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Dissociative identity disorder

Dissociative identity disorder (DIS; the diagnosis of multiple personality disorder is also used; sometimes referred to as split personality in a wide culture) is a mental disorder from a group of dissociative disorders in which a person's identity is not whole and it seems that there are several different personalities (or, in another terminology, ego states) in the body of one person. or alterers).

The identity can be divided into two or more parts. At the same time, at certain moments, a "switch" occurs in a person — one part of the identity replaces another. In addition to "switching", there may also be "passive influence" (passive influence), in which part of the identity does not assume executive control, but somehow interferes with the functioning. Examples are the voice of a child in his head, which appeared as if out of nowhere and are not perceived as his thoughts, talking about things that a person does not remember or did not want to say.

These parts of identity can have different gender, age, nationality, character, mental abilities, worldview, react differently to the same situations. Parts of the identity may or may not share memories. In the first case, one part of the identity will fully or partially remember what the other remembers, in the second case, on the contrary.

There may also be "lapses in time" - a situation when a person looks at the clock and sees that it is, say, nine in the morning, and the next time he looks at them, he sees that they show three o'clock in the afternoon. At the same time, he does not know anything about what happened to him between nine o'clock in the morning and three o'clock in the afternoon. Or there may be another oddity - the situation of finding some other items, the acquisition of which they cannot remember.

Until recently, it was considered a relatively rare disorder, but modern studies have shown that this disorder occurs with a frequency of 1% to 3% among the entire population, and is diagnosed among 5% of patients who have received inpatient treatment for psychological health.

The causes of this disorder can be severe emotional trauma in early childhood, repeated extreme physical, sexual or emotional abuse, as well as other mental disorders not previously identified.

This disorder is an extreme manifestation of dissociation — a psychological defense mechanism in which a person begins to perceive what is happening to him as if it is happening to someone else. This mechanism is useful because it allows a person to protect himself from excessive, unbearable emotions, but in cases of excessive activation of this mechanism, dissociative disorders appear.

If a patient has a dissociative disorder, it does not mean that it is a manifestation of a mental illness. A moderate degree of dissociation can occur as a result of stress; people who have spent a long time without sleep, received a dose of "laughing gas" during dental surgery or suffered a minor accident often get a short dissociative experience. Another simple example of dissociative disorder is a person who is sometimes so completely interested in a book or a movie that the surrounding world and a period of time pass by him unnoticed. Dissociation is known to be associated with hypnosis, which in turn involves a temporary change in the state of consciousness. 

People often experience dissociative experiences during the practice of religion (being in special trance states), or other group or individual classes (meditative practices, the highest stage of autogenic training).

Moderate or complex forms of dissociation are observed in persons with traumatic experiences of abuse in childhood, participants in hostilities, robbery attacks, torture, or when suffering a natural disaster, car accident. Dissociative symptoms may develop in patients with pronounced manifestations of post-traumatic stress disorder, or with disorders that have formed during somatization (diseases of internal organs, as a result of psychological conflicts).

Contrary to popular misconception, dissociative disorders are not associated with schizophrenia. However, in schizophrenia and dissociative identity disorder, there may be similar psychopathological symptoms (in particular, symptoms of the first rank according to K. Schneider and auditory hallucinations), which indicates the need for differential diagnosis.

The first evidence of the existence of a multiple personality can be considered Paleolithic cave paintings with images of shamans, in which they "reincarnated" into animals, or in which spirits "inhabited".

Many modern experts consider multiple personality disorder to be what was previously called demon possession. There are references to the description of a woman who did not remember the second person who stole her own money, which was made by a Swiss Renaissance physician Paracelsus.

Dissociative identity disorder is closely related to the mechanism of psychogenic amnesia — memory loss, which is purely psychological in nature, without organic brain damage. This is a psychological defense mechanism through which a person gets the opportunity to expel traumatic memories from consciousness, but in the case of identity disorder, this mechanism helps individuals to "switch". Too much involvement of this mechanism often leads to the development of common everyday memory problems in patients suffering from identity disorder.

Many patients with dissociative identity disorder also experience phenomena of depersonalization and derealization, there are bouts of confusion and confusion when a person cannot understand who he is.

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