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Treatment
[edit]There is a general lack of consensus in the diagnosis and treatment of DID.[1] Common treatment methods include an eclectic mix of psychotherapy techniques (including cognitive behavioral (CBT)[2][3] insight-oriented therapies,[4] dialectical behavioral therapy (DBT), hypnotherapy and eye movement desensitization and reprocessing (EMDR)) and medications for co-morbid disorders and/or targeted symptom relief.[5][6] Some behavior therapists initially use behavioral treatments such as only responding to a single identity, and then use more traditional therapy once a consistent response is established.[7] Brief treatment due to managed care may be difficult, as individuals diagnosed with DID may have unusual difficulties in trusting a therapist and take a prolonged period to form a comfortable therapeutic alliance.[5] Regular contact (weekly or biweekly) is more common, and treatment generally lasts years - not weeks or months.[2][5]
Therapy for DID is phase oriented. Different alters may appear based on their greater ability to deal with specific situational stresses or threats. While some patients may initially present with a large number of alters, this number may reduce during treatment - though it is considered important for the therapist to become familiar with at least the more prominent personality states as the "host" personality may not be the "true" identity of the patient. Specific alters may react negatively to therapy, fearing the therapists goal is to eliminate the alter (particularly those associated with illegal or violent activities). A more realistic and appropriate goal of treatment is to integrate adaptive responses to abuse, injury or other threats into the overall personality structure.[2]
The International Society for the Study of Trauma and Dissociation has published guidelines[5] to phase-oriented treatment in adults as well as children and adolescents that are widely used in the field of DID treatment,[8][9][10][11] and other authors and publications have expounded on treatment techniques within this model.[12] The first phase of therapy focuses on symptoms and relieving the distressing aspects of the condition, ensuring the safety of the individual, improving the patient's capacity for forming healthy relationships, and improving general daily life functioning. Co-morbid disorders such as substance abuse and eating disorders are addressed in this phase of treatment.[5] The second phase focuses on stepwise exposure to traumatic memories and prevention of re-dissociation. The final phase focuses on reconnecting the identities of disparate alters into a single functioning identity with all its memories and experiences intact.[5] Movement through the phases is often non-linear; patients in the second or third phase of treatment may need to go back to a previous phase to maintain safety and/or process previously unprocessed material.[12]
Medications
[edit]- ^ Cite error: The named reference
Reinderswas invoked but never defined (see the help page). - ^ a b c Gillig, P. M. (2009). "Dissociative Identity Disorder: A Controversial Diagnosis". Psychiatry (Edgmont (Pa. : Township)). 6 (3): 24–29. PMC 2719457. PMID 19724751.
- ^ Cite error: The named reference
pmid15014580was invoked but never defined (see the help page). - ^ Cite error: The named reference
Kihlstromwas invoked but never defined (see the help page). - ^ a b c d e f International Society For The Study (2011). "Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision" (PDF). Journal of Trauma & Dissociation. 12 (2): 188–212. doi:10.1080/15299732.2011.537248. PMID 21391103.
- ^ Cite error: The named reference
MacDonaldwas invoked but never defined (see the help page). - ^ Kohlenberg, R.J. (1991). Functional Analytic Psychotherapy: Creating Intense and Curative Therapeutic Relationships. Springer. ISBN 0306438577.
{{cite book}}: Unknown parameter|coauthors=ignored (|author=suggested) (help) - ^ Petrucelli, J (2010). Knowing, not-knowing and sort-of-knowing: psychoanalysis and the experience of Uncertainty. Karnac Books Ltd. pp. 83. ISBN 9781855756571.
- ^ Chu, 2011, p. 16-7.
- ^ Luber, Marilyn (2009). Eye Movement Desensitization and Reprocessing (EMDR) Scripted Protocols Special Populations. Springer Pub. Co. p. 357. ISBN 9780826122452.
- ^ McWilliams, Nancy (2011). Psychoanalytic diagnosis: Understanding Personality Structure in the Clinical Process (2nd ed.). New York: Guilford Press. p. 351. ISBN 9781609184940.
- ^ a b Baars, E. W.; Van Der Hart, O.; Nijenhuis, E. R. S.; Chu, J. A.; Glas, G.; Draijer, N. (2010). "Predicting Stabilizing Treatment Outcomes for Complex Posttraumatic Stress Disorder and Dissociative Identity Disorder: An Expertise-Based Prognostic Model". Journal of Trauma & Dissociation. 12 (1): 67–87. doi:10.1080/15299732.2010.514846. PMID 21240739.