Multiple personality disorder

Multiple personality disorder (MPD) is a mental illness. It is classified asa dissociative disorder and has been renamed dissociative identity disorder (DID). MPD or DID is a condition in which two or more distinct identities or personality states alternate in controlling the patient's consciousness and behavior.

The precise nature of DID (MPD) is still a subject of debate. Some researchers think that DID may be a culture-specific syndrome found in western society,caused primarily by both childhood abuse and unspecified long-term societalchanges. Unlike depression or anxiety disorders, which have been recognized for centuries, the earliest cases of persons reporting DID symptoms were not recorded until the 1790s. Most were considered medical oddities or curiositiesuntil the late 1970s, when increasing numbers of cases were reported in theUnited States.

Psychiatrists are still debating whether DID was previously misdiagnosed andunderreported, or whether it is currently over-diagnosed. Because childhood trauma is a factor in the development of DID, some doctors think it may be a variation of post-traumatic stress disorder (PTSD).

The most distinctive feature of DID is the formation and emergence of alternate personality states, or "alters." Patients with DID experience their altersas distinct individuals possessing different names, histories, and personality traits. It is not unusual for DID patients to have alters of different genders, sexual orientations, ages, or nationalities. The average DID patient has between two and 10 alters, but some have been reported to have over one hundred.

The severe dissociation that characterizes patients with DID is currently understood to result from a set of causes that include: an innate ability to dissociate easily; repeated episodes of severe physical or sexual abuse in childhood; and lack of a supportive or comforting person to counteract abusive relative(s).

The major dissociative symptoms experienced by DID patients are amnesia, depersonalization, derealization, and identity disturbances.

Amnesia in DID is marked by gaps in the patient's memory for long periods oftheir past, in some cases, their entire childhood. Most DID patients have amnesia, or "lose time," for periods when another personality is "out." They mayreport finding items in their house that they can't remember having purchased, finding notes written in different handwriting, or other evidence of unexplained activity.

Depersonalization is a dissociative symptom in which the patient feels that his or her body is unreal, is changing, or is dissolving. Some DID patients experience depersonalization as a feeling of being outside their body or as watching a movie of themselves.

With derealization the patient perceives the external environment as unreal.Patients may see walls, buildings, or other objects as changing in shape, size, or color. DID patients may fail to recognize relatives or close friends.

Identity disturbances in DID result from the patient's having split off entire personalities or characteristics as well as memories. When a stressful or traumatic experience triggers the reemergence of these dissociated parts, thepatient switches -- usually within seconds -- into an alternate personality.

Diagnosis of DID is complex. Patients are often treated under a variety of other psychiatric diagnoses for a long time before being re-diagnosed with DID.Many DID patients are misdiagnosed as depressed because their primary personality is subdued and withdrawn.

Other misdiagnoses include schizophrenia, borderline personality disorder, somatization disorder, and panic disorder. DID patients are often frightened bytheir dissociative experiences and may go to emergency rooms or clinics because they fear they are going insane.

When a doctor evaluates a patient for DID, he first rules out physical conditions that sometimes produce amnesia, depersonalization, or derealization. Ifthe patient appears physically normal, the doctor next rules out psychotic disturbances, including schizophrenia. Many patients with DID are misdiagnosedas schizophrenic because they may "hear" their alters "talking" inside theirheads. If the doctor suspects DID, he or she can use a screening test calledthe Dissociative Experiences Scale (DES) followed by specific additional testing.

Treatment of DID may last for five to seven years in adults and usually requires several different treatment methods. Patients should be treated by a therapist with specialized training in dissociation. Psychotherapy for DID patients has several stages: an initial phase for uncovering and "mapping" the patient's alters; a phase of treating the traumatic memories and "fusing" the alters; and a phase of consolidating the patient's newly integrated personality.Many DID patients are helped by group as well as individual treatment, provided that the group is limited to people with dissociative disorders.

Some doctors prescribe tranquilizers or antidepressants for DID patients because their alter personalities may have anxiety or mood disorders. Other therapists prefer to keep medications to a minimum because DID patients can easilybecome psychologically dependent on drugs. In addition, many DID patients have at least one alter who abuses drugs or alcohol, substances which are dangerous in combination with many medications.

While not always necessary, hypnosis is a standard treatment to help patientsrecover repressed ideas and memories. Hypnosis can also be used to control problem behaviors that many DID patients exhibit, such as self-mutilation or eating disorders. In the later stages of treatment, the therapist may use hypnosis to "fuse" the alters.

Alternative treatments that help to relax the body are often recommended forDID patients as an adjunct to psychotherapy and/or medication. These includehydrotherapy, herbal medicine, therapeutic massage, and yoga. Meditation is usually discouraged until the patient's personality has been reintegrated.

Some therapists believe that the prognosis for recovery is excellent for children and good for most adults. Although treatment takes years, it is often ultimately effective. As a general rule, the earlier the patient is diagnosed and properly treated, the better the chances for improvement.

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Apr 1, 2011 @ 9:09 am
I am doing a long term project on D.I.D and I was wondering if you could explain more to me on the transitions between each alter and what happens during the process: How quick is it...How obvious is it...How does it happen?
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Jun 21, 2011 @ 1:01 am
In the case of my fiancee, the transitions can be very quick, sometimes so quick that both of her two alters will be participating in the same conversation with me at the same time. There have been cases two where the two alters have argued with each other in my presence. Other times one will show up for a few days, the the other will show up for a few days, and I may not know what brought about the transition. About how obvious it is, it varies. Sometimes the personalities are a bit blurred together and other times they are very distinct. When they are blurred together the situation is actually the most volatile as she'll get irritated if I misidentified which one I am talking too and her two alters get jealous of each other. Many times I've been asked to say which one of them that I love more, and I have gotten in trouble for sleeping with the wrong one at the wrong time.

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