Have you ever heard about how one person can have multiple personalities? This mental health condition is known as dissociative identity disorder, in which a person identifies having two or more personality states within them. These personalities, also referred to as 'alters' or 'ego' states, have distinct behaviours, memories, and thoughts. It is mostly seen in the form of possession by demons in our country. It is a form of dissociative disorder, which means the separation of some aspects of mental functioning from conscious awareness, leading to mental dysfunction. We spoke to our expert, Dr. Krithishree Somanna, Consultant Psychiatry, KMC Hospital, Mangalore, who explained the causes, diagnosis, and treatment for dissociative identity disorder.
Causes Of Dissociative Identity Disorder
The primary cause of dissociative identity disorder is a result of some overwhelming stress or trauma in childhood. Children are not usually born with a unified identity. A person's personality is shaped by the goodness of fit between that person's biologically determined temperamental qualities and environmental influences. When a child experiences overwhelming emotional disturbances, many parts of what needs to be blended to form a personality may tend to remain separate.
Children with chronic or severe physical, sexual, or emotional trauma or neglect are frequently shown to have developed this condition.
Sometimes, the loss of a significant other or severe mental illness, even without any major trauma/abuse—may cause this condition.
Following this, whenever the person has to face any negative emotions or thoughts, they use dissociation as a coping technique to deal with them. During such episodes, the person disconnects from the surroundings by lowering the fear, shame, and anxiety, stopping the trauma memories from reemerging. These switches are involuntary, and the person has no control over them and sometimes is unaware of them.
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Diagnosis Of Dissociative Personality Disorder
This condition is usually seen in adults, where these distinct sets of personality states would be identified by others or the person themselves, along with associated memory gaps. As a result, it becomes imperative to understand that these switches to the alters should not be considered part of any accepted cultural or religious tradition. In addition, it should not be under the influence of alcohol or any form of drug or be related to any neurological or medical condition. It should also not be seen in regular children as a part of any fantasy play or imaginary playmates. At the same time, these switches happen involuntarily and cause significant distress to individuals in their relationships, work, and other important areas of life.
During these switches to the alters, people often experience being spectators to their own speech and behaviours without having any control from within. They often report hearing voices like hallucinations, having memory gaps or amnesia, feeling depersonalisation, or sometimes addressing themselves in plurals. They may experience some bodily-related symptoms like aches and pains and may not recognise the people they otherwise know. They may not even remember the things they have done during these switches. As a result of these above features, they often get misdiagnosed as other entities like schizophrenia, dementia, rapid cycling bipolar disorder, autism, or borderline personality disorder.
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Treatment For Dissociative Personality Disorder
Patients can attain complete recovery and lead a normal life with appropriate treatment. Psychotherapy remains the mainstay of treatment. The goal of the treatment is to integrate the different elements of the personality. The therapists help to understand the underlying causative factor for the condition, followed by teaching techniques to cope with stressful situations without escaping them, that is, without dissociating.
Although there are no specific medications to treat it, medications are mostly used to regulate overwhelming emotional fluctuations like apprehension, sadness, or frustration. These medications may indirectly help the individual develop the integrity of self without dissociating. In rare situations, the symptoms may vanish without any treatment. However, it may surface from time to time or may have a waxing and waning course.