Dissociative identity disorder(English) dissociative identity disorder , or DID listen)) - a psychiatric diagnosis taken into account "an individual's behavior, as well as memory loss, beyond the limits of normal forgetfulness. Memory loss is commonly described as "switching." Symptoms must occur regardless of any substance abuse (alcohol or drugs) or general medical condition.
Dissociative identity disorder is also known as multiple personality disorder(English) multiple personality disorder, or MPD) . In North America, the disorder is commonly referred to as "dissociative identity disorder" due to differences of opinion in the psychiatric and psychological communities regarding the concept that one (physical) individual can have more than one personality, where personality can be defined as the sum total of mental states of a given (physical) individual.
Diagnostic criteria
The criteria for diagnosing dissociative identity disorder published by DSM-IV have been criticized. In one of the studies (), a number of shortcomings of these diagnostic criteria were highlighted: in this study they are claimed to be inconsistent with modern psychiatric classification, not based on a taxometric analysis of the symptoms of dissociative identity disorder, to describe the disorder as a closed concept, to have poor content validity, to ignore important data, to interfere with taxonomic research, to have low reliability, and to often lead to misreporting diagnosis, they contain a contradiction and the number of cases with dissociative identity disorder is artificially low. This study proposes a solution to the DSM-V in the form of what researchers consider to be more user-friendly polythetic diagnostic criteria for dissociative disorders.
Multiple personality disorder and schizophrenia
Timeline of the development of understanding multiple personality
1640s - 1880s
1880s - 1950s
After 1950s
Definition of dissociation
Divergence of opinion about multiple personality
Until now, the scientific community has not come to a consensus on what is considered multiple personality, since in the history of medicine before the 1950s there were too few documented cases of this disorder. In the 4th edition "personality". The same designation was adopted in ICD-9, but in ICD-10 the variant “disorder” is used multiple personality" It should be noted that a serious mistake is often made in the media when multiple personality disorder and schizophrenia are confused.
A 1944 study of 19th- and 20th-century medical literature on the topic of multiple personality found only 76 cases. In recent years, the number of cases of dissociative identity disorder has risen sharply (some estimates estimate that there were approximately 40,000 cases between 2000 and 2000). However, other studies have shown that the disorder does have a long history, stretching back about 300 years in the literature, and it affects less than 1% of the population. According to other data, dissociative identity disorder occurs among 1-3% of the general population. Thus, epidemiological data indicate that in the population, dissociative identity disorder is actually as common as schizophrenia.
Dissociation is now viewed as a symptomatic manifestation in response to trauma, critical emotional stress, and is associated with emotional dysregulation and borderline personality disorder. According to a longitudinal study by Ogawa et al., the strongest predictor of dissociation in young adults was lack of access to mother at age 2 years. Many recent studies have shown a link between disturbed attachment in early childhood and subsequent dissociative symptoms, and there is also evidence that childhood abuse and neglect often contribute to the development of disturbed attachment (manifested, for example, when the child is very closely monitoring whether the parents are paying attention to on him or not).
Critical attitude towards the diagnosis
Some psychologists and psychiatrists believe that dissociative identity disorder is iatrogenic or contrived, or argue that cases of true multiple personality are very rare and most documented cases should be considered iatrogenic.
Critics of the dissociative identity disorder model argue that the diagnosis of multiple personality disorder is a phenomenon more common in English-speaking countries. Until the 1950s, cases of split personality and multiple personality were sometimes described and treated as rare in the Western world. That year, the publication of the book The Three Faces of Eve and later the release of the film of the same name contributed to the growth of public interest in the phenomenon of multiple personalities. In 1973, the filmed book “Sybil” was subsequently published, describing the life of a woman with multiple personality disorder. However, the diagnosis of multiple personality disorder itself was not included in the Diagnostic and Statistical Manual of Mental Disorders until 1980. Between the 1980s and 1990s, the number of reported cases of multiple personality disorder increased to between twenty and forty thousand.
Main article: Multiple Personality as a Healthy State
Some people, including those who self-identify as having multiple personality, believe that the condition may not be a disorder, but a natural variation of human consciousness that has nothing to do with dissociation. One of the staunch supporters of this version is Trudy Chase, author of the bestseller “When Rabbit Howls.” While she acknowledges that in her case the multiple personalities were the result of violence, she claims that her group of personalities refused to be integrated and live together as a collective.
Intercultural studies
Anthropologists L. K. Suryani and Gordon Jensen are convinced that the phenomenon of pronounced trance states in the Bali community has the same phenomenological nature as the phenomenon of multiple personality in the West. It is argued that people in shamanic cultures who experience multiple personalities define these personalities not as parts of themselves, but as independent souls or spirits. There is no evidence of a relationship between multiple personality, dissociation, and memory retrieval and sexual violence in these cultures. In traditional cultures, plurality, such as that exhibited by shamans, is not considered a disorder or disease.
Potential Causes of Multiple Personality Disorder
Dissociative identity disorder is believed to be caused by a combination of several factors: intolerable stress, the ability to dissociate (including the ability to separate one's memories, perceptions or identity from consciousness), the manifestation of defense mechanisms in ontogenesis and - during childhood - a lack of care and participation in relation to the child with a traumatic experience or lack of protection from subsequent unwanted experiences. Children are not born with a sense of a unified identity; the latter develops based on a variety of sources and experiences. In critical situations child development encounters obstacles, and many parts of what should have been integrated into a relatively unified identity remain segregated.
North American studies indicate that 97-98% of adults with dissociative identity disorder describe situations of childhood abuse and that abuse can be documented in 85% of adults and 95% of children and adolescents with multiple personality disorder and other related forms of dissociative disorder. These findings indicate that childhood violence plays a role main reason disorders among North American patients, while in other cultures the effects of war or natural disaster may play a major role. Some patients may not have experienced violence but have experienced an early loss (eg, the death of a parent), a serious illness, or another extremely stressful event.
Human development requires the child to be able to successfully integrate different types of complex information. In ontogenesis, a person goes through a number of developmental stages, in each of which different personalities can be created. The ability to generate multiple personalities is not observed or manifested in every child who has experienced violence, loss or trauma. Patients with dissociative identity disorder have the ability to easily enter trance states. This ability, coupled with the ability to dissociate, is thought to be a factor in the development of the disorder. However, most children who have these abilities also have normal adaptive mechanisms and are not in an environment that can cause dissociation.
Treatment
The most common approach to treating multiple personality disorder is to relieve symptoms to ensure the individual's safety and to reintegrate the various personalities into one well-functioning identity. Treatment can occur using various types psychotherapy - cognitive psychotherapy, family psychotherapy, clinical hypnosis, etc.
Insight-oriented psychodynamic therapy has been used with some success, helping to overcome the trauma received, revealing conflicts that determine the need for individuals and correcting the relevant
