Dissociative Identity Disorder
When a personality is splitted
An attempt of a scientific and symbolic depiction
Dissociative Identity Disorder or short DID, is a serious disorder
with a substantial prevalence of 1% in the general population.
It occurs as often as schizophrenia.
The main symptom consists of switching between identities,
meaning a switch between different alternate states of consciousness (alters)
which are dissociated from one another.
There are many people, even scientists who think that Dissociative Identity Disorder is an invention
and affected people merely are fantasizing or persuading themselves to have DID.
Someone with Dissociative Identity Disorder has several alters that are dissociated from one another.
These alters are like distinct personalities. They can have a different age or even a different gender.
They can think, feel and act separately.
When a switch does occur one alter is taking over and later another alter can take control
while they often are not aware of each other.
Because these different alters do not know that other alters exist,
gaps in memory occur. Because these different alters do not know that other alters exist,
gaps in memory occur.
This is not only difficult for an everyday life but also very irritating.
The duration of these amnestic periods can vary, ranging from minutes to days or even months.
The thought of multiple alters in a single human body that are dissociated and can act independently
can be hard to grasp.
Models and metaphors can be helpful, but are not able to show the whole complexity of DID.
These are three giraffes from Africa.
It's more than a simple sculpture because it has been carved from a single piece of wood.
In Dissociative Identity Disorder we have one person,
but this person has been split in personalities with their own wills, bodies and sensations.
The different alters do not have to long for the same things, they don't feel or think identically.
In most cases Dissociative Identity Disorder emerges in childhood.
To understand the causes it's important to know the difference
between dissociation and dissociative identity disorder.
Among experts dissociation is defined differently.
Mostly it is described as a protective mechanism which is activated in very stressful situations
and reduces the perception of the adverse event.
Dissociative Identity Disorder is usually caused by trauma
with two important conditions:
occurring very early in childhood and for a prolonged period of time.
It's called Dissociative Identity Disorder because the identity is disturbed.
The person is not able to develop a „normal", whatever normal means, personality.
The child does not have the chance to develop naturally
and is doing its best to adapt to a very hostile environment.
If a human being is often and severely traumatized as a child
and dissociates consistently,
Dissociative Identity Disorder can manifest itself.
Experts are calling this structural dissociation.
In this theory two different personality types are differentiated.
The emotional part, short EP and the apparently normal part, short ANP.
While the emotional part is concentrating on the trauma,
the apparently normal part is avoiding it.
This means that the ANP does not want to deal with the trauma
and has partial or complete gaps of memory.
Sometimes they remember the trauma or parts of it and sometimes they don't.
This results in tensions
in the relationship of EPs and ANPs,
because ANPs do not want to deal with the trauma
while EPs are the carriers of the trauma.
This leads to tensions in the system itself.
These are the parts that are in the inner world of the person.
On this side, the parts are oriented outwards.
We can see additional parts in the background.
You can see childlike parts, who carry the memory of earlier traumas.
The black parts are censorious and strict parts.
In everyday life, it is often the case that one part is in control, The black parts are censorious and strict parts.
In everyday life, it is often the case that one part is in control,
active and does not notice what is happening in the background.
If a certain stimulus is present, a trigger, a childlike part can be activated.
This part can become active and take over,
while the others are in the background.
It is now possible that the affected person
talks with the voice of child and behaves as if she was a child.
After the situation is over,
the childlike part moves into the background After the situation is over,
the childlike part moves into the background
and one of the apparently normal parts takes control again.
Diagnosing DID is very difficult.
Other mental disorders can cause similar symptoms,
which often leads to confusions and misdiagnoses.
One of these disorders is schizophrenia
which is mainly characterized by psychoses. One of these disorders is schizophrenia
which is mainly characterized by psychoses.
It's often the case that DID is confused with schizophrenia.
Therefore it's important to distinguish psychotic from dissociative symptoms.
They are very similar but there are also differences.
The main difference is a delusional symptomatology.
People that suffer from psychosis
can feel like they are being followed,
have delusions and hear voices from the outside.
People who suffer from dissociative disorders
experience voices more as originating from the inside.
While schizophrenia receives more attention in the meantime,
there are still many people with doubts about the existence of DID.
The social environment often reacts with a lack of understanding
because they think that the patient is simulating and that it is some kind of play.
People affected from DID often hear that they should pull themselves together.
The more stress they receive from the social environment
the less they are able to control it.
Often, they manage it anyway,
remain undetected and are able to hide their disorder from others.
Their apparently normal parts are strong and protective.
They can live an almost normal life, as it sems from an outside perspective.
Inside it is a different story,
but they can hide it until it becomes too much.
It is like you are walking on thin ice,
constantly gaining weights.
At some point you break in and can't go any further.
There are many people, even scientists who think that
Dissociative Identity Disorder is an invention
and affected people merely are fantasizing or persuading themselves to have DID.
Unfortunately, there is not much research on DID.
One of the reasons is its complexity
which brings along a tremendous amount of effort and work.
Dr. Yolanda Schlumpf faced this challenge
and specialized in research on DID using medical imaging procedures.
Emotional and apparently normal parts of the same person
are scanned and their data compared to each other.
Depending on which part was present during measuring, are scanned and their data compared to each other.
Depending on which part was present during measuring,
it was shown that there were completely different neurophysiological patterns in brain activity.
In research, apparently normal and emotional parts
usually are confronted with a stimulus that reminds them of their trauma.
Afterwards it is evaluated, which areas of the brain were active.
Emotional Parts show activities in brain areas which are connected to fear and anxiety.
Apparently normal parts show contrary brain activity.
Brain activity is reduced and the presented stimulus
is processed on a less emotional basis.
Dr. Schlumpf used pictures of angry and neutral faces for her studies.
These pictures were shown between a pattern for only 17 ms.
Due to this short time,
participants didn't even know that they had seen pictures of faces.
Our research also shows that emotional parts are experts
in detection of threatening stimuli. Our research also shows that emotional parts are experts
in detection of threatening stimuli.
They are even able to identify stimuli as threatening,
which cannot be perceived consciously.
This is not the case for apparently normal parts,
who showed a deactivation of brain activities.
Basically, while there is a firework of brain activity in emotional parts,
apparently normal parts don't show such activity in the brain.
Therefore, it seems like emotional parts are fixed
on threatening stimuli and automatically shift their attention to those.
Apparently normal parts do not only show non-attention
but even avoid the stimuli,
which supports the theory of the structural dissociation of the personality.
We also tested professional actors
who tried to simulate emotional and apparently normal parts,
but who were not able to reproduce a difference in brain activity.
This disagrees with the assumption that DID is a simulated disorder
or could be explained by simulation.
The ideal treatment would be a psychotherapy
with a varying duration from approximately five to ten years.
A supporting environment like family, friends or even employers
can help to reduce the duration of the therapy.
Trauma that happened over several years
and helped to create such a severe disorder
cannot be treated in a few therapy sessions.
The disorder is long established
and it is not enough to tell someone
that they should snap out of it,
that it happened a long time ago
and that they should take some time off to get better.
These people need to build a whole new and healthy identity.
I had several patients with DID
who told me that they will not come to therapy
if it would cause the disappearance of personality parts.
They want to stay who they are,
but they would like to function better together.
There are also patients who want
to get rid of the time losses
and amnestic periods and function better in everyday life.
An inner team where everyone is working together,
where they can exchange and consider the needs of everyone
would be ideal to use all synergies and resources available.
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