Recovering Identity: A Qualitative Investigation of a Survivor of Dissociative Identity Disorder

Article excerpt

This qualitative study investigated the subjective experience of a female survivor of Dissociative Identity Disorder (DID). The study utilized the narrative method, interviewing the participant three separate times. Each semi-structured interview reconstructed a particular time in the participant's life (past, present, and future) as it related to the disorder Three themes emerged from the participant's experiences with DID: (a) therapeutic outcomes, (b) chronology of DID, and (c) misperceptions of DID.

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The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; American Psychological Association [APA], 2000) identified Dissociative Identity Disorder (DID) by the following four criteria: (a) There must be evidence of two or more distinct and enduring personality states, defined as a unique way of perceiving, relating, and thinking about the environment and self. (b) At least two of the personality states described must repeatedly control the individual's behavior. (c) The person experiencing the alter personality cannot recall information for significant periods of time that are not better explained by ordinary memory loss. (d) The first three criteria are not better explained by the consumption of a psychoactive chemical or by a general medical condition.

With the advent of the DSM-5 in May 2013 (APA, 2013), several of the criteria for diagnosing DID remain the same, but the DSM-5 Dissociative Disorder Work Group proposed changes that will help clinicians to diagnose DID more accurately (APA, 2012). The new diagnosis for DID has five criteria rather than four. The first is a more complete description of personality states, defined as "marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning" (APA, 2013, p. 292). Furthermore, these symptoms can be observed by either the person experiencing possession or by external witnesses. The second criterion, consistent with the current diagnosis, requires a loss of memory not better accounted for by normal forgetfulness. The third requires the individual to experience clinically significant distress in social, occupational, or other important domains of functioning. The fourth prohibits diagnosis if the client's experience is part of an accepted religious or cultural practice (e.g., imaginary friend in childhood). The fifth requires that the symptoms cannot be ruled out as the result of consuming psychoactive substances or a preexisting medical condition.

DID falls in the section of dissociative disorders in the DSM-IV-TR; as the section title suggests, the key clinical feature is dissociation (APA, 2000), which is defined as "a psychological state in which the individual's level of consciousness is altered" and for those who have experienced it, it is described as "being separated from their body, 'zoned out,' floating above or apart from the body, detached" (Stickley & Nickeas, 2006, p. 182). More specifically, dissociation is a "disruption of and/or discontinuity in the normal, subjective integration of one or more aspects of psychological functioning, including--but not limited to--memory, identity, consciousness, perception, and motor control" (Spiegel et al., 2011, p. 826). Although some degree of dissociation is normal and does not contribute to client impairment, it is beyond the scope of this discussion to adequately explain this highly nuanced topic. Generally speaking, however, pathological dissociation is typified as "more pervasive, disruptive, and/ or distressing than normal psychobiological capacities and their failures (e.g., ordinary forgetfulness, absorption in imaginative activities, uncertainty whether one has done something or not, etc.)" (Spiegel et al., 2011, p. 827). For a more thorough discussion of the differences between normal and pathological dissociation, see Dalenberg and Paulson (2009). …