Signs/SymptomsMultiple different attitudes
Feeling of a loss of time Depression Depersonalization Sudden anger for no reason Panic attacks Unexplained phobias Diagnosis:People with DID often spend many years in the mental health system, and it is often misdiagnosed as schizophrenia or other psychotic disorders, affective disorders, substance abuse disorders, or a personality disorder (most commonly borderline personality disorder).
Well-validated screening tools to assist in diagnosis: Dissociative Experiences Scale Somatoform Dissociation Questionnaire 'Gold-standard' Structured Clinical Interview for DSM-IV disorders Despite the screening tools the majority of DID patients fail to receive a correct diagnosis |
Treatment:The treatment choice for DID is long-term, one-to-one, relationally based psychotherapy. Therapy is a minimum once weekly, but therapy is dependent on a number of factors such as the patients level of functioning, resources, support and motivation.
An eclectic use of techniques such as cognitive behavioural therapy, dialectual behaviour therapy, eye movement desensitisation and reprocessing and sensorimotor psychotherapy, amongst others are also other treatments used. Three stages most commonly used are: Establishing safety, stabilisation and symptom reduction. Working through and integrating traumatic memories Integration and rehabilitation Issues for the TherapistThe extreme and chronic nature of the trauma suffered by many DID patients can lead to complex and changeable transference and countertransference responses in the therapy.
Extreme care must be given to the issue of boundaries: There must be a open and honest discussion and negotiation of boundaries at every stage of the treatment. Quality of the relationship between therapist and patient which is the best predictor of therapeutic success. A warm, empathic, consistent, engaged therapist who is willing to be flexible and work a long term with extremely distressing material is essential. |