A complex disturbance of identity and memory, dissociative identity disorder (formerly referred to as multiple personality disorder) is characterized by the existence of two or more distinct, fully integrated personalities in the same person. The personalities alternate in dominance. Each comprises unique memories, behavior patterns, and social relationships; in many cases, rigid and flamboyant personalities are combined. Usually, one personality is unaware of the existence of the others.
The cause isn’t known. The patient typically has experienced abuse, commonly sexual, or another form of emotional trauma in childhood. A child may evolve multiple personalities to dissociate herself from the traumatic situation. The dissociated contents become linked with one of many possible shaping influences for personality organization.
Dissociative identity disorder usually begins in childhood, but patients seldom seek treatment until much later in life. The disorder is three to nine times more common in women than in men.
The patient may seek treatment for a concurrent psychiatric disorder present in one of the personalities. She may have a history of unsuccessful psychiatric treatment, or she may report periods of amnesia and disturbances in time perception. Family members may describe incidents that the patient can’t recall as well as alterations in facial presentation, voice, and behavior.
Stress or idiosyncratically meaningful social or environmental cues commonly trigger the transition from one personality to another. Although usually sudden, the transition can occur over hours or days. Hypnosis and amobarbital may facilitate transition.
For characteristic findings in patients with this condition, see Diagnosing dissociative identity disorder.
Psychotherapy is essential to uniting the personalities and preventing the personality from splitting again. Treatment is usually intensive and prolonged, with success linked to the strength of the patient-therapist relationship with each of the personalities, all of which require equal respect and concern.
❑ Establish an empathetic relationship with each emerging personality.
❑ Monitor the patient’s actions for evidence of self-directed violence or violence directed at others.
❑ Recognize even small gains.
❑ Stress the importance of continuing psychotherapy. Point out that the therapy can be prolonged, with alternating successes and failures, and that one or more of the personalities may resist treatment.
Review other book chapters online related to Dissociative Identity Disorder:
Copyright notice for book excerpts: Copyright © 2008 Lippincott Williams & Wilkins. All rights reserved.
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More About This Book:
Title: Professional Guide to Diseases (Eighth Edition) Authors: Springhouse Publisher: Lippincott Williams & Wilkins Copyright: 2005 ISBN: 1-58255-370-X 
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