Dissociative Identity Disorder among Teenagers - Essay Example

Dissociative Identity Disorder Among Teenagers Introduction The American Psychiatric Associations Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) defines Dissociative Identity Disorder (DID) as "a mental condition whereby a single individual evidences two or more distinct identities or personalities, each with its own pattern of perceiving and interacting with the environment." Previously, this condition was known as multiple personality disorder. It is one of the most challenging disorders (Kluft, 71-72). To make a diagnosis of DID, the person should have at least 2 personalities routinely taking control of the individuals behaviour. Also, the person should have associated memory loss that is actually beyond normal forgetfulness. It is important while making the diagnosis that symptoms of DID must not be the direct result of substance abuse or a more general medical condition (Kluft, 71-72). There are many controversies which swirl around this condition because of which it is difficult to diagnose, treat and discuss it objectively (Kluft, 71-72), making it an interesting topic for me to write on. Also, DID amongst adolescents is a relevant topic to discuss in the wake of rising child abuse and neglect which has a predominant effect on the development of DID. The true prevalence of this condition is not known, although it is estimated to be more than previously thought (Waseem, eMedicine). Etiology Disruption of the normal integrative processes of consciousness, perception, memory, and identity that define selfhood is known as dissociation (Waseem, eMedicine). It is a psychophysiologic process that alters a persons thoughts, feelings, or actions so that, for a time, certain information is not associated or integrated with other information as it normally is (Waseem, eMedicine). There is lot of controversy revolving the etiology of DID. Infact, the very existence of this condition itself is a controversy. While some researchers argue that this disorder occurs naturally, others implicate an iatrogenic role in this condition. Those who propagated the theory of iatrogenesis argued that DID is an artifact of the expectations and suggestive interventions of enthusiastic clinicians and that it never occurs prior to such expectations and interventions (Kluft, 71-72). Some others have proposed the interaction of several factors as the cause for DID. These include severe stress conditions in life, enlistment of steps in normal developmental processes as defenses and lack of sufficient nurturing and compassion in response to hurtful experiences during childhood. Traumatic experiences in childhood have been attributed to the enhancement of dissociation (Waseem, eMedicine). These experiences may disturb personality development, leading to greater potential for psychodynamic dividedness. Also, continued emotional and/or social deprivation may deny the chance to recover spontaneously (Kluft, 75-76). This is because individuals have an innate potential to dissociate that is reflected in hypnotizability ratings (Kluft, 75). It has been found that people who are easily hypnotized are more susceptible to DID (Kaplan, Serendip, 1998). There also appears to be a biological component given the fact that most people with DID have a family history of the disorder (Kaplan, Serendip, 1998). Thus, DID can be viewed as a chronic dissociative post traumatic stress disorder originating in childhood. The stress is known to come from severe physical, emotional, and/or sexual abuse at a developmentally sensitive stage in childhood (Kaplan, Serendip, 1998). In times of acute stress, various hormones like cortisol, epinephrine and norepinephrine, vasopressin, oxytocin and endogenous opioids are released which induce glucose release and activate the immune system, enabling the organism to effectively deal with the stress. However, in chronic stress, this effect is blunted and the system is desensitized. This causes the person to have an intense stress reaction in the presence of even the smallest trigger. Also, desensitisation causes exacerbation of the dissociative process and in order to survive extreme stress, individuals separate their thoughts, feelings, memories, and perceptions of traumatic experiences. This is what is actually dissociation (Kaplan, Serendip, 1998). The actual diagnosis of DID is not made until adulthood or adolescence. Since child abuse has been reported from most racial, religious, and socioeconomic groups of people from most geographic, educational, and occupational backgrounds, DID can occur in any racial and social economic group (Waseem, eMedicine). Also, since girls experience childhood sexual abuse more commonly than boys, they are more prone to DID. Clinical manifestations The survivors of extensive childhood abuse frequently present complicated clinical dilemmas including dissociative episodes, flashbacks, and self-destructive and suicidal impulses (Waseem, eMedicine). Clinical presentation varies. A child or adolescent who is experiencing dissociative symptoms may appear withdrawn, frightened, or uninvolved. These individuals appear different from their colleagues. They exhibit a plethora of fluctuating abilities, moods, fears, and anxieties; shifting preferences; inconsistent knowledge; and other evidence of erratic access to information and skills (Waseem, eMedicine). Most children and adolescents with DID have hallucinations which are mainly auditory. Some may even have phobic hallucinations and presence of these may not necessarily implicate psychological conditions because these hallucinations can be a transient manifestation after severe stress. The essential feature of dissociative disorders is a disturbance or alteration in the normally integrative functions of identity, memory, or consciousness and if identity happens to be the main function affected, and then it is known as DID (Kaplan, Serendip, 1998). Dissociation often enables victims to maintain a relatively healthy level of functioning because traumatic memories are disconnected from other information in their minds (Kaplan, Serendip, 1998). The various personalities exhibited are almost always are quite discrepant and often seem to be opposite. When a given personality is dominant and interacting with the environment, the other personalities may not perceive all that is happening. Thus the original personality usually has no knowledge of the other personality. However, each personality is well integrated and is a complex aggregate of unique memories, behavior patterns, and social relationships that control each individuals function during its dominant intervals (Waseem, eMedicine). These individuals may exhibit school difficulties, truancy, running away from home and juvenile delinquencies. In the long term, these individuals suffer from anxiety, depression and tension. There will an impact on interpersonal relationships and parents may find it difficult difficulty in parenting and responding to their own children. Also, these individuals have difficulty in trusting others, develop undifferentiated fear, have a sense of betrayal for no reason and are hostile. Those married either have difficulties in sexual life or are promiscuous and can contract various sexual related diseases. Some may even take solace in substance abuse (Waseem, eMedicine). Co-morbidity Most often DID is associated with other conditions like temporal lobe epilepsy, schizophrenia, borderline personality disorder, malingering and dissociative amnestic disorder (Waseem, eMedicine). These conditions must be identified and treated appropriately. In many situations, these conditions are more obvious than DID and DID may go unrecognized. Common treatments The commonly used treatment of DID is hypnotherapy and non-verbal therapy. The benefits from hypnotherapy are because of its facilitation of memory retrieval and calming, soothing, containment, and ego strengthening qualities. The main concept in hypnosis is "fusion rituals". The non-verbal forms of treatment are art and play therapy. These methods allow the individual to feely express their emotions and expressions in the form of art and play (Kaplan, Serendip, 1998). The response to treatment has been good in many cases (Kaplan, Serendip, 1998). Conclusion DID is one of the common psychological disorder and categorized as one of the four major dissociative disorders. The main factor which is dissociated in this condition is “Identity”. As discussed before, there are lot of controversies swirling around DID. The main issue is whether there is anything called "I-function" and if at all are there many I-functions and are they different? (Kaplan, Serendip, 1998). Although many factors have been attributed to the development of this condition, the more obvious cause seems to be repeated severe trauma in childhood and formative years. The trauma can be physical, emotional or sexual. Though the roots of the condition lie in early childhood, the diagnosis is not made until adolescence. In the childhood, a child who is isolated, sad and “looks different” from others gives a clue about DID. In adolescence, the individuals may exhibit a plethora of fluctuating abilities, moods, fears, and anxieties; shifting preferences; inconsistent knowledge; and other evidence of erratic access to information and skills. As they grow by into adults these individuals may have difficulty in parenting, socializing and trusting others. Married people may exhibit averse or excess sexual behaviour. The condition needs to be identified appropriately as many do well with treatment. Many associated co-morbid conditions exist. Hence even they must be identified and treated appropriately. Though there are many controversies about the etiology and the very existence of the condition, enough light has been thrown by research because of which more and more individuals are being diagnosed and given the benefit of treatment. References Kaplan, Rachel. “Dissociative Identity Disorder.” Serendip. 1998. 5 November 2007 Kluft, Richard. “Current Issues in Dissociative Identity Disorder.” Bridging Eastern and Western Psychiatry 1.1 (2003): 71- 87. Waseem, Muhammed. “Child Abuse & Neglect: Dissociative Identity Disorder.” eMedicine from WebMD. 2005. 5 November 2007 Read More