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Multiple Personality Disorder

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Description: Multiple Personality Disorder, now known as Dissociative Identity Disorder (DID), is characterized by the presence of two or more distinct personality states or identities that control an individual's behavior at different times.
Type: Multiple personality disorder, more accurately known as dissociative identity disorder (DID), is not considered a genetic disorder. It is a complex psychological condition often associated with severe trauma during early childhood, usually extreme, repetitive physical, sexual, or emotional abuse. There is no established mode of genetic transmission for this disorder.
Signs And Symptoms: The full presentation of dissociative identity disorder can onset at any age, although symptoms typically begin at ages 5–10. According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), symptoms of DID include "the presence of two or more distinct personality states" accompanied by the inability to recall personal information beyond what is expected through normal memory issues. Other DSM-5 symptoms include a loss of identity as related to individual distinct personality states, loss of one's subjective experience of the passage of time, and degradation of a sense of self and consciousness. In each individual, the clinical presentation varies and the level of functioning can change from severe impairment to minimal impairment. The symptoms of dissociative amnesia are subsumed under a DID diagnosis, and thus should not be diagnosed separately if DID criteria are met. Individuals with DID may experience distress from both the symptoms of DID (intrusive thoughts or emotions) and the consequences of the accompanying symptoms (dissociation rendering them unable to remember specific information). The large majority of patients with DID report childhood sexual and/or physical abuse. Amnesia between identities may be asymmetrical; identities may or may not be aware of what is known by another. Individuals with DID may be reluctant to discuss symptoms due to associations with abuse, shame, and fear. DID patients may also frequently and intensely experience time disturbances.Around half of people with DID have fewer than 10 identities and most have fewer than 100; although as many as 4,500 have been reported.(p 503) The average number of identities has increased over the past few decades, from two or three to now an average of approximately 16. However, it is unclear whether this is due to an actual increase in identities, or simply that the psychiatric community has become more accepting of a high number of compartmentalized memory components.
Prognosis: Little is known about prognosis of untreated DID. It rarely, if ever, remits without treatment, but symptoms commonly wax and wane over time. Patients with mainly dissociative and post-traumatic symptoms face a better prognosis than those with comorbid disorders or those still in contact with abusers, and the latter groups often face a lengthier and more difficult treatment course. Suicidal ideation, suicide attempts, and self-harm are common in the DID population. Duration of treatment can vary depending on patient goals, which can range from merely improving inter-alter communication and cooperation, to reducing inter-alter amnesia, to integration and fusion of all alters, but this last goal generally takes years, with trained and experienced psychotherapists.
Onset: The onset of Multiple Personality Disorder, now known as Dissociative Identity Disorder (DID), typically occurs in childhood, often between the ages of 5 and 10. However, symptoms may not be fully recognized or diagnosed until adolescence or adulthood. The condition is usually associated with severe trauma or abuse during early developmental years.
Prevalence: The term "multiple personality disorder" is outdated; it is now known as dissociative identity disorder (DID). The prevalence of dissociative identity disorder varies, but it is estimated to affect about 1-2% of the general population.
Epidemiology: Multiple Personality Disorder, now known as Dissociative Identity Disorder (DID), has an unclear epidemiology due to historical diagnostic challenges and varying criteria. Estimates suggest DID affects approximately 1-2% of the general population, but this figure can vary. It is often underdiagnosed and misdiagnosed due to its complex clinical presentation and overlapping symptoms with other psychiatric disorders. Diagnosis is more common in females, and the condition often has roots in severe trauma or abuse during early childhood.
Intractability: Multiple Personality Disorder, now referred to as Dissociative Identity Disorder (DID), can be challenging to treat, but it is not considered intractable. Treatment typically involves long-term psychotherapy, including techniques like cognitive-behavioral therapy (CBT), dialectical behavior therapy (DBT), and eye movement desensitization and reprocessing (EMDR). While progress can be slow and requires a committed therapeutic relationship, many individuals with DID can achieve significant improvement and lead functional lives with appropriate treatment.
Disease Severity: Multiple Personality Disorder, now known as Dissociative Identity Disorder (DID), can vary in severity. The severity depends on factors such as the number of identities present, the degree of dissociation, and the impact on daily functioning. Cases can range from mild, where individuals may function relatively well, to severe, where there is significant disruption in an individual's life and ability to function. Treatment often involves long-term psychotherapy.
Healthcare Professionals: Disease Ontology ID - DOID:10934
Pathophysiology: Despite research on DID including structural and functional magnetic resonance imaging, positron emission tomography, single-photon emission computed tomography, event-related potentials, and electroencephalography, no convergent neuroimaging findings have been identified regarding DID, with the exception of smaller hippocampal volume in DID patients. In addition, many of the studies that do exist were performed from an explicitly trauma-based position. There is no research to date regarding the neuroimaging and introduction of false memories in DID patients, though there is evidence of changes in visual parameters and support for amnesia between alters. DID patients also appear to show deficiencies in tests of conscious control of attention and memorization (which also showed signs of compartmentalization for implicit memory between alters but no such compartmentalization for verbal memory) and increased and persistent vigilance and startle responses to sound. DID patients may also demonstrate altered neuroanatomy.
Carrier Status: Multiple Personality Disorder, now known as Dissociative Identity Disorder (DID), is not a genetic condition, so there is no carrier status associated with it. It primarily arises from severe trauma during early childhood, usually extreme, repetitive physical, sexual, or emotional abuse.
Mechanism: Multiple Personality Disorder (MPD), now known as Dissociative Identity Disorder (DID), is a complex psychological condition. The exact mechanism is not fully understood, but there are several hypotheses:

1. **Psychological Mechanism**: DID is believed to result from severe trauma during early childhood, usually extreme, repetitive physical, sexual, or emotional abuse. The disorder is thought to be a coping mechanism, where a person dissociates themselves from a situation or experience that’s too violent, traumatic, or painful to assimilate with their conscious self.

2. **Neurobiological Mechanism**: Studies have shown abnormalities in the hippocampus and amygdala, brain regions involved in memory and emotion. Neuroimaging studies have reported changes in brain metabolism and connectivity in these regions in individuals with DID.

3. **Neurochemical Mechanism**: Dysregulation of neurotransmitters, such as serotonin and dopamine, may play a role in DID. However, the specifics of these neurochemical changes are not well-defined.

4. **Genetic Factors**: There is limited evidence suggesting a genetic component, but the condition is more likely due to environmental factors combined with individual vulnerabilities.

Currently, the molecular mechanisms involved in DID are not well-characterized, as it is primarily considered a disorder with psychological roots rather than a direct result of identifiable molecular or genetic changes. Further research is needed to elucidate any potential molecular underpinnings.
Treatment: Treatment aims to increase integrated functioning. The International Society for the Study of Trauma and Dissociation has published guidelines for phase-oriented treatment in adults as well as children and adolescents that are widely used successfully in the field of DID treatment. The guidelines state that "a desirable treatment outcome is a workable form of integration or harmony among alternate identities". Some experts in treating people with DID use the techniques recommended in the 2011 treatment guidelines. The empirical research includes the longitudinal TOP DD treatment study, which found that patients showed "statistically significant reductions in dissociation, PTSD, distress, depression, hospitalisations, suicide attempts, self-harm, dangerous behaviours, drug use, and physical pain" and improved overall functioning. Treatment effects have been studied for over thirty years, with some studies having a follow-up of ten years. Adult and child treatment guidelines exist that suggest a three-phased approach, and are based on expert consensus.Common treatment methods include an eclectic mix of psychotherapy techniques, including cognitive behavioral therapy (CBT), insight-oriented therapy, dialectical behavioral therapy (DBT), hypnotherapy, and eye movement desensitization and reprocessing (EMDR).Hypnosis should be carefully considered when choosing both treatment and provider practitioners because of its dangers. For example, hypnosis can sometimes lead to false memories and false accusations of abuse by family, loved ones, friends, providers, and community members. Those who suffer from dissociative identity disorder have commonly been subject to actual abuse (sexual, physical, emotional, financial) by therapists, family, friends, loved ones, and community members.Some behavior therapists initially use behavioral treatments such as only responding to a single identity, and then use more traditional therapy once a consistent response is established. Brief treatment due to managed care may be difficult, as individuals diagnosed with DID may have unusual difficulties in trusting a therapist and take a prolonged period to form a comfortable therapeutic alliance. Regular contact (at least weekly) is recommended, and treatment generally lasts years – not weeks or months. Sleep hygiene has been suggested as a treatment option, but has not been tested. In general there are very few clinical trials on the treatment of DID, none of which were randomized controlled trials.Therapy for DID is generally phase oriented. Different alters may appear based on their greater ability to deal with specific situational stresses or threats. While some patients may initially present with a large number of alters, this number may reduce during treatment – though it is considered important for the therapist to become familiar with at least the more prominent personality states as the "host" personality may not be the "true" identity of the patient. Specific alters may react negatively to therapy, fearing the therapist's goal is to eliminate the alter (particularly those associated with illegal or violent activities). A more realistic and appropriate goal of treatment is to integrate adaptive responses to abuse, injury, or other threats into the overall personality structure. There is debate over issues such as whether exposure therapy (reliving traumatic memories, also known as abreaction), engagement with alters and physical contact during therapy are appropriate and there are clinical opinions both for and against each option with little high-quality evidence for any position.The first phase of therapy focuses on symptoms and relieving the distressing aspects of the condition, ensuring the safety of the individual, improving the patient's capacity to form and maintain healthy relationships, and improving general daily life functioning. Comorbid disorders such as substance use disorder and eating disorders are addressed in this phase of treatment. The second phase focuses on stepwise exposure to traumatic memories and prevention of re-dissociation. The final phase focuses on reconnecting the identities of disparate alters into a single functioning identity with all its memories and experiences intact.A study was conducted to develop an "expertise-based prognostic model for the treatment of complex post-traumatic stress disorder (PTSD) and dissociative identity disorder (DID)". Researchers constructed a two-stage survey and factor analyses performed on the survey elements found 51 factors common to complex PTSD and DID. The authors concluded from their findings: "The model is supportive of the current phase-oriented treatment model, emphasizing the strengthening of the therapeutic relationship and the patient's resources in the initial stabilization phase. Further research is needed to test the model's statistical and clinical validity."
Compassionate Use Treatment: Multiple Personality Disorder (MPD), now referred to as Dissociative Identity Disorder (DID), primarily relies on psychotherapy as the standard treatment. For compassionate use or off-label treatments, some approaches include:

1. **Medications**: While no drugs are specifically approved for DID, off-label use of medications such as antidepressants, antianxiety medications, and antipsychotics may help manage associated symptoms like depression and anxiety.

2. **Experimental Treatments**: These may include novel psychotherapeutic techniques, such as Eye Movement Desensitization and Reprocessing (EMDR) for trauma processing. Other approaches might involve the use of neurofeedback or transcranial magnetic stimulation (TMS), though these are still in early research phases.

It’s essential for these treatments to be managed by professionals experienced in DID to ensure patient safety and efficacy.
Lifestyle Recommendations: Multiple Personality Disorder, now more commonly referred to as Dissociative Identity Disorder (DID), requires comprehensive management that includes lifestyle and therapeutic interventions. Here are some lifestyle recommendations:

1. **Consistent Routine**: Establishing and maintaining a consistent daily routine can provide a sense of stability and predictability.

2. **Sleep Hygiene**: Prioritize regular sleep patterns to help manage stress and improve overall mental health.

3. **Regular Physical Activity**: Engage in regular exercise, which can help reduce anxiety, improve mood, and enhance overall well-being.

4. **Healthy Diet**: Maintain a balanced diet that supports physical health and can positively influence mental health.

5. **Stress Management**: Practice stress-reducing techniques such as deep breathing exercises, meditation, or yoga.

6. **Social Support**: Build a network of supportive friends, family, or support groups who understand the condition and provide emotional support.

7. **Avoid Substance Misuse**: Avoid the use of alcohol and recreational drugs, as they can exacerbate symptoms and interfere with treatment.

8. **Therapeutic Activities**: Engage in activities like journaling, art therapy, or other forms of self-expression to help process emotions and experiences.

9. **Professional Treatment**: Regularly attend therapy sessions as recommended by healthcare providers, which may include psychotherapy and medication management.

10. **Awareness and Education**: Educate oneself about the disorder to better understand and manage it effectively.

It's crucial to work closely with mental health professionals to tailor these recommendations to individual needs and circumstances.
Medication: For multiple personality disorder, now referred to as dissociative identity disorder (DID), there is no specific medication to treat the disorder itself. However, medications may be prescribed to address associated symptoms such as depression, anxiety, or mood swings. Antidepressants, anti-anxiety medications, and mood stabilizers are commonly used in such cases. Treatment typically also involves psychotherapy, such as cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT), to address the underlying trauma and help integrate the identities.
Repurposable Drugs: Multiple Personality Disorder, now known as Dissociative Identity Disorder (DID), is a complex psychological condition with no established pharmacological treatment specifically approved for it. The management typically focuses on psychotherapy. However, some medications used in related symptoms or conditions (like depression, anxiety, or PTSD) might be repurposed:

1. **Antidepressants:** SSRIs such as Fluoxetine or Sertraline to manage depressive symptoms.
2. **Mood Stabilizers:** Drugs like Lamotrigine for mood swings.
3. **Antipsychotics:** Atypical antipsychotics like Risperidone can be considered if there are severe symptoms of psychosis.

These medications are not cures for DID but can help manage associated symptoms.
Metabolites: Multiple Personality Disorder, also known as Dissociative Identity Disorder (DID), is characterized by the presence of two or more distinct personality states. The investigation into metabolites in DID is limited, but research has suggested abnormalities in stress-related metabolic pathways. Specifically, studies indicate potential alterations in neurotransmitter metabolites and stress hormones such as cortisol. However, more research is needed to draw definitive conclusions.
Nutraceuticals: There are no nutraceuticals specifically proven to treat Multiple Personality Disorder, now known as Dissociative Identity Disorder (DID). Treatment generally focuses on psychotherapy. Nutraceuticals like vitamins and minerals may support overall health but should be discussed with a healthcare provider for individualized care.
Peptides: Multiple Personality Disorder, now known as Dissociative Identity Disorder (DID), is a mental health condition characterized by the presence of two or more distinct identity states. There is no direct link between peptides and DID in current medical literature. Peptides, which are short chains of amino acids, are more commonly associated with various physiological processes and not directly with DID. Research into neuromodulation involving peptides and other biochemical factors in mental disorders is ongoing, but no specific peptides have been established as relevant to DID.