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It is very important to diagnose a case of dissociative identity disorder; if it is not diagnosed, it may lead to death. However, therapists have had many problems in diagnosing this type of disorder. This is due to two major factors. The first is that DID is seen as a very unusual disorder, and most cases of DID are mistaken for Schizophrenia. The second factor is that there is a lack of guidelines for the diagnosis of DID.
Hence, even when DID is diagnosed it usually takes multiple weeks-or even months to recognize. There are three categories of special techniques that are used to diagnose DID. The first category is screenings tools that are used to identify patients at risk for any dissociative disorder, not exclusively DID. The second category is structured interviews, and the third category is informal interviews. There are three screenings tools that are used to identify patients at risk for a dissociative disorder. The first tool is the Dissociative Experiences Scale (DES).
The DES is a twenty-eight question self-report that rates a patients dissociative symptoms and experiences. The patient indicates his / her agreement with a question by circling a percentage from 0 % to 100 %. The sum of the twenty-eight scores is taken and averaged to determine whether or not the patient suffers from a dissociative disorder. The DES is reported to have 80 % sensitivity, and DID patients usually score above forty points. The two other screenings tools are the Dissociative Questionnaire and the Questionnaire of Experiences of Dissociation, and are both very similar to the DES.
There are four types of structured interviews that can be used to diagnose DID. The first interview is the Dissociative Disorder Interview Schedule (DDIS). This interview is very time consuming (it can take anywhere from forty-five minutes to three hours) and is used more in research settings than clinical. There are one-hundred thirty-one items in the interview, most which ask about childhood sexual abuse.
The DDIS serves to diagnose dissociative disorders, somatization disorders, major depression, and borderline personality disorder. It is reported to have high sensitivity and a specificity for diagnosing DID. The second interview is the Structured Clinical Interview for DSM-IV Dissociative Disorders Revised (SCID-D-R). This interview is also very time consuming and is used more in research settings than clinical. In addition, it requires special training. The interview is highly sensitive to DID and is also able to detect all five dissociative disorders.
The third type of interview is the symptom cluster method, which was formulated by Loewen stein. The symptom cluster method divides DID symptoms into six different phenomenological categories that should be watched for during an interview with a potential DID patient. The six categories are process symptoms or switching (symptoms that reflect transitions between alter personalities or interactions between alters), amnesia, auto hypnotic, post-traumatic, somatoform, and affective symptoms. The fourth type of interview is the hypnosis interview. However, this type of interview should be used only when a definite diagnosis has not been reached from another diagnostic measure and diagnosis is necessary, or in the case that diagnosis is a medical necessity.
This is because hypnosis alters a patients state of consciousness, and hypnosis may yield symptoms that look like dissociative pathology even if a patient does not have DID. In the case that hypnosis must be used, it should be used only by a trained practitioner, and leading or suggestive questions should not be asked. The third category of special techniques, informal interviews, is probably the most common way to diagnose DID. This is partly due to the fact that most DID patients are diagnosed unexpectedly. A therapist will notice that a DID patient will display certain characteristics that fall under six broad factors. These are history of present illness, psychiatric history, medical history, family history, social and developmental history, and the results of a mental status exam.
When observing the patients history of present illness, the therapist will probably be told about or observe suicide attempts, self-mutilation or self-destruction, and desperate depression, also known as atypical affective symptoms. These symptoms include amnesia, fugue, auditory hallucinations, Schneiderian symptoms (made phenomenon, made impulses, feelings, volitional acts), PTSD symptoms (detachment, avoidance, re experiencing of trauma, nightmares), concurrent somatic and psychiatric symptoms, and hysteria. When reviewing the patients psychiatric history, the therapist will most likely observe numerous previous diagnoses and treatment failures prior to the current disorder. These diagnoses will include PTSD, borderline personality disorder, eating disorders, psychotic disorders that are unresponsive to medications, somatoform disorder, substance or alcohol abuse, gender identity disorder, transsexualism or transvestism, Schizoaffective disorder, Schizophrenia, and a history of sexual abuse. The patient will also probably have had numerous previous psychiatric hospitalizations. The patients medical history may contain headaches, numerous physical complaints of the sexual nature, unexplained pain (usually gynecological or gastrointestinal), fear of physical exams, or rejection of care.
The patient almost always has a chaotic family situation, and is usually estranged from both parents and sometimes siblings. The patients social and developmental history will usually contain repetitive sexual, psychological, and physical abuse from an early age. He or she usually has had a history of neglect and a greatly distorted childhood, being involved in cults as a young child. He / she displays from unusual sexual impulses and tends to act out.
There are six different categories that fall under mental status exam. These categories are appearance, behaviors, affect and mood, thought process and content, perceptions, and cognition. The patients appearance will not appear unusual during the first interview, but over the course of many sessions, the therapist will observe a significantly different style in clothes, hair, makeup, glasses, posture, and jewelry. The patient will also display signs of injury. There may also be variances in the patients behavior. The therapist may observe intra-interview amnesia, spontaneous regression, strange behavior despite the apparent rapport between the patient and therapist, the use of we, spontaneous voice or accent changes, sudden involuntary movements, changes in facial muscles, changes in handedness (whether the patient uses his / her right or left hand), marked changes in creative abilities or styles, and handwriting changes.
The patient may also display dramatic shifts in anxiety or mood. The patient may have an abnormal self-concept, abnormal body concept, an obsessive imagination, and marked phobias. He / she may also suffer from negative hallucinations, Schneiderian symptoms, illusions, flashbacks, revivification's, depersonalization, de realization, and marked detachment. The patient may also suffer from psychogenic amnesia and abstraction despite an apparent psychosis. The therapist may also suspect DID if probing questions are answered in a puzzling or out of character manner. He / she should proceed to ask the patient if another personality is present.
A negative response may indicate denial instead of the absence of DID. If the response is positive, the therapist should understand that this revelation could be de-stabilizing and frightening to the patient, and should give the patient time to cope without trying to proceed with the interview too quickly. If, during the course of an interview, or after many interviews, the therapist observes a poly symptomatic presentation, he / she will probably choose to ask questions about the presence of other personalities. This presence will settle the diagnosis of DID (however, alters are more likely to emerge unexpectedly when a patient is in crisis, or if the diagnosis has been made previously). Questions can be asked relatively directly. There are three common examples of question to be asked of a suspected DID patient: Have you ever been told by others that you seem like a different person?
Have you ever referred to yourself by different names? Have you ever acted in a completely different manner? There is only one effective approach to treat dissociative identity disorder. This approach is outpatient therapy sessions. There are currently no medications for DID patients. There are a few alternative approaches to treat DID, but these are usually used in conjunction with outpatient therapy sessions.
There is usually a negative result when these alternative approaches are not used in conjunction with outpatient therapy sessions. Treatment of DID is long-term, intense, and painful. However, if the patient receives and completes the correct treatment, his / her condition will be...
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