Psychology

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Multiple personality disorder ( which the American Psychiatric Association ( APA) renamed Dissociative Identity Disorder in 14,) has always been fascinating and mysterious. In the past people with this disorder were seen as being possessed with demonic spirits and were often treated with exorcisms. When this belief began to decline the true nature of dissociative identity disorder ( also known as DID) began to unfold. With the awareness of a child abuse increasing and statistics showing 5% to 8% of more than a 1,000 patients with DID reporting a history of child abuse (Braun 10), Dissociative Identity Disorder quickly gained the publics attention.


People also began to gain interest in the disorder with the rise of feminism. When research showed that % of 100 DID cases reported were females, many feminist groups began to show their concern (Kluft, 1). The number if DID cases are increasing rapidly, it is said that DID affects approximately 0.1% of the United States population (Braun 10). However, some people remain very skeptical about this disorder, saying that it is drummed up by the media ( in movies like Three Faces and Eve) While others believe doctors created it. On many lawyer shows at times we do see cases of people with memory defects, moodiness, and unpredictable behavior (symptoms of DID, Nathan & Groman 18) commiting a crime, then convincing a lawyer that they did not do it, that the crime was committed by another personality within them. The lawyer then develops a defense of Multiple Personality Disorder. This leaves audiences in shock and wondering what the disorder really is, How does it develop? And does it really exist?


According to many researchers and the American Psychiatric Association this disorder does exist, and has its origin in dissociation. Dissociation " is a depression in the usual integrated function of the consciuusness, memory, identity and perception of the environment" (Encyclopedia of Psychology,000 pg56). According to Putnam (a leading researcher of Dissociation is said ,to be a normal process that is initially used defensively by an individual to handle a traumatic experience. This may explain why dissociation seems to occur when a traumatic situation is present (Nathan and Gorman 18).


Disassociation becomes maladaptive, it forms four main disorders. These may be considered the children of dissociation, and can fall under the family name dissociative disorders, they are Amnesia, fugue, depersonalization and dissociative identity disorder. When a person is involved in a natural disaster or has been raped, the mind may try to block any memory of that experience; this is known as amnesia. Amnesia becomes maladaptive when people begin to forget their name, age or personal history. Dissociative Amnesia is the most common form of dissociative disorders. People suffering from dissociative fugue are not. Disassociative fugue is characterized by "unexpected travel away from home or one's customary place of daily activities ( for days), with inability to recall some or all of the past." (Nathan & Gorman 18, pg.45). Funguecan seem sometimes like aimless wondering (Putnam 18). Not much is known about this disorder; however , researchers do know that in most cases a person with disorders sometimes take on a new identity and is unable to remember personal information until they return to the original identity (Nathan & Gorman, 18).


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Another form of dissociation is depersonalization; it is a chronic and recurrent experience of feeling detached from one's thoughts. Feelings, sensations or experiencing that they are some how unreal or in a dreamlike state ( Encyclopedia of Psychology,000 pg.57). It is important to realize that these disorders are developed by the mind as a form of protection against traumatic experiences. In most cases of amnesia the mind tries to block traumatic situation from the memory; sometimes this works, sometimes it does not. In fugue state, the mind may be trying to escape the traumatic situation by wondering away from the environment that is causing the trauma. In the case of depersonalization the mind may be trying to create a sense that the experience is not reality, in order to help the person suppress and repress the trauma. Disorder is one of the main four disorder of dissociation. It is the extreme of all four disassociative disorders. According to Diagnosis and Stastistical Manual of Mental Disorders, the fourth edition, there is four criteria for DID The presence of two or more distinct identities or personality states. At least two states recurrently that are taking control of the persons behavior. Inability to recall important personal information to which can not be explained by normal forgetfulnesds. This distirbance cannot be caused by a substance or a general medical condition (as cited in Encyclopedia of Psychology, 000).


Dissociative Identity Disorder is example of dissociation becoming maladaptive to the extreme. It becomes maladaptive when "it exceeds certain limits in intensity, frequency or occur in a inappropriate context" (Putnam 18 pg. ). Many researchers believe that there are predisposing factors that leaad to the development of DID. Richard Kluft developed the four-factor theory.


1. The person's innate ability to disassociate


. A pattern of abuse


. Occurrence of overwhelming trauma (which creates a reason to disassociate)


4. Inadequate protection of a child suffering from the trauma,the -P model


Braun and Dachs proposed their model similar to Kluft four factors theory in that they both agree that the same predisposing factor account for DID development . Other researchers on the issue of Dissociative Identity Disorder suggested the double-bind theory (as cited by Kluft, 1). An example of the double-bind theory , would be when a child is raped by a sibling and the sibling tells the child that they are doin it for the child's own good. If the child decides to tell the parent, then he/she may be called a liar and made feel like a bad person for making that type of accusation on a sibling (Kluft,E 1). The child may be left with the feeling of fear, humiliation and conflicting demands to please everyone, without being rejected by others (Waithes 1). Baldwin (author of the article Child Abuse as an Antecedent of Multiple Personality Disorder) explains that this forces the child to become two conflicting person. He or she is forced to create a good and a bad self. Childhood trauma is the leading cause of dissociative identity disorder.


According to Putnam , a study done by the National Institute of Mental Health shows that of a 100 reported cases of patients with DID, 7% reported experiencing trauma as a child. Childhood trauma can be sexual abuse, physical abuse, extreme neglect, witness to a violent death, or extreme poverty. Sexual abuse is the most common form of childhood trauma reported. Incest accounting for 68%, making it the most common form of sex abuse. Sexual abuse may include insertion of instrument in the vagina, mouth, anus and sexual torture. Physical abuse was the second most reported, it was reported in 75% of the 100 cases studied. Physical abuse can range from beating with hands or fists to different forms of tortures.


In trying to cope with these traumatic experience DID may develop. It becomes "an adaptive dissociative response of a young child's mind to fear and pain of an overwhelming trauma" (Dell & Eisenhower 10 pg7). Not all children who suffer a traumas develop DID but according to researchers ,DID is easier for children to develop, than for adults. One reason for this is that children tend to be easier to hypnotize, thus making it easier for them to dissociate (Putnam 18). Another reason, according to Stephen Marmer pg85 ( a researcher involved in the study of DID), is that at a certain age about "18 months to 4 and 5 years of age they are at a vulnerable time in development." According to him at thid phase the distinction between self and object is still cloudy and there is a tendency to use the defense mechanisms of splitting instead of repression. He writes that the "cognitive ability to conjure different identities is not present prior to the vulnerability window and the ability to use more advanced commences at the end of the vulnerability window".


Braun (developer of the -p theory) compared the development of DID to the learning process. According to him when a child suffers a trauma he or she develops a response of dissociation to it. A repetition of this trauma reinforcement's the response of dissociation. This response will later become associated with trauma. Then whenever the child experiences this trauma, this response automatically happens. One might say it becomes a conditioned response. After a period of time the child's personality becomes "split". By split this means other personalities develops. This gives the child the sense that the trauma it is not happening to him/her, but to someone else (Waites, 1). This split will now occur whenever the child feels it necessary for defend (DELL & Eisenhower 10). These personalities are known as alternates. These alternate personalities will now act as a "stimulus barrier to overwhelming experience, memories and conflicts serving as a defense against internal disorganization an chaos (Armstrong,14 pg15). These personalities help the child to escape the trauma, but once this type of defense is chosen any stimuli in the environment can trigger a splitting reaction, causing other personality to develop (Whitman, 11).


Dissociative Identity Disorder begins in childhood , but in most cases it is diagnosed in adults. Also children tend to have to have fewer alternate personalities than adults (Baldwin, 10). According to Baldwin, upon diagnosis children have an average of approximately a alternate personalities, while adults have an average approximately 1. Alternate personalities may be a difference in voice, sex, accent, reaction to medication, and even handwriting (Kluft 1). Putman described the many different kinds of alternate personalities that may develop over a period of time dissocitive identity disorder.writing (Kluft 1). Putman described the many different kinds of alternate personalities that may develop over a period of time dissocitive identity disorder. In this research, he found that in almost all cases, one or more of these alternate personalities is a child. Child alternates usually hold the memories of the traumatic experiene. Then there is the protector alternate. This alternate personality protects the host personality from internal and external danger. It tries to bring a balance to the chaos going on inside the host. In most cases the protector personality is a male. There can be many other alternate personality. However, the personality that is depicted the most on television is the prosecutor personality. According to Putnam this personality may have originated from the protector personality. This means it may have been the one to suffer from most the traumatic experience. It blames the host personality for being weak and may try to take control of the host life by sabotaging. It may even try to kill the host personality. Since alternate personalities believe strongly in what they say they are, they do not see killing the host as killing themselves (Waites 1). This alternate personality may try turning the host personality family against them or causing legal troubles for the host personality. According to Putnam 167 the host personality is not the original personality,


It is the alternate personality that has "executive control of the body the greatest percentage of any given time ". They are often not aware of the other personalities. They are also the ones to seek out medical attention (Putnam, 18); Kluft believes that everyone at birth develops at least on alternate and that the original personality is put to sleep and only after intense treatment it is revealed (Putnam,18).


Treatment of dissociative identity disorder may involve, psychoanalytic techniques, encouraging integration of alternate personalities and formal hypnosis in order to facilitate.


Memory retrieval (Nathan & Gorman 18). Hypnosis as a treatment is causing most of the controversy about the validation of dissociative Identity Disorder. Skeptics claim that through suggestion and hypnosis patients are made to believe that they have this disorder. This means that while patients are made to brlieve that they have this disorder. This means that while patients are under hypnosis doctors use the power of suggestion to create this disorder , by implanting information into the patient's memory. Some also say that individuals looking for therapists willing to believe their condition created dissociative identity disorder.


The supporters of DID claim that skeptics are just plain "missing it, either failing to look for it or by recognizing it" (North, Ryall, Ricci,&Wetzel,1,pg7). The argument between the two sides about the validity of DID is a very heated , to the point where doctors are questioning each others compentency. According to North, Ryall, Ricci, and Wetzel, to settle this disagreement the five phrases of validating a psychiatric disorder should be used. The first clinical description, which means that the criteria of the disorder should be specified. One of the arguments made by skeptics is that the diagnosis of DID have risen dramatically because of the media influences. Supporter says this not so, the criteria is too vague, which cause DID to be misdiagnosed for illnesses such as schizophrenia. Secondly, laboratory studies, which would involve neurophysiologic investigation. These would attempt to observe the physiologic difference in the alternate personalities.


Skeptics believe that actors can be trained to trick doctors into believing that they have this disorder. Supporters of DID say that anyone could pretend that they are ill, however ,that may not be the truth. The third phase is delimitation from other disorders. This means specifying the criteria that an excluded, making sure this disorder can't be mistaken for any other disorder. The fourth phase is follow-up study. North. Ryall, Ricci, and Wetzel pg41. Claim that it will support the validility of dissociative identity disorder "if time proves the disorder remains the same it will suppoet the idea of natural history and prognosis".


The final phase involves a family study. This entails looking into family history since most psychiatric disorders seems to run in the family. According to North, Ryall, Rucci, and Wetzel these five items are called Robins Guze Methods, can help prove the validity of any psychiatric disorder. They claim that researchers are "struggling with the first item in that laboratory investigations, deliniations from other disorders, followed-up study, and family all have yet to yield consistent findings" (pg.41).


The fact that the American Psychiatric Association recognizes this disorder has existed shows that much has already been discovered about this disorder. We now know Dissassociative Identity Disorder is the presence of two or more distinct identity stating that one take control of the body and is a result of trauma suffered as a child; and is not a result of demonic spirit taken control of the body, but there is still much work to be done. One thing to keep in mind, is just as there will always be skeptics about Dissassocitive Identity Disorder, it will always remain a fascinating and mysterious.


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