Broadly speaking, DID is a condition that involves….
the existence of multiple distinct identities or personalities within a single person
What is the estimated global prevalence of DID?
1.5%
What are the 4 etiological areas for DID?
Biological
Social
Psychological
Cultural
Outline the etiological factors for DID from a biological point of view
- genetics (45-50%) variance
- deficiency in orbitofrontal region of the brain (due to early trauma)
- deficiencies in amygdala and hippocampus (emotion and memory)
Outline the etiological factors for DID from a social point of view
85-97% of those diagnosed with DID report SEVERE childhood trauma (abuse, neglect, conflict, dysfunctional childhood dynamics)
In the psychological etiology of DID there are two models. Name and outline them
Post-traumatic model
- DID caused primarily by abuse in childhood
- events are compartmentalized as a coping mechanism -> allows victims to see event as happening to someone else. Alter can be created to be the one who takes the abuse
Socio-cognitive model
- influenced by culture and is mostly socially constructed
- psychiatric techs like hypnosis and prompting of alters develops the disorder in suggestible/fantasy-prone individuals
Outline the cultural etiological factors for DID
Possession form DID
- fragmented parts of self take form of possessing spirits?
Views of self
- non-western self = relations, therefore possession form DID
- western self = individual therefore internal alters
DID vs culturally acceptable possession?
- DID uncontrollable, involuntary, causes distress
Broadly speaking, what are the 4 diagnostic criteria for DID?
- two or more distinct personality states
- discontinuity in sense of self, agency, affect, memory, cognition etc
- clinically significant distress
- not part of acceptable cultural or religious practice, or explicable by subs-use
Name two screening tools for DID
- The Dissociative Experiences scale (DES-II)
- The Structured Clinical Interview for DSM-5 Dissociative Disorders (SCID-D)
What are the 2 paths for treatment of DID?
Psychotherapy
Pharmacology
Outline the psychotherapeutic treatment of DID (3 phases)
Phase 1: Stabilization (safety, symptom management)
- stabilization
- psycho-ed
Phase 2: Trauma processing
- EMDR
- Abreaction (reliving of memories)
Phase 3: Integration and rehabilitation (…of identities -> achieve more functional and cohesive identity)
- not all patients reach full integration, but goal is to reduce dissociative episodes and improve functioning
- CBT: helps address irrational beliefs and build healthier emotional responses. Also helps address comorbid anx/dep/ptsd.
- hypnotherapy suggested to access IDs and integrate trauma
Outline the pharmacological treatments for DID
- no specific DID medication
Atyp AntiPsychs:
- dissociation
- mood dysreg
- hallucinations
Antideps:
- depression
- PTSD
*complex, needs to be individualized and combined with skills training/emotional support/trauma-focused therapies
What is one of the controversies surrounding DID?
The sociocultural model
- DID comes from therapist intervention and media influences in fantasy prone indis
- cases 6 000 -> 40 000 after popular DID biography
- indis with DID found to be easier to hypnotize, more suggestable and fantasy prone
How does the PT model counter the SC model of DID?
- histories of sever trauma in almost all DID patients
- brain activation in DID shown to be independent of fantasy
- even if iatrogenic DID exists, doesn’t take away from real, trauma related DID
What are some of the difficulties in DID diagnosis?
- overlapping symptoms (PTSD,BPD,Anx,Dep)
- subtle changes when switching, (clients conceal or are unaware of change)
- difficulty in separating DID from GD
- Factitious disorder/malingering
What are some warning signs for factitious disorder/malingering in terms of DID?
- over reporting of media-based symptoms: dramatic dissociative amnesia, melodramatic switching behavior
- under reporting less-publicized comorbid symptoms (e.g. depression)
- may ask clinicians to “find” traumatic memories
- may present “all-good” and “all-bad” identity
- feigns amnesia for events they want to
Outline DID in children
- DID stems from childhood, but shows itself in adulthood
- emotional neglect from family a big risk factor
- DID presentation dependent on age, autonomy and lifestyle of child
- children often used dissociation to deal with abuse
Three points on DID in SA?
- widespread expose to trauma in childhood = risk factor
- minimal mental health care in certain areas = risk factor
- potential for DID to be denied in favor for spiritual explanations = risk factor
