2. Characteristics A person displays multiple distinct identities, known as alter egos, each with its own pattern of interacting with the environment Also known as Multiple Personality Disorder
3. Diagnosis At least 2 personalities take routinely control of an individual Memory loss that goes beyond normal forgetfulness. Cannot be temporary effects of drug use
4. Signs and Symptoms • lapses in memory (dissociation), particularly of significant life events, like birthdays, wedding, or birth of a child • blackouts in time, resulting in finding oneself in places but not recalling how one traveled there • being frequently accused of lying when they do not believe they are lying (for example, being told of things they did but do not recall) • finding items in one's possession but not recalling how those things were acquired • encountering people with whom one is unfamiliar but who seem to know them as someone else • being called names that are completely unlike their own name or nickname • finding items they have clearly written but are in handwriting other than their own • hearing voices inside their head that are not their own • not recognizing themselves in the mirror • feeling unreal (derealization) • feeling like they are watching themselves move through life rather than living their own life • feeling like more than one person.
6. Controversy Most diagnoses and literature in the US (overrepresentation) Pope, Oliva, Hudson, Bodkin, and Gruber (1999) surveyed a group of 301 board certified American psychiatrists their results indicated that only 1/3 of those surveyed felt that DID should be included in the DSM-IV (1994) without hesitation, while the remaining felt that it should only be a proposed diagnosis.
7. Case Study In the DSM-IV casebook (Spitzer, et al.,1994), a case study of Mary Kendall, a 35 year-old caseworker is discussed. Mary does not have much of a social life, but rather devotes herself to helping others. Mary has a quite extensive medical history, including chronic pain in her right hand and forearm, which is actually what led her to meet with a psychiatrist. She displays many of the characteristics common in individuals diagnosed with DID such as the ability to be easily hypnotized and frequent gaps in her memory (especially memory for events that occurred in her childhood).The case study of Mary Kendall (Spitzer, et al., 1994) describes her frequent gaps in memory, which she realized when she noticed that her gas tank would often be almost full when she returned home from work, but almost empty in the morning. After Mary began to keep track of the odometer reading she realized that 50-100 miles were often put on the car overnight, even though she could not remember driving anywhere. During a hypnosis session with the therapist, one of the hostile personalities (Marian) emerged. Marian described rides that she often took at night in an attempt to work out her problems. The alter personality, Marian, displayed strong contempt for Mary. Marian felt that Mary was very pathetic and that it was a waste of time to always be concerned about others. In the course of therapy about six personalities emerged, who were often in conflict with one another Spitzer, et al., 1994). Various childhood memories emerged through the course of therapy including abuse (physical and sexual) committed by her father and guilt surrounding these events since she did not protect her other siblings from encountering the same fate (Spitzer, et al., 1994). Psychotherapy, especially in the case of DID, is not a rapid process. Mary Kendall participated in therapy for four years before a gradual integration of the personality states was evident. Although some of the personality states were able to integrate, others were not and remained in conflict with one another (DSM-IV casebook, 1994).
