Dissociative Identity Disorder: A Literature Review

Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder, is characterized by a single patient inhabiting two or more personalities, or alters. Normally one personality at a time can be present.The patient is not normally aware of when the transition to a personality takes place, which is considered an amnesia or fugue like state. “Some predisposing factors making patients more apt to developing this disorder are: Having experienced a traumatic life event, most often in childhood, possessing tendency for the disorder to develop (biological or psychological), and the absence of external support from loved ones. Before a patient is diagnosed with DID, many are misdiagnosed. Some patients are diagnosed with depression,

borderline and antisocial personality disorders, schizophrenia, epilepsy or bipolar disorder.” (Townsend, 2003) DID is normally not properly diagnosed until the patient is in their 20’s.
The Nursing Diagnosis that I have chosen to accompany the diagnosis of DID is, Disturbed personal identity related to childhood trauma/abuse evidenced by the presence of more than one personality within the individual. It has been theorized that the patient’s diagnosed with DID has suffered from some sort of long-term abuse in their lifetime, whether it be sexual abuse (ie.rape), physical abuse, psychological abuse, or interparental violence. One nursing interventions that can be helpful for a patient diagnosed with DID is to develop a therapeutic/ trusting nurse patient relationship with the primary personality. This will make a more comfortable atmosphere for the patient to be able to trust. “Each of the persoanlities views itself as a separate entity and must initially be treated as such.” (Townsend, pg 590).. Another nursing intervention that can be performed is to assist the patient with identifying the situations that can cause the transition from one personality to another. “Identification of stressors is required to assist client in responding more adaptively and to eliminate the need for transition to another personality.” (Townsend, pg. 590). One of the most important nursing intervention involves patient safety. The nurse and patient must identify any maladaptive behaviors inregaurds to the patient’s alters. An example of a maladaptive behavior is one of the alters whom are suicidal. Safety percautions need to be identified to keep the patient and others safe. This is a nursing priority.
I chose three different articles which all referred to Dissociative Disorder and Childhood abuse.

The first article that I chose was titled, Lifetime Axis I and II comorbidity and childhood trauma history in dissociative identity disorder. This article mentions that with most patients whom are diagnosed with DID, have also experienced a prolonged physical or sexual abuse in their childhood. It also states, “There is evidence that dissociative identity disorder may be more prevalent than once believed in general population and among general adult psychiatric inpatients.” (Ellason 1996) This article goes on to show the results supporting this statement. The second article I chose, Objective documentation of child abuse and dissociation in 12 murderers with dissociative identity disorder, remarks on the skepticism regarding the existence of DID as well as the abuse that the murderers with DID endured in their childhood. 12 separate murderers with DID, some on death row, were interviewed for this article, and objective verification was presented for dissociative symptoms and severe abuse during childhood. “The data demonstrates that the disorder can be distinguished from malingering and from other disorders. The study shows that it is possible, with great effort, to obtain objective evidence of both the symptoms of dissociative identity disorder and the abuse that engenders it.”(Lewis 1997) The third article that I chose, Childhood trauma and perceived parental dysfunction in the etiology of dissociative symptoms in psychiatric inpatients. This article focuses on the link between childhood trauma and parental dysfunction (severe neglect or seperation by the parent or guardian or interparental violence) vs. dissociative symptoms. There is more research that strongly exhibits information about physical or sexual abuse in childhood being a precurser to DID. On the other hand, there is little evidence showing the relation to parental dysfunction. “The severity of

dissociative symptoms was significantly related to reported physical abuse and sexual abuse but not to early separation.” (Draijer, 1999). All three of these articles support my nursing diagnosis by confirming with research the cause of DID being directly linked to prolonged childhood trauma.
In conclusion, DID is a very hard disorder to diagnosis, and many medical professionals still debate the existence. But research does indicate that the disorder is caused from a long-term abuse that occurs during a person’s childhood, in which the person is trying to dissociate from.