Friday, 9 June 2017

ABC's of the DSM-V: DID begins with D!

In light of recent media coverage and general lack of understanding, I’ve chosen this week’s disorder to be Dissociative Identity Disorder (DID) – commonly referred to as split personality disorder. Negative stigma has been commonly associated with it, mainly due to the lack of understanding and belief that those with DID are violent and unable to lead a “normal” life. I’m going to address those claims as well as a quick DID 101 to help you understand it better, so if you have a friend who is suffering from it, they can take comfort in knowing that you are at least a little bit clued up on what it is – it always helps.

"Walking into the fire" - Art by Harli Tree - Artist with DID.
 Dissociation is a state of mind where one feels like they have been detached from themselves either mentally and/or physically. It affects behaviour and function as the sufferer is unable to have a feeling of unity within themselves and therefore their functional ability is compromised – memory and perception being the most affected. DID is part of a group of dissociative disorders which includes depersonalization (DPD)/derealisation disorder(s), which consist of simply dissociating when triggered such as periods of high anxiety or stress. The difference between DID and DPD is that someone who is dissociating with DPD feels as if they are going through a dream sequence; the lapse in memory is not as profound as that in DID, things are simply hazy or foggy. In the case of DID, during this state they take the form of another personality – referred to as an alter – and continue to function as that alter without making the conscious choice to do so.

Underlying cognitive functions are not impaired – a person with DID will dissociate and change alter whilst driving or walking – but they won’t lose the ability to do so the minute they do. They will continue to drive or walk perfectly well, as if they were on autopilot, but they won’t be able to remember doing it specifically. Think of the alters like hackers: They hack into your mainframe (brain) and rewire the cameras so your screens black out and they can see everything instead. That’s why you can’t remember it – the cameras were rewired but everything else was still functioning perfectly.

"Balanced" by Ria Pratt - One of Kim Noble's alters.
 Now the cause of DID has been debated in some circles, with varying schools of thought on what actually causes it, and with little research we are still unable to pinpoint a direct cause. The first theory is that it is due to trauma: There has been a lot of research pointing at traumatic experiences, particularly from a young age being the cause and being a form of coping mechanism. The theory checks out to a point because it is usually believed to be the cause of DPD – abuse or trauma leads the person to dissociate during the experience, and any triggering moments lead back to that point. In a way it’s a coping mechanism for the brain – by dissociating the brain can say to itself “it’s not really me going through this.” The same principle applies to DPD in this case, by detaching as a defence mechanism and giving the detached body a different identity (giving it a name, personality, etc) it can in a sense, lead to the “development” of alters. Think of Tulpas, but instead of manifesting separately they manifest into your body.

Note: I could honestly write a whole new post on the topic of Tulpas but I’ll cover it briefly here. Tulpas are a mystic concept, taken from Buddhism, where an object or being is created through the power of the mind. It’s basically an imaginary friend but taken to the extreme. You create an imaginary friend and concentrate on it as hard as you can until it becomes sentient and begins to function without you. You create your own hallucination, people have claimed to hear or see them – separate from their own voices and thoughts. This my friends, is self-induced schizophrenia. 
On a lot of the message boards I’ve seen discussing Tulpas, many “Tulpamancers” already have mental illnesses and are more likely to be susceptible at developing more disorders – which in this case is schizophrenia. Neuroplasticity is real and by trying to rewire your own brain (in essence) like this is extremely dangerous. A good example is this well written Creepypasta (Yes, I know it’s a fake story but it’s a good illustration of what a Tulpa is and exactly why they are dangerous). Here is a post where someone who is clearly suffering from intrusive thoughts and auditory hallucinations that are clearly distressing them, and yet members of the community are telling them it’s a Tulpa. Here is a case of what looks like DID under the guise of a formidable Tulpa. Honestly, this is a rant for another time.

The second school of thought on the cause of DID is that it is caused by improper therapeutic practices from medical professionals. Known as the iatrogenic approach (induced inadvertedly), it is biggest argument against a neurobiological cause for DID, believing that a form of coercion (whether intended or unintended) is the real cause, suggesting the idea that DID does not truly exist as a naturally occurring phenomenon and is simply a result of poor treatment. Dr Joel Paris is an outspoken nay-sayer of DID, stating there is lack of validation of the child abuse stories from patients  who claim to have DID as a result of childhood trauma (stating the possibility that they may well be lying), and poor therapeutic practices can “induce” the disorder as it seemed like an attractive result of abuse. He states that hypnosis is nothing more than a form of “roleplay” and the memories recovered are nothing more than false memories moulded by therapists.

An example of iatrogenic DID is treating younger patients’ alters as real children during therapy. By choosing to refer to the child’s alter as a real child, it is welcomed with warmth, nurturing and empathy and can make the treatment process of getting rid of the alter, much harder. By acknowledging the alter as a child it can cause a resistance to treatment from the child, therefore exacerbating symptoms and causing what is thought to be iatrogenic DID.

Note: False memories – Founded by Freud and Janet, the theory is not about creating false memories but rather a manipulation of memory. The human memory is nothing like a tape recorder, a memory is never as accurate as they are nothing more than reinterpretations of what happened, and that fragility of the memory can be easily manipulated by insinuating things that may not have happened.
There is another belief that the childhood abuse theory may not be as robust as we think. A large number of studies including all of the neuroimaging studies done on neurobiology of DID have looked only at patients who have suffered traumatic experiences. Differences in amygdalar and hippocampal volumes have been found in DID patients but only those who have suffered trauma. There have been no DID neuroimaging studies of those who have not suffered traumatic abuse so the idea “correlation does not equal causation” may be true here.

McAvoy's alters in the movie "Split"
One of the biggest myths about DID and something that causes so much stigma is that they are portrayed as being extremely violent. Movies such as “Split” or “Identity” have used characters with DID to portray them as violent which is a very extreme portrayal of the disorder. Like many other mental disorders, the media portrays the most extreme aspects of it as it is what makes the “best” characters or storylines – the media makes caricatures of those with illness’ which are inaccurate. The chances of a person with DID being excessively violent and hurting others is extremely rare, as they are more likely to hurt themselves. The changing of alters is no different than changing your demeanor to match the situation (eg. Acting professional in a professional situation, acting silly in a more informal setting etc) just on a slightly more intense level. It is nothing like portrayed in the media.

"The Emotional Dinner" by Judy (Kim Noble)
Kim Noble is a great example of someone coming to terms with DID and using it to her advantage - using it as a way to enhance her as a person and it has worked out fantastically. She has 20 alters I believe and at least 14 of them are artists, with each having a distinctive art style. Her works have managed to find a place at the Saatchi gallery and her openness about it has been an eye opener at reducing stigma and showing it is possible to function just like you and me. She has raised a daughter, she has done well in her career and has done a fantastic job raising awareness and making something beautiful out of a horrible experience. She is just one example of how inaccurate media portrayals of DID are and how very real it is.

"Too much" by Ria Pratt (Kim Noble)
I hope this has given you some insight into DID and you've learnt something. You know a little bit more than you did yesterday, and maybe this knowledge will come in helpful one day. What you see in the media isn't always accurate and it's important to take initiative and educate yourself on important things such as this - you never know when your knowledge may help another person one day. Having a little bit of information on something makes all the much difference to someone who is going through it - it may allow them to feel a little big more comfortable and a little less alone, and that's what we all need.

 "All of Me" is Kim Noble's story of how she came to terms with her disorder and gaining back control and understanding of her body. Buy it here.

"Though I cannot even begin to imagine horrors Kim faced as a child, I am struck that neither the abuse nor its devastating consequences have destroyed this woman's spirit, humor, or capacity to love. [S]he is one terrible, exquisite, and beautiful work of art." -- Independent"

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