Theories and Treatments of Dissociative Identity Disorder

Posted On October 28, 2024

There are many methods clinicians can use to treat dissociative identity disorder.  Sadly, many clinicians do not believe that DID is real treating the symptoms with drugs. Instead of looking into the DSM to see the criteria for DID and that it is accepted as a real diagnosis by the American Psychological Association. But first, we must examine the different theories associated with dissociative identity disorder.

 

The Theory of Structural Dissociation

The leading theory in the formation of dissociative identity disorder is the theory of structural dissociation, postulated by Ellert Nijenhuis, Bessel Van der Hart, and Kathy Steele states that no one is born with an integrated personality. Instead, very young children have a loose collection of ego states for their different needs such as attachment to a caregiver and feeding.

 

Before the age of 6-9, children integrate into themselves the different personality states into one cohesive self.

 

However, trauma interrupts the normal process of integration leaving the child dissociated and unable to merge due to traumatic memories and learned action paths to respond to trauma. The one coherent self cannot form when the child’s caregivers are inconsistent and abusive.

 

This failure to integrate in early childhood is the beginning of a person having alters and forming dissociative identity disorder. Each part becomes a vessel containing information of a trauma or a series of related traumas that the other self-states do not remember.

 

The main or host personality is known as an apparently normal part, where an individual part formed from a traumatic event or series of events is called an emotional part. When multiple emotional parts are separate from the apparently normal part, this is called secondary structural dissociation. With DID, where both types of parts (emotional and apparent) exist in one person it is known as tertiary structural dissociation.

 

Apparently Normal Parts. Apparently normal parts are the present-oriented and rational parts of the individual with dissociative identity disorder. The job of the apparently normal part includes social interactions and taking care of things such as play, work, exploration, learning, and their physical needs. Apparently, normal parts are highly avoidant about triggers that remind them of the trauma they survived in childhood. Avoidant behaviors they may exhibit include amnesia, limited emotions, or numbing, and can make the person with DID become depressed, feel chronically anxious, and hopeless because they become worn down.

 

Emotional Parts. Emotional parts are parts of the personality that contain memories, internalized beliefs, and perceptions of a traumatic event. EPs are triggered to life by triggers that remind them of the trauma they survived. EPs are also known as alters. These parts experience a range of emotions such as anger, disgust, and fear. These parts remain separate from the apparently normal part and in DID take on lives of their own. One may have one or many emotional parts or alters.

 

The Theory of Functional Dissociation of the Self

The theory of functional dissociation of the self is an approach concerned with facilitating the active participation of the person who has dissociative identity disorder in the psychotherapeutic process as a good treatment that can cut years from the healing process (Kluft, 1993).

 

Sar & Ozturk (2007) postulated a theory of dissociation and dissociative disorders based on what they termed the “functional dissociation of the self.” Their theory involves the psychological and sociological selves of a person and how dissociative identity disorder is the splintering of these two conditions.

 

The psychological self describes an enduring and complex unity of knowledge that serves to unify diverse descriptions of the ego to clarify the function of the ego personality states. The psychological self has many traits including creativity, resilience, time as continuity, and authenticity.

 

The sociological self is regarded as a universal phenomenon instead of a culture-bound concept and has traits different from, and often opposite to, the psychological self, including imitation, modeling, copying, vulnerability, and seeing time as periods rather than as a continuum.

 

The theory proposes that the main source of dissociation is trauma causing the detachment of the sociological and psychological selves and the expansion of the sociological self. It states that abuse and neglect during development periods inhibit the development of the psychological self and accelerate the development of the sociological self. Thus, the psychological self is saved and hidden, remaining frozen in time and the sociological self develops enormously.

 

It is proposed in the theory of functional dissociation of the self that although the sociological self may function as a go-between of the individual to society, it is not a relational self (Sedikides & Brewer, 2001).

 

Because the sociological selves’ realities reign, it motivates the person to make decisions and choices based on their perspectives. This control restricts overall functioning as it protects the psychological self from acquiring mental health issues that further traumatic experiences could bring.

 

Thus, effective psychotherapy must curtail the enlargement of the sociological self and reactivate the psychological self. It is hoped that this conceptualization will contribute to efforts both toward understanding the everyday dissociation of the average contemporary individual and toward developing novel psychotherapeutic approaches which might shorten the length of treatment of dissociative disorders.

 

The Socio-cognitive Model

There are those who insist that dissociative identity disorder is really some other form of mental illness, and that overzealous therapists cause DID by suggestions and hints that make their clients believe they have the disorder. This theory suggests that DID is not a valid psychiatric disorder of post-traumatic origin but instead a psychotherapist’s creation due to the popular notions in popular culture.

 

Because people who have DID are highly suggestible, the socio-cognitive model suggests that patients present as someone with dissociative identity disorder because that identity has been imposed upon them by their therapist.

 

It is this theory of dissociative identity disorder that fuels and keeps alive the controversy surrounding DID even though it is widely held that it is caused by childhood trauma.

Treatment Options for Dissociative Identity Disorder

While there are no definitive treatments for dissociative identity disorder, there are some options available. It is important to do some research on each choice before moving ahead and choosing the therapy that’s right for you. Two types of psychotherapy, including the most common, are listed below.

 

Psychotherapy. The most common treatment for dissociative identity disorder is psychotherapy (AKA talk therapy). With this therapy, one sits with a licensed mental health professional who helps in gaining control and safety.

 

Cognitive behavioral therapy (CBT). This is a highly structured and goal-oriented therapy that helps those with dissociative identity disorder unlearn negative behaviors and thinking.

 

Dialectical behavioral therapy (DBT). This type of therapy aids people living with DID to balance the knowledge of the benefits of change with the acceptance of who they are.

 

Medications. Although there are no medications to treat dissociative identity disorder, psychiatrists use certain drugs to treat diagnoses that often co-occur with DID such as depressive disorders and anxiety disorders.

 

References

 

Nijenhuis, E.R.S.; Van der Hart, O. & Steele, K. (2004). Trauma-related structural dissociation of the personality. Trauma Information Pages website, January 2004. Web URL: http://www.trauma-pages.com/a/nijenhuis-2004.php

 

Van der Kolk, B. A. (1994). The body keeps the score: Memory and the evolving psychobiology of posttraumatic stress. Harvard review of psychiatry, 1(5), 253-265.

Brand, R., Classen, C., Lanius, R., Loewenstein, R., McNary, S., Pain, C., & Putnam, F. (2009). A naturalistic study of Dissociative Identity Disorder and Dissociative Disorder NotOtherwise Specified patients treated by community clinicians.Psychological Trauma: Theory, Research, Practice, and Policy, 1(2)153–171.

Buchele, B. (1993). Group psychotherapy for persons with multiple personality and dissociative disorders. Bulletin of the Menninger Clinic, 57(3), 362.

Cormier, J., & Thelen, M. (1998). Professional skepticism of Multiple Personality Disorder.Professional Psychology: Research and Practice 29(2), 163-167.

Kluft, R. P. (1993). The initial stages of psychotherapy in the treatment of multiple personality disorder patients. Dissociation: Progress in the Dissociative Disorders.

Gleaves, D., May, M., & Cardena, E. (2001). An examination of the diagnostic validity of dissociative identity disorder. Clinical Psychological Review, 21(4), 577-608.

International Society for the Study of Dissociation. (2005). [Chu, J., Loewenstein, R., Dell, P., Barach, P., Somer, E., Kluft, R., Gelinas, D., Van der Hart, O., Dalenberg, C., Nijenhuis, E., Bowman, E., Boon, S., Goodwin, J., Jacobson, M., Ross, C., Sar, V., Fine, C., Frankel, A., Coons, P., Courtois, C., Gold, S., & Howell, E.]. Guidelines for treating Dissociative Identity Disorder in adults. Journal of Trauma & Dissociation, 6(4) pp. 69-149.

Maldonado, J. R., Butler, L. D., & Spiegel, D. (2002). Treatments for dissociative disorders. In A Guide to Treatments That Work (2nd Ed.). New York: Oxford University Press.

Okugawa, G., Nobuhara, K., Kitashiro, M., Kinoshita, T. (2005). Perospirone for treatment of Dissociative Identity Disorder. Psychiatry and Clinical Neurosciences, 59, 624.

Şar, V., & Öztürk, E. (2007). Functional dissociation of the self: A sociocognitive approach to trauma and dissociation. Journal of Trauma & Dissociation, 8(4), 69-89.