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Understanding the phenomenology of dissociative identity disorder, the lived experience, of the patient.


The purpose of this essay is to attempt to explain the inner experience or phenomenology of the patient suffering from dissociative identity disorder.

Characteristics and Risks of Dissociative Identity Disorder

Dissociative identity disorder found to be a severe health condition where two or more different identities or states of personalities are there in an individual. Each personality takes control alternatively. Some of the people considered it as a possession. This disorder also associated with memory loss that is far different from ordinary forgetfulness. This disorder is characterized by the identity fragmentation instead of the proliferation of separate the personalities. Until 1994 it was considered as multiple personality disorder and then the term was changed for the better understanding of this condition. The failure of identity, memory, and consciousness has been reported in various patients with this disorder (psychology today, 2018). The DID is a complex disorder which can be caused by various factors including severe trauma in childhood (Webmd, 2018). Dissociative identity disorder previously considered a rare disorder and frequency diagnosed in the 18th and 19th century (Paris, 2012). There are still some gaps in understanding the DID phenomenology and the real experience of the patient. In this essay, the related gaps in the understanding phenomenology of DID and inner experience of the patient will be discussed. Another major concern will also be argued that is dissociation is the defensive reaction in the condition of trauma and a difficult satiation to live with.

The symptoms associated with DID are Memory loss, feeling of being detached from ourselves and from emotions, distorted and unreal feeling about the surrounding environment and people, stress and problems in relationships, unable to cope up with emotional and professional stress, depression, anxiety, and thoughts related to suicide. The risk factors of DID includes people who are abused sexually and emotionally for a longer time, people who experience other events such as war, natural disasters, torture and kidnapping (Mayo Clinic, 2018).

According to a report published in Medscape (2018) it was estimated that nearly 2000 children die every year because of abuse. Traumas are the main cause of death due to physical abuse. Girls are abused more than boy’s with the ratio of 10:1. The prevalence of DID was estimated between 0.1 % - 2 %. DSM-5 reported the 12 months prevalence of this disorder as 1.5 % of total population of adult Americans (American Psychiatry Association, 2013). It was determined that did affect between 7.5 to 10 % people in the inpatient setting. Particular in Canadian hospital did affect nearly 6 % of psychiatric inpatients which is similar as in the American outpatient setting (DID Research, 2016). Almost 1/3rd of the population with dissociation revealed that they occasionally feel that the seen themselves in a movie, 7 % people may have suffered from this disorder once in a life. But these diseases are not easy to identify and remain undiagnosed for many years (Mental Health America, 2018).

Prevalence and Symptoms Associated with Dissociative Identity Disorder

The understanding of dissociative identity disorder is distinctive among people. Dissociation is the adaptive response to a threat and is a form of freezing. It is a mechanism that is used when there is no option of running and fighting (fleeing). The person shut down themselves and draws less attention to them. In extreme situation play dead by leaving their body and shut down mentally and emotionally (Trauma Recovery, 2013). According to Nijenhuis, Vanderlinden, and Spinhoven (2005), the complex dissociative condition remains in alternating psychological situations such as discrete, resistance against integrative tendency and discontinues. Patient living with this disorder may cause confusion and distress situations. The people with DID may experience amnesia and multiple personalities may take place that causes the patient forgot the other personality. These conditions are difficult to understand. The different patient suffers different symptoms and situations caused by DID and they have a different experience of having dissociative identity disorder. A report published by Tracy in healthy place (2018) reported the experience of some patient suffered from DID where a women explained her conditions before the diagnosis and she stated that she convinced herself that things happen to her were totally baffling and unexplainable, she asked herself that did not everyone loose the track of time, their belonging s and people? Did not everyone forget to money spent they could not recall?. One other patient with DID experience nightmares and hallucinations but still manages to do their best and fir with other people. The patient stated that he/she started having nightmares most of the time in the night, used to see things that are really not there, the things that were happening out of is control so he/she decided to pretend to be normal. Further, he/she was suicidal for a time.

One of the other 25 years old patient, Sandra hospitalized for changes occurs in her behavior suddenly and suffered a poor memory. She was unable to remember the things happened in past and she even believed that she was admitted to a hospital which is 800 miles far from the place where she was actually admitted. She was diagnosed with schizophrenia, antisocial personality disorder, bipolar disorder and substance abuse. There was a different component of her identity reported, who named herself Mary, calmly stated to cutting her legs with the knife. She said that Mary has done that to punish Mary. Sandra was treated with various treatments such as psychotherapy and tranquilizers use and she was benefited from these treatments (American Psychological Association, 2018).

Understanding Dissociation as a Defense Mechanism against Trauma

Another case of multiple identity disorder was Louis Vivet. He was one of the first cases of multiple personality disorder. He was born to a prostitute and neglected as a child at the age of eight. He has turned himself towards criminal activities due to an adverse condition. At the age of seventeen, he started working in a vineyard and his left arm was wrapped out by a Viper. This situation terrified him so much that he became paralyzed from waist. After a period of time, he recovered and seems to behave totally like a different person. When he was 18 years old he has diagnosed with10 different personalities.  

A study conducted by Dell (2002) among 167 people to examine dissociative phenomenology by using Dissociative Experience Scale contains 28 questionnaires to quantify dissociative experience. The study investigated 34 patients with the dissociative disorder, 23 with a nonspecific dissociative disorder, 52 patient with the psychiatric disorder, and 58 normal people. The patient with DID scores higher than other three groups. Patient with nonspecific dissociative disorder scored higher than other two groups. That study has two implications for dissociation. First one was, individual with DID do not manifest more dissociation compare to other individuals. The dissociative person has a pathological disorder that does not occur in non-dissociative persons. Second, suggested that the phenomenon such as pathological dissociation, amnesia, trance, depersonalization, derealisation, and voices are no different type of dissociation. The study also revealed that dissociation is the natural type of unifactorial type which has different aspects or epiphenomenon’s, and this indicates that the person with DID should experience a wide range of the dissociative phenomenon. The results of this study further revealed that DID patients manifest depersonalization, memory problems, derealisation, identity confusion, ego-alien, trance and passive influence experiences such as child voices, persecutory voices, voice commenting, conversing, time loss and fugues.

According to Ross and Halpern (2011) dissociation is the defensive reaction to trauma defined as disconnection of two or more reactions that were once linked to each other. It occurs when someone detached from some part of himself or the environment. It can be occurred by different events such as emotional disconnection from someone, memories, body sensations and senses. A common phenomenon can occur in mild forms even in absence of stress. Dissociations are considered a vital part of our survival system. Dissociation is a reaction that takes place in fighting with the stressful situation, which may be overwhelmed in the absence of dissociation. It is not pathological and it is in build reaction. When the trauma occurs dissociations might be disconnected to a higher degree to protect the person form traumatic event, emotions, body sensations and memories that result in an overwhelmed situation.

Variation in Patient Experience of Dissociative Identity Disorder

Dissociation associated with trauma occurs in different degree. For the person with trauma, dissociation may help to survive the circumstances that might be intolerable in the absence of dissociations. Dissociations may help an affected people feel as if events, his or her sensations, and emotions are muted and distorted that is why he or she can then put herself of himself in autopilot mode and may survive the extreme situations, and other circumstances when trauma is still there. But the events occur for longer time dissociations can become stable and automatic. In this case, it is difficult for the brain to integrate memories and it continues to send messages of danger, even after the trauma is over. This can be continuing for years after the traumatic situation. The five symptoms of dissociations are: Amnesia; it is associated with loss of memory for short term or long term and forgetfulness about the past events or an incident, Depersonalization; it is the feeling of separation from our self, body parts and the emotions such as robotic feeling, Derealisation; feeling of detachment from the surroundings and the people, identity confusion; feeling of uncertainty and conflict about own, identity alterations; behavioral and personality alterations that can be noticed by others (Pollock, 2015).

People living with dissociative identity disorder often find themselves in multiples. DID can protect the person from a traumatic event but if occur at the severe level than it can affect mental health, relationships and ability to do normal tasks. Living with dissociation identity disorder may be frustrating, isolating and scary sometimes.  Majority of the people do not take it seriously and avoid diagnosis until they are young, which indicates that they might suffer frightening symptoms for years without even knowing why. Sometimes the personality occurs in DID do not cooperate with the other one. But sometimes both the personalities with together to help the person to cope with everyday situations. Some of the people with DID can also develop social stigmas (National Alliance on Mental Illness, 2018). Some of the other studies also supported dissociation as a defense strategy of the body.  

According to an article published by Brown (2012) dissociation is technically considered as defense mechanism which is helpful in the case of trauma and one can get trained to dissociate and use this mechanism against ourselves. Jepsen, langeland, and Heir (2013) stated that severe forms of dissociation including memory and identity which further leads to a poorer outcome after the impatient treatment. A person can achieve health multiplicity when he/she has multiple identities but does not show clinically distress or symptoms as a result of the dissociative identities (American Psychiatric Association, 2013). A report published by Sidran traumatic stress institute (2010) also argued about the dissociative disorder and stated that dissociation can help an individual to tolerate traumatic experience such as accident, disaster, crime victimization but the severity of this disorder leads to serious pathology. It was also stated that in children who experienced sexual abuse, dissociation works as the self-protection technique Dissociative identity disorder is a psychological disorder where a person shows two or more identities and each personality takes control alternatively. Earlier it was considered as multiple identity disorder in1990s. People with this disorder show symptoms such as memory loss, detached from ourselves, distorted and fake feelings and stress, depression, and suicidal thoughts. Risk factors for dissociative identity disorder include abuse for a longer time, events such as war, disasters, torture, and kidnapping. The disorder affects 2000 children's every year. Various studies argued on dissociation and show different opinions. By analyzing various case studies of people suffered from DID it was found that the people with this psychological conditions suffered a variety of experience and phenomenology. Understanding of this disorder is distinctive in different people. Majority of studies revealed that dissociation has positive and negative impacts on person’s personality. It works as a defense mechanism in case of trauma. People living with this disorder may feel frustrating, isolating and scary.  After reviewing various studies it can be concluded that dissociation works as a defense mechanism for person suffer traumatic events but in severe conditions, it may also cause long time serious impact on memory and other physiological problems such as suicide.

References

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). Washington, D.C.: American Psychiatric Association.

American Psychological Association (2018). Patient Story: Dissociative Disorder. Retrieved from: https://www.psychiatry.org/patients-families/dissociative-disorders/patient-story

Brown, S. (2012). Dissociation isn’t a life skill: dissociation is technically a defense mechanism. Retrieved from: https://www.psychologytoday.com/us/blog/pathological-relationships/201211/dissociation-isnt-life-skill

Dell, P. F. (2002). Dissociative phenomenology of dissociative identity disorder. The Journal of nervous and mental disease, 190(1), 10-15.

DID Research (2016). Prevalence. Retrieved from: https://did-research.org/did/basics/prevalence.html

Jepsen, E. K. K., Langeland, W., & Heir, T. (2013). Impact of dissociation and interpersonal functioning on inpatient treatment for early sexually abused adults. European Journal of Psychotraumatology, 4(1).

Mayo Clinic (2018). Dissociative disorder. Retrieved from: https://www.mayoclinic.org/diseases-conditions/dissociative-disorders/symptoms-causes/syc-20355215

Mental Health America (2018). Dissociation and dissociative disorders. Retrieved from: https://www.mentalhealthamerica.net/conditions/dissociation-and-dissociative-disorders

Mescape (2016). Dissociative identity disorder. Retrieved from: https://emedicine.staging.medscape.com/article/916186-overview

National Alliance on Mental Illness (2018). Dissociative Disorders. Retrieved from: https://www.nami.org/Learn-More/Mental-Health-Conditions/Dissociative-Disorders

Nijenhuis, E. R., Vanderlinden, J., & Spinhoven, P. (1998). Animal defensive reactions as a model for trauma-induced dissociative reactions. Journal of Traumatic Stress, 11(2), 243-260.

Paris, J. (2012). The rise and fall of dissociative identity disorder. The Journal of nervous and mental disease, 200(12), 1076-1079.

Pollock, A. (2015). The brain in defense mode; how dissociation helps us survive. Retrieved from: https://www.goodtherapy.org/blog/the-brain-in-defense-mode-how-dissociation-helps-us-survive-0429155

Psychology today (2018). Dissociative identity disorder (multiple personality disorder). Retrieved from: https://www.psychologytoday.com/us/conditions/dissociative-identity-disorder-multiple-personality-disorder

Ross, C., & Halpern, N. (2009). Trauma Model Therapy: A Treatment Approach for Trauma, Dissociation and Complex Comorbidity. Richardson, Texas: Manitou Communications.

Sidran Traumatic Stress Institute (2010). What is a dissociative disorder? Retrieved from: https://www.sidran.org/resources/for-survivors-and-loved-ones/what-is-a-dissociative-disorder/

Tracy, N. (2018). Dissociative identity disorder case: famous and amazing. Retrieved from: https://www.healthyplace.com/abuse/dissociative-identity-disorder/dissociative-identity-disorder-cases-famous-and-amazing

Trauma Recovery (2013). Dissociation. Retrieved from: https://trauma-recovery.ca/impact-effects-of-trauma/dissociation/

WebMd (2018). Dissociative identity disorder (Multiple personality disorder). Retrieved from: https://www.webmd.com/mental-health/dissociative-identity-disorder-multiple-personality-disorder#1

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