The phenomenon of a Multiple Personality Disorder (MPD), or Dissociative Identity Disorder (DID), as it has been called since recently, is one of the most widely known personality disorders. Traditionally defined as “a condition in which a person has two or more distinct identity or personality states, which may alternate within the individual’s conscious awareness” (Dissociative Identity Disorder, 2014), MPD/DID has recently been redefined as a Dissociative Identity Disorder (DID) due to the lack of criteria for the identity disorders, which the above-mentioned notion embraces (Sadock & Sadock, 2011, p. 674).
Reasons for Diagnosing MPD
Among the key reasons for diagnosing the disorder, the recognition of more complex forms of psychopathology (Paris, 2007, p. 38) should be listed. It should also be noted that diagnosing MPD/DID is only possible in adults (American Psychiatric Association, 2013, p. 293). Children often have imaginary playmates that they personify to the point where these playmates seem real (American Psychiatric Association, 2013, p. 293); however, the given phenomenon cannot be technically called the Dissociative Identity Disorder, as it does not involve the recognition of the playmate as a part of the child’s self.
Criteria to Be Followed When Diagnosing MPD
The behavioral patterns of the patient being controlled by at least two identities are the most important criteria for detecting an instance of the MPD/DID in a patient (American Psychiatric Association, 2013). Another important factor, which allows for identifying the possible threat of the MPD/DID development, the medicine consumed previously must be considered. If a patient displays the aforementioned characteristics without being under the influence of specific medicine, MPD/DID tests must be carried out.
History of the Disorder
The history of the disorder discovery and the development of approaches for addressing it is quite complex and even controversial. In fact, the very existence of MPD/DID is still viewed as questionable by some scholars (American Psychiatric Association, 2013). Because of the elusive nature of the subject matter, it is quite hard to nail down the point in time, when the problem was identified as such. Eberhardt Gmelin is often credited as the first person to define the disorder (Plante, 2013); however, it was not until the study of Dr. Samuel Latham Mitchell that the MPD issue was looked into (Plante, 2013). Finally, in 1906, Mortin Prince published his study on dissociative disorders, thus, launching a series of researches on the phenomenon of MPD/DID. In 1994, the disorder was recognized as such in DSM-IV (Plante, 2013).
Causes of the MPD
Though the exact mechanism of the MPD/DID development has not been defined precisely yet, certain factors have been identified as a potential threat to the wellbeing of patients and a probable cause of MPD/DID. Specifically, traumas that occurred at significant stages of a child’s development must be mentioned as the key cause of MPD/DID in patients (Lewis, Yeager, Swica, Pincus & Lewis, 2014). As a result of a childhood trauma, the process of dissociation starts so that the patient could detach themselves from the painful memories.
Symptoms of the MPD
As a rule, the presence of at least two clear states of personality is the basic symptom of the MPD/DID (American Psychiatric Association, 2013, p. 291). The recurrent episodes of amnesia are also characteristic of the MPD (American Psychiatric Association, 2013, p. 291).
Types of the MPD: Classification
As it has been stressed above, the phenomenon of MPD/DID incorporates a variety of mental conditions. As a result, the need to differentiate between several types of MPD/DID arises. Traditionally, the MPD/DID includes a dissociative amnesia, which is classified as the inability to recall the information related to one’s autobiography (American Psychiatric Association, 2013, p. 291).
The depersonalization disorder is another variation of the MPD/DID phenomenon. The aforementioned disorder is known as a series of “sever dissociative responses” (American Psychiatric Association, 2013, p. 286) and is usually referred to as one of the effects of amnesia.
Technically, preventing MPD/DID is nearly impossible because of the gap between its development and diagnosis. Although MPD/DID develops in the early childhood stage (American Psychiatric Association, 2013), it can only be identified in an adult patient (Greyber, Dulmus & Cristalli, 2012). As a result, the prevention of the MPD/DID can be considered a major difficulty. Nevertheless, preventing the instances of various traumas, psychological and physical abuse, etc., can be considered one of the key approaches to preventing MPD/DID altogether (American Psychiatric Association, 2013).
As a rule, psychotherapy is suggested as the key tool for addressing the MPD/DID issue. The intervention is preceded by the analysis of the patient’s past traumas and the design of the appropriate intervention strategy. The treatment plans are stratified into long- and short-term goals so that the process of treatment could occur at a steady pace and that assessments could be made in an adequate manner.
Short-term goals. Patients must learn the basics of interacting with others, as well as recognizing and preventing the instances of anxiety. The design of the appropriate crisis prevention techniques is, therefore, the primary short-term goal for the therapist working with an MPD/DID patient.
Long-term goals. Depression and the traumatic memories of the past are typically considered the long-term goals of treatment. In order to attain the specified goals, eye movement desensitization and reprocessing can be suggested as the tools for assisting the patient (Greyber et al., 2012). As a rule, long-term treatment strategies tend to be more efficient, as they allow for the patient to remain more committed to the intervention throughout the treatment process (Leble & Snell, 2004).
Overcoming the Disorder: Tips
Despite being a very difficult process of mental and psychological healing, the process of MPD/DID recovery may be enhanced once certain pieces of advice are taken into account. The cooperation between the therapist and the patient’s family members is imperative to the success of the intervention and the future recovery. In other words, the patient must receive strong support from at least one member of their family.
The next and nonetheless essential step in enhancing the process of healing, the recognition of the problem by the patient must occur. Although the intervention and the following treatment is technically possible even without the active engagement of the patient, it is desirable that the latter should recognize the problem and, therefore, be aware of the issue.
Finally, the therapist and the family members involved must facilitate the reconciliation of the patient with their painful past. It is imperative that the patient should realize that they should not blame themselves for what happened, and nor should they be ashamed of it. It is only with embracing of the previous experiences and the development of emotional control that the patient will be capable of healing successfully (Leble & Snell, 2004).
There is no need to stress that the support of both nurses and family members is essential to the patients with MPD/DID. The skills that allow the patient to engage in the socially acceptable behavioral patterns are required in parents and family members for addressing the issue; specifically, the need to engage the patients into games that simulate social activities deserves to be mentioned (Hauggaard, 2004). Thus, the patient learns to accept and use socially acceptable patterns of behavior. It is suggested that the specified activities should be carried out in the form of games when dealing with young patients (Hauggaard, 2004).
Apart from family involvement, patients with the specified issue require an evidence-based therapy. The necessity to deploy the specified strategy into the overall framework of the intervention is predetermined by the fact that there is very little actual evidence on the phenomenon of MPD/DID (Corrigan & Hull, 2015). As a result, there is a consistent need to supply new data to therapists so that they could design an appropriate intervention strategy for treating a specific instance of the MPD/DID.
Another reason for the necessity to incorporate the evidence-based approach concerns the uniqueness of each case of MPD/DID. Indeed, as the existing studies show, the only characteristics that all DID patients have in common is a major trauma in the past. Hence, the need to address a specific trauma emerges. The latter goal is only attainable with the definition of the unique factors, which the patient was exposed to, as well as the characteristics of the trauma. Consequently, the EBP approach is crucial to the success of the intervention.
Not being fully researched, the issue of multiple personality disorder needs close attention of nurses and therapists, as its development impedes the process of social interactions in the patient and poses a threat to the wellbeing of both the latter and the people around them. The support of the family is crucial to the successful treatment outcomes; moreover, it is imperative that the patient should be involved in the therapy processes and eager to recover. While the suppression of childhood traumas impedes the process of recovery, the design of strategies, which will allow the patient to reconcile with their past is essential to the success of the intervention. Seeing that the issue has not been studied fully yet, the incorporation of evidence-based practices into the design of the intervention is imperative to the outcomes thereof.
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