Dissociative identity disorder is a mental disorder that is characterized by either having two or more personalities or a state of disconnection from the outside world, one's own identity, and an inability to remember certain daily life events and important personal information. This disorder is often mistaken for depression, anxiety or psychosis. Long before our days, this condition was called possession, and it was treated with exorcism. In the 19th century, this disorder was called hysteria, and in the 20th century, it was called multiple personality disorder.
Types of dissociative identity disorder
There are several types of dissociative disorders, which are characterized by different symptoms and manifestations. One of them is dissociative fugue - a disorder in which a person may find himself in a completely unfamiliar place and not remember how he got there. In this case, a person may forget some important information about himself and may not even remember his name. At the same time, memory for some information, such as literature, science, and other things, can be preserved. In a fugue state, a person assumes a different personality and identity with a different character, manners and behavior. While in this identity, a person can lead an outwardly normal life. A dissociative fugue can last from several hours to several years. After this, a person may find himself in a completely unfamiliar place and at the same time not remember anything that happened to him in a fugue state.
A person who has dissociative disorder actually suffers greatly from his condition.
Another type of dissociative disorder is the presence of several personalities in which a person finds himself in turns or simultaneously. At such moments, he disconnects from himself and stops feeling his own body, and also cannot see himself from the outside. Personalities within a person can have different ages, genders, nationalities, mental abilities, temperaments and behave completely differently. Often these personalities may even have different physiological manifestations. For example, being in one personality, a person may see poorly and wear glasses, but in another, have excellent vision and walk without glasses or contacts (or think that he sees perfectly and does without glasses). Just as in the case of a dissociative fugue, when switching, one personality cannot remember what happened to the person while immersed in another.
Description
In the works of Pyotr Borisovich Gannushkin on constitutional psychopathy, “antisocial psychopathy” is an analogue of dissocial personality disorder.
Robert D. Hare, a PhD candidate in experimental psychology and a renowned researcher in the field of criminal psychology, uses the word “psychopath” in his works to refer to people with this type of personality disorder.
McWilliams
In the works of Nancy McWilliams, dissocial personality disorder is described within the framework of the concept of “psychopathic personality” and its synonym “antisocial personality.” McWilliams describes this personality disorder as being based on a deep-seated inability (or severely impaired ability) to form attachments to other people, including one's own parents and children. From her point of view, a sociopath does not see attachments between other people and interprets their relationships solely as mutual manipulation. In accordance with his perception of society, a sociopath builds his relationships with people around him: on manipulation, for the sake of satisfying his own desires. Since a sociopath has no attachments, other people's needs and desires have no value for him and he acts based only on his own. Since he doesn't expect anyone to consider his own needs, the only long-term plan he can make for safe coexistence with society is to "get everyone to listen to him." The sociopath expects the same from those around him and, as a result, does not see the long-term benefit of observing social norms, including legally established ones: social norms and moral norms are perceived by the antisocial psychopath as a means of coercion and manipulation. Sociopaths have no qualms about lying and committing illegal acts. In most cases, they are driven by their own benefit/disadvantage, but only in the short term. They act impulsively and are not prone to planning. They take restrictions on freedom and the fulfillment of their desires seriously; they try to prevent this using methods available to them, mainly through threats or the use of physical force. Refusal to use force is perceived as weakness. They can make an extremely positive impression for some time in order to later use it to their advantage. They do not experience remorse, or rather, do not have a conscience or have it in an extremely underdeveloped form (the development of conscience is directly related to the formation of a sense of attachment).
It is important to understand that such people fully “understand” social norms, but ignore them. They are able to interact with society according to its rules, but do not feel the need to do so and have poor control over their own impulsiveness.
Eric Bern
According to Eric Berne's definition, there are two types of sociopaths:
- The first type, the latent or passive sociopath, behaves quite well most of the time, accepting the guidance of some external authority, such as religion or law, or becoming attached at times to some stronger personality, regarded as an ideal (we are not talking here about those those who use religion or law to guide their conscience, and those who use such doctrines instead of conscience). These people are not guided by ordinary considerations of decency and humanity, but are simply obeying their accepted interpretation of what is written in the “book.”
- The second type is an active sociopath. It is free of both internal and external delays. Even if he can pacify himself for a while and put on a mask of integrity (especially in the presence of people who expect decent and responsible behavior from him), but as soon as such sociopaths find themselves beyond the reach of persons authoritative for him, who demand good behavior, they immediately cease to restrain themselves.
Typical types of deviant behavior in sociopathy may include:
- directly criminal - sexual attacks on people, murders for hooligan reasons or fraud;
- not formally punishable, but condemned by society - inappropriate behavior of drivers on the road, deliberate evasion of duties at work, minor dirty tricks on others. “Non-criminal” sociopaths, however, do not care about the danger or extra work that they will incur on other people, and are indifferent to their possible losses.
Manifestations of dissociative identity disorder
This disease occurs in both children (adolescents) and adults, and occurs with similar symptoms. However, dissociative disorder with multiple identities is quite rare in adolescents. In old age, dissociation practically does not develop. When a specialist suspects a person has dissociative identity disorder, he usually asks if it has ever happened that the person suddenly found himself in some place and did not understand how he got there. Also, the patient may suddenly speak in a completely different voice, he may have a different handwriting. For example, a person whose one of his personalities is that of a child may suddenly begin to write in a child's handwriting. Such phenomenal manifestations can be caused in a patient suffering from dissociative identity disorder and in a state of hypnosis. That is why the French psychiatrist Jean-Martin Charcot at one time mistakenly believed that hypnosis is a pathological condition that causes hysteria and the manifestation of multiple personalities. However, it later turned out that hypnosis is only superficially similar to dissociative identity disorder, but does not cause it, and the disease itself develops without any connection with hypnosis.
How is mental illness diagnosed?
A characteristic feature of multiple personality disorder is memory gaps. Depersonalization and derealization are inherent in a person suffering from split personality disorder. Such concepts characterize a low level of perception of the environment with loss of self-identification. The diagnosis is made through a conversation with the suspected patient and his immediate environment. This process in the scientific community is called anamnesis.
Criteria by which the disease is diagnosed:
- Definition of more than two personalities in the human mind, retaining individual thinking, worldview and attitude towards oneself;
- Replacing personalities with each other;
- Serious memory loss associated with important events in the patient’s life;
- The parameters indicated above are not characterized by the use of alcohol, drugs, or epilepsy.
Causes of dissociative identity disorder
Scientists have not yet found the genetic causes of dissociative identity disorder. The main theory about the origin of this disease is based on the fact that in childhood such people experienced a traumatic situation, usually bullying or violence. However, even this theory does not explain 100% of cases of dissociative states. There are patients who, without an obvious or identified traumatic situation in childhood, suffer from dissociative identity disorder. As for the physiological manifestations of this disorder, there is an assumption that in such patients certain areas of the brain stop working and others turn on. However, none of the theories suggesting physiological causes of dissociation currently explains all cases of the disease.
Story
The terms psychopathy, sociopathy, and antisocial personality disorder are often used interchangeably. Unfortunately, there is no single set of defining criteria that are common to these three terms. Much of the existing literature notes the interchangeable use of these terms, along with differences in methods for defining the study population. As a result, the relevance of psychopathy and sociopathy research to patients with APD can only be determined empirically, as there may be significant differences among these populations. However, the treatment literature for APD has been based primarily on empirical studies conducted on subjects (usually criminals rather than psychiatric patients) identified as psychopaths or sociopaths. For this reason, it is important to briefly review the main trends in this literature.
The psychopathy literature has devoted considerable attention to the distinction between “primary” and “secondary” psychopathy (Cleckley, 1976). The primary psychopath is characterized by an apparent lack of anxiety or guilt regarding his illegal or immoral behavior. Because of its ability, for example, to deliberately lie for personal gain or cause physical harm to another person without experiencing nervousness, doubt, or remorse, primary psychopathy is regarded as a lack of moral responsibility. A secondary psychopath is a person who may exhibit the same exploitative behavior but reports feelings of guilt caused by harming another person. He may fear the likely consequences of the offense, but continues to behave in an antisocial manner, perhaps due to poor impulse control and emotional lability. Prisoners classified as primary psychopaths on the basis of significantly lower anxiety were more likely to exhibit severe forms of aggressive behavior (Fagan & Lira, 1980) and reported less somatic arousal than prisoners with secondary psychopathy in situations in which they perceived hostility from others ( Blackburn & Lee-Evans, 1985).
Numerous laboratory studies have tested the hypothesis that primary psychopaths suffer from dysfunction of the central nervous system, resulting in an increased threshold for the autonomic nervous system to respond to danger (Lykken, 1957; Quay, 1965). However, as Hare (1986) points out, there is evidence that, under many conditions, psychopaths as a group do not differ from normal people in autonomic nervous system and behavioral responses. For example, psychopaths have shown the ability to learn from experience under the influence of specific, well-defined, tangible and personally significant circumstances such as gaining or losing access to cigarettes. Thus, according to Hare, laboratory findings of decreased GSR activity in primary psychopaths may have been overemphasized, especially since this response can be influenced by a variety of forms of cognitive activity. Alternatively, the response characteristics of psychopaths may be clarified by differentiating between motivational and cognitive features.
Reviewing some research on cognitive development, Kagan (1986) concludes that sociopaths exhibit developmental delays in moral maturity and cognitive functioning. Kagan describes the moral and cognitive development of sociopaths as organized at Kohlberg's second epistemological level (Kohlberg, 1984), as seen in children with developmental delays. At this level, cognitive functions are regulated according to Piaget's concept of concrete operations. Such people are usually unable to correctly assess their capabilities. They rely on a personal rather than an interpersonal view of the world. In social cognitive terms, they cannot consider other people's points of view while maintaining their own. They also cannot impersonate another person. Their thoughts are linear and concern other people only when they realize the wishes of these patients. Because of these cognitive limitations, their actions are not based on social choice.
Kagan also refers to Erikson's (1950) study of developmentally delayed individuals in the context of psychosocial development and effort. People with effort problems are profit-seeking and “full of plans”; they do not worry about how others evaluate them, which is typical of adolescence and young adulthood. Kagan further suggests that treatment interventions for sociopathy are best pursued with strategies that include limiting patients' desire for independence and promoting understanding of the rights and feelings of others.
Diagnosis of dissociative identity disorder
Diagnosis of dissociative identity disorder is made through a clinical interview with several specialists. Sometimes making a diagnosis requires not one, but several meetings with psychologists and psychiatrists so that they have the opportunity to identify different aspects of the disorder, look at the patient’s condition from several points of view and gather a consultation. However, the specialist who identifies this disorder must have extensive experience and qualifications, since this disease can often be confused with others. Its manifestations may be similar to depression, anxiety or psychosis. Also, patients suffering from dissociative identity disorder are often diagnosed with schizophrenia. Dissociation is a rare disorder and not every mental health professional can diagnose this disorder.
Medications do not cure dissociative identity disorder, but only relieve some of the symptoms.
Basic information about the disease
Personality disorder of the dissocial type occurs more often in adolescence. The person does not experience feelings such as remorse, guilt or shame. Such traits get worse over time and persist throughout life. Timely treatment will help you return to a normal state of mind.
Such patients have an impaired ability to form any types of attachments. They cannot sincerely be friends, love and rejoice for a loved one. Patients with this diagnosis are convinced that their own needs come first and that all actions are legitimate. If necessary, they rudely violate the personal boundaries of other people and neglect their feelings.
In some cases, a psychiatric clinic is the only place where the patient can get help. The diagnosis is based on studying the medical history and talking with the patient. Treatment for dissocial personality disorder involves the use of medication and psychotherapy.
According to statistics, this pathology develops more often in men than in women. At risk are residents of large cities, representatives of low-income segments of the population, and children from large families. These people often believe that they have suffered a lot in life, and therefore consider others to be indebted to them for the hardships they have experienced.
Treatment of dissociative identity disorder
Hypnosis is mainly used to treat dissociative identity disorder. Sometimes specialists incorporate psychoanalytic methods or cognitive behavioral psychotherapy into treatment. In some cases, medication is also used to relieve symptoms. The drugs are prescribed if the disorder is accompanied by depression, panic attacks, drug or alcohol addiction. Medications do not cure dissociative identity disorder, but only relieve some of the symptoms. If a child suffers from this disease, then specialists carry out separate work with his parents, providing them with methods of proper communication with the child to improve the results of his treatment.
If you do not treat dissociative identity disorder, but let the disease take its course, then in the case of multiple personalities, a person in an inadequate state may commit some extremely negative actions towards others, for example, violence. In the case of a dissociative fugue, a person may become lost and never return home - it will simply be impossible to find him.
- Diseases and disorders
Symptoms of the disorder
Sociopathy can manifest itself already in early preschool and adolescence; symptoms of the disorder in boys usually become visible already in early school age. In girls, symptoms appear a little later - during prepuberty. The symptoms of the disorder are numerous: the child is selfish, hostile, stubborn, cruel (does evil to peers, tortures animals, skips classes, runs away from home, damages property, steals). When communicating with people, he is angry, quick-tempered, and attacks of rage are possible. Has a very high opinion of himself. A distinctive feature of patients with dissocial personality disorder is early opposition to parents. Due to the lack of attachment to others and a critical assessment of their actions, they neglect family traditions, moral and legal norms.
A person can deceive, speculate or manipulate other people for his own purposes, using his intellectual abilities for this. In order to get what they want, they are extremely charming, talkative, and endearing. They constantly crave easy entertainment and pleasure, an idle lifestyle, and try to avoid any work, study, or fulfilling any duties. Since adolescence, they have been drawn to antisocial companies, alcohol, and drugs. They are indifferent to their future and live in the present. They are weak-willed and cowardly - they try to run away from any difficulties and troubles.
Patients with antisocial personality disorder may rationalize their actions by blaming those they have offended, saying that they are to blame or deserve such treatment. They do not feel remorse or remorse, they are always confident that they are right, and at any cost they do what they consider best for themselves at the expense of other people. They are guided not only by selfish interests, but also by the desire to annoy and offend others. Any recovery from them is regarded as a manifestation of injustice.
In adulthood, a person with a similar disorder most often looks adequate and socially adapted. There are no problems in communication - thanks to their charm and ability to win over others, they often make a pleasant impression during superficial contacts. Sociopaths have a special magnetic power, and people who need to be nurtured and guided enjoy being around such a “strong” person. This calms them down and gives them confidence. A person with sociopathy is often sexually attractive, which he takes advantage of. Sexual life is a source of pleasure. Such a person is not able to love, empathize, sympathize, but can imitate love. you will never suspect that he does not feel anything for you.
A person with dissocial disorder is a desperate arguer who always wins, and if they try to catch him, he will dodge to the end, but will not admit to being wrong or lying and will most likely launch a counterattack. When trying to argue the accusations and his wrongness, the sociopath will respond with accusations that they want to denigrate his honor. There is no point in competing with such a person; in any situation, it is important for him to always win, and he will use any means to achieve this.
As a result of their impulsiveness, patients do not plan in advance, are socially and financially irresponsible - they handle money carelessly, often move, change their place of residence, work, and relationships. They may not pay bills, loans, alimony. Very often, sociopaths end up in prison; for many people with this disorder, criminal behavior begins to decrease after 40 years. Abuse alcohol and psychoactive substances. In a state of intoxication, conflict and aggressiveness increases.
Dissocial personality disorder persists throughout life; treatment is ineffective, but it helps to slightly correct behavior. Some patients create social groups isolated from society, becoming leaders of sects or criminal groups. With age, many patients develop concomitant affective and somatization disorders, alcoholism, and drug addiction.
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.
Diagnosis of the disease: split personality
The diagnosis is made based on the following criteria:
- A person has two or more personal identities or two or more personal states. It is important to note that each of them involves the formation of a separate behavioral model, worldview
- The minimum number of identities that exercise control over a person is about two or more
- The patient is unable to retain even important information data in his memory. It is worth noting that forgetting is pathological and differs from the ordinary mechanism when a person cannot remember an ordinary event or birthday
- Adverse symptoms do not develop as a result of alcohol or drug intoxication.
Experts face an important task: to separate the actual occurrence of the disease and the human game. However, it is worth noting that there are still discussions among experts about how effective the above criteria really are. They lack validity, which is why a specialist can form an incorrect diagnosis. Studies such as MRI, CT, and EEG also help eliminate the possibility of error.
