Dissociative identity disorder

Definition

Dissociation is a mental process in which there is a lack of connection in thoughts, memories, feelings, actions or identity. While dissociating, certain information is not associated with other information as it normally would be. Some believe that dissociation exists on a continuum ranging from daydreaming to Dissociative Identity Disorder at the other. However there is great overlap between the different dissociative disorders (DD), including DID.

DID was previously called multiple personal disorder but in 1994 the name was changed to reflect the changes in understanding of the disorder. It involves a disturbance in identity whereby two or more separate personalities or identities, known as alters, control an individual's behavior. "Personality" here is defined as "enduring patterns of perceiving, relating to, and thinking about the environment and oneself" (American Psychiatric Association, 1994, p. 270). When under the control of one alter, they may exhibit different behaviors, mannerisms, personalities, gender orientation, and physical properties (such as handedness, allergies and eyesight) and might not remember what transpired when another personality was in control. They may have as many as 100 alters or as few as two, though the average is 10 distinct ones, and they are stable over time. It is sometimes known as "disaggregate self state" because it is dissociated parts of the mind influencing behavior in DID patients.

Personalities may be aware of each other to some degree though only one will be in control at a given time; transitions are typically sudden and precipitated by stress (Morrison, 1995). Usually personalities are aware of loss of time when another personality is interacting with the environment.

Symptoms

The most known story of  multiple personalities is the one of Sybil Dorsett:

Shirley Ardell Mason (January 25, 1923 – February 26, 1998) was an American psychiatric patient and commercial artist whose life was documented in 1973 in the book Sybil, which was turned into the film of the same name in 1976. Both the book and the films used the name Sybil Isabel Dorsett to protect Mason's identity, though the 2007 remake stated Mason's name in its conclusion.

The book stated that Mason suffered from the condition as a result of severe sexual abuse at the hands of her mother, who Dr. Wilbur believed was clearly schizophrenic.
List of Sybil's "alters," together with the year in which each appeared to have dissociated from the central personality. The names of these selves were also changed to ensure privacy. List of names below.

1. Sybil Isabel Dorsett (1923): a depleted person; the waking self.
2. Victoria Antoinette Scharleau (1926): nicknamed Vicky; a self-assured, sophisticated, attractive blonde; the memory trace of Sybil's selves.
3. Peggy Lou Baldwin (1926): an assertive, enthusiastic, and often angry pixie with a pug nose, a Dutch haircut, and a mischievous smile.
4. Peggy Ann Baldwin (1926): a counterpart of Peggy Lou with similar physical characteristics; she is more often fearful than angry.
5. Mary Lucinda Saunders Dorsett (1933): a thoughtful, contemplative, maternal, homeloving person; she is plump and has long dark-brown hair parted on the side.
6. Marcia Lynn Dorsett (1927): last name sometimes Baldwin; a writer and painter; extremely emotional; she has a shield-shaped face, gray eyes, and brown hair parted on the side.
7. Vanessa Gail Dorsett (1935): intensely dramatic and extremely attractive; a tall redhead with a willowy figure, light brown eyes, and an expressive oval face.
8. Mike Dorsett (1928): one of Sybil's two male selves; a builder and a carpenter, he has olive skin, dark hair, and brown eyes.
9. Sid Dorsett (1928): one of Sybil's two male selves; a carpenter and a general handyman; he has fair skin, dark hair, and blue eyes.
10. Nancy Lou Ann Baldwin (date undetermined): interested in politics as fulfillment of biblical prophecy and intensely afraid of Roman Catholics; fey; her physical characteristics resemble those of the Peggys.
11. Sybil Ann Dorsett (1928): listless to the point of neurasthenia; pale and timid with ash-blonde hair, an oval face, and a straight nose.
12. Ruthie Dorsett (date undetermined): a baby; one of the lesser developed selves.
13. Clara Dorsett (date undetermined): intensely religious; highly critical of the waking Sybil.
14. Helen Dorsett (1929): intensely afraid but determined to achieve fulfillment; she has light brown hair, hazel eyes, a straight nose, and thin lips.
15. Marjorie Dorsett (1928): serene, vivacious, and quick to laugh; a tease; a small, willowy brunette with fair skin and a pug nose.
16. The Blonde (1946): nameless; a perpetual teenager; has blonde curly hair and a lilting voice.

Treatment

Treatment is mainly psychotherapy with hypnosis. The goal is to deconstruct the different personalities and unite them into one. The therapist attempts to make contact with as many alters as possible and tries to understand their roles and functions in the person's life. The therapist seeks to make a connection with personalities that especially display violent or self-destructive tendencies. Another goal of the therapist is to set up a communication among the personalities to retrieve traumatic memories from the past. Generally treatment is as an outpatient, though inpatient treatment may be used to achieve a specific goal. Behavior analysis has not been demonstrated to be effective.

Prognosis

Following diagnosis of DID, most therapists see 3-5 years as a minimum length of treatment, though more complex patient may require six or more years of therapy for the patient to be stabilized and unite their different personalities.

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