Dissociative Identity Disorder Analysis

This assignment delves into the multifaceted nature of Dissociative Identity Disorder (DID). It requires a comprehensive understanding of DID's etiology, clinical presentations, and therapeutic approaches. Students are expected to analyze research findings, critically evaluate treatment modalities, and demonstrate an awareness of the ethical considerations surrounding DID diagnosis and treatment.

1
NRS2342
Mental Health Nursing
Student name: Fatima Mohammed Al saedi
FC1100094
Semester 1
2017-2018

2
Dissociative identity disorder also known as multiple personality disorder is a
condition wherein the identity of a person is divided into two or more personalities that are
distinctively present (Dorahy et al, 2014). The people who suffer from this mental illness are
generally the targets of severe bullying and abuse. The following essay deals with the
portrayal of dissociative identity disorder in the movie Split. The essay proceeds to discuss
the issues presented by the illness worldwide as well as the concerned country. It also
discusses the socio-cultural impacts of the disease on the individual suffering from the
condition as well as their families and their workplaces. The essay also attempts to find out
some ways of treating and managing the illness. The essay concludes with the
recommendations towards the clients on the ways to manage the mental condition.
The movie talks about the central character Kevin. The psychological horror-thriller
deals with the 23 different types of personalities that exist in the same person
(Www.youtube.com, 2017). The person is shown to have kidnapped three girls who are in
their teenage years. They had been imprisoned in an underground facility and had been kept
isolated from the outer world. The three girls were meant to serve as offerings to the dark
powers.
The mental illness that is described in the movie is commonly known as Dissociative
identity disorder or DID. In the storyline of the movie is found that the protagonist suffers
from the condition. The victims of Kevin learn about this character trait of the person only
after their kidnapping and imprisonment. The doctor who had been dealing with the case of
Kevin had reported to have identified 23 different personalities within the same person.
According to the doctor Dr. Fletcher, the different personalities can be viewed as sitting in
chairs in a room inside the mind of Kevin. They wait for their turns in order to take control
over the body of Kevin. The major dominating personality is that of Barry and this is the

3
persona that is found deciding on which personality should be taking control of the physical
attributes of Kevin at a given point of time. The doctor identifies that these personalities had
risen to power in order to help the protagonist to cope up with the abuses that were inflicted
upon him during his childhood by his mother who suffered from the obsessive-compulsive
disorderly state of mind.
The dissociative identity disorder is mainly characterized by two or more split or
distinct personalities of the same person (Paris, 2012). These personalities continuously
control the behaviour of the person. As a result, the patients who suffer from this disorder are
unable to remember any of the personal information. This forgetfulness is not similar to the
simple forgetfulness that people face in their daily lives (Staniloiu & Markowitsch, 2014).
The person may experience memory variations that are highly distinct and fluctuate with the
split personalities that are resident within the mind of the concerned person. The different
personalities of the person may belong to different ages, racial divisions and even may have
different genders. All these personalities may have different behavioural patterns like
gestures, postures and the way of speech even. The identities may be imaginary people or
even animals. The different identities reveal themselves and take control over the thoughts
and behaviours of the concerned individual. This process is known as switching and may take
days, minutes or even seconds to take place. The person suffering from dissociative identity
disorder may face a number of symptoms such as tendencies towards committing suicide,
symptoms inclusive of visual and auditory hallucinations that are similar to psychotics,
feelings of depression and anxiety, disorders of sleep and eating, drug and alcohol abuse
(Ross, Ferrell & Schroeder, 2014).
Dissociative identity disorder had been considered to be a rare phenomenon in the
earlier days. However, in the modern times, the disorder is considered to be a more
commonplace occurrence than it was earlier. The number of reported incidents of childhood

4
abuse has seen a rapid increase in the recent times as compared to the number of reported
cases in the past. People who are diagnosed with the dissociative identity disorder may be
loving towards their children. The chronic defensive nature of the dissociation identity
disorder may cause serious malfunctions in the spheres of society, family, work, and other
day-to-day activities. The repetition in the dissociations may lead to a series of separate
mental states or entities. The trauma survivor takes these identities to be his own identity at
the given point of time (Markowitsch & Staniloiu, 2012). The victim keeps switching
between these identities from time to time. The parent who has grown up in an abusive
environment may display the characteristics of the violence he has experienced during his
growing years from his own parents.
It may also be that this disorder of the parent comes to the forefront as the child grows
up to attain the age when the parent was traumatised. The appearance, age and behaviours of
the child may serve as a trigger to the parent, thereby reminding him of the abuse he had
faced during his childhood days (Www.sidran.org, 2017). The parent may subconsciously act
in a way that may prove to be non-nurturing for the child. The alternative personalities of the
person are manifestations of the same person and not separate persons. The children may be
abused or deliberately hurt by the parents. The parent who has been brought up in the abusive
environments may under the influence of these identities wrongly perceive their kids to be
someone else thus treat them with hostility. There may also be incidents wherein an alternate
aggressive identity turns hostile towards the child. This behavioural tendencies may also lead
to development of the similar conditions in the child. In the places of work too, the people
suffering from dissociative identity disorder may lead to the suffering of the co-workers of
the concerned person.
The most common methods for the nursing of dissociative identity disorder include
hypnosis, psychotherapy, family and group therapy and the cognitive behavioural therapy

5
(Krakauer, 2013). Identity confusion, amnesia, alteration of identity, flashbacks, headaches,
nightmares, emotional instability are several symptoms that a patient of dissociative identity
disorder may portray (Gentile, Dillon & Gillig, 2013). The patients may also face certain
somatic conditions that may include genitourinary and gastrointestinal disturbances. Family
and group therapy requires the involvement of the family of the patient suffering from the
condition in order to bring about change in the condition of the patient. This therapeutic
process includes the identification of the situation that the victim is facing and passing on the
same towards their family and closed ones. The rationale behind this theory rests in the fact
that the first care givers in case of mental illnesses are the family members. The family
members are the ones who provide the victim with the primary support. Cognitive
behavioural therapy aims to change the dysfunctional feelings, thinking patterns and
behaviours of the person suffering from the condition (Brand et al, 2012. The common
interventions of this therapy include the identification of the situations that are generally
avoided and the identification of and the challenging of the negative thought-processes
(Chlebowski & Gregory, 2012). The patients are fully informed of their conditions and only
then is the treatment started.
There are certain issues that a person might face while undergoing the recommended
treatment for the mental illness. The individual outpatient psychotherapy is considered to be
one of the primary modalities for the dissociative personality disorders. The characteristics
and abilities of the patient, the clinician’s preferences as well as the external factors such as
availability of the skilled therapists, insurances and other similar financial resources pose a
hindrance in the way of the treatment needs to be meted out to the patients (Ross, et al.,
2008). In conclusion to the above discussion, some recommendations might be put forward in
order to help the patients suffering from the mental condition. The patients must be dealt with
very carefully so as to help in reduction of the split in their mental conditions. They should be

6
treated with regular counselling and hypnosis sessions so as to help them overcome the
trauma that may have been deep-rooted in their memories (International Society for the Study
of Trauma and Dissociation, 2011). The victims must be helped to free themselves from the
clutches of the trauma that they might have been facing which may have resulted in the
mental illness of dissociative identity disorder in them.
Dissociative identity disorder can effectively be controlled using the specific and
recommended nursing diagnosis and interventions. While the diagnosis of the condition has
been a subject of discussion due to lack of conclusive way of diagnosis; there is no denying
that the condition seriously affects the affected people. The utmost interventions are needed
to control the effects of the disease.
The recommended diagnosis of DID is the presence of the two or more distinct
personality traits or behavioural patterns being exhibited differently by the affected
individuals. The clinician should note the number of the personalities or the identities that
takes control of the patient’s behaviours. The presence of more than two personality traits
results in the twisted way a patient perceives almost everything and in this case, the
behavioural patterns changes rapidly.
The nurse should also look at the patient’s inability to remember very crucial
information, the extraordinary forgetfulness that cannot be explained. The nurse should also
consider the fact that this illness is not associated with the patient’s abuse of any kind of drug
substances such as alcohol or any form of hard drugs (Klanecky, Harrington, & McChargue,
2008). It is also important for the professional nurses to gather important information about
the history of the patient and detect all the important aspects in comparison, that might lead to
the conclusion of DID detection.

7
The recommended nursing interventions in terms of treatments for DID incorporate a
variety of means (Peterson, 2010). Psychotherapy is the commonly and the widely used
treatment for dissociative identity disorder. In treating the DID patients using this method, the
therapists should strive to help the patients develop good relationships with other people,
open up their minds to feel in the way they have never felt before and even being open about
their past history. This method should be best done by the aid of the family or group
psychotherapy or the combination of both and it is carefully paced to prevent the patient from
being overwhelmed by anxiety.
Since DID may be accompanied by other mental conditions such as depression and
excessive expression of anger and anxiety, certain medication can be used to control these
conditions. However, there must be extra caution especially with the dissociative identity
disorder patients because any medication that alters their feeling patterns may lead them to
think that they are being controlled. And that feeling leads them back into the DID trauma
once more much easily.

8
References
Brand, B. L., Myrick, A. C., Loewenstein, R. J., Classen, C. C., Lanius, R., McNary,
S. W., ... & Putnam, F. W. (2012). A survey of practices and recommended
treatment interventions among expert therapists treating patients with
dissociative identity disorder and dissociative disorder not otherwise
specified. Psychological Trauma: Theory, Research, Practice, and
Policy, 4(5), 490.
Chlebowski, S. M., & Gregory, R. J. (2012). Three cases of dissociative identity
disorder and co-occurring borderline personality disorder treated with dynamic
deconstructive psychotherapy. American journal of psychotherapy, 66(2), 165-
180.
Dorahy, M. J., Brand, B. L., Şar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas,
A., ... & Middleton, W. (2014). Dissociative identity disorder: an empirical
overview. Australian & New Zealand Journal of Psychiatry, 48(5), 402-417.
Gentile, J. P., Dillon, K. S., & Gillig, P. M. (2013). Psychotherapy and
pharmacotherapy for patients with dissociative identity disorder. Innovations
in clinical neuroscience, 10(2), 22.
International Society for the Study of Trauma and Dissociation. (2011). Guidelines
for Treating Dissociative Identity Disorder in Adults, Third Revision. Journal
of Trauma & Dissociation .
Klanecky, A., Harrington, J., & McChargue, D. (2008). Child sexual abuse,
dissociation and alcohol: implications of chemical dissociation via blackouts
among college women. American Journal of Drug and Alcohol Abuse , 277-
284.

9
Krakauer, S. Y. (2013). Treating dissociative identity disorder: The power of the
collective heart. Routledge.
Markowitsch, H. J., & Staniloiu, A. (2012). Amnesic disorders. The
Lancet, 380(9851), 1429-1440.
Paris, J. (2012). The rise and fall of dissociative identity disorder. The Journal of
nervous and mental disease, 200(12), 1076-1079.
Peterson, G. (2010). Assessment and treatment tools for dissociative disorders.
Clinical Lecture Series, UNC-CH School of Social Work .
Pulver, A. (2017). M Night Shyamalan announces sequel to Unbreakable and Split in
same film. the Guardian. Retrieved 1 November 2017, from
https://www.theguardian.com/film/2017/apr/27/m-night-shyamalan-
unbreakable-sequel-split
Ross, C. A., Ferrell, L., & Schroeder, E. (2014). Co-occurrence of dissociative
identity disorder and borderline personality disorder. Journal of Trauma &
Dissociation, 15(1), 79-90.
Ross, C., Keyes, B., Yan, H., Wang, Z., Zou, Z., Xu, Y., et al. (2008). A cross-cultural
test of the trauma model of dissociation. Journal of Trauma Dissociation , 35-
49.
Staniloiu, A., & Markowitsch, H. J. (2014). Dissociative amnesia. The Lancet
Psychiatry, 1(3), 226-241.
Www.sidran.org. (2017). The Effects of DID on Children of Trauma Survivors |
Sidran.org. Sidran.org. Retrieved 1 November 2017, from
https://www.sidran.org/resources/for-survivors-and-loved-ones/the-effects-of-
did-on-children-of-trauma-survivors/

10
Www.youtube.com. (2017). Split Official Trailer 1 (2017) - M. Night Shyamalan
Movie. YouTube. Retrieved 1 November 2017, from
https://www.youtube.com/watch?v=84TouqfIsiI