People with split personality. Critical attitude to the diagnosis. Difference of opinion.

14.09.201827.05.2017

Before taking the test for multiple personality disorder, we suggest that you familiarize yourself with basic information about the disease.

Dissociative identity disorder, split or split personality, is a fairly rare mental disorder. It belongs to the group of dissociative disorders, that is, mental conditions characterized by disturbances:

What matters is the type of service, its function and the team's ability to meet the needs and requirements of these customers. Important various types interventions available to the agency, social worker skills to implement them, supervision, team development, use of referrals.

The ability of social workers to provide effective family interventions and successfully influence interpersonal relationships, especially in the case of destructive and violent behavior. Characteristics of social workers. Since the basis of treatment and work with borderline people is the interaction of the subject and the creation of a corrective emotional experience, workers in this.

memory;
continuity of self-awareness;
self-identification.

A severe form of dual personality is characterized by alternating periods of self-awareness with periods of oblivion. This happens because the primary personality of the individual is temporarily suppressed by the manifestations of another personality that has arisen in consciousness.

The other “I” may have a different gender, nationality, age, but the periods of functioning of the other “I” are erased from the patient’s memory, he does not remember himself in a different image, he only notes gaps in his memory.
The social worker must be able to connect with the client to create a therapeutic relationship with him; to be able to provide the support, empathy and understanding that was so lacking for the client in his early life. The social worker must help the client become a separate person with his own identity.

The social worker should not be passive; he must behave like a real person and reduce fantasy and negative transmission. The social worker must focus on reality issues and problem solving to help the client experience a sense of success and create a more positive perception of themselves.

Contrary to popular belief, schizophrenia and multiple personality disorder are not the same thing. Schizophrenia is characterized by a complete loss of self-identification, and split personality can be expressed by temporary manifestations that are completely unusual for a person (statements, eating habits, leisure activities) without loss of self-identification.

The social worker must build relationships of mutual respect and expectation to achieve positive results. This is the only way for clients to improve their self-esteem and gain more confidence in their strengths. The social worker must be able to set ground rules and enter into an agreement with the client so that he does not act impulsively and recklessly. He must be able to curb these impulses for thoughtless behavior during the therapy session and thus make them available for discussion and step-by-step processing.

Doctors see the cause of split personality, which occurs in a mild form, in information oversaturation and the high level of stress inherent in modern life.

Causes of split personality

The main reason for the emergence of another/other personalities in a person’s mind is strong emotional trauma suffered in early childhood. The leader among them is violence in various forms: emotional, physical, sexual.

The social worker must be prepared to take on a caring role and demonstrate this clearly to the client at the outset of work. The social worker must be able to use his own ego in the relationship, act as a monitor and help the ego for the client.

The social worker must be able to help the individual client and at the same time be able to involve the family in the therapeutic process because, whenever possible, working with the family is of paramount importance. The social worker must focus his efforts not only on the client's personality, but also strive to provide specific services and use them as interventions to reach the client.

In response to a trauma suffered or a terrible picture seen, a defense mechanism is triggered in the child’s psyche - another child appears who has not seen or experienced difficult events. Or the child is replaced by another person who takes revenge for the insults inflicted on him.

If traumatic circumstances are repeated again, new images begin to dominate the mind, triggering the onset of dissociative disorder.

The work should be both individual and family oriented and be either supportive or rehabilitative. Goals must be achievable and realistic. The immediate social situation must be part of the work plan. If the client and social worker understand themselves as a long-term endeavor, they must define three phases.

Stage of trust, trust and creation of a trade union; the processing stage, which includes, but is not limited to, coping with the underlying depression; stage of separation and constructive direction in life. These long-term goals can be easily defined, which makes it difficult to achieve this goal due to the tendency of these clients to run away from work. Their peculiarity is related to their long-term behavior that is detrimental to their own interests, the pain caused by repressed pain and their narcissistic rage. If the client may be involved for some time, the theories described in this article suggest the following goals.

Test

The test for multiple personality disorder is one of the means of identifying a tendency to the disease and its development at an early stage.

With a clear clinical picture and developed symptoms of the disease, the doctor no longer needs tests - he will make a diagnosis without them.

But if you notice the manifestations described above, take this test, you may actually be developing a dissociative disorder. However, to make an accurate diagnosis, you should contact a neuropsychiatrist, psychotherapist or psychiatrist.

Providing support for the integration and aggregation of good and bad parts, eliminating splitting mechanisms and associated behavior patterns. Instead of accepting primary first aid rather than fighting it. Inclusion of primitive idealizations and projective identifications in the context of reality and the development of normal release.

Developing mature dependence through the therapeutic relationship instead of infantile immaturity. Developing a sense of mastery, impulse control, and frustration tolerance. Involving the ego in realistically planning and carrying out a healthy solution through the problem solving process.

Test for multiple personality disorder

Do you sometimes forget important details of events?
Do you tend to frequently change your opinion about yourself, the people around you, and moral values?
Do you experience repeated mood swings (3-5 times during the day)?
Do you experience frequent depression?
Is stress common in your life?
Have you experienced severe psychological shocks, after which depression, suicide attempts, or personal degradation occurred?
Do you plunge into states of reverie, into imaginary worlds with your heroes and actors? Does time stop for you during periods of immersion in them, do you want to stay in them longer?
Is your discomfort among strangers severe?
Do you have eccentric behavior, self-talk, and untidiness in clothing?
Do you have confused, unclear, abstract speech with frequent deviations from the topic?
Do you have excessive restraint or inappropriate emotional expressions?
Do your religious beliefs and thoughts about the supernatural differ from generally accepted ones?
Do you notice frequent internal contradictions in yourself?
Do you remember stressful situations clearly and for a long time?
Can you restore the chronological sequence of all the events of your life?
Are nightmare or dream-like memories, vivid, terrible images invading your memory?
If you were sexually abused as a child, do intrusive images, visual or sensory memories of it return to you during sexual intimacy with your husband or partner?
Are there supportive voices in your head commenting on your actions?
Do you speak to these voices?
Are they answering you?
Do you sometimes talk out loud to yourself?
Would you describe your thinking as illogical? Do you experience strange associations, blocked thoughts, or out of sequence?
Do you remember experiencing auditory and/or visual hallucinations?
Every person has a second “I”, which does not always manifest itself. Does your other self have a name?
Do you remember circumstances in which you acted automatically or completely against your will?

Results

Wake up, feel better, embrace them and create best feeling self-esteem, reducing behavior that violates their own interests and recognizing achievements. Acceptance of our own separation and wholeness. Developing the client's ability to connect with and accept others to connect with them through a therapeutic relationship of trust and warmth. Achieving intimacy without fusion, separation without rejection and individuality in society and family.

Assisting the customer in meeting specific needs. Using these experiences as part of a relationship and building trust. General considerations related to work. Working with a borderline client places many demands on the social worker: to be imaginative, creative, flexible, patient, and aware of the client's complex behavioral patterns in order to adapt to them. Providing a corrective experience when a client is filled with anger or feels completely empty requires constant assessment, slow relationship building, and the professional's ability to tolerate rejection and at the same time remain sensitive to the person versus himself.

For each “Yes” answer, 4 points are awarded, for each “No” answer - 2, the points are summed up.

Up to 30 points

Your chance of developing multiple personality disorder is practically negligible; there is no reason to talk about the beginning of the development of the disease.

From 30 to 70 points

Perhaps you have experienced events that have severely damaged your psyche. You either successfully coped with the consequences of these incidents or stopped on the verge of developing the disease. Contact us for psychological help, avoid stress, fill your life with pleasant experiences.

Because these clients often collapse, the social worker is immediately available to confront conflicts immediately and as soon as necessary, calm and shut down anger, and offer a helper ego to help the client cope with the situation and resolve immediate problems.

The social worker must be able to tolerate compliance with clients' demands and demands and make them the focus of realistic discussion. The professional must also be well aware of when to step up and care for a client and when to distance themselves because the person cannot hold back at the moment. The employee can set boundaries and express expectations politely, be approachable and maintain a reality orientation, and at the same time become a positive role model that can be internalized by the client.

From 70 to 100 points

There is a high probability of the disease starting in the near future; urgently seek psychological help.

Dissociative identity disorder– this is a whole complex of mental personality disorders, which is characterized by transformations or disorders of a number of processes occurring in the psyche of subjects, such as a sense of personal identity, memory, consciousness, awareness of the continuity of one’s own identity. As a rule, the listed processes are united in the psyche of subjects, but when dissociation occurs, individual processes are isolated from consciousness and become somewhat independent. For example, a personal identity may be lost and a new one may appear, as in dissociative fugue or multiple personality states, or individual memories may become inaccessible to consciousness, as in psychogenic amnesia.

If a person can meet these requirements, he is an ideal professional to work with edge clients. Because many borderline clients tend to satiate their stress, hypochondriasis, especially among adults, is widespread. For this reason it may be necessary medical examinations symptoms that may clearly reject the possibility of actual somatic problems. Expressing concern and acceptance is important, especially because many clients tend to translate bad feelings about themselves into bad physical symptoms.

Causes of dissociative disorder

Dissociation is a specific mechanism by which the mind splits into component parts or separates certain memories, images, thoughts of consciousness. Such split subconscious mental images are not erased and can spontaneously reappear in consciousness due to the influence of certain triggers, which are called triggers. Objects, events, and circumstances surrounding during the occurrence of a traumatic event can serve as such triggers.

Among the interventions used by social workers, reaching out to clients outside of the service setting is a particularly important method because these individuals should be actively sought out and invited to participate in some type of work or treatment. Either they tend to distance themselves, or their biting causes the social worker to act distant. Once a therapeutic alliance has been established, possible transduction reactions must be the subject of active intervention by a professional who takes into account the client's fears and fluctuations in mood.

This condition is caused by a combination of several reasons, such as the ability to dissociate, severe stress, the demonstration of protective mechanisms in the processes of ontogenetic development and childhood due to a lack of care and compassion for the baby during a traumatic experience or a lack of protection from subsequent hostile experiences. After all, children are not born with a sense of a single identity. Identity is formed based on a large number of sources and many experiences. In critical conditions child development encounters obstacles, and some parts of what should have been integrated into a relatively unified identity remain segregated.

Moreover, since these people tend to express their feelings in their behavior rather than reframe them, the social worker must play a strong role in initiating impulse control. When the relationship is going well, confrontation and interpretation are periodically used to address destructive patterns of behavior as an attempt to help the client protect himself. Changing a client's low self-esteem requires a strong working relationship and a quick response to the employee when a problem arises.

Repetition and maintenance of successful decisions and experiences is important. Many methods, concepts and processes of long-term work can also be used in a shorter period of time. Short-term, well-planned goals are often the only possible approach for borderline clients.

Numerous studies show that nearly 98% of adults with a history of dissociative identity disorder report incidents of childhood abuse. age period. Such violence can be documented in 85% of the adult population and 95% of children and adolescents with multiple personality disorder and other similar forms of dissociative disorder. These research data demonstrate that in childhood violence is one of the main reasons dissociative disorder. However, some patients had no history of violence, but all had experienced early loss of a loved one, serious illness, or other major stressful events.

We should not frown or laugh at this as an inadequate idea. This way of working may be most practical when services involve many such clients, and when it is clear that clients cannot or will not participate in long-term treatment plans. Crisis interventions are a type of short-term work that can at least temporarily create some balance. Planned short-term interventions focusing on special attention smaller, immediate and irreversible problems do not create an intense relationship, and the separation plan created may be better than the borderline client as it makes them feel more secure.

The process of human development requires the individual to be able to successfully integrate different shapes complex information. During ontogenetic formation, an individual goes through a number of stages of development, in each of these stages different personalities can be created. The ability to produce multiple personalities is not found or found in every child who has suffered violence, severe loss or trauma in childhood. Patients with dissociative disorder have the ability to freely enter trance states. This skill, combined with the ability to dissociate, acts as a factor in the development of the disorder. At the same time, most children who have these abilities also have adaptive mechanisms that correspond to the norm, but are not in circumstances that provoke dissociation.

If the short-term work is successful and the goals are achieved, the client will feel better and be more confident. Therefore, he will be more inclined to work longer hours later. An invitation to re-use the service and an offer to work in a series of short-term contracts separated by periods of interruption of contact may be more feasible and acceptable to many clients. According to some therapists, telephone contact between work periods is a good solution because it maintains the relationship at a level that is acceptable to the client.

Dissociation is a serious and rather lengthy process with a huge range of effects. Just because an individual has a dissociative disorder does not mean that they have a symptom of a mental illness. A less pronounced degree of dissociative disorder can occur as a result of stress factors, in subjects who spend a long time without sleep, or when suffering a minor accident. Another simple example of dissociative disorder in individuals is the periodic complete fascination with a film or book, which leads to the fact that the world around us simply ceases to exist, and time passes unnoticed.

Most of these clients have families; Maintaining such contact is also a good solution for these families. Once a therapeutic relationship with the boundary has been established, treatment techniques can be used to treat any other person's disorder. Methods available include confrontation, insight, interpretation, support, client availability, crisis intervention, and the use of transfer. Working with loss, depression, ego and object splitting, neutralizing aggression, reducing projective identification and primitive idealization are the goals of the work.

So, dissociative identity disorder is often closely associated with exposure to stress factors that lead to stressful conditions in individuals. A stressful conditions can occur after suffering various traumas, as a result of abuse, internal personal conflicts, attention deficit and immense empathy in childhood, the ability to share one’s own memory and identity from awareness.

Since individuals are not born with a sense of personal unity, children who experience stress remain divided. Patients with identity disorder often experienced severe or persistent violence in childhood, which can be either physical or sexual. Therefore, children living in unfavorable living conditions experience a disconnection of various feelings and emotions. Such children develop the ability to protect themselves from difficult life conditions by withdrawing into their own special world. Each stage of formation can form new personalities.

Symptoms of dissociative disorder

There are a number of symptoms characteristic of this disorder:

- changing clinical picture;

— temporary distortions;

- intense pain in the head or other painful bodily sensations;

- changing degree of activity of the individual from intense to complete inactivity;

- amnesia;

- memory lapses;

- derealization;

- depersonalization.

Depersonalization consists of a feeling of unreality, detachment from one’s own bodily manifestations and mental processes, and a feeling of distance from oneself. Patients with depersonalization observe their own behavior from the outside, as if they were watching a movie. They feel like outside observers of their own lives. Patients may also experience transient sensations of the body not belonging to itself.

Derealization is expressed in the perception of familiar individuals and interiors as unfamiliar, unreal or strange. Patients find various things, handwriting samples, objects that they cannot identify. It is also common for such patients to refer to themselves in the third person or plural.

Patients with dissociation experience switching personalities, and barriers between them due to amnesia often lead to disorder in life. Personalities can interact with each other, so the patient often hears an internal conversation conducted by other personalities who discuss the patient himself or address him. As a result, there are times when a patient is misdiagnosed because the doctor perceives the patient's internal dialogue as hallucinations. Although the voices heard by the patient during dissociation are reminiscent, there are qualitative differences that delimit hallucinations typical of or other mental disorders. People with dissociation believe that voices are abnormal or unreal, unlike people with schizophrenia who believe they hear natural voices that are not auditory hallucinations. Individuals with dissociation may have difficult conversations and hear multiple conversations at the same time. This is quite rare in schizophrenia. Also, people with dissociation may have brief moments in which they see their own identities talking.

Often, individuals with dissociative identity disorder exhibit symptoms similar to those observed in schizophrenia, post-traumatic stress disorder, mood disorders, eating disorders, and epilepsy. Quite often, patients may also have suicidal attempts or plans, or cases of self-harm in their anamnesis. Many of these patients often abuse psychoactive drugs.

Patients with dissociation typically have a history of three or more mental health problems with a history of treatment resistance.

Diagnosis of this disease requires a specific survey regarding dissociative phenomena. A long interview (sometimes with the use of medications) and hypnosis are often used. The patient is recommended to keep a diary between visits to the therapist. The psychotherapist can also attempt direct contact with other personalities of the patient, offering to broadcast to the part of consciousness responsible for the actions during which the individual developed amnesia or had depersonalization and derealization.

Dissociative identity disorder

Dissociative identity disorder is also called multiple personality disorder. Sometimes this disorder is also called multiple personality disorder. A mental phenomenon that results in an individual having at least two different personalities, or “egos,” is a multiple personality condition or organic dissociative disorder. In this state, each alter ego has personal patterns of perception and an individual system of interaction with the environment.

To determine that a subject has dissociative identity disorder, it is necessary to have at least two personalities that take turns regularly controlling the individual’s actions, actions, as well as memory problems that go beyond the boundaries of normal forgetfulness. The condition associated with memory loss is usually described as “switching.” Such symptoms must be observed autonomously in the individual, i.e. they do not depend on the subject’s abuse of any substances, drugs (alcohol, drugs, etc.) or medical indicators.

Although dissociation is now considered a demonstrable psychiatric condition associated with a variety of disorders related to early childhood trauma and anxiety, multiple personality disorder as an actual psychological and psychiatric phenomenon has been questioned for some time.

In accordance with the classification of diseases, dissociative disorder is considered as amnesia of a psychogenic nature (in other words, amnesia that has only psychological roots and not a medical nature). As a result of such amnesia, the individual is able to repress memories of traumatic situations or some period of life. This phenomenon is called the splitting of the “I”, or according to other terminology, the self. Possessing multiple personalities, the subject can experience his or her alternative personalities, characterized by individually distinguishable traits. For example, alternative personalities may be of different genders or ages, may have different health conditions, intellectual abilities, handwriting, etc. Long-term therapy methods are mainly used to treat this disorder.

As various studies show, individuals with dissociative disorders quite often hide their symptoms. Usually, alternative personalities arise in early childhood. Also, many subjects may experience comorbidity, in other words, along with dissociative disorder, they also have other disorders, for example, anxiety disorder.

Dissociative conversion disorders

These disorders were previously called conversion hysteria. Disorders expressed in selective or absolute loss of conscious control over body movements, on the one hand, and control over sensations and memory, on the other, are called dissociative conversion disorders. Typically, there is a significant degree of meaningful control over the sensations and memories that are selected for direct attention and over the actions that are to be performed. In disorders associated with dissociation, such meaningful and selective control is thought to be quite impaired. Therefore, it can change every day and even hourly. The level of loss of function that is under conscious control is, in most cases, difficult to assess. Dissociative disorders include: dissociative movement disorders, dissociative amnesia, stupor, anesthesia, fugue state, obsession and trance, dissociative convulsions.

The concept of “conversion” is widely used for certain variations of disorders and refers to the unpleasant affect that is generated by problems and conflict situations that the individual is unable to resolve and is transformed into symptoms. Subjects with dissociative disorders tend to deny problems and burdens that are obvious to others. Any problems and burdens that they recognize they attribute to dissociative symptoms.

Such disorders are characterized by a direct connection in time of occurrence with traumatic events, intolerable events and insoluble problem situations or broken relationships. As a result, the following pattern is observed: during wars, natural disasters, pandemics and other conflicts, the number of disorders increases.

Dissociative conversion disorders are more typical for the female part of the population in comparison with the male part and for children in puberty.

The origin of these disorders is influenced by biological factors, psychological causes and social aspects. Biological causes include exposure hereditary factors and constitutional characteristics of individuals. Previous illnesses also have an impact. More often, disorders are observed during periods of crisis and menopause. Demonstrative features before the onset of the disease, previous hardships, various mental traumas experienced in childhood, intimate disharmony in marriage, and increased suggestibility are among psychological reasons. In addition, the psychology of dissociative disorders embraces the mechanism of relative pleasantness and conditional desirability of symptoms - the individual receives some gain due to his own illness. For example, in this way, symptoms contribute to keeping the object of love close to oneself. The social aspects include dissociated upbringing, which covers the dual demands of father and mother in relation to the child, and the individual’s desire for a rental attitude.

Dissociative personality disorders are primarily manifested by somatic and mental symptoms caused by unconscious psychological mechanisms. Somatic symptoms during dissociation are often similar to manifestations of neurological diseases. Mental symptoms can easily be mistaken for symptoms of another mental disorder, for example, dissociative stupor can be observed in depressive states and schizophrenia.

Dissociative personality disorders are not caused by somatic diseases, neurological illnesses, the influence of psychotropic substances, and are not a symptom of other mental disorders. The main condition for the correct diagnosis of dissociative disorders is the exclusion of somatic illness and other mental disorders. For example, organic dissociative disorder should be differentiated from dissocial conversion disorders.

Treatment of dissociative disorders

Often, in acute dissociative disorders, treatment requires only persuasion, suggestion, and reassurance, coupled with immediate attempts to resolve the stressful circumstances that triggered the reaction. For diseases that last more than a couple of weeks, more serious and comprehensively targeted therapy is required. It is considered common practice in medical practice for the therapist to work aimed at eliminating the causes that provoke the worsening of symptoms and stimulating normal behavioral reactions. It is necessary to explain to the patient that the functioning disorders observed in him (for example, memory impairment) are not caused by a physical illness, but by psychological reasons.

Treatment of protracted dissociative disorders involves the integrated use of psychotherapeutic techniques and drug treatment. Psychotherapy often requires a physician who specializes in helping people with dissociative disorders.

Some therapists prescribe antidepressants or tranquilizers to eliminate symptoms of excessive activity, anxiety, and depression that often accompany dissociative disorders. But these medications should be prescribed with extreme caution due to the fact that subjects with such disorders are more susceptible to addiction and become dependent on the drug. medicines. Hypnosis or narco-hypnosis is often recommended as one of the treatment methods for dissociative disorders. After all, hypnosis has a connection with dissociative processes. Hypnosis helps you get rid of depressing thoughts or memories. It also helps in the process of so-called closing of alternative personalities. Dissociative movement disorders involve the use of psychoanalysis, less often hypnosis.