Dissociative Identity Disorder
The international psychiatric criteria in the DSM IV specify that DID is:
- The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
- At least two of these identity or personality states recurrently take control of the person's behaviour.
- Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness and not due to the direct effects of a substance (e.g. blackouts or chaotic behaviour during alcohol intoxication) or a general medical condition (e.g. complex partial seizures).
Professor Peter Fonagy and others have shown that the most common aetiology for DID is a disorganised attachment followed by abuse at the hands of a care-giver (McQueen, D; Kennedy, R; Itzin, C; Sinason, V and Maxted, F, 2009).
Whilst some people with DID have 'alters' that can communicate with each other, others can experience partial or total amnesia between personality states. Particular events may trigger flashbacks or bring other personalities to the fore. The results can have a devastating impact on an individual's ability to maintain relationships and jobs and even to carry out everyday tasks.
Because DID is a complex and rare disorder, and because people with DID very often have a 'main' personality that is very capable and highly intelligent, misdiagnosis is common. DID can coexist with other physical or mental health conditions and consequently a specialist assessment can be the only way that DID is identified.
International research has shown that long-term specialist therapy is the most effective treatment option, and that as with work with extreme post-traumatic stress, short-term interventions are unlikely to have a lasting effect if used in isolation. For some patients, particularly those coming to treatment early, the prognosis can be good. For others, particularly if they are still being exposed to trauma and abuse, treatment needs to be approached in a similar way to that for long-term conditions, with the aim of minimising further psychological damage, improving quailty of life and reducing risk.
Major research from the Albert Einstein College of Medicine (Foote, Smolin, Neft and Lipschitz, 2008) has shown that adults with dissociative disorders are at high risk of suicide or self-harm, as well as sectioning and other unplanned psychiatric admissions.
As a result of its clinical and theoretical understanding of this subject, there have been no deaths from suicide and no involuntary hospital admissions of patients attending the Clinic for Dissociative Studies since its inception in 1998.