The Psychology of Splitting: Dr. Priyanka Koundinya on Dissociative Identity Disorder

Dr. Priyanka Koundinya: In simple terms, Dissociative Identity Disorder is a condition where multiple personalities exist within the same individual. These personalities, also known as alters, self-states, or self-identities, can take on different forms. Each one has distinct traits that, together, make up the whole person. Compared to other dissociative disorders, DID is less common and more complex to identify. Diagnosis requires detailed history-taking and specific interviews aimed at identifying and understanding these distinct personalities. This is a primary task for psychiatrists and psychologists.

Dr. Priyanka Koundinya: DID is relatively rare compared to other dissociative disorders. Identifying it requires thorough clinical interviews and careful history-taking to understand the emergence of different identity states. Psychiatrists and psychologists play a key role in this diagnostic process.

Dr. Priyanka Koundinya: The key difference between dissociative identity disorder (DID) and other dissociative disorders is that DID is characterized by the presence of multiple distinct personalities. This aspect is a main subset of its classification. In contrast, other dissociative disorders, such as depersonalization-derealization disorder or dissociative amnesia, primarily involve disruptions in self-awareness, perception, or memory, rather than distinct identity states.

Dr. Priyanka Koundinya: Dissociative Identity Disorder (DID) is primarily recognized as an unconscious defense mechanism in which a person's personality splits, a process known as "splitting." This phenomenon typically arises in response to severe trauma, abuse, or extreme stress, often experienced during childhood. To protect themselves, the mind suppresses or represses these traumatic experiences, leading to the development of dissociative defenses. It is crucial to analyze and evaluate these defense mechanisms carefully during the diagnostic process.

Dr. Priyanka Koundinya: While DID is not primarily a genetically inherited disorder, genetic factors may play a minor role. Biological contributors like childhood trauma, stress, and environmental triggers are significant in the development of DID.

Dr. Priyanka Koundinya: The onset of DID is often linked to a history of severe or prolonged stress. In cases of prolonged stress or PTSD, the persistent effect of traumatic experiences can act as a trigger, leading to dissociative responses. The continuous presence of stressors overwhelms the mind’s coping mechanisms, increasing the likelihood of DID development as a protective response.

Dr. Priyanka Koundinya: The key difference in Dissociative Identity Disorder (DID) is the presence of multiple personalities. In other mental health disorders, like schizophrenia, where individuals experience delusions and hallucinations, or OCD, which involves obsessions and compulsions, and depression, which is marked by low mood or sadness, these symptoms occur without the presence of separate identities. The way a person with DID thinks and processes thoughts is different from those with other mental health conditions.

Dr. Priyanka Koundinya: The Dissociative Experiences Scale (DES) and the Multidimensional Inventory of Dissociation (MID) are commonly used to screen for dissociative symptoms. When DID is suspected, a thorough evaluation is conducted to analyze symptom patterns and how different personality states emerge in various situations. This helps distinguish separate identities and confirm the diagnosis. These diagnostic tools, along with clinical interviews based on DSM-5 criteria, are essential for accurately identifying DID.

Dr. Priyanka Koundinya: Brain imaging can play an important role in identifying key brain regions that show variations in individuals with DID. Neurobiological research is crucial for improving the understanding, diagnosis, and treatment approaches for DID.

Dr. Priyanka Koundinya: Therapies like Cognitive Behavioral Therapy (CBT) and Dialectical Behavior Therapy (DBT) can be beneficial for individuals with DID, though they are often used as part of a broader treatment approach. Psychotherapy, including group therapy and family therapy, can provide support by involving family members and individuals with similar experiences. Various therapeutic interventions help patients gradually process their trauma and manage their symptoms. Self-help groups also play a role in recovery by offering shared experiences and coping strategies. Additionally, Eye Movement Desensitization and Reprocessing (EMDR) is commonly used to reduce the effects of PTSD, which is often associated with DID. DBT, in particular, helps patients regulate emotions and cope with distress, making it a valuable tool in symptom management.