DID

Marasigan, Lorrie Gayle G.
ABPSYCH A51
What DID I just do?: A Specialization Paper on Dissociative Identity Disorder
1. What is this disorder?
Dissociative Identity Disorder (DID), formerly known as Multiple Personality
Disorder, is the presence of two or more identities or personality states that recurrently take
control of the person’s behavior (American Psychological Association, as cited in Kong,
Allen & Glisky, 2008, p. 686).” In addition, the person’s tendency to not remember what he
or she did should not be characterized by ordinary forgetfulness (Oltmanns & Emery, 2001).
Neutral identity states and traumatic identity states are the components of DID. Neutral
identity states repress traumatic experiences, thereby enabling normal functioning (Sno &
Schalken, 1999). The name MPD was changed to DID in the DSM-IV because according to
the chairperson of dissociative disorders committee, Spiegel (as cited in Oltmanns, Neale &
Davidson, 1999, p.85), “the problem [of people with DID] is not having more than one
personality; it is having less than one personality.”Most literature describe DID as such an
abstract disorder that it has sparked controversies (Forrest, 2001; Oltmanns & Emery, 2001;
Scroppo, Drob, Weinberger & Eagle, 1998).
Causes
Though to date, several debates and discussions have been held about DID, there are
not many empirical studies on it (Forrest, 2001; Scroppo et al, 1998), yet, since there has
been no unanimous account for its etiology and treatment, several models or theories have
been formulated to explain them (Forrest, 2001). Four will be tackled in this paper: the
neurobiological model, the development of the self, the reorganization of neurons based on
experience, and a more skeptic point of view, social construction.
Neurobiological model. A distinct feature of DID is amnesia for subjective experiences. As
explained in this model, it may be a possibility that damage on the prefrontal lobes, more
specifically the orbitalfrontal cortex (OFC), of the brain is a factor in the development of
DID. Since the OFC is powered by neurotransmitters such as dopamine and norepinephrine
that balance “emotion, attention, movement and visceral functioning (Forrest, 2001, p.263),”
damage to this part of the brain may cause disorganization of behavior, particularly the
regulation of information. However, in a study conducted by Cicerone and Tanenbaum (as
cited in Forrest, 2001), people with damage in the OFC tend to show an appropriate
behavioral template or schema in a simple, structured situation. Nonetheless, the problem
with this is that social contexts tend to be complex, thus, sometimes these people do not
succeed in showing an appropriate behavior (Forrest, 2001).
The development of the self. Self-schema or the conceptual framework of the self is a unified
concept of different Me concepts. Basically, this is generally an integrated sense of a Global
Me. The ability to accommodate and assimilate or think about concepts, perceptions and their
relationships is necessary to build an integrated sense of self. Piaget’s model of cognition
inspired Forrest’s (2001) Cognition Model where interaction of projection, assimilation,

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accommodation and dissociation is explained. Perceptions or the tangible objects are linked
to concepts or the abstract subjects. This process is where accommodation and assimilation
occur. Later on, this process would be projected in a behavior. If a person does not have a
concept of a certain perception, dissociation tends to happen. This is an unconscious act
which may explain the DID patient’s inability to recall his or her alter personality state
(Forrest, 2001).
The reorganization of neurons based on experience. Plasticity is said to be the human brain’s
central feature. It is the ability of the brain to change and adapt to whatever stimulus is
embedded (Pinel, 2008). Receptive fields or the activated neural network are composed of
excitatory and inhibitory neurons. If two different excitatory neurons are stimulated, the
inhibitory neurons step in to make a distinction between the two. Failure to do so will create
an overlap of the two stimuli, thus distinction would be difficult to detect. For people with
DID, the continuity of excessive unstable experiences (e.g. schizophrenic parenting, abuse,
trauma) may contribute to the overlap of two or more supposedly distinct self representations
(Forrest, 2001).

Social construction. Among the causes discussed in this paper, social construction may just
be the most controversial. This hypothesis came from the article Host of Significant Others
(n.d.) where it was stated that the mainstreaming of DID in pop culture most especially the
publication of ‘The Three Faces of Eve’ in 1957 and ‘Sybil’ in 1973 may have contributed to
the inflation of the number of DID diagnosis. The number increased from less 200 to almost
40,000 cases. A more recent portrayal of DID is the film ‘Fight Club’ in 1999. These pop
culture icons may have contributed to people’s awareness and preparedness to DID, but they
may also be representations that DID is simply a social construction (Host of Significant
Others, n.d.). This phenomenon may also be coined as role enactment (Oltmanns & Emery,
2001).
Likewise, it has always been a debate over nature and nurture; nonetheless, it has
always been the compromise of the two which remains prevalent.
Prevalence
DID is said to be a rare condition (Oltmanns & Emery, 2001). Before the 1980s, only
about 200 cases were reported in the whole of world literature. However, as mentioned
earlier, controversies about the diagnosis of DID sparked as the number of cases dramatically
increased after the 1980s. Using a structured interview guide, The Dissociative Disorders
Interview Schedule (DDIS), Ross (as cited in Oltmanns & Emery, 2001) depicted that 10% of
the entire Canadian population actually has dissociative disorders, 3% of which is DID.
Using the same interview guide, Sar, Akuz, and Dogan (2007), found out that 1.1% of the
Turkish general population of women were diagnosed to have DID. In a 1986 survey
conducted in North America in 1986, 6,000 cases of DID were reported. These results seem
to be in contrast to stating that DID is rare, so Waller and Ross (as cited in Oltmanns &
Emery, 2001) argued that there has been many misdiagnosis of DID and other dissociative
disorders.

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People commonly affected
DID occurs commonly at the mean age of 30-35, commonly among 87.7%-92% in
women, a 1:9 ratio of men to women (Sno & Schalken, 1999), with the average of 13-15
personalities, 53-63% of which are of the opposite sex. 95-98% of these patients have
personality states which do not know each other. 75-84% of the patients have a history of
sexual or physical abuse (Ross, as cited in Oltmanns & Emery, 2001; Putnam, Oltmanns &
Emery, 2001). Majority of the patients, however, were outpatients (Sno & Schalken, 1999).
Symptoms
Symptoms of DID include symptoms of conversion hysteria (now called Somatoform
disorders), auditory hallucinations, various manifestations of borderline personality disorder,
sudden and uncontrollable transition between personality states, time lapses, headaches, and
the most important feature, amnesia or memory disturbances (Oltmanns et al, 1999). Of
course, diagnosis cannot be made final unless the criteria from the DSM-IV-TR are met.
These are:
A. The presence of two or more distinct identities or personality states (each with its own
relatively enduring pattern of perceiving, relating to or thinking about the
environment and the self)
B. At least two of these identities or personality states recurrently take control of the
person’s behavior
C. Inability to recall important personal information that is too extensive to be explained
by ordinary forgetfulness
D. The disorder is not due to the direct physiological effects of a substance (such as
blackouts or chaotic behavior during alcohol intoxication)
2. What are other disorders associated with it?
DID is often related to, of course, other dissociative disorders such as transient
depersonalization, depersonalization disorder, dissociative amnesia, and dissociative fugue,
and somatization disorder. People with these disorders may exhibit the same symptoms,
though they differ in the degree of dissociation. Transient depersonalization has the least
degree of dissociation while DID has the highest. The difference lies in the presence of
multiple distinct personality states. Post-traumatic stress disorder (PTSD) is also a
differential diagnosis for DID due to the presence of severe trauma in most cases.
Schizophrenia and other psychotic disorders are also said to be related to DID, however, DID
patients do not manifest severe hallucinations, delusions and other negative symptoms of
schizophrenia. Bipolar disorder is somehow related to DID, but it is more of the different
mood states rather than the manic, hypomanic, major depressive and mixed states that matter.
Finally, borderline personality disorder is also a differential diagnosis in the sense that there
is an unstable identity, but again, DID manifests two or more distinct personality states (First,
Frances, & Pincus, 2002)
3. What are the possible treatments for this disorder?

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Psychotherapy, medications and the combination of both are the main methods of
treatment for DID. Therapy for DID involves two major alternatives: to emphasize the most
functional or productive personality state or to consolidate and compromise the different
states (Oltmanns & Emery, 1999). The first method proved to be difficult and unstable as
seen in Chris Seizemore’s(the woman behind the story of The Three Faces of Eve) treatment
by Thigpen and Cleckley (as cited in Oltmanns et al, 1999) where in the course of a ten-year
follow-up, additional personalities still continued to emerge. The second method is the one
currently applied to DID patients. This includes several steps. First, the patient is familiarized
with the existence of his or her other identities. This may be done through videotaping the
patient during therapy. Second, the patient is made to understand about the disorder itself.
Books like ‘Sybil’ are ways to do this. Last, to be able to integrate the personality states, the
patient’s ability to share memories and emotions to the alters may be helpful, thus he or she is
taught to react to stress in an adaptive manner. Hypnosis could also be used to facilitate the
patient’s recall of events, though this seems problematic because it may lead to further
emergence of other alters (Oltmanns et al, 1999). Medications involve, but are not limited to,
serotonin inhibitors, tricyclic antidrepressants, anxiolytics, neuroleptics, anticonvulsants and
naltrexone, though their effectiveness were only slight to moderate (Sno & Schalken, 1999).
Besides these frequently used treatment for DID, Nejad and Pouya (2008) proposed painting
or art therapy as a way to pinpoint the patient’s problems and later on help integrate the
personality states.
References:
First, M.B., Frances, A., & Pincus, H.A. (2002). DSM-IV-TR handbook of differential
diagnosis. Retrieved August 29, 2010, from Google Books.
Forrest, K. (2001). Towards an etiology of dissociative identity disorder: A
neruodevelopmental approach. Consciousness and Cognition, 10, 259-293.
Host of significant others. (n.d.). Retrieved August 26, 2010, from
http://issuu.com/devondeaundrelinen/docs/host_of_significant_oters_issue
Kong, L.L., Allen, J.B., & Glisky, E.L. (2008). Interidentity memory transfer in dissociative
identity disorder. Journal of Abnormal Psychology, 117(3), 686-692.
Nejad, A.G. & Pouya, F. (2008). Paintings as instrument for treating patients with
dissociative identity disorder. European Psychiatry, 23, S304-S409.
Oltmanns, T. & Emery, R. (2001). Abnormal Psychology, 3rd ed. Upper Saddle River, NJ:
Prentice Hall.
Oltmanns, T., Neale, J., & Davidson, G. (1999). Case studies in abnormal psychology, 5th ed.
New York: Wiley.
Pinel, J. (2008). Biopsychology, 7th ed. Singapore: Pearson Education, Inc.

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Sar, V., Akuz, G., & Dogan, O. (2007). Prevalence of dissociative disorders among women
in the general population. Psychiatry Research, 149, 169-176.
Scroppo, J.C., Drob, S.L., Weinberger, J.L., & Eagle, P. (1998). Identifying dissociative
identity disorder: A self-report and projective study. Journal of Abnormal
Psychology, 107(2), 272-284.
Sno, H.N. & Schalken, H.F.A. (1999). Dissociative Identity Disorder: diagnosis and
treatment in the Netherlands. European Psychiatry, 14, 270-277.

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