Dissociative Identity Disorders:

Nature, Types, Symptoms,

Diagnostic Criteria & Causes
Asst. Prof. Tanmay L. Joshi
https://www.chaitanyapsychology.com
Types
1. Dissociative Identity Disorder,

2. Dissociative Amnesia,

3. Dissociative Fugue,

4. Depersonalization.
➢D i s a s s o c i a t i o n : human mind’s capacity to mediate complex mental activity in
channels split from, or independent of, conscious awareness (kihlstrom; 1994, 2001,
2005).

➢W e a l l d i s a s s o c i a t e t o a d e g r e e s o m e o f t h e t i m e .

➢Dissociative disorders appear mainly to be ways of avoiding anxiety and stress and of
managing life problems that threaten to overwhelm the person’s usual coping resources.

➢Individual deny personal responsibility for his/ her “unacceptable” wishes or behavior.

➢The person avoids the stress by pathologically dissociating – in essence by escaping from
his/ her own autobiographical memory, or personal identity.
Dissociative Identity Disorder
➢ Before 1979: only 200 cases all over the world.
➢ By 1999: 30,000 + in North America alone (Ross, 1999).
 ➢Author's (Sydney Sheldon)Note

➢During the past twenty years, there have been dozens of criminal trials involving
defendants claiming to have multiple personalities.

➢The charges covered a wide range of activities, including murder, kidnapping, rape
and arson. (MPD)/ (DID), is a controversial topic among psychiatrists.

➢Some psychiatrists believe that it does not exist. On the other hand, for years many
doctors, hospitals and social services organizations have been treating patients who
suffer from MPD.

➢Studies: 5 and 15 % of psychiatric patients are afflicted with it.

➢Current statistics from the Department of Justice indicate that approximately one third
of juvenile victims of sexual abuse are children under six years of age, and that one out
of three girls is sexually abused before the age of eighteen.

➢Most reported cases of incest involve a father and daughter.

➢Dissociative disorders are often misdiagnosed, and studies have shown that, on
average, people with MPD have spent seven years seeking treatment, prior to an
accurate diagnosis.

➢Two thirds of the cases of multiple personality disorder are treatable.

➢A patient manifest 2 or more distinct identities that alternate in someway in taking control of

behavior.

➢Inability to recall important personal information that cannot be explained by ordinary

forgetting.

➢Each identity may appear to have a different personal history, self-image and name.

➢In most cases, the one identity that is most frequently encountered and carries the person’s real

name is the host identity.

➢The alter identities may differ in striking ways involving gender, age, handedness, handwriting,

sexual orientation, prescription for eyeglasses, foreign language spoken and general knowledge.
➢Alter identities take control at different points in time and the switches typically
occur very quickly.

➢Easy to observe the gaps in the memories for things that have happened.

➢Other symptoms:

✓ Depression, self-mutilation, frequent suicidal ideation & attempts.

✓ Moodiness, erratic behavior, headaches, hallucination, PTSD.

✓ Amnesic & fugue symptoms.

 Dissociative Identity Disorder 300.14 (F44.81)
A. Disruption of identity characterized by two or more distinct personality states, which may be described in
some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense
of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory,
perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by
others or reported by the individual.

B. Recurrent gaps in the recall of everyday events, important personal information, and/ or traumatic events
that are inconsistent with ordinary forgetting.

C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important
areas of functioning.

➢Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play.

E. The symptoms are not attributable to the physiological effects of a substance or another medical condition.
Treatment:
▪No systematic research.

▪Psychiatric drugs: Prozac, benzodiazepines, barbiturates, sodium

pentabarbital, sodium amobarbital.

▪Hypnosis
 Dissociative Amnesia 300.12 (F44.0)
A. Inability to recall important autobiographical information, usually of a traumatic or
stressful nature, that is inconsistent with ordinary forgetting.

B. The symptoms cause clinically significant distress or impairment in social, occupational,

or other important areas of functioning.

C. The disturbance is not attributable to the physiological effects of a substance or a

neurological or other medical condition.

D. The disturbance is not better explained by DID, PTSD, acute stress disorder, somatic
symptom disorder, or major or mild neuro-cognitive disorder.
➢Retrograde amnesia: partial or total inability to recall or identify previously acquired
information or past experiences.
➢Anterograde amnesia: partial or total inability to retain new information (Kapur,
1999).
➢Dissociative amnesia (psychogenic amnesia): Failure to recall previously stored
personal information, when that failure cannot be accounted by ordinary forgetting.
➢Localized: a person remembers nothing that happened during a specific period,
first few hours/ days following some highly traumatic event.
➢Selective: a person forgets some but not all of what happened during a given
period.
➢Generalized: a person forgets his/her personal life history, including identity.
➢Continuous: a person remembers nothing beyond a certain point in the past until
present.
➢Individuals cannot remember certain aspects of their personal life history
or important facts about their identity.

➢But their basic habit patterns (to read, walk, talk, perform skilled work)
remain intact and they seem normal aside from the memory deficit
(Kihlstrom, 2005).

➢Episodic memory or autobiographical memory is get affected.

➢A patient who could not retrieve any
autobiographical information was asked to dial
numbers on a phone randomly. Without
realizing what he was doing, he dialed his
mother’s phone number, which led to her
identifying him.
 Dissociative Fugue
➢Primary disturbance is sudden, unexpected travel away from home/ work with inability
to recall one’s past.

➢Confusion about personal identity/ assumption of a new identity.

➢Symptoms cause distress or impairment in functioning.

➢A person unconsciously avoids thoughts about the situation or in the extreme, leaves
the scene (Maldonado, 2002).

➢Reduced activation in right frontal and temporal brain areas (Kihlstrom, 2005).
❖Fugue: Flight.

➢A person not only is amnesic for some or all aspects of his/her past but also departs from home
surroundings.

➢Confusion about personal identity or even the assumption of a new identity.

➢Unaware of memory loss for prior stages of their life, but their memory for what happens during the
fugue state itself is intact.

➢Behavior during the fugue state is usually quite normal and unlike to arouse suspicion that something
is wrong.

➢A person unconsciously avoids thoughts about the situation or in the extreme, leaves the scene
(Maldonado, 2002).

➢Reduced activation in right frontal and temporal brain areas (Kihlstrom, 2005).
 Depersonalization 300.6 (F48.1)
A. The presence of persistent or recurrent experiences of depersonalization,
derealization, or both:
1. Depersonalization: Experiences of unreality, detachment, or being an outside
observer with respect to one’s thoughts, feelings, sensations, body, or actions
(perceptual alterations, distorted sense of time, emotional and/ or physical
numbing).
2. Derealization: Experiences of unreality or detachment with respect to
surroundings (individuals or objects are experienced as unreal, dreamlike, foggy,
lifeless, or visually distorted).
B. During the depersonalization or derealization experiences, reality testing remains
intact.
C. The symptoms cause clinically significant distress or impairment.
D. The disturbance is not better explained by physiological or mental disorder.
➢Normal person: usually during/after periods of severe stress, sleep deprivation or sensory
deprivation (khazal, 2005).

➢Derealization: one’s sense of the reality of the outside world temporarily lost.

➢Depersonalization: one’s sense of one’s own self and one’s own reality is temporarily lost.

•Episodes of depersonalization become persistent and recurrent and interfere with normal
functioning.

•Persistent and recurrent experiences of feeling detached from their own bodies & mental
processes.

•External world: strange and new in various ways.

•Feelings like they are living in a dream or movie.

•The DSM-IV term somatoform disorders was confusing and is replaced by somatic symptom and related
disorders.

•The prominence of somatic symptoms associated With significant distress and impairment.

•Commonly encountered in primary care and other medical settings but are less commonly encountered
in psychiatric and other mental health settings (?).

•Diagnosis made on the basis of positive symptoms and signs (distressing somatic symptoms + abnormal
thoughts, feelings, and behaviors in response to these symptoms)

•rather than the absence of a medical explanation for somatic symptoms.

❖Characteristic: the way they present and interpret them.

•Important to note that some other mental disorders may initially manifest with primarily somatic
symptoms (e.g., major depressive disorder, panic disorder).
❖Factors may contribute to somatic symptom and related disorders:

• Genetic and biological vulnerability (e.g., increased sensitivity to pain),

• Early traumatic experiences (e.g., violence, abuse, deprivation), and

• Learning (e.g., attention obtained from illness, lack of reinforcement of non-somatic

expressions of distress),

• Cultural/social norms that devalue and stigmatize psychological suffering as

compared with physical suffering.
 MAILING ADDRESS
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