198 Dissociative Identity Disorder (300.14)
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DID, formerly refer to as multiple personality disorder, is characterized by the existence of two or more identities or personality traits within a single individual. Patient with this disorders demonstrate transfer of behavioral control among alter identities either by state transitions or by interference and overlap of alters who manifest themselves simultaneously. It is observed in 1-3% of the general population. (American Psychiatric Association, 2000)
Mental Status
- Patient is alert and oriented in all spheres.
- Affect may be labile or irritable.
- Mood is euthymic or anxious.
- Relatedness is very limited, and eye contact is very frequently minimal.
- Thought content may be characterized significant hypervigilance, preoccupations, or hallucinations.
- Patient appears fixed on extraneous or internal stimuli.
- Reasoning and judgment are diminished and insight is poor.
- An overall increase incidence of both suicidal and homocidal ideation in these patients is present.
- Orientation is frequently off.
- Long-term memory is poor.
The DSM-IV-TR criteria according to the American Psychiatric Association (2000) includes the following:
- A. “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)” (p. 529).
- B. “At least two of these identities or personality states recurrently take control of the person’s behavior” (p. 529).
- C. “Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness” (p. 529).
- D. “The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play” (p. 529).
Several symptoms are characteristic:
- Fluctuating symptom pictures
- Fluctuating levels of function from highly effective to disabled
- Severe headaches or other pains
- Time distortions, time lapses, and amnesia
- Depersonalization or derealization occurs when a person feels unattached to him or herself. During this phenomenon, it is almost as if one can see themselves from another view point. Derealization is when one experiences surroundings or people as if they are new, eccentric, or dreamlike when they are clearly not.
- Patients can lose time; they can end up in places and not know how they arrived there or why. They also may find objects that they do not identify or handwriting that they do not think they wrote.
- Individuals with Dissociative Identity Disorder frequently report having experienced severe physical and sexual abuse, especially during childhood. However, each child’s mind can produce distorted ima