Multiple Personalities: Dissociative Identity Disorder

It’s scary to think that one day you might lose control over your own thoughts, actions, or do something beyond the control of your conscious mind.
Dissociative identity disorder causes a reverse reaction: the patient commits actions, sometimes illegal, lives several lives simultaneously, but his main personality is not aware of these metamorphoses. The disease exhibits unique abilities, at the same time it is a way of protecting the individual from super-emotional stress, and a mental illness that causes complete disorganization, splitting of the patient’s consciousness, and loss of identity. Particularly dangerous is the onset of complete anarchy in an individual’s behavior, the lack of ability to control oneself.

General information

In psychiatry, a special place is occupied by dissociative disorders (Latin dissociare “to separate from the community”), which include dissociative amnesia , dissociative fugue , dissociative stupor , trance and obsession , as well as multiple personality disorder .
Signs that characterize dissociative and conversion disorders (hysterical): partial or complete loss of integration between memory, awareness of personality and control of body movements. Normally, there is conscious control over memory and sensations and at the same time over movements. In dissociative disorders, this control is significantly impaired. The main function of dissociative disorders is to isolate negative experiences. In psychiatry, the term “split personality” is outdated. What is the current name for split personality? The term used is “dissociative identity disorder” or, according to the classification, multiple personality disorder. This type of disorder is characterized by the presence in one person of more than two personalities (these are called alter personalities, or identities), which do not manifest themselves simultaneously. This condition is post-traumatic stress disorder and a way of protecting yourself from the difficulties of real life. Dissociative disorder is the loss of control of the “I” over subpersonalities that are under its control in a normal state.

The disease multiple personality disorder is defined on Wikipedia as a rare mental disorder in which the patient seems to experience a split, a disintegration of the personality as a whole and some part of the whole gets out of control. There is a main principle - separation and alienation. The entire structure is destroyed from the inside. One gets the impression that in one person there are several partial personalities (subpersonalities or alter personalities), which at certain moments replace one another. They are not personalities in the broad sense - they are artificial parts of the personality that help cope with distress.

Wikipedia notes that different identities are expressed to varying degrees, one of the personalities is dominant and both are unaware of each other's existence. Each personality is characterized by its own memory and behavior and does not have access to the memories of the other. The change from one personality to another occurs suddenly and is directly related to events that traumatize the psyche. The transition from one identity to another is possible for various periods - from several minutes to years. Subsequent shifts are also tied to stressful and dramatic events, and also occur during therapeutic sessions of relaxation or hypnosis. The personality that prevails in a given period completely subordinates a person’s behavior, and it is strikingly different from the personality of the owner.

Dissociative identity disorder can appear at any age, from childhood to old age, but is most common in adolescence and young adults. This disorder is more prevalent in women (ratio 1:10). There is evidence that the disorder may be hereditary: close relatives of the patient have a predisposition to this pathology. Perhaps this disorder is not rare, but cases of patients turning to specialists are rare. This disorder is subject to correction. Schizophrenia is also manifested by the presence of multiple personalities, and it is important for psychiatrists to understand and not impose the label of this disease on the patient for life.

Drug treatment

Among the drugs can be noted:

• Neuroleptics. They help reduce the progressive effects of the disease, for example, by eliminating the most dangerous symptoms and signs - manic behavior and hallucinations. They are an excellent drug for reducing stress, relax the body, help you fall asleep and not think about the problem.
• Tranquilizers. Do not use without a doctor's prescription! Otherwise it could cost your life! This drug can push a person to suicide, so it is prescribed under the supervision of a doctor.
• Antidepressants. They help cope with depression, apathy, reluctance to live, loss of interests and hobbies. They help fill yourself with energy and fight for life with new strength.

Pathogenesis

How to get split personality? One of the mechanisms by which the psyche tries to cope with stress and uncontrollable memories is dissociation (separation). Trauma affects the child’s psyche, splitting it into several autonomous particles, which become the basis for subpersonalities in the future. Dissociation is activated under appropriate conditions and is of a purely unconscious nature. It plays a protective role and gradually acquires a complex character, and this entails the destruction of the integral structure of the personality.

Dissociation protects the individual from trauma by splitting experiences into parts. Subpersonalities are formed from five to twenty-five years and on average, from 6 to 16 subpersonalities can be formed. The earlier re-traumatization occurs, the greater the risk that dissociative disorder will develop and personalities will be formed. Alter personalities take on a traumatic past, which is why they are formed. The new Alter personality is freed from experiences, a new biography, a new personal history is formed.

Splitting occurs at the unconscious desire of a person as a desire to fence off and isolate from negative memories. But not every alarming event can provoke a “crack.” The trigger (trigger mechanism) must be very serious. The various ego states in an individual's body are changeable and there is one personality - the “master”. It is important to emphasize a feature: the host personality and alter ego suffer from dissociative amnesia if one of them “captures” the person’s consciousness. The remaining parts of consciousness are “inactive.” Sometimes there are cases when one of the parts comes to doctors for help.

According to the second mechanism for the development of dissociations, a child at birth lacks personality integrity, and it is formed under the influence of experience and external factors. Under favorable conditions, the personality is integrated into a single whole, and severe traumas delimit the formation of the personality - two independent personalities arise before and after psychological trauma. Also important for mental evolution is the process of differentiation - thanks to it, the individual “I” of a person is isolated, and multiple partial personalities move into the sphere of the unconscious and function in dreams, in borderline states, in neurotic and psychotic disorders.

Classification

Despite the fact that multiple personality disorder is included in the ICD (code F44.81), in a number of countries doctors deny the existence of this disease. There are blind spots, riddles, questions and secrets in this issue. All researchers argue about the reality or falsity of the disease. How does a person have multiple personalities? Perhaps this is just a fantasy, and not a disease? Indeed, there are individuals who react this way to unpleasant events in their lives. Perhaps this is the activation of personalities of previous incarnations, who have their own experience, characteristics of consciousness and their own history?

Since this problem is dealt with by psychoanalysts, psychologists, and psychotherapists who are not experts in psychopathology, it is difficult to draw statistical conclusions from their descriptions. There are only 350 case reports with a diagnosis according to ICD-10 F.44.81. It is impossible to deny the possibility of this phenomenon being suggested by psychologists and psychotherapists and of their cultivation of this phenomenon.

The topic often appears in feature films, but almost all cases of split personality described are related to crimes, forensic psychiatric examinations and escaping punishment. In forensic psychiatric practice, this is most often a simulation. Films about multiple personality disorder: “The Three Faces of Eve”, “Duplicate” (2018, USA), “Black Swan” (2010, USA), “Mrs. Hyde” (France 2017), “Me, Myself and Irene” (2000, USA), “Dark Mirror” (2018, USA), “Frankie and Alice” (2009, Canada), “Hide and Seek” (2005, USA), “Split” (2016, USA). Examples of split personality are shown to us in fiction and documentary works - books by Trudy Chase “When the Rabbit Howls”, Flora Schreiber “Sibyl”, Anastasia Novykh “AllatRa”, Crabtree “Multiple Man”, Daniel Keyes “The Multiple Minds of Billy Milligan” and “The Mysterious Case of Billy Milligan."

The last two are documentary: the real patient Billy Milligan tells the author about his subpersonalities in an interview, the author’s conversations with the doctors who examined and treated this patient are recorded. Disintegrated Billy's adaptive capabilities increased, despite the fact that there were internal conflicts and struggle between individual subpersonalities. Integrated Billy lost significantly in general adaptive abilities. The Billy Milligan case set a precedent for exoneration of criminal liability for those who committed a crime due to multiple personality disorder. This fact clearly demonstrates the attitude that it is more profitable to be a split personality than to be a holistic one.

In the West, this disorder is not considered a disease, but is considered as a variant of the norm. If the state of multiple personality is not uncomfortable for a person and does not cause social consequences, then it cannot be treated, and many patients refuse to integrate subpersonalities into a single whole and do not seek help.

Videos from psychologists and psychiatrists will be more useful: “Split Personality” by Veronika Stepanova, “Dissociative Identity Disorder” by Evgeniy Chibikov. At the same time, many psychiatrists admit that in all their practical activities they have never encountered such patients. Still, it is believed that with multiple personality there is a predisposition to this from birth and the ability to self-hypnosis. Most often, a child is emotionally abandoned, and he finds an imaginary friend and mentally turns into him (a horse, a spider-man) - a defense mechanism against loneliness is triggered (now there are two of us, and we are not bored or scared). Severe psychological trauma in childhood (usually of a sexual nature) contributes to the emergence of alternative personalities - saviors, guardian angels, or evil and aggressive ones.

People with a split personality are sometimes critical of themselves and describe their condition as follows: “I see another personality, but it takes over me, it sucks me in, and I cannot control this process.” These selves are different and have different qualities, inclinations and abilities. A person with a split personality often goes on social networks and these subpersonalities “write” under different names and describe pictures from their lives. They have different gender, age, nationality, writing style and presentation of thoughts.

Many psychiatrists are not inclined to identify this disorder as an independent nosology and consider it as a manifestation of a hysterical disorder. To raise a hysterical child, you need to create an idol out of him; he is allowed everything, he is surrounded by attention, but as an adult he does not receive such attention and does everything to attract him to himself. According to many authors, hysterical psychosis is a psychogenically caused, functional disorder, and not an organic one.

Hysterical (dissociative) psychoses are heterogeneous in clinical manifestations. Hysterical psychoses include: hysterical twilight stupefaction , puerilism , pseudodementia , personality regression syndrome , hysterical stupor . Depending on the severity, the picture of psychosis can combine various hysterical disorders, or some hysterical manifestations can be successively transformed into others. These psychogenic reactions are formed against the background of situations of loss (death of relatives, breakup of relationships) and are interpreted as a “repression reaction” of mental trauma.

Puerilism, considered as hysterical psychosis, is manifested by a hysterical narrowing of consciousness and childish behavior in adults. Childish speech, movements, behavior, and emotional reactions are typical. Patients lisp, speak in childish intonations, play with dolls, run in small steps, pout their lips in response to insult or stomp their feet, and promise to “behave well.” In general, there is a return of psychological functioning to the childhood level caused by mental disorders (stress, schizophrenia).

This disorder can be a temporary phenomenon (with stress) or persistent and irreversible (intellectual regression in schizophrenia in adults). Unlike foolishness in schizophrenia, symptoms in puerilism are more changeable, varied and have a strong emotional overtones. Symptoms of puerilism are combined with other hysterical manifestations.

Causes

Causes of multiple personality syndrome:

• mental trauma due to physical, sexual or emotional abuse suffered before the age of five;
• stress (for example, separation from mother);
• shocks;
• shock trauma.

Patients with dissociative disorder often experience prolonged and severe abuse and neglect during their childhood years. Some patients were not exposed to violence, but had strong experiences. Children who have experienced abuse or stress do not integrate their memories and life experiences and remain separated. And children develop an adaptive ability (withdrawal, separation from the harsh environment, “detachment”), which protects the psyche. Each negative experience experienced can provoke the development of a new personality, resulting in the formation of multiple personality.

But not every child reacts to violence this way. Only an easily suggestible person with hysterical tendencies is capable of dissociative response mechanisms. These are demonstrative people, prone to theatricality, wanting to be the center of attention and loving to impress others. People with this disorder are highly sensitive to hypnosis. Another predisposing factor is organic pathology of the nervous system (abnormalities in the encephalogram).

Fighting schizophrenia is useless

This is wrong. Thanks to modern medications and psychotherapeutic tools, schizophrenia can be effectively treated. To begin with, it is very important that the patient realizes that he has a disease and is convinced of the need for treatment. Next, the specialist helps the patient learn to recognize the symptoms of the disorder, control their behavior and communication with loved ones in order to prevent exacerbation. Drug treatment allows the patient to lead a normal daily life. Modern medications must be prescribed in such a way that side effects are kept to a minimum. In each case, they are selected individually, taking into account the characteristics of the patient and his condition.

Split Personality: Symptoms and Signs

Only a highly qualified specialist can make an accurate diagnosis by analyzing the signs of split personality. Signs such as imbalance, poor sleep, memory loss, and mood swings are not noticeable to the patient himself, but the doctor takes them into account. If the patient “switches” from one ego state to another, and at this time the heart rate and breathing rhythm change and become characteristic of the “newly emerging” personality. This also does not escape the attention of the doctor.

Symptoms of dual personality appear in different forms:

• In the obsessive form, the personality is noticeable to others. Patients act in a way that is unusual for them - another person has moved into them.
• In the non-possessed form, subpersonalities are not obvious to other people, but patients experience a feeling of “remoteness” from themselves, the unreality of what is happening to them, detachment in relation to the physical and mental processes occurring with them. The patient feels like observers of their own life from the outside and have no power over it or the ability to change anything (there is a loss of self-organization). It may feel like the body does not belong to oneself or feel like a small child or person of the opposite sex. Patients suddenly develop thoughts and emotions that are not typical for them, and these manifestations are noticeable to relatives and friends. At the same time, preferences in food, clothing, or their interests may change. Moreover, preferences suddenly change and return to their previous state. Such patients are faced with intrusions of subpersonalities into everyday life: at work, an angry and unkind personality suddenly makes them shout at a co-worker or boss.

The second important symptom is amnesia, which manifests itself:

• gaps in memory regarding events of personal life and biography;
• failures in stable memory (a person loses well-mastered computer user skills);
• discovering that he does not remember what was done or said.

Some periods of time disappear completely from memory because amnesia occurs between individuals. The patient may find objects in a bag or note, but cannot determine their origin. Patients find themselves in places with no memory of how or why they got there. Patients forget both everyday and stressful events. The degree of awareness of their amnesia varies and some try to hide it. Their amnesia is noticeable to others because they cannot remember what they said, promised or did. Some people forget their name.

Subpersonalities coexist with each other: they may or may not conflict with each other and with the main personality. Non-conflict coexistence is mild, does not cause changes, and the patient does not consult a doctor.

With conflict coexistence, the patient experiences anxiety , depression , bulimia , anorexia , substance abuse , and suicidal behavior . Patients may hear voices and experience visual, olfactory, tactile, and taste hallucinations. But these hallucinogenic symptoms are not the same as those seen in schizophrenia. Patients perceive these voices as voices of an alternative personality.

Switching between them is manifested in a change in voice and facial expression. Periodically, the patient refers to himself in the third person or plural. Switching between personalities leads to a chaotic life for the patient. These symptoms cause significant discomfort or interfere with social and professional activities.

Tests and diagnostics

Diagnosis of this condition is difficult. It is based on anamnesis, questioning, and sometimes in combination with hypnosis.

The main diagnostic signs are taken into account:

• The existence of two or more personalities and only one can seize control over a person at a certain point in time.
• The presence of individual characteristics, preferences and memories in subpersonalities.
• A person forgets important information, but this is not associated with ordinary forgetfulness.
• The above symptoms are not a consequence of organic damage to the central nervous system and the use of psychoactive substances.

When making a diagnosis, the connection between the occurrence of symptoms and the use of drugs and alcohol is excluded. Children often display imagination and play with imaginary friends. Long and repeated interviews are recommended to be carried out under the influence of hypnosis or medications (amytal-caffeine disinhibition), and between doses, patients should keep a diary, which is then reviewed and analyzed by the doctor. Drug disinhibition has diagnostic significance: in a person, under the influence of medications, subcortical structures are disinhibited. While in a relaxed state, the patient reports information that was inaccessible due to psychogenic amnesia, repression, and conscious concealment.

In a state of hypnosis, the doctor gains access to other personalities and tries to establish direct contact with them. Over time, the clinician can map out the personalities as well as their relationships. This helps the patient better control dissociated states. The doctor also takes into account the possibility of simulation for personal gain (evading responsibility and punishment).

Patients are asked to take a test for dissociative identity disorder, which includes easy questions that anyone can answer. There are a lot of tests developed and you can pass them all. It is advisable for people whose relatives have had such disorders to take the online split personality test. Knowing the existing problem makes it possible to prevent it by working with a psychologist.

Principles of therapy

At the Leto clinic, treatment of such disorders occurs on an outpatient basis, with a specialist visiting your home or in a hospital. The main attention is paid to psychotherapy, which helps to overcome previous trauma, reveals conflicts and fears that provoked pathology, and corrects the defense mechanisms of the subconscious.

Sometimes (especially when presenting late) it is difficult to determine how to treat dissociative disorder. In such a situation, the goal of the psychotherapist’s work is to achieve a kind of “compromise” and safe interaction between individual personalities. At the same time, the doctor treats all individuals with the same amount of respect and care and does not take sides in an internal conflict - this is the key to a trusting relationship with the patient.

As practice shows, drug therapy does not achieve significant results. Only in some cases, according to strict indications, the doctor prescribes antidepressants and sedatives, but their use is rather symptomatic.

Prevention

Because dissociative identity disorder is a mental illness, there are no preventive measures. But since the main cause is child abuse, it is important to avoid traumatic situations in childhood. International organizations and social services are working to identify and eliminate violence. If severe stress and psychological trauma have occurred in a child, it is important to contact a specialist in a timely manner, which will prevent the development of dissociative disorders in the future.

Excursion into history

This pathology was first mentioned in the late 1970s. During the trial in the case of William Milligan, it was established that the accused committed all the offenses without realizing his own actions. At the same time, his body was controlled by one of 23 personalities. The defendant was declared mentally ill and placed in a specialized clinic. It was V. Milligan who became the first person to be officially diagnosed with dissociative disorder.

For a long time, there were heated debates regarding this disease. Many experts were inclined to think that such a diagnosis was the result of a clever game that psychiatrists and psychologists could not recognize. After analyzing a lot of data obtained during clinical studies, the pathology was included in the ICD list as a disease requiring professional intervention.

Forecast

In terms of prognosis, it can be noted: the earlier the disorder begins, the worse the prognosis for a person in social terms. Recovery is most often not complete. Impairments in dissociative identity disorder vary widely, from mild to severe. Treatment can reduce social, occupational, and relationship problems. Some patients respond slowly to treatment and require long-term treatment.

In this regard, patients are divided into groups:

• Patients whose symptoms are dissociative and post-traumatic in nature. Such patients retain their legal capacity and fully recover during treatment.
• Patients who, in addition to dissociative symptoms, also have other disorders: eating behavior, affective disorders, personality disorders, substance abuse disorders. Treatment in such patients is less effective, and improvement occurs slowly.

In both groups there are symptoms of mental disorders (emotional attachment to offenders). In this connection, it is necessary to carry out a longer course aimed not only at achieving personal integrity, but also at eliminating the symptoms of mental disorders. Dissociative identity disorder, compared to other personality disorders, is the most severe and has a chronic course. This is due to the fact that each alter personality may have its own mental disorders.

What to do if a person refuses treatment?

You need to understand why he does this. It may take time to talk about the problem. Try to explain that there are no difficulties in the course of treatment and you will easily go through the path together. You shouldn’t tell scary stories, but you don’t need to lie that you’ll be cured in a month.

You can call a doctor yourself, without permission. You need to write a statement that will be the reason for the home inspection. If the doctor sees that the patient’s condition does not have symptoms that threaten his life and those around him, he is asked to sign papers for the course of treatment, but you have the right to refuse. Involuntary hospitalization is possible when a person is in a complex psychological disorder, and his actions can harm loved ones.

List of sources

• Brushlinsky A.V. Psychology of the subject. M., 2003. 272
• Korolenko T.P., Dmitrieva N.V., Zagoruiko E.N. Identity in normal and pathological conditions. Novosibirsk, 2000. 255 p.
• Turbina E.G. Multiple personality syndrome // Kemerov V.E., Kerimov T.Kh. (ed.) Social philosophy. Ekaterinburg, 2006. P. 205
• Nikiforova P. The phenomenon of multiple personality in science and culture. St. Petersburg, 2014. 20 p.
• Putnam Frank W. Diagnosis and treatment of multiple personality disorder. Per. from English - M.: Cogito-Center, 2004. - P. 10, 138-150.