Treatment, prognosis and prevention of dissociative identity disorder

How is dissociative identity disorder treated?

Psychotherapy

Psychotherapy, which is a form of psychology, uses psychological methods that are based on the regular interaction between a mental healthcare professional and their patient. Psychotherapy is the main form of treatment for those suffering from dissociative disorders. It is also known as counselling, talk therapy and psychosocial therapy. This form of treatment will involve the patient talking about their condition and the issues related to it with a trained professional who will have had experience in working with individuals with mental health conditions as severe as dissociative identity disorder.

The therapist will attempt to lead the patient to an understanding of the underlying cause of their condition and form ways that suit them in coping with these traumatic circumstances. Eventually, the therapist will try to form a relationship of trust with their patient in order for the individual to feel comfortable in expressing their emotions.

The therapist treating a case of DID will need to have a thorough understanding of the condition in order to adequately deal with the different alters or personalities of the patient and be able to identify whom they are working with at any given session. The psychology behind these alters will be explained further in the section that follows.

Therapists will focus on trying to aid their patients in improving their relationships with loved ones and others and to feel comfortable with their emotions and how to express them. This can be conducted using family/group or individual psychotherapy. These therapy sessions will be paced carefully in order for the person dealing with DID to not be overwhelmed by strong emotions or anxiety.

A form of therapy that is used in a number of cases of DID is known as dialectical behaviour therapy (DBT). This kind of psychotherapy is a type of cognitive behavioural therapy that focuses on mindfulness and aids the patient through decreasing their negative reactions to specific stressors or triggers. Dialectical behaviour therapy focuses on the following factors:

• Identifying and labelling emotions
• Identifying any obstacles to emotions changing
• Increasing positive emotions and events
• Reducing vulnerability to specific emotions
• Increasing mindfulness to emotions currently being experienced
• Taking opposite action
• Applying techniques to aid in dealing with distress

The therapist will also guide the patient in finding a way that will allow for each of their alters to work together and coexist. As well as this, the mental health professional will also aid in developing techniques that will help to prevent crises and find ways in which to cope with memory issues and lapses that occur at periods of dissociation.

Therefore, the therapist will work towards achieving a peaceful coexistence within the individual’s different personalities. This goal is vastly different than reintegrating all of these multiple personalities into one single state of identity. While the goal of reintegration may form an integral part of the therapy sessions, this is sometimes done as an underlying goal as the patient suffering from DID may feel as though the therapist is seeking to ‘kill’ or ‘destroy’ certain parts of them and may feel attacked if this is the case.

Some professionals may also use hypnosis, though the scientific evidence to support this form of treatment is yet to be proven, there has been some research showing that hypnosis may be able to help change or ‘switch’ the patient between their different alters and give the therapist a more in-depth understanding of whom they are dealing with.

Hypnosis is also used to aid in increasing the information the patient has on their alters and increase the control they may have over these personalities.

Another form of treatment is known as EMDR (eye movement desensitisation and reprocessing). EMDR makes use of the individual’s traumatic memories and tries to reform them in a way that allows for the patient to see the distressing material in a new and enlightened way that is less disturbing. EMDR works through detecting the exact memory that is causing the dissociation and working with the individual to reimagine this in a way that does not provoke emotional distress in the present. EMDR has been seen to have positive results in improving the patient’s healing and processing of trauma.

Medication

There are currently no specific medications to treat someone with a dissociative condition, however, the medical professional working with the patient will typically prescribe medications to address a number of other health disorders that those suffering from DID often have, these include:

• Severe anxiety
• Depression
• Anger
• Impulse-control issues

Caution should be taken when administering medication to DID individuals as a number of these can often make the patient feel ‘numb’ and in a sense, ‘controlled’. This can cause the patient to experience a form of trauma and provoke emotions of distress.

Some medical professionals may explore the route of ECT (electroconvulsive therapy) combined with medication and psychotherapy in order to relieve the symptoms of dissociative identity disorder.

ECT is conducted under general anaesthetic. The patient will have tiny electric currents passed through their brain that will intentionally trigger a brief seizure. An ECT has been seen to result in changes to the brain’s chemistry that may be able to reverse the symptoms of a number of mental conditions.

 

What is the prognosis for dissociative identity disorder?

There has been research that shows that those suffering from dissociative identity disorder will have the best chance of living a healthy and productive life if they are able to undergo comprehensive treatment for their disorder. Granted, there are often a number of variables present in how different practitioners conduct their diagnostic procedure and treatment plans. These differences make it rather difficult to predict the outcomes for patients.

DID is still a largely misunderstood condition and requires a great deal of research in order for a more thorough understanding of the condition to be reached.

Can dissociative identity disorder be prevented?

Due to the fact that the cause of DID in most patients with the condition is related to the patient’s exposure to a traumatic event, the prevention of this condition lies in minimising the exposure that children have to trauma, especially in the form of physical and sexual abuse and helping the trauma survivor to deal with their past in a healthy and beneficial way.