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State-Dependent Learning:

The theory states that if something is learned under the certain conditions, it will be remembered best when a person is again under the same condition. The explanation for this is arousal level, which is important for learning and memory. When the individual faces some situation at a particular level of arousal, he/she is more likely to recall the memories which are linked to it. This theory suggests that in patients with DID their thoughts, memories, skills are tied to a certain level of arousal, so they recall an event only when they experience the same state of arousal.

Self-Hypnosis:

Theorists concluded that dissociative disorders might be the forms of self-hypnosis, so people hypnotize themselves to forget traumatic experiences. Supporters of this theory suggest that children who experience abuse/trauma try to escape from the dangerous world by hypnotizing themselves; they mentally separate themselves from their bodies in order to avoid the traumatic event and to become another person.

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In DID memory and the construction of self-identity are mainly disrupted. When a person collects some experiences, he/she associates them with himself and develops a sense of self, meaning that a person forms his self, based on the semantic and episodic autobiographic memories. For example, “a certain experience happened to me, I remember it, so I experienced it”. In DID there is a breakdown between memory and the sense of self. So subpersonalities feel like they own certain memories, experiences. They might differ from each other in heart rate, blood pressure, brain activation, and also in the ability to own certain experiences.

Some theorists suppose that personality is made up of “modes” (Beck, 1996). They contain of cognitive, affective, behavioral, and physiological schema for remembering the experiences. It is kind of a role, for example, a mode of “mother”, which can be activated when a person is caring for her child, and she will feel, think, behave as a “mother”. Normally all modes are unified into one sense of self. When modes are decoupled DID arises. As a result, multiple subpersonalities appear, and each one has its own sense of self.

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Brand, B. L., Sar, V., Stavropoulos, P., Krüger, C., Korzekwa, M., Martínez-Taboas, A., & Middleton, W. (2016). Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder. Harvard review of psychiatry, 24(4), 257–270. https://doi.org/10.1097/HRP.0000000000000100

Burton, M. S., Feeny, N. C., Connell, A. M., & Zoellner, L. A. (2018). Exploring evidence of a dissociative subtype in PTSD: Baseline symptom structure, etiology, and treatment efficacy for those who dissociate. Journal of consulting and clinical psychology, 86(5), 439–451. https://doi.org/10.1037/ccp0000297

Comer, R., J. (2014) The Fundamental of Abnormal Psychology, 7th Edition. Worth Publishers.

Davidson, P. R., & Parker, K. C. H. (2001). Eye movement desensitization and reprocessing (EMDR): A meta-analysis. Journal of Consulting and Clinical Psychology, 69(2), 305–316. https://doi.org/10.1037/0022-006X.69.2.305

Bethany L. Brand, Richard J. Loewenstein, and David Spiegel (2014). Dispelling Myths About Dissociative Identity Disorder Treatment: An Empirically Based Approach. Psychiatry: Interpersonal and Biological Processes: Vol. 77, No. 2, pp. 169-189.

https://doi.org/10.1521/psyc.2014.77.2.169

Madden, N., E. (2004). Psychologists' Skepticism and Knowledge about Dissociative Identity Disorders in Adolescents.  PCOM Psychology Dissertations.

Muller, R., T. (2013). The Media and Dissociative Identity Disorder. Examining the facts and fictions of media portrayals of DID. Psychology Today.

Phelps, B., J. (2000). Dissociative Identity Disorder: The Relevance of Behavior Analysis. The Psychological Record, 50, 235-249.

Phelps, B., J. (2000).  Personality, Personality "Theory" and Dissociative Identity Disorder Disorder: What Behavior Analysis Can Contribute and Clarify. The Behavior Analysts Today.

Şar, V., Dorahy, M. J., & Krüger, C. (2017). Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective. Psychology research and behavior management, 10, 137–146. https://doi.org/10.2147/PRBM.S113743

Tesfaye, E., Alemayeha, S., Masane, M. (2019). Dissociative Identity Disorder Presenting with Multiple Suicidal Attempt: A Case Report. EC Psychology and Psychiatry, Vol. 8(6), 512-517.

https://www.youtube.com/watch?v=ek7JK6pattE

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How are the symptoms of the two disorders (PTSD and DID) similar? In what ways are they different?

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How are the symptoms of the two disorders (PTSD and DID) similar? In what ways are they different?

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Comparing PTSD and DID, PTSD can develop in the only single traumatic event/experience in adult or childhood (for example, when observing sexual violence), where DID occurs, in most cases, from childhood trauma, and not in adulthood. And also, DID develops with repeated stress or traumatic events. PTSD depends more on the severity of the traumatic event, and less depends on age (2020).
There are symptoms that are related to DID and PTSD: memory loss, depersonalization (feeling as if the self is not real), or derealization (feeling as if the world is not real). DSM-5 (DSM-5; APA, 2013) includes a dissociative subtype of PTSD marked by symptoms of derealization and depersonalization.
Also similar symptoms such as: feeling that you briefly lose touch with the outside world, forgetfulness of a certain time, a distorted sense of reality, and flashbacks

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Dissociations are the responses which are learned from operant conditioning (reward and punishment), according to behaviorists. When a person experiences a traumatic event, he/she finds it helpful when they drift off to other subjects. So basically, he/she is reinforced for forgetting, and learns escaping from anxiety/stress. Behaviorists suggest that dissociations are the escape behavior, it helps people with overcoming anxiety/stress, the explanation for that is a reinforcement process. This theory mostly relies on historical cases to support its point, and does not explain precisely the development of a disorder.

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Theorists believe that it is caused by repressions, unconsciously preventing painful memories, thoughts, impulses. People with DID use repression excessively. According to this view, DID is a result of those excessive repressions, and it is motivated by traumatic childhood experiences. When a child experiences such events, he/she is afraid of a dangerous world, consequently, he/she tries to escape it by pretending to be another person. Moreover, the child believes that there is an excessive punishment which is caused by his/her impulses. Thus the child unconsciously denies impulses and disowns them by assigning them to other personalities.

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Typically, the purpose of treating DID is to combine various identities into a single personality, but integration is not always feasible. The aim is to achieve a harmonious relationship between individuals in such circumstances. Medication may relieve some specific associated symptoms, such as anxiety or depression, but it does not affect the disorder itself. Anecdotal reports suggest that a panoply of treatments, as hypnosis, psychoanalysis, family and couples therapy, videotaped sodium amytal (so-called “truth serum”) interviews, CBT can be helpful in the treatment of DID (Caddy, 1985). Psychotherapy is the main treatment used to integrate different personalities. It is often long, difficult, and emotionally painful. People may experience many emotional crises as a result of the actions of individuals or because of the desperation that can arise from evoking traumatic memories during therapy. It may take several periods of hospitalization in a psychiatric hospital to help the patient get through difficult periods. Psychotherapists might use methods such as: desensitization using eye movements and reprocessing (EMDR), a novel, popular, and controversial treatment, was introduced by Shapiro (1989a, 19895) as a new treatment for traumatic memories, one of the most effective, soft and safe methods of working with the subconscious, and hypnosis to help such people calm down, change their opinion about events and gradually return to normal the effects of traumatic memories. Hypnosis sometimes helps people learn how to access their personalities, facilitate communication between them, and control the transition from one to the other of them. Key components of effective psychotherapy for DID are:
- The provision of a method of stabilization of strong emotions;
- Reconciliation of relationships between States of personality;
- Working through traumatic memories;
- Protection from further sacrifice;
- Establishing and developing a good relationship between the patient and the therapist.

With a working diagnosis of dissociative identity disorder (a form of lack of obsession), a well-known type I DM was admitted to our ward for treatment and follow-up. Psychotherapy with 3 sessions of eye movement desensitization and processing (EMDR) and hypnosis conducted during patient's hospital stay focuses on her past traumatic event and how to overcome it. In addition, the patient received psychiatric medications (fluoxetine and diazepam) to control symptoms of anxiety and aggression. She comes to terms with her two identities during her time in the hospital, which they present as a defensive mechanism to cope with her childhood memories of sexual trauma. She also said that since she is now an adult and healthy, she won't be blamed. With her real mother, she has also reached consensus and reconciliation, and has less personality swings. After a 3-week stay, the health of the patient improved and she was discharged. The patient is still under close monitoring and care has progressed until the present moment.

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Have you seen reports or discussions of DID in the popular media? Why do you think some therapists say they have treated dozens of patients with DID while the vast majority of mental-health professionals have never seen a single case?

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Have you seen reports or discussions of DID in the popular media? Why do you think some therapists say they have treated dozens of patients with DID while the vast majority of mental-health professionals have never seen a single case?

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1:  Multiple Personality Disorder, now known as Dissociative identity disorder, was discovered last century and since then was mentioned often in different parts of media. It was mentioned firstly in literature, then movies, shows and some of them are forgotten, and some of them became very popular. Nowadays there are a lot of information given not only in library but also in social media. There are a lot of cases, interviews or videos in quick access. Despite the popularity of this disorder in media, there are a lot of myths and disinformation given to the auditory. Myths such as the wrong symptoms or maniacal alters (subpersonalities), that made out stereotypes. For example in the online journal PsychologyToday.com author describes the disorder and then discusses briefly the myths and real. This is not only a good example of discussion of DID in media, but also a valid source to gain information from.

2: This question is more about the skepticism of some psychologists, than about the number or frequency of patients in specific time or place. DID is in the number of the poorly studied disorders. Even though psychologists do not have enough resources and information about this disorder, psychologists continue having different and various patients with this disorder and working with them bringing out all that they can and discovering everything that they can about DID.  However, besides therapists working with patients with DID, there are some psychologists that have skeptic vision on this disorder. So what they say and what they do? Basically their work is about to make sure that therapists bringing valid and reliable information. They try to dispel myths and get rid of useless/wrong information. Therefore, they look at this, for now poorly studied, disorder with skepticism and mistrust.

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23-y-o female. She is type 1 diabetic since 7. First behavioral disturbances started in 2005. At the age of 8,11, and 15 experienced sexual assault. She changed her place of living, but behavioral disturbances became frequent and severe. After that she graduated from school and joined the University in physics department. She is industrious, calm, sociable, and funny except during her illness periods, according to her family and friends.

She made 3 attempts of suicide within 2 weeks. However, she reported that she had no plans to harm herself. Additionally, attempted episodic choking of her dorm mates, but does not remember those episodes. After her second attempt, she was considered as having DID with possible strong differential diagnosis of borderline personality disorder. After the third attempt she was admitted to female Psychiatry.

Patient claimed having 2 personalities: ‘A’ is a good, disciplined, sociable polite person with respect of norms and values; whereas ‘M’ is violent, aggressive, impulsive and suicidal with no accountability for her action.
Childhood.
The patient claims that she had childhood full of trauma and incidents. During her altered state reported that she was not happy with her parents. She characterized her father as verbally aggressive towards her, she feared him excessively, and blamed him not preventing those sexual abuse attempts especially the first one. Even she stated that she doesn’t recognize her mother as her real mother but assumes her as grandmother explaining that she was brought up by her elder sister.