One Disassociative Identity Disorder Individual example essay topic

Dissociative identity disorder, more commonly known as multiple personality disorder, is one of the most intriguing and least understood of mental disorders. The publication of Sybil in 1973 created a wave of public fascination and, more importantly, professional recognition of childhood physical and sexual abuse as precipitants of the disorder. Dissociative identity disorder is characterized by the presence of. ".. at least two separate ego states, or alters, different modes of being and feeling and acting that exist independently of each other, coming forth and being in control at different times" (Davison and Neale 180). "Each personality is fully integrated and a complex unit with unique memories, behavior patterns, and social relationships that determine the nature of the individual's acts when that personality is dominant" (Breiner 149). While psychologists now recognize childhood abuse as a precipitant of DID, the general public is, for the most part, unaware of the strong, almost universal connection. "The vast majority (as many as 98 to 99%) of DID individuals have documented histories of repetitive, overwhelming, and often life-threatening trauma at a sensitive developmental stage of childhood" (DID (MPD) 2).

The two main types of abuse that occur are sexual, involving incest, rape, molestation, and sodomy, and physical, involving beating, burning, cutting, and hanging. Neglect and verbal abuse are also contributing factors. DID is more common among women, probably because females are more frequently subjected to sexual abuse than males. This disorder is often referred to by professionals as and "emergency defense system" (Alexander, et al. 94), comparable to the defense a helpless animal uses when being preyed upon. By going into a trance-like state, the animal believes its attacker will think it is dead and leave.

By the same token, an abused child uses this defense to distance its mental self from its physical being. The child dissociates, or breaks the connection between his / her thoughts, feelings, and his / her very identity. The child becomes like a "hidden observer" (Alexander, et al. 94) who does not have to deal with the pain or fear of the attack. All thoughts and memories of the abuse are psychologically separated from the child. After repeated abuse, this dissociation becomes reinforced.

If the child is good at it, he / she will use it as a defense mechanism in any situation that he / she perceives as threatening, and different personalities begin to develop. "Trance-like behavior in children has been found to be the single best predictor of childhood dissociative identity disorder" (Carlson, et al. 118). It has been documented that disassociative identity disorder can only develop during childhood, usually between the ages of 3 and 9. There is no "adult onset" disassociative identity disorder, due to the fact that. ".. only children have sufficient flexibility (and vulnerability) to respond to trauma by breaking their 'still coalescing's elf into different, dissociated parts" (Rainbow House 2).

It has also been found that only children who are highly susceptible to hypnosis are able to accomplish disassociative behavior. This is because a hypnotic state is very similar to the trance-like states that the children enter into, so if the children can be easily hypnotized, they can also easily go into trances. Others respond to their abuse in a more typical fashion. Children with disassociative identity disorder may have several different alters or personalities, each with its own distinct characteristics and strengths. These alters become dominant at different times according to the outside stressors, but. ".. there are usually only 3 to 6 alters who are particularly active... on any given day" (Rainbow House 3).

When active, these alters may or may not be apparent to observers (In fact, the personality differences in children with disassociative identity disorder tend to be subtle and fewer in number than seen in adults suffering from this disorder). When the alters are of different ages, talents, or temperaments, the distinctions between them become more obvious. It is also interesting to note that the same may be true for the disassociative identity disorder sufferer him / herself ; that is, one personality may or may not be aware of the existence of another personality. In some cases, there may be an awareness of only one or two of many alters, in others, an awareness of all.

One case study involves a young woman named Elly. During the course of Elly's therapy, four alters came out. There was Little Elly (age 5), who was fearful of more abuse; Jed, a male teenager who was a helper and protector; the Protector, who was aware of the other, alters and the incest Elly had been subjected to; and the Evil One, who wanted to destroy the other, alters. "Elly was amnesiac for the other alters, Little Elly knew about the Protector only, and Jed and the Protector knew about everybody" (Ross 128). "When the Protector was out, the Evil One was amnesiac and unable to listen" (Ross 129). The actual number of alters appears to increase proportionately with the severity of the abuse, its frequency, and the length of time it has been perpetrated on the child.

Since the purpose of the alter is to protect the. ".. host personality from the knowledge and experience of the trauma" (Rainbow House 3), the more alters there are, the more easily the trauma is dispersed. It is during times of stress or anticipated stress that the different personalities emerge. (Sybil's mother sexually abused her with a buttonhook. Subsequently, Sybil suffered from hysteria whenever her shoes were buttoned; only after intensive therapy did she remember the abuse and realize why the buttonhook evoked such a strong reaction). While the personalities themselves may differ, the characteristics and basic type of progression of disassociative identity disorder do not. There may be many types of alters in any one disassociative identity disorder individual, but most are variations on the theme of five primary alters: "a depressed, depleted host; a strong, angry protector; a scared, hurt child; a helper; and an embittered internal persecutor who blames one or more alters for the abuse" (Rainbow House 4).

Disassociative identity disorder individuals are usually not diagnosed until they approach or reach adulthood, and even then, not until having undergone years of misdiagnoses. There are many reasons for this. A person with DID often presents symptoms that are common to many other mental disorders. Depression, panic disorders, sleep disorders, and suicidal tendencies are but a few of the reasons these people seek help.

Furthermore, their host personality may be amnesiac with regard to their alters and / or the experiences of those alters. Their personality changes may be passed off as mood swings, or, they may have gone for a long time without experiencing a disassociative episode. These are compounded by reluctance on the part of professionals to diagnose DID, and the DID individual to be able or willing to provide necessary information. At one time, some psychiatrists began to believe that DID was simply a. ".. artifact of hypnotic suggestion" (Alexander, et al. 101). Many are hesitant to believe that the bizarre abuse to which their patients were subjected as children actually occurred.

(This is particularly true when incest was a part of the abuse, as it frequently is). Also, because DID was long thought to be extremely rare, it simply was not a considered diagnoses for many clinicians. The great majority of DID individuals know they have a problem: they may fear that they are crazy, but do not realize they have multiple personalities. Once diagnosed, they may themselves be strongly resistant to the idea, spending months of therapy denying what their therapist has found.

This is unfortunate, because of all the severe mental disorders, DID has one the best prognoses. However, in order to successfully help the patient, the therapist must first gain his / her trust and willingness to assist in the treatment. An acceptance of the diagnosis is the first step, and it may be many months in coming. Once contact and trust are accomplished, the therapist must. ".. establish communication with all of the alter personalities in order to learn their names, origins, functions, problems, and relationships to the other personalities" (Coons 6). The amount of time required to do this is dependent upon the degree of trust the patient places in the therapist. The host personality and his / her alter personalities must then be helped to begin coping with their traumatic experiences.

Only after this has been done can the. ".. fusion of integration of the personalities... ". (Coons 6) begin. "The treatment of DID is excruciatingly uncomfortable for the patient.

The dissociated trauma and memory must be faced, experienced, metabolized, and integrated into the patient's view of him / herself " (Rainbow House pg. 5). As each alter exposes its trauma, it can. ".. yield its separateness and re-integrate (because that alter is no longer needed to contain undigested trauma) " (Rainbow House 5). Recovery from DID and the childhood trauma which perpetuates it can take years. It involves a painful re-examination of one's past and a long. ".. process of mourning" (Rainbow House 5). It is particularly difficult because the individual must come to terms with the fact that (in many cases) the beatings, sexual abuse, neglect, and other forms of trauma that were suffered as small children, were perpetrated by the very people they depended on to love, care for and protect them. In a case cited by Ross, paternal sexual abuse was related by a child alter whom he was neither aware of nor attempting to contact.

When the adult female host personality was brought out of her trance, .".. she suddenly declared, 'those aren't my pictures! Those are Doctor Ross's pictures!' " (Ross 157). The woman insisted that Ross had. ".. implanted these memories by suggestion" (Ross 157). "She was offended that I would ever think such a thing about her father, or try to get her to think the same" (Ross 157). However, Ross had never even mentioned sexual abuse by her father to the patient. In recent years, there has been a dramatic rise in the amount of interest paid to disassociative identity disorder.

There are several reasons for this, not the least of which is. ".. the recognition of DID as a free-standing condition, and the provision of landmark clinical descriptions in The Diagnostic and Statistical Manual of Mental Disorders, third edition" (Alexander, et al. 339). Feminism made a powerful impact by sensitizing the mental health professionals. ".. to the hitherto unacknowledged high incidence of child abuse, incest, and the exploitation of women" (Alexander, et al. 339). Therapists no longer dismiss their adult patients' accounts of childhood abuse as a mere fantasy, and the recognition of disassociative identity disorder of sexually abused females has soared. Also, .".. there has been an explosion of interest in post traumatic stress disorder, which, like DID, occurs consequent to trauma, and has been documented in children following their exposure to, among other things, natural disasters (i.e. the Oakland, California firestorm of 1991).

The similarity between the two conditions brought credibility to disassociative identity disorder. The media has also played a role in the resurgence of interest, with its fictional representation of DID cases such as in the films "Primal Fear" and "The Color of Night"-much as it did with "Sybil" and "The Three Faces of Eve". Perhaps with this increased interest in and acceptance of both DID and its causative roots, children trying to survive severely abusive situations will be removed from the perpetrators and provided with the proper therapy at a young age rather than having to face years of missed diagnoses and continued mental trauma. The consequences of childhood sexual abuse are not limited to disorders such as anxiety, depression, nightmares, amnesia, and DID. It also. ".. traps the person in complicated, self-destructive relationship patterns" (Ross 44).

It is for these reasons that adults eventually seek professional help, and only then do they sometimes learn that they suffer from DID. "Dissociation is a major way in which human beings cope with trauma" (Ross 45). This coping mechanism is but one example of how strong the human will to survive actually is. In the face of almost unbelievable trauma, a child as young as 3 or 4 years old can use dissociation to enable him / herself to continue to function normally. It is up to the non-abusive adults in such a child's life to recognize signs of abuse, to believe the child when abuse is reported, and to take steps to stop the abuse. Only then will the number of adults diagnosed with disassociative identity disorder decrease, and the number of children developing it diminish.

Bibliography

1. Davison, Gerald, and John Neale. Abnormal Psychology. New York, Chichester, Brisbane, Toronto, Singapore: John Wiley and Sons Inc., 1996.
This book provides all the basic facts and an broad overview of dissociative identity disorder 2. Carlson, et al... Split Minds, Split Brains. New York and London: New York University Press, 1986.
Split Minds / Split Brains focused mainly on the history of dissociative identity disorder. 3. Coons, Philip. Child Abuse and Multiple Personality Disorder. (April 13, 1997) This article focuses on child abuse as being a precursor of dissociative identity disorder.
4. Rainbow House. The Collective Homepage of Rainbow House. (April 13, 1997) This article was written by a non-profit organization and it discusses the trauma of dissociative identity disorder.
5. Sird an Foundation. Dissociative Identity Disorder (Multiple Personality Disorder). 1994.
April 13, 1997) This article provided an outline of dissociative identity disorder, but instead of just brushing over the surface of the factors, it went into more detail.
6. Michaelson, Larry K., Ray, William J. Handbook of Dissociation. Theoretical, Empirical, and Clinical Perspectives. Plenum Press, New York. 1996.
This book goes into great deal of detail of the facts, treatments, causes, etc. of all the dissociative disorders. 7. Breiner, Sander J. "Multiple Personality". Psychological Reports vs. 76 (April 1995): 419-422.
This article gives a brief review of the some of the characteristics of dissociative identity disorder. 8. K luft, et al... Expressive and Functional Therapies in the Treatment of Multiple Personality Disorder. Springfield, Illinois: Charles C. Thomas, 1993.
This book goes into great detail about all of the treatments and therapies that are used with multiple personality disorder. 9. "Dual Personality Disorder". American Family Physician vs. 34 (July 1986): 260 This article briefly discusses a precursor to the switching of alters in DID patients.