Multiple personality, academically called dissociative identity disorder (dissociative identity disorder), also known as multiple personality disorder, manifested as the disintegration of identity, two or more independent personality states (dissociative identity), accompanied by obvious disruption of the sense of self and agency.
Each personality state has its own unique patterns of experience, perception, conception, and relation to the self, body, and environment. At least two separate personalities repeatedly gain executive control over the individual's conscious and communicative functions with others and the environment, including the performance of specific aspects of daily life (eg, parenting, work), or responses to specific situations (eg, being viewed threatening situations).
Changes in personality status are often accompanied by severe amnesia and cannot be explained by simple forgetfulness.
Basic cause
Dissociative identity disorder is a complex, chronic form of post-traumatic stress disorder in which nearly all individuals with the disorder have experienced childhood trauma, which may include neglect, physical abuse, and sexual abuse.
This kind of trauma usually causes the patient to develop a defense method of division and separation before the age of 5. By retaining his own good object, separating and removing incompatible feelings or cognitions, causing a change in the state of consciousness, in order to remove a certain event or scenario.
Because of the previous trauma, the patient developed a defense method of schizophrenia and personality separation, and after repeated application, he gradually became good at using this defense ability to resolve conflicts.
In childhood, due to being in an abused environment for a long time or not receiving due care and love, children's secure attachment was destroyed, and there was a lack of behavior templates for cultivating self-defense strategies, which made it difficult to deal with interpersonal aggression and inner self-blame. Over time, dissociative disorders gradually formed.
Due to certain genetic factors, some people have abnormal neurological characteristics, including the inability to unify personal memory, perception and identity in consciousness, which can easily lead to the occurrence of multiple personality disorder. The specific cause is still unclear.
symptom
Patients mainly show that there are two or more completely different identity states, which appear successively or alternately in one person. May be accompanied by manifestations such as hallucinations
Typical symptoms
- The main manifestation is that there are two or more unique personalities in the individual patient, and each personality appears successively or alternately at different specific time stages, showing different identity states.
- The patient suddenly loses all memory of his past events, cannot recognize his original identity, and carries out daily activities with another identity.
- Each personality state can have a different personal history, self-image, identity, and separate name.
- The identities are not aware of the existence of the other identities, it is just that the identity feels as if it has lost its existence for a while when the other identity is active.
- The transition from one identity to another is often sudden, often taking only a few seconds, and occasionally gradual. The manifestations of these facets of identity are often distinct but represent aspects of the patient's identity that cannot be integrated. Personality switching can be triggered by associations or specific life events.
- Some patients experience hallucinations.
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Accompanying symptoms
Patients are often accompanied by depressed mood, and some patients with dissociative identity disorder also meet the diagnostic criteria for depression.
Patients often have frequent, rapid mood swings, but these are often caused by post-traumatic and dissociative symptoms. Some patients may experience post-traumatic stress disorder (PTSD)-related symptoms such as anxiety, sleep disturbance, irritability, and mood disorders
seek medical attention
When the family members find that the patient has two or more personality states, and may have forgotten personal information, etc., they should seek medical treatment in time.
The doctor may ask the following questions when seeing a doctor, and the patient or family member can prepare relevant questions in advance to answer:
- what are the symptoms;
- when the symptoms were first noticed;
- Are there periods of time that you cannot remember;
- Do you feel like you have more than one person living in your head, or perhaps many people;
- Was physically abused or neglected as a child;
- Did you witness other family members being abused as a child?
- Are currently receiving treatment for any other medical condition, including mental illness.
Doctors make a comprehensive diagnosis based on the results of detailed inquiries about symptoms such as emotional changes and abnormal behaviors, psychological tests and other related examinations.
Diagnostic criteria
The diagnostic criteria in DSM-5 are as follows:
- A disintegration of identity characterized by the presence of two or more distinct personality states, which may in some cultures be described as a possessive experience. Disruption of identity involves a marked disruption of self-perception and sense of self-control, with changes related to affect, behavior, consciousness, memory, perception, cognition, and/or sensorimotor function. These signs and symptoms can be observed by others or reported by the individual.
- Recurrent gaps in recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetfulness.
- These symptoms cause clinically significant distress or impair social, occupational, or other important functioning.
- The disorder is not part of a broadly accepted cultural or religious practice.
- These symptoms cannot be attributed to the physiological effects of a substance (eg, transient amaurosis or confusional behavior during alcohol intoxication) or to another medical disorder (eg, complex partial seizures in epilepsy).
Note: In children, these symptoms are not better explained by imaginary playmates or other imaginary play.
Medical department
lab test
Clinician Assessment Scale
self-assessment scale
Differential diagnosis
major depressive disorder
Individuals with dissociative identity disorder are often accompanied by depression, and their symptoms appear to meet diagnostic criteria for a major depressive episode. Detailed evaluation revealed that, in some cases, the depression did not meet all the diagnostic criteria for major depressive disorder.
In individuals with dissociative identity disorder, the concomitant depressive manifestations often have an important feature: depressive mood and cognition fluctuate because they can experience depressive mood in some identity states but not in others. Can't experience it in the state.
bipolar disorder
Individuals with dissociative identity disorder who have altered mood due to personality state switching can be depressed or develop manic features such as hypersexuality or aggression. Dissociative identity disorder is more likely to be diagnosed if these mood states persist for no more than a few hours and are abruptly terminated, usually in response to environmental stimuli.
People with bipolar disorder typically do not switch from depression to mania in seconds, but this can also be a feature of altered states that occurs in people with dissociative identity disorder.
psychotic disorder
Dissociative identity disorder may be confused with schizophrenia or other psychotic disorders.
People with dissociative identity disorder may report hallucinations, which are often related to trauma and dissociative factors, such as partial flashbacks. Individuals with dissociative identity disorder experience these symptoms as a result of alternate identities that cannot be explained by delusions.
general treatment
Psychotherapy
treatment steps
- determine psychotherapy;
- initial intervention;
- medical history collection;
- Trauma management;
- towards integration/resolution;
- integration/resolution;
- learn new coping skills;
- Consolidate the achievements and curative effects achieved;
- Follow up.
talk through
Refers to talking to the entire personality system as a whole. In this way, any and all parts of the patient's consciousness can be enabled to listen, encouraging as many relevant parts of consciousness as possible to listen.
drawing
The dominant personality is asked to write its name in the center of a piece of paper and the other personalities are invited to write their names. This method can be used repeatedly to discover some new personalities.
journal
Writing a diary in the way of free association for 20 to 30 minutes a day can lead to more communication between different personalities.
hypnosis
Hypnosis can induce a dissociated state and facilitate access to a dissociated personality. Therapists can teach patients to manage dissociation in this way. Hypnosis moderates traumatic work and helps patients relieve anxiety.
vent
The cathartic personality is usually the child, and after repeated catharsis, the stand-in stops regressive and frightened behavior. The therapist often uses touch and words to comfort the catharsis child, ease the excruciating pain, and provide a sense of security.
Integration/Solution
Refers to mutual understanding and recognition among multiple personalities. If the patient does not accept his other personalities and blindly denies them to escape past painful experiences, then there may be huge conflicts between multiple personalities, and even hurt each other.
fix
The patient successfully helped the patient by developing multiple personality states in order to survive the horrific traumatic experience. When patients receive treatment and are able to perceive the futility of these extreme coping strategies and to face memories and emotions that were previously unacceptable, the existence of a dissociated personality state is no longer necessary.
Medical treatment
Due to large individual differences, there is no absolute best, fastest, or most effective medication. Except for commonly used over-the-counter drugs, you should choose the most appropriate drug based on your personal situation under the guidance of a doctor.
Drug therapy is only used to treat depression, anxiety, etc. in people with dissociative identity disorder. The following drug treatment programs need to be comprehensively evaluated by a psychiatrist and carried out under the guidance of a doctor.
Prognosis
In general, doctors treat dissociative identity disorder as a complex, chronic, trauma-related disorder. In severe cases, treatment may continue for several years.
The multiple personalities of some patients can complete personality integration to form a unified and complete personality. There are also some patients who cannot recover, continue to receive treatment, and even need to be hospitalized repeatedly. Foreign studies have shown that most patients can benefit from the correct treatment.
Complication
Patients with dissociative identity disorder are at increased risk for the following disorders and events:
- Self-harm or suicidal thoughts and actions;
- sexual dysfunction;
- depression;
- anxiety;
- post-traumatic stress disorder;
- Sleep disorders, including nightmares, insomnia, and sleepwalking
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