Nadine was hyperalert, knew who she was i. Her speech was rapid, had a stop-and-start quality and was loud with poor modulation.
Asked about her mood, she said she felt sad, but denied any disturbance of sleep or appetite, weight loss, anhedonia, psychomotor retardation she had been agitated earlier, most likely because of anxiety, but was relatively calm during the interview , extended disturbance of daily routine she had come to us directly from her volunteer work or thoughts of being better off dead.
She denied any intent or plan to hurt herself or anyone else. She insisted that her father had abused her physically and sexually. Four months earlier, Nadine had been discharged from a state mental institution following a one-year stay.
Currently, she was living with a female friend. Nadine told me she wanted to get the prescriptions for her medication and go home. She assured me she could manage on her own. She denied any history of alcohol or substance abuse the toxicology screen was negative. Her physical health was currently good, she said, though she did have asthma and was taking Synthroid for hypothyroidism. When I finished the interview, I spoke with the ER attending physician, who agreed the patient could be given the prescriptions she asked for and discharged.
We were busy that evening, and Nadine had to wait for me to write follow-up orders for her discharge form and for the attending doctor to sign it.
She sat on one of the high stools that ring the nurses' station, taking her place among several of the ER staff, talking confidently with them. When I brought her the discharge form to sign, Nadine repeated what she said during the interview about garbage being inserted into her while she was in the bathroom.
When I did not respond, she quickly become agitated and refused to sign the form. Later, she insinuated it was the technician who had spoken to her in the seclusion room. Agitation quickly gave way to hysterics. The patient whatever facet of her dissociated, fractured identity was paramount now, possibly not Nadine was screaming, and drawing the attention of the ER staff, as well as other patients being evaluated or waiting to be seen. In a few seconds, she went from what appeared to be a composed young woman Nadine?
Or, alternatively, simply an hysterical adult , screaming that we were not giving her the attention she needed and was promised. When Nadine left the ER area, she was followed by a male technician, and wandered past the radiology waiting room. She then started down a hall leading to the south hospital. She was clearly out of control now, but eventually took our suggestion to go back to the waiting room.
She refused several chairs in the empty room, choosing instead to sit in a corner, legs pulled up, head down. After about 15 minutes, she was calm enough to coax back to the seclusion room. Having seen part of this display, the ER attending insisted that Nadine be admitted to the hospital's psychiatric unit. Loudly objecting, she became agitated again and said she wanted to go home.
I suggested we wait to see if she would regain her composure, and then reevaluate. But the consensus was for admission, and I did not disagree strongly enough to pursue the point. A change introduced in the DSM-5 makes it possible to diagnose DID without the diagnosing clinician directly observing a switch between alters: instead DID can be diagnosed if the person self-reports their presence and effects, or if another person describes observing a switch between alters.
Two clusters of symptoms indicate the presence of alters if they are not observed, these are described in the DSM-5's extended description of Dissociative Identity Disorder:. Sense of Self and Agency The terms "sense of self" and "sense of agency" are used in the DSM's DIssociative Identity Disorder Criterion A, which describes the presence of distinct personality states , better known as alter personalities.
It is the discontinuities switches between alters, as well as their presence that this criteria describes. A discontinuity in a person's sense of self can affect any part of someone's functioning. Attitudes, outlooks and personal preferences like preferred foods or clothes may change suddenly and inexplicably, and then change back again. This happens because alter personalities have different attitudes, outlooks and preferences, so a very sudden change without explanation occurs when an alter has either taken control or is strongly influencing the person.
When that alter is no longer active, everything changes back until the next time the same alter is active.
During these times, a person may find have bought clothes they would never choose to wear, or a very outgoing person may suddenly become shy and introverted with no apparent reason. Discontinuity in a person's sense of agency means not feeling in control of, or as if you don't "own" your feelings, thoughts or actions.
For example, experiencing thoughts, feelings or actions that seem as if they are "not mine" or belong to someone else. Emotions and impulses are often described as puzzling to the person. This happens in Dissociative Identity Disorder because some of the thoughts, feelings or actions of alter personalities intrude into their conscious awareness, even when they are not aware they have any alter personalities, or have amnesia for their actions.
A similar depersonalized experience can happen briefly during times of severe stress, especially in people with Borderline Personality Disorder , except that the person perceives the behavior as "out of character" rather than like another person; but in Dissociative Identity Disorder there may not be any obvious stressor causing the change, the actions and words may not relate to any prior distress, and the duration can be considerably longer hours, days, or more.
In DID, this happens because an alter personality has taken control, so attitudes, outlook and personal preferences change at the same time - leaving a feeling as if someone totally different in control of your body.
This change in control is known as switching , only in Dissociative Identity Disorder can a person switch, because no other diagnosis has alter personalities that control of the body can be switched to. Rapidly switching moods within minutes or hours are commonly caused by the presence of alters which have different moods, these changes in moods can be puzzling and lead to a misdiagnosis of Bipolar Disorder , type 2, however mood changes in Bipolar Disorder do not switch back and forth as rapidly.
The person has become a depersonalized observer of themselves. Some people describe this combined change of "sense of self" and "sense of agency" as feeling like an experience of possession , in a non-religious sense, or having their body "hijacked".
A person with DID may find that their body feels totally different during this time e. The passive influence of alters cause many common secondary symptoms Dissociative Identity Disorder, symptoms that are often described as confusing and frightening, and can make a person feel like they are going crazy. While none of these symptoms are unique to Dissociative Identity Disorder, understanding why they happen and that they are common in DID can be very helpful.
Examples of passive influences:. In DID they not given delusional explanations because they do not have a psychotic origin in people except in the uncommon case that a psychotic disorder also exists. Schizophrenia is a very common misdiagnosis for DID. An influential study of people with Dissociative Identity Disorder found that most people experienced several of the symptoms above, although no single symptom was experienced by everyone, and none are actually diagnostic criteria.
These symptoms can be understood as the result of alter personalities partially intruding into a person's conscious awareness. At least two dissociative identities are capable of functioning in daily life, recurrently take executive control of the individual's consciousness and functioning and include a substantial set of sensations, affects, thoughts, memories, and behaviours.
The symptoms are not consistent with a recognized neurological disorder or other health condition. The disturbance is sufficiently severe to cause significant impairment in personal, family, social, educational, occupational or other important areas of functioning. The ICD states that at least two identities must be able to function in daily life, it is unclear how much functioning is needed: does it refer to time in control, or is it looking for two Apparently Normal Parts hosts?
The name has also changed from Multiple Personality, and it has been given greater prominence. The diagnostic criteria are:. The Adult Treatment Guidelines for Dissociative Identity Disorder were first produced over 20 years ago, they were developed by expert consensus and guided by large-scale clinical research.
The current Adult version, from , is free to download from the International Society for the Study of Trauma and Dissociation. Psychotherapy talking therapy is the primary method of treatment for Dissociative Identity Disorder, and has the most evidence-based research showing significant improvements with psychotherapy which adheres to the treatment guidelines. Asked 5 years, 2 months ago.
Active 5 years, 2 months ago. Viewed 7k times. Improve this question. Seanny 8, 3 3 gold badges 21 21 silver badges 56 56 bronze badges. Sarthak Garg Sarthak Garg 33 1 1 silver badge 5 5 bronze badges. Anything more than 5 years old will be drastically different. The latest I was able to find a couple years ago was from dx. Also see the Journal of Trauma and Dissociation: tandfonline. Add a comment. Active Oldest Votes.
The name was changed for two reasons. The DSM-5 updated the definition of DID in , and the summary of changes listed the changes as: Several changes to the criteria for dissociative identity disorder have been made in DSM Improve this answer.
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