Causes, symptoms and treatment of dissociative identity disorder

Dissociative personality (or identity) disorder is a condition in which thinking is divided into separate components, and connections between them that are normally present are lost.

This is manifested by the fact that a person behaves as if two or more different personalities coexist within him at the same time. A stressful situation or simply a memory of a tragedy experienced provokes the activation of another identity.

The personalities are not connected to each other, each of them has its own memory and personality. While one of them dominates, the other is not realized. When the leading personality changes, the person does not remember what he did in the role of the other. Habits, views, handwriting, physical and mental abilities, voice, even visual acuity change.

Is it a disease or not

Dissociation is one of the innate mechanisms for protecting consciousness from stress. The brain fragments memory and blocks access to the most painful memories. Different personalities emerge from different fragments of memories.

Using MRI, activity is recorded in different areas of the hippocampus (the brain structure responsible for memory) during periods of dominance of different personalities.

This is the paired part of the brain located in the temporal regions

But dissociation does not lead to a solution to the problem, but aggravates the situation. A person cannot build normal interpersonal relationships; the instability of self-identification interferes with work.

Dissociative disorder is a disease and must be treated. In most cases, it progresses over time.

A person, not knowing how to cope with difficult life situations, creates more and more new personalities in himself. Life for him and the people around him is becoming more and more complicated.

How can we help?

Our clinic, near the Eastern Administrative District of Moscow, in Reutov, employs specialists who have extensive experience in treating mental disorders. We use the most modern and advanced techniques, guided by the principles of evidence-based medicine. Effective assistance and confidentiality of information constituting medical confidentiality are guaranteed.

Symptoms and signs

Symptoms of dissociation appear when exposed to a strong stressor. Internal defense turns on: a person wants to forget difficult moments. He begins to live as if he were a different person: with a different character, preferences, perhaps a different gender and age. For a while, the real personality fades into the background; it does not remember the events that happen to the person while he identifies himself as someone else.

A common sign of dissociation is that a person wakes up in an unfamiliar place, with unknown people, and cannot understand why he is there, what he did there. This greatly disrupts a person’s adaptation to society.

In a state where a person does not control himself, he can commit a crime, take out a loan, leave in an unknown direction, or commit suicide.

Twenty in One: The Kim Noble Story

Kim Noble is a London-based artist in whom 20 subpersonalities coexist. Among them there are men, women and children. Most often, Patricia occupies consciousness. She owns her own bank card, which receives funds from the sale of paintings. The pin code is known only to Patricia. The change of other subpersonalities occurs approximately four times a day. Kim has published an autobiographical book, All of Me, co-authored with her Alter Personalities.

14 out of 20 Kim subpersonalities paint pictures. She first took up artistic creativity after the birth of her daughter. Yes, Kim has a daughter. But not all of her ego states are aware of this fact. A certain part of them thinks that Aimee is the name of Kim’s daughter, this is the daughter of her friends.

Now the artist is about 60. The disorder has accompanied her since childhood. The woman assumes that the onset of changes occurred between 1 and 3 years of life. Her parents often quarreled and treated the girl cruelly. Sometimes she had to spend the night with family friends.

Kim recalls that school was especially difficult. She did not remember many of her actions and words. School material was not fully absorbed by the main personality, since different subjects were covered by different subpersonalities. The material learned during the lesson was immediately forgotten during the break, as the characters changed.

Adolescence is the most difficult period in Kim's life. Switching ego states caused bewilderment in everyone, and, as a result, stress and panic. Most of them tried to commit suicide, others suffered from anorexia and bulimia. Because of this, Kim ended up in a psychiatric hospital several times.

The woman had to endure a fire, arrest, and threats. She was even doused with acid.

One day, Kim, in the guise of Haley, got a job as a driver, where she stayed for five years, until her consciousness was taken over by another personality - Judy, who could not drive. This happened while Haley was driving the truck. In essence, Judy rammed a number of cars, for which she was arrested. She was diagnosed with schizophrenia.

Kim was correctly diagnosed only at the age of 35. Now she lives with her daughter and continues to coexist with her twenty hypostases, with which she managed to come to a consensus.

Examples of behavior from life

In life, it can look like this: an adult suddenly begins to speak and behave like a child, the manner of speaking and judgments change. Another example: a person may not understand where he is, who surrounds him, or finds new things in his home environment, the appearance of which he cannot explain.

In the worst case, a person can commit a crime (kill, rob, cause bodily harm) during the period of activity of one of the individuals, and then not understand what happened and deny his involvement.

Film "Glass" (Glass, 2019)

There is a well-known example from life when two personalities within one person competed for the love of a girl. If one person wants the death of another, everything can end in suicide if you do not intervene in time.

Diagnostic errors: why it is better to immediately contact Leto

A sad consequence of errors in diagnosis and lack of proper examination is the formulation of many intermediate diagnoses. In this case, the person receives treatment that he simply does not need. But most drugs used in psychiatric practice cause a variety of adverse reactions, so this treatment tactic is dangerous for the patient himself.

Schizophrenia is often suspected, but in this case the individual is more inclined to look for the cause in the symptoms of his own pathology in other people and events. What occurs is not a splitting of personality, but rather a degradation of individual mental functions, which leads to a change in identity as a whole.

It is also important to exclude simulation, which is a symptom of other psychological disorders. At the same time, identities are quite primitive, and an experienced doctor at our medical center will immediately notice the pretense.

Films about mental dissociation

Famous film about dissociation: “The Three Faces of Eve” (1957, directed by Nunnally Johnson), based on real events. Three personalities coexist within a woman; her husband and psychiatrist are trying to help her cope with the different “I”s within herself. The series “Sybil” (1976, Daniel Petrie) is also about a real woman who experienced sexual abuse as a child and throughout her life feels alternately like completely different people. You can also call Frankie and Alice (2009, Jeffrey Sachs), Psycho (1960, Alfred Hitchcock).

Dissociative seizures

These are the names of false seizures, which strongly resemble an epileptic attack. In contrast, with dissociative convulsions there is no complete loss of consciousness, a life-threatening fall in an unexpected place, or biting of the tongue. In addition, the patient clearly remembers all events during this period. The main symptom of the disorder is the appearance of sudden convulsive movements, without a certain stereotype; sometimes some theatrical manifestations are noticeable. The attack can last for several minutes or hours.

Often a pseudo-seizure is demonstrative in nature and stops as soon as the people around him lose interest in it. Dissociative convulsions also include abortive forms in the form of fainting, uncontrollable laughter or crying, trembling of the whole body in the absence of loss of consciousness.

Causes of the disorder

The most common cause is severe or long-term psychological trauma in childhood: cases of sexual or physical abuse, death of a loved one, natural disasters. For adults, the trigger can be stress at work, being convicted of a crime, going to prison, or going to the army. Genetic predisposition matters.

The prevalence in the population is 0.5–5%. Women suffer 3 times more often than men. The first manifestations are usually observed in adolescence and young adulthood. In the future, symptoms and signs of the disease may decrease or progress.

There is a separation of one’s inner “I” into several independent parts

Brief description of the disease

Pathology is difficult to classify and diagnose, which is primarily due to the characteristics of a person’s personality. According to psychotherapists, the personality of an individual patient includes many traits determined by his own life experience, memory, character, characteristics of upbringing, and abilities. Depending on the circumstances, these factors, roughly speaking, “regroup” in the mind in a completely unpredictable way, which gives rise to a new personality.

At present, there are no accurate statistics on incidence, especially since in Russia people began to talk about such a disorder only recently. Only a few specialized clinics, including the Leto mental health center, deal with such pathology. But it is known that pathology in 75–90% of cases manifests itself in childhood and adolescence. The problem is that loved ones may not immediately notice such a state, mistaking it for another child’s game, and, moreover, take an active part in it.

It is believed that genetic predisposition also plays an important role in the formation of this type of dissociative disorder - signs of the disorder are often identified in direct relatives. Approximately 25% of cases have concomitant epilepsy, and half have additional symptoms of borderline disorders.

Treatment

The main treatment is psychotherapy. A person needs to be convinced that the problems happening to him have not external, but internal roots. When the patient agrees that he is the cause, he can be helped in the following ways:

1. To teach how several personalities can coexist within his “ego” without causing harm or discomfort.
2. Learn to recognize situations that most often provoke a change in these identities.
3. Give a feeling of support and security, this may reduce the frequency and severity of episodes of dissociation.

It is important to involve relatives and close friends in the patient’s adaptation: they must react correctly and help a person suffering from personality dissociation cope with themselves.

Drug therapy relieves anxiety, aggression, depression and other conditions associated with this mental disorder.

Principles of therapy

At the Leto clinic, treatment of such disorders occurs on an outpatient basis, with a specialist visiting your home or in a hospital. The main attention is paid to psychotherapy, which helps to overcome previous trauma, reveals conflicts and fears that provoked pathology, and corrects the defense mechanisms of the subconscious.

Sometimes (especially when presenting late) it is difficult to determine how to treat dissociative disorder. In such a situation, the goal of the psychotherapist’s work is to achieve a kind of “compromise” and safe interaction between individual personalities. At the same time, the doctor treats all individuals with the same amount of respect and care and does not take sides in an internal conflict - this is the key to a trusting relationship with the patient.

As practice shows, drug therapy does not achieve significant results. Only in some cases, according to strict indications, the doctor prescribes antidepressants and sedatives, but their use is rather symptomatic.

Other non-organic personality disorders

Other personality disorders also occur. They are not caused by structural changes in the brain. Hereditary predisposition in combination with stress exposure is important. At the same time, the normal perception of oneself and other people changes, behavior becomes inappropriate to the situation. Interpersonal relationships deteriorate, professional suitability is lost, and emotional stability is lost. It is difficult for people to fit into society without the qualified help of a psychotherapist.

Schizoid

It is characterized by a person’s disinterest in social life and detachment from other people. He does not strive for communication, prefers solitude, weakly expresses emotions, both positive and negative, and does not respond to praise and criticism from other people. The cause may be a hereditary predisposition, as well as an emotionally cold upbringing in childhood. Treatment is aimed at teaching the patient to communicate and integrate into society.

Schizoid personality type

Schizotypal

This is a state between normal and schizophrenia. The person behaves strangely, eccentrically, and is divorced from reality. Touchy, speaks illogically, conversation is slow or accelerated. Characterized by emotional poverty, severe shyness, anxiety, and absent-mindedness. A person is subject to sudden mood swings, outbursts of anger, and sometimes experiences short-term delusions and hallucinations. Such people tend to believe in magic, in the presence of dead people. They are often bothered by intrusive thoughts.

The treatment is complex: medications, psychotherapy, including through art, social adaptation.

Narcissistic

A person overestimates his role and success in life, often by belittling the role of others. He considers himself talented, chosen, worthy of worship. A good mood depends on praise and admiration from others. In response to criticism, in case of failures, the mood changes sharply, and attacks of anger are possible.

The task of a psychotherapist is to shift towards the environment, to teach you to think about other people without arrogance and neglect, to correlate the interests and desires of your own and those of loved ones.

Narcissism

Border

Occurs due to hereditary predisposition and stress in childhood. Such people are afraid to be alone, attract the attention of others, and need care. Relationships with people begin with the idealization of the partner, followed by disappointment. They constantly accuse their loved ones of not being valued enough and rejecting them. They often become angry, irritable, impulsive, and make threats of suicide in order to attract the attention of their family and keep them close.

Angry outbursts are replaced by a feeling of emptiness, guilt, and shame. Mood changes are most often associated with problems in interpersonal relationships. Treatment is psychotherapy with the goal of learning to understand oneself and others, to behave more predictably and adequately in stressful situations.

Bipolar

This disorder is otherwise called “manic-depressive psychosis.” Hereditary factors and disturbances in the metabolism of serotonin and norepinephrine play a role in its occurrence. It can be provoked by the use of alcohol, drugs, certain medications, or stress. Characterized by alternating episodes of mania and depression. In each patient, one of the conditions prevails, the other is less pronounced. The frequency, duration and severity of attacks vary greatly.

During increased activity, a person may shout, sing, or perform actions that pose a danger to himself and those around him. Absent-mindedness, a low need for rest, and a lack of self-criticism are also characteristic. Then comes a period of depressed mood, decreased physical activity and interest in life, and an increased tendency to commit suicide. The person cannot engage in professional activities.

Individual and group psychotherapy can help the patient. It is useful for loved ones to monitor such a person during dangerous periods in order to prevent suicide, attacks on people, spending large sums of money, and incidents of violence. Sometimes isolation from society is required.

People with the disorder have a distorted self-perception

How to make a diagnosis

When diagnosing dissociative identity disorder, a specialist must immediately rule out organic brain damage; for this, magnetic resonance imaging, computed tomography, and electroencephalography are performed. It is necessary to exclude:

• delirium (impaired consciousness);
• mental retardation;
• amnesia after surgery, trauma, concussion;
• somatoform (psychosomatic) disorders;
• dementia;
• temporal lobe epilepsy;
• schizophrenia;
• amnestic syndrome;
• bipolar disorder;
• influence of psychotropic substances and alcohol;
• borderline personality disorder;
• normal simulation;
• neoplasms of various nature.

Dissociative disorder is confirmed by the presence of several personality states that differ from each other and have their own pattern of behavior, perception of the environment, etc. At least two of these identities alternately receive full control of the patient. The patient cannot remember any personal information and this is not at all forgetfulness.

If the patient is a child, then one cannot speak of a diagnosis of “multiple personality disorder” if he talks about imaginary friends or is talking about a fantasy game. The latter also applies to adults, since split personality in this case is a feature of the psyche to react in this way to certain life situations.

To make a diagnosis, patient observations and special questionnaires are used. Hypnosis or the introduction of the so-called “truth serum” - amytal-caffeine disinhibition - can be used. Both of these make it possible to immerse a person in a euphorically relaxed state in which his hidden subcortical structures are “revealed.” He tells about himself what he deliberately hid or what was inaccessible due to psychogenic amnesia.

Organic personality disorder

There is a reason for this disorder: anatomical changes in the brain that can be recorded using CT, MRI, EEG and other research methods. This could be a traumatic brain injury, infectious and non-infectious inflammatory processes in the brain, cerebral palsy (cerebral palsy), Parkinson's disease, circulatory disorders in the brain, epilepsy, chronic manganese poisoning.

It manifests itself as character disturbances – the strengthening of individual traits. Thus, thrift and rationality can develop into stinginess, caution into timidity and distrust.

Characteristic emotional disorders: apathy, euphoria, emotional instability. The most insignificant reason can provoke an attack of anger and rage. Suspicion also develops, and sexual behavior is disrupted. This causes inconvenience to loved ones.

Without treating the underlying disease, it will not be possible to help. Symptomatic drugs are used to reduce anxiety, depression, and improve cognitive functions. As the lesion decreases, personality disturbances disappear.

Depersonalization

Depersonalization refers to dissociative disorders; it manifests itself in the patient in the form of a feeling of foreignness of one’s mental processes or one’s body, as happens when watching a movie. It can be permanent or appear periodically, the patient experiences a distortion of time and space, the person sees himself as if from the outside, or in the role of a robot, as well as a character in a dream. Depersonalization is often accompanied by derealization, when the world around us seems unreal.

Depersonalization often occurs in various mental illnesses: manic-depressive syndrome, panic disorder, schizophrenia. As an independent deviation, it occurs under severe stress; women under 40 years of age are more often affected; the manifestation of depersonalization syndrome is sometimes observed in early childhood. The onset is usually acute; if left untreated, it can progress to a chronic condition.

Clinical picture

Usually in such situations, all pronounced symptoms are in full agreement with how the patient imagines the process of the disease. Medical diagnostics, as a rule, do not give a clear answer about the presence of any neurological diseases or physical disorders.

In such situations, it becomes obvious that the loss of mental functions is a consequence of the unmet emotional needs of the patient or a serious mental conflict caused by the corresponding trauma. Often, the existing symptoms have a gradual development associated with the patient being in a stressful state for a long time, and are followed by a sudden manifestation, since the tension is cumulative.

This may include types of disturbances associated with physical condition and functions that are normally controlled in a healthy state, as well as dulling of sensitivity.

It's still the same person. Can personalities be so different?

As a rule, individuals have different names, ages, gait, manner of speaking, and facial expressions. They are also diagnosed with different EEG indicators, and IQs can range from retardation to genius. In addition, differences are found in nationality, sexual orientation, and religions professed by individuals [2]. D. Keyes, in a book about Milligan, describes the characteristics of each of his personalities: a strong Slavic accent (Ragen), lack of initiative (Mark), a tendency to cheat (Allen), composure (Arthur). The latter also tends to connect his fingers with a “spire” - a gesture by which Arthur is recognized in the videos by many fans of the book.

Despite the layering of “new kids,” the original personality (usually still calling herself by her real name) remains among them, although not always in a dominant position.