Dissociative identity disorder

1.1 Background

DID dissociative identity disorder or multiple personality disorder is a disease in which the person exhibits distinct multiple personalities (called alter egos) where each alter egos has different patterns of how they perceive the world and have their own background and interest. DID is described as a psychological defense mechanism where an individual uses a “protection” called dissociation. Dissociation is an element of life where the person shields himself from his experiences/trauma. This is when the person handles conflicts or stress through mental avoidance.

So the individual uses dissociation to be able to handle a serious trauma and in that way, that person develops one or even several different personalities to handle the experiences. The alter egos that the individual develops can be of the opposite gender and at different ages. DID develops most in childhood because the boundary between reality and imagination is weak. The individual creates a parallel identity that handles the trauma to which the child is exposed. I will talk about what symptoms there are, the differences in symptoms, and how it occurs. I will also address the difference between DID and schizophrenia.

1.2 Issues

Today we will answer the following questions;

1. What is the cause of DID?

2. What are the symptoms of DID?

3. How is the diagnosis made?

4. How to treat the disease?

5. What is the difference between DID and Schizophrenia?

6. Do today’s movies tell the truth about people suffering from DID?

3.1 Cause

It is not entirely clear what causes DID. There are several different guesses and research that say and show different causes. Some researchers are investigating the difference in the brain between DID patients and ordinary people. Some focus on DNA. Some are based on the individual’s trauma that has arisen in her life.

So the reason is completely unclear and you do not know which are true and which are wrong but I took some of the reasons that are more credible and have many followers of the presented theory.

I start from three different causes of Dissociative identity disorder;

1. Dopamine and hallucinations

2. DNA and schizophrenia

3. Trauma

The first “cause” is about the brain and how dopamine receptors work in humans and why they are different in each individual.

The second reason is the genetic material DNA, how it can affect the disease, and what risks are associated with it.

The last and most credible (which has the most followers among researchers and psychologists) is Trauma. How childhood or even adult trauma can cause the disease.

There are of course lots of other “causes” for DID that exist if you look on the internet and in literature books, but I took one of the most famous and credible. The last two “causes” have been most common in my sources when I searched on the internet. I mentioned the first because it is about hallucinations and reasons why people see hallucinations or why others can see more hallucinations than others. The first reason may sound or even be bullshit, but I will take it anyway because it has something to do with hallucinations.

1. Dopamine and Hallucinations;

Dopamine is a substance formed by tyrosine that is bound by G-protein at dopamine receptors. Dopamine receptors are mostly found in the central nervous system but it is also found in different parts of the body such as the heart and kidneys and there they have different functions. The central nervous system takes care of such things as pleasure, motivation, joy, and enthusiasm. When tyrosine is bound by G-protein at dopamine receptors, it receives signals to the brain that receive “pleasure”. For example, we say that you have a goal for the New Year to read 69 books in a whole year and when it is New Year’s Eve and you reached your goal and are happy about yourself. This is when dopamine receptors have been activated and you experience joy and become more motivated by feeling pleasure.

Dopamine is also found in nicotine. That is why you feel pleasure when you smoke. Dopamine is activated in dopamine receptors in the cells and it gives signals in the brain and then we experience pleasure. The brain’s approximately 100 billion nerve cells communicate with the help of neurotransmitters. The nerve signals are further promoted by a nerve cell releasing the neurotransmitter in a synapse which then binds it to a receptor (and in this case, it is a dopamine receptor) on the next nerve cell. These signaling systems have long been thought to be important for brain function in schizophrenia. The background is that some drugs (antipsychotic drugs) for schizophrenia affect by blocking dopamine receptors. Besides, it has been discovered that people with ADHD have an excess of dopamine and those with ADHD have an increased risk of developing schizophrenia or that their children may develop schizophrenia more than people without ADHD. We know that in some parts of the brain in people with schizophrenia an excess of the neurotransmitter dopamine is produced, while in other parts there may also be too little dopamine. There is another clue that proves that increased addition of dopamine can cause psychosis which in turn causes hallucinations, amphetamine (found in drugs) is a substance that increases the concentration of dopamine in the synapses and it can cause a psychosis reminiscent of schizophrenia.

As we can see, dopamine can cause psychoses, which in turn causes hallucinations. And it is assumed that DID sick people can talk and see things that do not exist in reality, but mostly it is so that they can hear other voices that are not “theirs”, it is auditory hallucinations while schizophrenia has more visual hallucinations.

As a decision, I wanted to show that the dopamine supplement (which is different in people, it is individual, and the genome plays a role here as well) has a “role” in Dissociative identity disorder because dopamine gives us hallucinations such as DID and schizophrenia sick get. People with balanced dopamine supplements do not see/hear things that others cannot see or hear.

2. The DNA genome and Schizophrenia

This part of the theory has fewer followers, but many researchers are sure that mental health is linked to DNA. Some researchers say that mental illness is almost the same as diabetes or high blood pressure and that there is a risk that it may accompany the genome to the next person.

For example, the risk that ex. Joe will become ill with schizophrenia is 1%, but if his grandfather/grandmother was clinically ill with schizophrenia the risk is 2% now but if it is the case that he has a twin brother/sister then the risk is as high as 50% that Joe will also become ill with schizophrenia. Heredity plays a big role. There is no evidence precisely with DID where heredity played such a large role, but it may be that heredity can make the process of DID “easier”.

By that (right now I don’t mean that if your twin brother had DID u will have a 50% risk that you will be sick too), I mean that people who are ill with DID have mostly survived severe and heavy trauma in their childhood or in life, such as that a person in the family has died, war, sexual abuse, etc. After such trauma, the person can change, but how big the change will be, is different for each people. Some are more stress-resistant while some are too sensitive, and it has to do with our personality. We are all different and react differently, but the fact that some can survive the war better than others also has to do with DNA. So DNA has to do with the psyche and with our mental health and we know that with great certainty.

3. Trauma

(Dissociation describes a psychological state in which an individual to some degree or aspect shields himself from his experiences. This can be done by the individual handling conflicts or stress through mental avoidance) DID is also described as a defense mechanism where the individual uses dissociation to be able to handle a serious trauma and for that, the individual develops one or more different personalities to handle the experience. It happens mostly in childhood because then the boundary between reality and fantasy is still weak.

There is evidence that DID mostly has to do with trauma because patients who have DID had serious or difficult trauma in their early life. The child creates a new identity that takes care of the difficult moments in life and controls it at the same time, which means that the person himself does not take “damage”

And before we deep into symptoms I wanted to talk about “Triggers”. It is an element that causes an identity to awaken in the person. Simply it is a cause, a function that awakens the person’s identity, and it is different for each person.

We take an example from the movie Split, but call that guy Joe. So Joe’s mama is strict and wants that there is always clean at home, and becomes furious when Joe messes up. And by furious I don’t mean just screaming or not letting me play Minecraft for a week, by furious I mean punching and hurting physically. After that Joe becomes afraid, and starts cleaning and becomes cleaner? But the thing is that he is a cleaner at home but not outside of the home. So he can mess up in school or at friends’ houses but not at home. So each time when Joe goes home to Joe mamma he turns into a pro cleaner. And that is what we call a “trigger”.

3.2 Symptoms

Common symptoms of DID are; memory gaps, inner voices, hallucinations, unexplained events, and unexplained destructive behavior. People with DID exhibit a remarkably large number of symptoms similar to other neurological and psychiatric disorders. It is difficult to see the symptoms in a person with DID. The secrecy, denial, and suppression of such characteristic symptoms in people with DID make it extremely difficult to obtain a correct diagnosis. In most cases, the person is not aware of their alternative identities and the inner alter egos are very careful to keep the disease and its symptoms secret, even from each other. All this is to protect the original core which is still usually undeveloped in the depths of the soul. The symptoms are also different for people, but these are the most common;

* Memory problems (amnesia), of certain periods, events, people, and personal information

* The feeling of being separated from yourself and your feelings

* A perception of the people and things around you as distorted and unreal

* Mental health problems such as depression, generalized anxiety disorder, and suicidal thoughts and behaviors

The symptoms are difficult to detect and understand that the person is ill, but if you just study more closely and look at the person so that you can see symptoms such as memory problems and personality change, then maybe you’ll probably see that person needs help.

3.3 Examination

The symptom picture is multifaceted and contains a combination of dissociative, affective, somatic, and post-traumatic symptoms. This multifaceted presentation, together with specific characteristics of DID, makes this diagnosis very difficult to establish. The individual is usually not aware of his alternative identities. Especially at the beginning of a therapy process. Studies in the USA show that people with DID have received at least three incorrect diagnoses and spent an average of seven years in treatment and often have had several hospital stays before they get the correct diagnosis. And as we have already talked about in the previous chapter “Symptoms” so denies the person and tries to hide the symptoms and that it has other individuals in it and this of course makes the treatment itself more difficult for a doctor to make a correct diagnosis. If the patient himself hides or says the wrong symptoms then it is difficult to detect the disease and when it comes to mental health it is difficult for the doctor to look into the person’s memory and thinking and see both symptoms and false symptoms. Mental health is not the same situation as ordinary physical care where you can see most of the symptoms yourself and the patient himself can not hide it. When it comes to mental health, it is much more difficult. The person may exhibit a remarkably large amount of symptoms similar to other neurological and psychiatric diseases that may constitute differential diagnoses. This cluster of symptoms and behaviors makes it very difficult to get a clear picture of the diagnosis and this contributes to why it takes so many years before the diagnosis can be established. As can be seen, it is not easy and it takes time for the person to get the right diagnosis and after that the right treatment, but the diagnosis itself is made according to symptoms that the person shows and to see the whole picture of the disease in patients, therapy is eventually used where the patient can tell their background, history, problems, and difficulties in social life.

3.4 Treatment

Psychotherapy in DID can be compared to family therapy where all individuals can talk, discuss, and express their feelings. Where everyone can be heard and accepted. One must accept and show respect for each of the alternative identities. Every individual must be equal whether it is a small child or an aggressive person. Each of them must be recognized and accepted by the patient.

Most often, the person who is seeking treatment is not aware of the diagnosis and alternative identities. The person seeks therapy because they may think that they have gone crazy because unexplained things and events in everyday life occur. For example, he/she loses time, his memory lapses have inner voices and suffer from hallucinations, etc. It can take a lot of time to get the person to accept the diagnosis even if several identities do not want this. Psychotherapy is necessary because it is important and it is almost all care that the person can receive to stabilize themselves and live a “normal” life. You can count on at least 3–5 years of intensive basic work. It is best to first try to help the destabilized identity-seeking treatment. Changes (“triggers”, a transition to other identities) usually occur spontaneously and involuntarily, which in turn makes it more difficult in the treatment. EMDR (Eye Movement Desensitization and Reprocessing) and hypnosis can facilitate the treatment for example, by getting in touch with different identities. One must also go to the same therapist for a long time because the basic trust is so damaged that not even the alter egos who are aware of each other are willing to reveal their secrets. It is necessary to first try to build trust and confidence in all identities of the therapist. There is also another treatment called “Integration” which has the goal that after the patient has accepted all his identities then deletes all and has only one left. The personality itself. But many different psychologists and patients have not accepted this treatment and have made sure that they keep their identities so that they can work together. One of the famous psychologists who also had such an idea is James Hillman who wrote about it in his book “Archetypal Psychology” one of the famous patients who had DID was a woman from the USA Truddi Chase. She wrote a book called “When Rabbit Howls”. She also follows the idea of accepting her personality and letting them live together.

4. Assay

I will briefly describe the answers I came up with, and answer questions 5 and 6.

Dissociative identity disorder (DID) arises as a consequence of trauma in life that has done great damage or has left a memory that the person suffers from for the rest of their life. It could be the person’s friend’s death, a car accident, sexual harassment, or other serious traumas. Research has repeatedly said that people who are ill with DID have had a difficult upbringing or childhood trauma. Then the child’s imagination and reality are not as strong as an adult’s. Trauma usually occurs under the age of 6 years. The person experiences things and moments of life that they do not want to experience and feel. Eventually, it starts to go away from reality so as not to feel hurt and this leads to the fact that one can start making an alter ego that will take care of the severe trauma.

The symptoms can be different and the level of the Dissociative identity disorder itself. Some have mild problems while some have such serious problems that you have to keep a constant eye on them. That said, the symptoms may be different for each person but one of the most common is memory gaps, not being able to fit times, hallucinations, inner voices, and the person starting to feel insane. The diagnosis is one of the most difficult in DID and it can take several years to make the right diagnosis and initiate the right treatment.

The alter ego in people (which can be many, the highest known to have William Stanley Milligan, 24 different personalities, but that’s not for sure) can be aggressive. The patient may be unaware of all their identities. They may hide and not want to talk to the doctor. This makes the treatment itself more difficult. If the alter ego does not come out (that it goes out and talks about its existence) then you will never know why the identity exists or what trauma created the identity. Trust plays a big role here as well. The patient must believe and trust the doctor. It must also accept all its identities in itself and accept that they are with him/her. The treatment is that you have therapy with all identities and try to get control of them. So that the person himself can control and accept them. So that they can live together without problems.

I had question 5, which was: what is the difference between Schizophrenia and DID. Here are some examples of the difference between DID and Schizophrenia;

* Schizophrenia is a mental illness that causes some disturbances in the brain’s function of processes for thinking and perceiving the world around it.

While people with DID do not have brain disorders, everything works normally. The only thing that bothers me is the memory.

* Schizophrenia can occur at any age. When DID occurs mainly in childhood.

* People with Schizophrenia take tablets and may even end up in a psychiatric ward. DID sick can be calm in society and its alter ego can live in society. For example; In childhood, the child sits at home all the time and has not been out that much and when it is taken out, the child is afraid that there are too many people at once and the child does not recognize them. At this moment, the child can create an alter ego that in peace can be in a group of people without fear. This is how a alter ego can arise.

Schizophrenia can be more dangerous because people who are sick of it are more aggressive and can do harm to other people. Ex. a detained man in the United States who was in a prison where 21 other inmates were sitting. The man was ill with schizophrenia and heard voices that one of the 21 people who are in prison due, was a child abuser. All the detainees and police who worked there already told him that only he heard it, but the man refused to listen. In the end, he and the person he suspected ended up in a fight where the suspect was seriously injured. Schizophrenia can lead to serious hallucinations.

DID patients have to alter egos who are different people. They can be aggressive, sick, and even have another life without others’ egos knowing.

And finally, the last question that remains is number 6. If the film shows the truth about DID sickness. I will talk about 3 movies about people who are sick with DID. They are; Split, Fight Club, Frankie, and Alice.

The film Frankie and Alice is a biography film that shows a woman who was ill with DID in the USA and it happened around 1973. She has two different personalities. A 7- year-old intelligent child and a white racist woman who does not like blacks. It’s a biography, so it’s only if you believe in it yourself or not, but how the identity changes and that you have memory gaps is true, and DID patients have problems with it. I will not describe why and how her identities were created, but you can read for yourself on Wikipedia.

The split film shows how human behavior, thinking, mood, and everything else changes when identity changes. The character (Kevin) in the movie already knows about his identity and goes into therapy. Kevin knows about all identities and what they like and do but he only has one very violent identity and all his other identities know about it. The film itself received bad reviews from the Australian mental health charity because the film Split shows DID sick as aggressive and violent people and that people will be afraid of such people. The film was criticized for showing the disease from a bad angle.

The last film called Fight Club is about a man who lives a routine life without meaning or goal. He gets tired and creates an identity of “Tyler” who does what the person wants and lacks rules.

The film does not show how the disease is treated or why it is created, but it has “triggers” that patients with DID have when they are transformed into another person.

Movies nowadays do not want to show the truth about the disease but rather show a romanticized version of the disease.

P.S. Sorry for the terrible English and my mistakes in this article. I wrote this one when I was 17 years old for my school project. Know that all I am saying here and writing is only the facts that I found myself. I am not a psychologist or have some degree in that field, and remember that it was only a school project.



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