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Treatment

The treatment of choice for DID is long-term, one-to-one, relationally based psychotherapy. In most cases, therapy will be at minimum once weekly, but this would be dependent on a number of factors such as the client’s level of functioning, resources, support and motivation. Longer sessions (of 75 to 90 minutes, or in some cases longer) are often required, and therapy may extend typically for five or more years. An eclectic use of techniques such as dialectical behavior therapy (DBT):  create a context of validating rather than blaming the patient  within that context, block or extinguish bad behaviors  teach more effective behaviors  figure out a way to make the effective behaviors so reinforcing that the patient continues the good ones and stops the bad ones. eye movement desensitization and reprocessing (EMDR), -> 8 phase therapy to help with trauma, During the processing phases of EMDR, the client focuses on disturbing memory in multiple brief sets of about 15–30 seconds. Simultaneously, the client focuses on the dual attention stimulus (e.g., therapist-directed lateral eye movement, alternate hand-tapping, or bilateral auditory tones). The consensus of experts is that phase-oriented treatment is most effective. The three stages most commonly used are:  Establishing safety, stabilization and symptom reduction  Working through and integrating traumatic memories  Integration and rehabilitation  In reality, there is unlikely to be a linear progression through these three stages: more commonly the work will spiral through each phase, with a frequent need to return to stabilization work during the middle and later stages. As well as addressing dissociative symptoms, and working through and integrating the underlying trauma, a third area of treatment is that of ‘attachment’, with the vast majority of DID clients presenting with disorganized attachment patterns. The use of medication, except for the treatment of acute, specific concurrent Axis I disorders, is not recommended. Maintenance and effective use of prescriptions given the multiple personality states is difficult to attain. If medication is prescribed, it should be carefully monitored.

Causes
In the majority of cases, DID is caused by extreme and prolonged trauma in childhood, such as childhood physical and/or sexual abuse. Some psychiatrists feel that other extreme and prolonged trauma such as being subject to combat, natural disasters, or severe emotional abuse can cause this condition. The theory is that in order to deal with such extreme and prolonged trauma, a child will create alternative personalities to compartmentalize and thus deal with the ongoing trauma. According to experts in the field, the original personality of a person with DID is often unaware of the other distinct, alternative personalities.

Control of the individual is switched to an alternative personality by triggers that are often related in some way, at least in the patient's mind, to the underlying trauma that caused the disorder. When control switches back to the original personality, some patients do not recall any of the time when they were under the control of one of the alternative personalities, while others do remember. DID is basically the inability to integrate together the individual's memory function, his consciousness, and his identity

Symptoms
• • • At least two or more distinct personalities existing within one person, with each personality being dominant (in control) at different times The person cannot remember personal information, which is beyond typical forgetfulness The person’s behavior is determined by the personality that is dominant at any given time

History
Before the 19th century, people thought the exhibited symptoms were signs of being possessed. The first case of DID was thought to be described by Paracelsus in 1646. Throughout the 19th and early 20th centuries, there was a growing interest for the concept of coexistence of multiple personalities and the theory of John Locke’s “Association of Ideas” John Locke argued that the association of ideas that someone makes when they are young are the most impacting and more important than those made later in one’s life. He argues that they are the foundation of one’s self” Ex. When your parents tell you don’t talk to strangers because they’ll do bad things to you as a childcould trigger a long term fear whether big or small- to your life in the long run. In the 19th center there were an estimated 100 cases of multiple personality disorder. Later, there was a general acceptance that emotionally traumatic experiences could cause long-term disorders which would lead to display a wide range of symptoms including epilepsy, amnesia and schizophrenia.

Impact on society and family
DID is described as one of most debated psychiatric diagnoses and forensic assessments. Family and friends may be in disbelief at some of the behavior symptoms shown at first and self-reported nature of symptoms used to reach a diagnosis can make it difficult to determine credibility. In the media and popular culture, people with DID are often shown as crazed killers or criminals. It’s important to know though that they are no more likely or capable of committing crimes than anyone else. The dissociations or personalities were most likely created to protect to person, not to all them to harm others. Having DID doesn’t necessarily mean that it makes the person unsafe to be around your children or family, but the risks need to be weighed based on the individual.

Because most people don’t understand it or ignore most odd behavior signs and symptoms, DID sufferers are often outcasts in society and that loneliness and helplessness could trigger them to “switch”. The situation is often out of control by the time the sufferer can get help. They can frequently feel like they have no one else to trust and family and friends could also feel helpless and isolated as their situation worsens.

Government and Institutions
There are programs for treatment available in the government disability program. In BC there is the BC Psychological Association and the BC Association of Clinical Counselors for referral services but there are very few public funded services for personality disorders and not many experts specialized in the treatment in British Colombia. Dissociative Identity disorder. Preferably in distinct bullet format.

Media: Recently it has been overpopularized by the media. Some media sources do offer good insight. The idea the media implies is not always what the reality is like. (Already have the Jekyll + Hyde Pic)

Testing: MRI scans to test the Amygdalar and Hippocampal values. Usually correlates to child abuse. Personal tests done by psychiatrists that include recognative aspects. Marking of distinct, individual 'alters'. Is sometimes difficult to differentiate from other conditions. (MRI scan or image of some standardized test with fill-in boxes) Controversy: Many people claim that such a condition is preposterous. .Some tests are describable as "Subjective" A rise from 1980 in documented cases does not support the child abuse idea. Sometimes the memories might be completely false. (Perhaps an image of a court case)

Nicole

Koko

Chris