anxiety, impulsivity and substance abuse, but they do not relieve the actual dissociation; the treatment for obtaining the integration of identities focuses on psychotherapy. In patients who do not seek this integration or can, the treatment aims to facilitate cooperation and collaboration between the different identities and reduce the symptoms. The top priority in psychotherapy have to stabilize the patient and the ensuring of security against the assessment of traumatic experiences and the exploration of problematic identities and reasons for the dissociation. Some patients benefit patient treatment with continuous support and supervision in dealing with the painful memories. Hypnosis can help to find access to the identities, to facilitate communication between them, stabilize them and interpret. Modified exposure method can be used to desensitize the patient gradually to traumatic memories that are sometimes tolerated in small fragments. To the extent in which the reasons for the dissociation to be addressed and worked through, therapy may continue to reconnect to integrate and rehabilitate the alternative self-patient conditions, relationships and social functioning. A certain degree of integration arises spontaneously during treatment. Intregration can be strengthened through negotiation with the identities and the arranging of their association or simplified by hypnotic suggestion and imaginative techniques. Patients who have been traumatized, especially during childhood, can expect a further abuse and develop complex transfer reactions to her therapist during therapy. Discussing this understandable feelings is an important part of effective psychotherapy.

Health Life Media Team

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