We here at Hope and Grace believe that education is crucial to alleviating the fear and stigma around mental illness. As part of those efforts, we thought it might be helpful to open a dialogue around each mental illness, its symptoms, and how you or someone you love can live a robust life with a diagnosis. We reached out to Dr.Elizabeth Fitelson, Assistant Professor of Psychiatry at Columbia University and director of their Women’s Mental Health Program, to help explain and open the dialogue around mental health diagnoses.
Our first topic: Dissociative Identity Disorder:
Philosophy: What is Dissociative Identity Disorder?
Dr. Fitelson: “It falls into sort of a new category of dissociative disorders; essentially, it’s characterized by episodes of dissociation. Dissociation can take several different forms: most classically, it’s a sort of memory lapse with an ultra-state of consciousness related to it or the phenomenon of depersonalization, which is where an individual feels disconnected from themselves or they have the realization that their current circumstances aren’t quite real. The hallmarks are memory lapses and forgetting about anything particular to traumatic events. Dissociative Identity Disorder, which was previously known as Multiple Personality Disorder, has the primary symptom of dissociation, and it’s defined by dissociative states that become so distinct that they become different personalities within the same person. Most mental health experts feel that it does fall on a spectrum with Post-Traumatic Stress Disorder, and it can happen with the events that cause PTSD. Most classically, it is thought to happen when someone has been exposed to severe trauma in early childhood, usually before age 5.”
Philosophy: Does it happen more to women or men?
Dr Fitelson: “So the prevalence (in the general population) is normally around 1%. It is diagnosed more in women than in men, similar to another common question, which is why does PTSD seem more prevalent in women? There may be several reasons for that. One of them is that sexual abuse of girls is actually more common than sexual abuse of boys, though obviously it does happen and is as damaging to boys as it is to girls. But that type of abuse in particular may be one of the precipitating factors that can cause Post Traumatic Stress Disorder later in life, and then also Dissociative Identity Disorder.”
Philosophy: What are the symptoms that lead to diagnosis?
Dr Fitelson: “The DSM (Diagnostic and Statistical Manual) says it must include the presence of two or more distinct personality states, accompanied by the inability to recall personal information that’s really beyond a normal kind of forgetfulness. It’s not like, “I can’t remember what I had for breakfast this morning.” There are details about the self that they can’t remember, like big chunks of memory that are missing. The clinical presentation can be very variable. So Dissociative Amnesia is when people have these amnesiac states where, when they come back to themselves, they don’t really remember what happened. Some people can really experience having a different personality and even a different voice at that time. Also, the number of different identities can vary widely: in first-time people, it’s two different personalities; for many people who live with the disorder, there can be many different personalities or what are called ‘alters.’ It should be noted that Dissociative Identity Disorder probably exists on a spectrum with other dissociative-type disorders which are really thought to come in most cases out of traumatic experiences.”
Philosophy: Can you clarify between compartmentalizing a bad experience of memory (repressing childhood molestation, for example,) and Dissociative Identity Disorder?
Dr Fitelson: “The dissociative states really are forgetfulness in the present. People may describe not knowing what happened for hours or even days at a time in the recent past. Dissociative Identity Disorder is really the sense of disconnectedness from different parts of the self. Behind the disorder is the fact that the person underwent such serious trauma at a very vulnerable developmental age, that different aspects of the personality had to be compartmentalized, so they’re so split off from the other aspects of the self so the person doesn’t have access to them all the time. So rather than experiencing identity as continuous, people with Dissociative Identity Disorder may actually experience themselves as having multiple different identities which can shift depending on internal or external stressers
The disruption and the identity involved mark discontinuity in the sense of self and agency, accompanied by related alterations and affect behavior, consciousness, memory, perception, cognition and other sensory motor functioning. These can actually be self-reported, where the person experiences themselves as very different but often other people can actually tell the difference and really experience the person as interacting in a very different way than they would at other times. The symptoms have to cause significant distress.
Philosophy: What’s the treatment for Dissociative Identity Disorder?
Dr Fitelson: “It’s not that well studied. Frankly, it’s a pretty rare disorder, and there are a lot of co-morbid disorders that come with it. People with Dissociative Identity Disorder have PTSD, or they might suffer from depression or eating disorders. Treating those co-morbid disorders is very important to help a person receive some of the treatment. For example, an anti-depressant isn’t going to treatment Dissociative Identity Disorder on its own, but it can help treat some of the anxiety and depression that might be related to it. There are many different ways to approach helping someone heal, but the core concept is trying to help them integrate these different aspects of the self into a more unified whole so they don’t experience themselves as disintegrated. It can take years of real, dedicated therapy, and there are many different theories of how to help someone with Dissociative Identity Disorder, but that’s really the core goal of treatment. Some people believe that helping someone remember the missing memories or the traumatic memories and integrating them into memory is important, other people feel like people with dissociation might be dangerous because you’re actually putting them in an altered state. There’s still some controversy about the diagnosis and proper treatment.”
Philosophy: So, if you have Dissociative Identity Disorder, how do you best manage it? What are some things you can do outside of seeking professional advice and help? Are there any best practices for self-care?
Dr Fitelson: Again, it’s not so well-studied, but I think in general the people who do the best have stable relationships in the present day; they have people they can trust and in which they can confide, who can help them re-ground themselves in the present if they slip into an altered state. Building on trusting relationships is one of the core things you can do. Also, know some basic principles if you have any dangerous behaviors around altered states: giving up drinking, for example. Certainly, I think for someone in treatment for Identity Disorder (the act of) being in an altered state with substances is not helpful and can be very destructive. Relaxation and/or grounding techniques can also be very helpful; there can be a real panic around dissociation, so being able to focus on the here and now along with your breathing can help your mind and body relax. The same holds true for Post-Traumatic Stress Disorder as well; really, any of those anxiety-based and trauma-based disorders can benefit from these techniques.
Philosophy:If someone you love is affected, how do you best support them?
Dr Fitelson: I think it’s tough. I think supporting them in whatever their recovery journey may be would be the most helpful thing, being very accepting. Also, learn about Dissociative Identity Disorder: having some understanding will help. Even if you may feel hurt by something the person says or does in a particular alter identity or a dissociative state, having some understanding that that person doesn’t feel in control and being able to tolerate, accept, and empathize with the suffering of the other person will help both of you. Asking them what’s going to be helpful and supportive for them will be a big help; (the condition) is so difficult and rare, so being non-judgmental and accepting is really helpful. But also be caring enough to point out any dangerous behaviors or any activity you’re really concerned about. Be supportive, and be strong.