Dissociative Identity Disorder in Children and Teenagers

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What do The Three Faces of Eve, Split, the Fight Club, Glass and Psycho have in common? They are all famous movies where one of the main characters had multiple personalities; but is it real? For years, many psychiatrists argued that multiple personality disorder was not real, in fact, I once worked with a psychiatric nurse who was adamant there was no such thing as multiple personality disorder, despite the fact that my client was diagnosed with and very clearly displayed all the signs and symptoms of a multiple personality disorder.

Sadly, the way multiple personality disorder has been portrayed in movies e.g. an evil alter, or a violent killer has led to so many myths and misconceptions which contribute to the stigma and shame. But did you know that celebrities such as Roseanne Barr, Lady Gaga, Nicki Minaj and Herschel Walker have all been diagnosed with a multiple personality disorder?

Today, instead of using the term multiple personality disorder, experts prefer the term Dissociative Identity Disorder (DID). Contrary to what many people may believe, DID is a very real and complex mental disorder thought to be caused by major factors involving extreme trauma in early childhood e.g. emotional, physical, sexual abuse, severe neglect.

The International Society for the Study of Trauma and Dissociation characterizes DID by the presence of one or more distinct personalities/identities each of which can take control of a child/teenager’s behaviour at different times.

According to Frank Putman, Psychiatrist: “young children faced with severe sexual or physical abuse or neglect have no effective way of fighting or avoiding the offender…To escape the painful reality, the only tool available during the abusive incident is that of dissociation. Separating mind from physical experience provides a sense of protection…dissociation interferes with the process of memory encoding, so there is little or no memory of the traumatic event” (National Institute of Mental Health).

In 1990, a study of Adolescent Multiple Personality Disorder found that 73 percent of teenagers had experienced severe sexual abuse, 73 percent had experienced physical abuse, and 82 percent had experienced severe emotional abuse. All the teenagers had become ‘multiple’ at age 4 years old and had angry alters, depressed alters, scared alters and child alters (Dell and Eisenhower).

Diagnosis
Whilst dissociation can help children short-term, it will become problematic if it is also used to cope with normal everyday stressors. The continued dissociation of memory, emotions and thoughts can interfere with normal development and ultimately result in long-term problems such as difficulty socializing, etc. Also, those with DID at an increased risk for drug and alcohol abuse. An accurate diagnosis of DID can be challenging as it presents with similar signs and symptoms of other mental disorders such as ADHD, depression, bipolar disorder and schizophrenia. Furthermore, it is not unusual that children/teenagers with DID will also have a second mental disorder such as PTSD, personality disorder and/or conversion disorder.

Signs and Symptoms

  • Inability to recall important personal information
  • Each personality can have a different name, identity, age and abilities/disabilities
  • Frequent episodes of ‘spacing out’ or daydreaming
  • Dramatic changes in preferences such as food, clothing, language, accent, voice, handwriting
  • Recurrent periods of amnesia or missing blocks of time
  • Denial of behaviours, incidents despite others witnessing them
  • Having imaginary friend(s) who are very real to child and may not act in child’s best interest
  • Unexpected unprovoked rages, violent behaviour
  • Vehemently denies misbehaviour and will blame on imaginary friend

Signs and Symptoms of Teenage Dissociative Identity Disorder

  • Self harm (NSSSI)
  • Non epileptic seizures
  • Sexual dysfunction
  • Realistic hallucinations
  • Suicidal behaviours

Treatment
The good news is that with appropriate therapy and supports, children and teenagers with DID have a higher rate of recovery compared to adults. However, it is important to note that the depression and anxiety, especially in teenagers can be quite difficult therefore it is important that treatment options include:

  • Psychotherapy
  • Hypnosis
  • Art therapy
  • Play therapy
  • Medications: anti anxiety, antidepressants
  • Talk therapy
  • EMDR

What Can A Parent Do?
Feelings of confusion are normal. It is important to remain patient and calm. Therapy will help and your child/teenager will improve, but it will take some time. What can you do?

  • Be an active participant in therapy
  • Join a support group
  • Try not to react to behaviours, remain objective and non-judgemental
  • Allow time for self and connection with partner, friends, etc.
  • Show love, understanding and support
  • Follow up with school, be aware of potential risk of being bullied
  • Encourage and validate your child/teenager
  • Be patient…

In my next Blog #15
I will be discussing depression in children and teenagers

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