What are the treatment options for dissociative identity disorder?
In order to plan the right treatment, it is vital to get an accurate diagnosis, as getting the wrong diagnosis could mean getting the wrong treatment. Because dissociative identity disorder (DID) can come with lots of different symptoms, it can be mistaken for other psychiatric conditions. Added to its many symptoms, its shame and secrecy can keep it hidden. This can get in the way of an accurate diagnosis. If you wonder whether you or someone you know might have DID, consider talking about this with your doctor. They will be able to help and advise you.
Treatment for DID is with psychotherapy. Psychotherapy sessions typically take place weekly and last for around one hour. Therapy for DID is often long-term - sometimes over several years. In the UK, because of the long-term nature of therapy for DID, NHS therapy is not always available. For this reason, people sometimes turn to private therapists. When choosing a private therapist, it is important to find someone who is familiar with DID and knows how to work with it. Not all therapists have the right kind of experience. The therapist must also have a supervisor who understands DID and is happy to oversee the work. If you are looking for a therapist, it is OK to check with them that they have everything in place to work long-term with DID.
What is psychotherapy?
Sometimes, people talk about dissociative identity disorder (DID) psychotherapy as being divided up into three phases. These are:
- Establishing safety, stabilisation and symptom reduction.
- Working through and integrating traumatic memories.
- Integration and rehabilitation.
The first phase in therapy is to establish a strong and trusting relationship between the client and therapist - a relationship which feels safe enough to explore traumatic experiences. For someone who has grown up with abuse, this can be an unsettling prospect. For this reason, it is crucial that the fit between the therapist and the client is a good one. If the therapy relationship is strong, the chances of recovery are greater. It can take time to develop a secure and trusting relationship, particularly when clients have been hurt by people they have trusted in the past; it doesn't happen straightaway.
Once the right therapist has been found and a safe relationship has been established, the next task is to work through traumatic memories. This allows the client to process trauma in ways that they have not been able to do before. Talking through trauma in a therapy relationship actually helps make sense of the past and to move forward, instead of reliving it over and over again. In DID, dealing with trauma often means dealing with dissociated identities. Working with these identities requires some finesse on the part of the therapist. The aim of therapy is to build relational bridges between the identities, allowing the client's personality to become more integrated. It is important that the therapist does not encourage greater autonomy for the dissociated identities. This can result in more separation rather than integration of identities. With a skilled therapist and a committed client, personality integration is possible, through gentle and careful unpicking of traumatic experiences.
The final phase of therapy - that of integration and rehabilitation - prepares the client for the end of therapy. This too can take some time. After working closely with a therapist, saying goodbye and moving forward need preparation. It can feel daunting. Whilst therapy can be thought of as consisting of three phases, it is rarely a smooth progression through them, as dealing with trauma can feel unsettling. Working through difficult memories requires frequent returns back to the first phase of therapy: establishing safety.
What about medication?
There are no medications which have been shown to work for dissociative identity disorder (DID). However, medication can help with some of the consequences of living with DID. It can sometimes help with anxiety and depression, or help with sleep problems. Medications can be used alongside therapy work and can help, during difficult times, to complement the therapy work. Your doctor might consider using antidepressants, anti-anxiety medication, antipsychotics or medication for sleep. There is a wide range of medication to choose from. Your doctor will be able to talk you through your medication choices and advise you about which is best for you.
Further reading and references
International Society for the Study of Trauma and Dissociation (2011); Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, Journal of Trauma & Dissociation, 12:2, 115-187
Brand BL, Sar V, Stavropoulos P, et al; Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder. Harv Rev Psychiatry. 2016 Jul-Aug24(4):257-70. doi: 10.1097/HRP.0000000000000100.
Reinders AA, Willemsen AT, Vos HP, et al; Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states. PLoS One. 20127(6):e39279. doi: 10.1371/journal.pone.0039279. Epub 2012 Jun 29.
Brand, B. L., Myrick, A. C et al. A Survey of Practices and RecommendedTreatment Interventions Among Expert Therapists Treating Patients With Dissociative Identity Disorder and Dissociative Disorder Not Otherwise Specified. Psychological Trauma:Theory, Research, Practice, and Policy. Advance online publication. doi: 10.1037/a0026487 (2011)
Cronin E, Brand BL, Mattanah JF; The impact of the therapeutic alliance on treatment outcome in patients with dissociative disorders. Eur J Psychotraumatol. 2014 Mar 65. doi: 10.3402/ejpt.v5.22676. eCollection 2014.
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