Research Paper

Term Project Research Paper - Student Example

Hendrix, Jimmy

Professor Shepherd

Psychology XXXX

12 December, 20XX

Dissociative Identity Disorder

Introduction

Imagine abuse so tremendous that a person's only escape is into one's thought-space. The very

means of survival, physically, is to escape the pain, but where does one hide when you can't run? The

only place one can cleverly run is to the corners of his or her own mind. This defense mechanism creates

a “doorway” to what is said to be the most severe of the dissociative disorders, Dissociative Identity

Disorder. Formerly referred to as Multiple Identity Disorder, this condition has come to be known as

Dissociative Identity Disorder putting emphases on dissociating one's identity as the primary

characteristic of this disorder. To be dissociated from one's identity means your inner being becomes

separated from the reality of consciousness, memory, and awareness of surroundings. Dissociating is a

mechanism of separating and grouping memories or simple thoughts from 'normal' thought. Dissociation

grants the ability to repress memories and allows an entirely separate personality state deal with them.

Dissociative Identity Disorder is an interesting, unique, intelligent mechanism gone awry. This goal of

this paper is to discuss the following information regarding this disorder: common terms, diagnosis and

symptoms, prevalence and history, contributors and mechanisms, biological components, social effects

and treatments.

Common Terms

There is common terminology one should be familiar with when learning about Dissociative

Identity Disorder (DID). The term ‘defense mechanism’ is at the core of understanding DID as an

unconscious process that protects an individual from painful ideas or impulses (American Dictionary,

2015). DID is actually a defense mechanism that effects normal mental compartmentalization, “the

division of events into mental categories or compartments” (American Dictionary, 2015). The DSM-IV,

Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (2013), defines DID as “a condition of

a patient which has more than one distinct personality or identity state. At least two of these personalities

control the affected person's behavior” (association). With this understanding, the term ‘thought-space’ is

used as a reference to mental visual or non-visual space within the boundaries of one's consciousness and

sub-consciousness. Common acronyms used are: ISH, IMP and BIP. An ‘Inner Self Helper’ (ISH) is the

actual core personality of the patient. An IMP and BIP are both playmates. There could be an ‘Imaginary

Malignant Playmate’ (IMP), mental entities fuelled by raw emotions, or a ‘Benign Imaginary Playmate’

(BIP), a “mental entity for companionship and advice” (Jackson & Jackson, 2005). ‘Alters’ is a term used

to describe the various personalities created by the patient when dissociating (Smith, 2009). According to

Koop, Tummers, and Wyborg (2000), a standard characteristic of DID is ‘amnesia’ which refers to the

loss of a large block of interrelated memories. Koop et al. (2000) also explains the important concept of

‘integration’ which is the act of combining the elements of one's personality into a coordinated,

harmonious whole.” Integration is the hoped for outcome for therapy.

Diagnosis and Symptoms

Someone diagnosed with DID must qualify with four absolute conditions present, according to

DSM-IV (2013). A person should exhibit two or more distinct identities or personality states. Each

identity must have its own way of thinking, perceiving, relating, and interacting with the environment and

self. Two or more of the identities assume control of the patient's behavior, one at a time and repeatedly.

Among these, the person will have extended periods of amnesia with absences of time. Lastly, a

determination must be made that the disturbance is not due to the direct physiological effects of substance

use or any general medical condition.

People diagnosed with dissociative disorders experience many symptoms such as, depression,

panic attacks, and phobias. They also usually have out of character alcohol and drug abuse, compulsions

and rituals, and psychotic-like symptoms such as hearing voices and hallucinations. Main symptoms that

are particular to DID are amnesia, de-realization, depersonalization, and identity disturbances (DMS-IV,

2013). Quite astoundingly, these include actual physical changes as well as character changes.

Prevalence and History

Demographically, North America has a more prevalent rate of DID than other world areas. This

may be due to the notion that the “United States is looking for the diagnosis” says psychologist and

psychology professor Reneaux Peurifoy (personal communication, 2011). In most countries, someone

displaying symptoms DID would fall under the “not otherwise specified” category rather this specific

diagnoses, which is not entirely recognized as being credible at various locations in the world

(Encyclopedia of Mental Disorders, 2010). There are very scattered statistics on this unique disorder. It

had been estimated approximately 1:10,000 people in population have DID (Koop, et al. 2000). Many

experts believe historical cases of demonic possession were actual cases of MPD (Jones, 2012). In 1791,

one person’s account of Multiple Personality Disorder (MPD) was written in detail using demonic terms.

lacking in understanding and knowledge. Through the 1970s, psychiatrists worked toward labeling and

defining MPD, as well as towards establishing validity of the disorder. Therapy of Multiple Personality

was published in 1971, which defined rules for treating the disorder. Then in 1971, the popular DID case

of Sybil Isabel Dorsett was recorded. This is considered the most important case of the twentieth century

(as cited in Cummins, 2010). With much evidence, this case is what substantially linked highly traumatic

child abuse and MPD together. In 1980, MPD was recognized, attaining credible status as a mental

disorder in the DSM-III, then in 1994 MPD was dubbed DID in the DSM-IV.

Contributors and Mechanisms

Early on, DID was viewed as a disorder only women could have, which we know today to be

false. This statistic could be explained simply because women generally are the attacked and sexually

victimized (R.Peurifoy, personal communication, May 8, 2011). Males also have the ability to use this

defense mechanism and lose control as well. Herschel Walker, retired NFL player, made his personal

diagnosis public. Being ostracized and bullied as a young child he created an aggressive, turbulent

character “that didn't feel loneliness and one that was fearless” (Smith, 2009). This ‘alter’ withstood the

abuse while the others helped him rise to fame. Later in life, Walker was met with accusations of

domestic abuse, abnormal cussing, and vulgar actions, but yet he had no recollection of the events. He

asked for help and conquered his disorder with much work. There is still room for skepticism, however.

As DID has an ominous controversy around it. A survey was given to 301 board certified American

psychiatrists relating to the relevance of DID. Incredibly, the results showed only one-third of the

psychiatrists felt this disorder qualified as a mental illness needing to be included in the DSM-IV manual

(Smith, 2009).

To explain further, contributors of DID can be linked to repeated episodes of severe emotional,

physical, sexual, or combination of abuse in childhood, usually before the age of nine. During the abuse

the child, or “smart kid” creates a personality or an ‘alter’ to suffer while the primary identity escapes into

thought-space (R. Peurifoy, personal communication, May 8, 2011). Once this mechanism is learned, the

child can choose to create various alters to handle different types of stresses. These other alters are

carefully assembled. Each will show different posture, vocabularies, possible voices, handwriting, and

ways of thinking. Typically alters are created to fulfill four basic categories: false-fronts, persecutors,

helpers, and identifiers. False-fronts are designed for everyday social life. The persecutors job is to deal

with any negative emotions; this alter is built to accept, hold, and express these emotions. Helpers are

built for the purpose of 'cleaning-up the messes' left behind from the persecutors (also called ISH). The

identifiers are developed by identification with others, such as playmates or caretakers (also called IMP;

(Keeno, 1998). Astonishingly, sometimes a “smart kid” creates an alter with physical disabilities. For

instance, creating a deaf alter to avoid hearing verbal abuse or a blind alter to keep one's consciousness

from seeing (R. Peurifoy, personal communication, May 8, 2011; Keeno,1998). Amongst these alters, it is

important to remember, the true personality is still present. Usually this is the hurt child repressed in

thought-space.

Biological Components

It has been said that when the nervous system is attacked by high intensity levels of stress, there

can be a malfunction in the hypothalamus and pituitary gland causing elevated cortisol production (Koop,

et al. 2000). Neuroimaging studies have shown abnormalities in the limbic system, decreased activity in

the speech area of the brain known as Broca's area, as well as increased activity in the right hemisphere

where emotional and visual information are processed when stimulated by a traumatic memory”

(Cummins, 2010). DID patient's store trauma tagged by emotional and visual representations built into an

identity (Cummins, 2010). To date, several neurotransmitter systems have been implicated in the

development of Dissociative Disorders: Hypothalamo-Pituitary-Adrenal Dysfunction (HPA),

Glutamate/N-methyl-D-aspartate (NMDA) receptor, Serotonin, GABA and Opioid receptors (Koop et al.,

2000).

Social Effects

DID can destroy all types of relationships. The relation to self, relation to others, and relation to

the physical environment are disrupted. People with this disorder tend to negatively connect romantically.

Social relations are damaged from the abnormal behaviors exhibited by the other alters. Patients describe

“feeling like a passenger in their body rather than the driver” (Smith, 2009). The relationship with self is

chaotic. The true self loses total awareness of minutes to days, sometimes making contact with people

who claim to know them yet call them by another name. The mind of the person becomes that of a

“roaming house” filled with alters” (Jackson & Jackson, 2005). The actual knowledge of the presence of

alters varies from patient to patient.

Treatments

The first step to approaching well-being of the patient is to establish safety. Having trust between

patient and therapist is key in cases of DID. Ideal treatment is a conjunction of several therapies. The idea

behind treatment is to integrate all alters, then treating the underlying trauma caused by the abuse, and

finally to rehabilitate. Peurifoy (2011) states that treatment consists of three stages, the first stage being

psychotherapy. A psychiatrist must reveal and map the most prevalent alters at the very least, recording

the functions of each. The second stage consists of ‘inner part’ communication to process the trauma.

Sometimes hypnosis is the best way to achieve contacting the inner part. It allows the patient's repressed

memories to resurface and be addressed through coaching the personalities with thinking methods, “the

abuse is over, today is different, you have abilities today that you did not have before” (R. Peurifoy,

personal communication, May 8, 2011). Art therapy and play therapy are also useful techniques. In these

the right hemisphere of the brain, the part involved with creativity and imagination, is stimulated to reach

sensorimotor and iconic memories (Jackson & Jackson, 2005). Once the trauma is dealt with, the need for

separateness is no longer significant and integration can become complete. After a client is integrated the

last stage of rehabilitation is necessary. The last stage is to teach the person how to live as an adult and

operate efficiently in society. This includes social training and stress management. Family therapy is

usually recommended to support the patient in understanding the disorder and the changes involved in

integration (Encyclopedia of Mental Disorders, 2010). Medications are sometimes subscribed to reduce

the anxiety usually caused by alters, but there are no medications to cure DID directly.

Conclusion

This paper has provided a thorough overview of DID. It seems beneficial to close on positive

notes making mention of the prognosis and the incredible ability of victimized human beings to survive.

Though the prognosis of this disorder is not fully known according to research, information from

psychologist R.Peurifoy (2011) reveals that many clients integrate successfully into a healthy unified

mental state, and many have had no recurrences. There are very few studies of long-term outcomes, but

relapse of symptoms is noted primarily when a previously integrated person experiences high-intensity

stress or substance abuse. This is where preventative measures can be effective (Encyclopedia of Mental

Disorders, 2010).

In support of these victims who have lost their grasp on reality and slipped away into thought-

space, the unimaginable pain that was inflicted on these clients cannot be fathomed. With that said, one

might want to think of giving credit to a person who is to be able to block pain in such a way and continue

life. People with DIDs literally tap into mind-over-matter, a unique defense mechanism that many of us,

gratefully, never have to access. In the future, hopefully more of society can work together to prevent this

disorder through interventions. Emotional, physical, and sexual child abuse is the most pronounced

contributor to this disorder. The more society can do to put an end to abuse through education, legislation

and ramifications, one would think, the less occurrences of Dissociative Identity Disorder would be

found.

References (On separate, final page, Alpha order, Double space, hanging indent)

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders

(5th ed.). Washington, DC: Author.

American dictionary (2015). (10th, Vol. 3) New York: Word. www.AmericanDictionaryOnline.com

Cummins, J. (2010. Dissociative Identity Disorder: A devastating disease. All Psych Journal, (24).

http://allpsych.comhournal/did.html

Encyclopedia of Mental Disorders (2010). Dissociative Identity Disorder. (2, Vol. 3, 27-40) New York:

Brethin Press.

Jackson A., & Jackson. D.(2005). An analytical overview: DIDs. Demonic Possession and Psychiatry

2.http://www.fortea.us/english/psiquiatria/history.

Jones, A. (2012). A history of Dissociative Identity Disorder: Formerly Multiple Personality Disorder.

Demonic Possession and Psychiatry 10 (23). http://www.fortea.usienglishipsiquiatria/history.htm

Keeno, T. (1998). The mysteries of Dissociative Identity Disorder. Journal of Social Psychology, 5.

http://serendip.brynmawr.edu/

Koop, A., Tummers, B., & Wyborg, G. (2000). The new findings on DIDs. Journal of Consulting

psychology 45(7). http://www.apa.org

Smith, M.(2009). Dissociative Identity Disorder: Multiple Personality Disorder.Web.MD.

http://www.webnnd.cominnental-healthidissociative-identity-disorder-multiple-personality-

disorder