psychiatric disorders
Dissociative Identity Disorder
Symptoms and Signs of Dissociative Identity Disorder
Several symptoms are characteristic of dissociative identity disorder. In thepossession form,the multiple identities are readily apparent to family members and associates. Patients speak and act in an obviously different manner, as though another person or being has taken over. The new identity may be that of another person (often someone who has died, perhaps in a dramatic fashion) or that of a supernatural spirit (often a demon or god), who may demand punishment for past actions. In thenonpossession form,the different identities are often not as apparent to observers, although the person may display a sudden shift in affect or interpersonal manner. Some patients experience feelings of depersonalization; ie, they feel unreal, removed from self, and detached from their physical and mental processes. Patients say that they feel like an observer of their life, as if they were watching themselves in a movie over which they have no control (loss of personal agency). They may think that their body feels different (eg, like that of a small child or someone of the opposite sex) and does not belong to them. They may have sudden thoughts, impulses, and emotions that do not seem to belong to them and that may manifest as multiple confusing thought streams or as voices. Some manifestations may be noticed by observers. For example, patients' attitudes, opinions, and preferences (eg, regarding food, clothing, or interests) may suddenly change, then change back. People with dissociative identity disorder also experience intrusions into their everyday activities when there is a shift in identities or interference by one identity state in the functioning of another. For example, at work, an angry identity may suddenly yell at a co-worker or boss. Patients with dissociative identity disorder typically have Dissociative Amnesia . It typically manifests as Gaps in memory of past personal events (eg, periods of time during childhood or adolescence, death of a relative) Lapses in dependable memory (eg, what happened today, well-learned skills such as how to use a computer) Discovery of evidence of things that they have done or said but have no memory of doing and/or that seem unlike themselves Patients report periods of time that they may have lost. Patients may discover objects in their shopping bag or samples of handwriting that they cannot account for or recognize. They may also find themselves in different places from where they last remember being and have no idea why or how they got there. Unlike patients with Posttraumatic Stress Disorder (PTSD) patients with dissociative identity disorder forget everyday events as well as stressful or traumatic ones. Patients vary in their awareness of the amnesia. Some try to hide it. The amnesia may be noticed by others when patients cannot remember things they have said and done or important personal information, such as their own name. In addition to hearing voices, patients with dissociative identity disorder may have visual, tactile, olfactory, and gustatory hallucinations. Thus, patients may be misdiagnosed with a psychotic disorder. However, these hallucinatory symptoms differ from the typical hallucinations of psychotic disorders such as Schizophrenia . Patients with dissociative identity disorder experience these symptoms as coming from an alternate identity (eg, as if someone else wanted to cry using their eyes, hearing the voice of an alternate identity criticizing them). Depression, anxiety, substance misuse, self-injury, self-mutilation, nonepileptic seizures, and suicidal behavior are common, as is sexual dysfunction. The switching of identities and the amnestic barriers between them frequently result in chaotic lives. Generally, patients try to hide or minimize their symptoms and the effect they have on others. 