Treating Dissociative Identity Disorder and Drug Abuse
Once known as multiple personality disorder, dissociative identity disorder (DID) is characterized by the presence of 2 or more personalities (or an experience of possession, in some cultures) as well as recurrent gaps in memory. Those who live with this disorder have usually experienced intense psychosocial stressors, such as trauma or childhood abuse.1
DID is a relatively uncommon condition, occurring in about 1.5% of the general population. The disorder tends to more commonly occur in males (1.6%) than females (1.4%). People with the disorder exhibit many different co-occurring or comorbid conditions, including substance abuse, post-traumatic stress disorder (PTSD), depressive disorders, eating disorders, and sleep disorders.1
Treatment for DID includes psychotherapy and may include the use of medications. Treatment for co-occurring disorders such as DID and addiction requires an integrated approach that can treat both conditions at the same time.
What Are the Symptoms?
The key characteristic of dissociative identity disorder is a disrupted identity evidenced by the presence of 2 or more distinct personalities. Each of these identities may have a name, along with unique characteristics, mannerisms, and voices. The person may hear the voices or have internal conversations among multiple identities. Voices, identities, or memories may intrude into their everyday activities.2,3
In addition, people with the disorder may experience amnesia, including gaps in memory for past events and lapses in memory of current everyday events and well-learned skills. They may also find evidence of certain activities and have no memory of doing them.2
Other symptoms can include:2
- Severe headaches.
- Aches and pains.
- Depression.
- Anxiety.
- Self-mutilation.
- Suicidal behavior.
- Sexual dysfunction.
- Hallucinations (as part of a flashback).
What Are the Short-Term and Long-Term Effects?
Associated long-term effects of DID can include more prevalent alcohol and drug abuse, increased risk of suicide, frequent self-injurious behavior, and impairment in relationships.1
Parents with the disorder may be emotionally unavailable to their children, neglect them, and be unable to model appropriate behavior. The differing styles of a parent with multiple identities can also compromise the safety of the children. The parent’s different identities may have different values, disciplinary codes, and memories of daily routines. Some may even have abusive identities or put themselves in situations that can cause trauma to the child.4
Impairment in personal relationships is more common, but DID can also affect a person’s functioning in other areas, such as at work. For example, a person who has an angry identity may lash out at a co-worker or boss.2
Additionally, people with DID can develop a range of other mental health disorders, including depression, PTSD, anxiety, personality disorders, eating disorders, obsessive-compulsive disorder, sleep disorders, conversion disorder, and somatic symptom disorder.1
How Is It Treated?
Treatment for dissociative identity disorder aims to:3
- Relieve symptoms.
- Keep the person and other people around them safe.
- Integrate the different identities into one well-functioning identity.
A therapist helps the person process memories related to their trauma, develop coping skills, improve functioning, and have better relationships.3
Talk therapy is usually the main treatment for those with DID. Therapy may be in the form of individual or group sessions. Behavior therapy can also help people with DID be more mindful and reduce their negative reactions to things that remind them of past traumas.
Types of therapies can include:3
- Cognitive behavioral therapy – works on changing dysfunctional thought patterns, feelings, and behaviors
- Eye Movement Desensitization and Reprocessing (EMDR) – treats people with nightmares, flashbacks, and other symptoms of PTSD
- Dialectical behavior therapy – helps people with personality disturbances and dissociative symptoms related to abuse or trauma
- Family therapy – educates the family about the disorder and how to better cope with it
- Meditation and relaxation techniques – teaches people how to tolerate their symptoms and develop self-awareness
Other treatments can also include hypnosis and medication. Hypnosis can help people with DID explore thoughts, feelings, and memories associated with trauma. Medication, such as antidepressants or anti-anxiety medications, can treat other symptoms in people with DID.3
What Is the Relationship Between Mental Illness and Substance Abuse?
Though there isn’t a lot of data on dissociative identify disorder and substance abuse, the two conditions are known to occur together. And there are many studies available that discuss mental illness in general and its links to substance abuse. In 2017, 8.5 million adults age 18 and older had both a mental health disorder and a substance use disorder.5
In many instances, mental health conditions and substance abuse occur together in the same person because:6
- The person may use drugs or alcohol to self-medicate the symptoms of their mental health problem.
- Substances may trigger mental health symptoms.
- Both disorders are believed to have similar causes, such as changes in brain functioning, genetic vulnerabilities, and early exposure to stress or trauma.
When someone has a mental health disorder and a substance use disorder, it’s called a dual diagnosis. Both conditions need to be treated simultaneously for the best chance of a complete recovery. Integrated treatment—treating a substance use disorder and mental health issues at the same time—is the optimal method to deal with co-occurring disorders. Increasingly, rehab programs offer dual diagnosis treatment.
According to the National Alliance on Mental Illness, integrated treatment methods that help people simultaneously manage both their mental health and substance use issues include:7
- Motivational interviewing.
- 12-step peer support programs.
- Trauma-informed therapy, as these programs help clients feel safer and more in control of their lives.
- Mindfulness, which may help people become more aware of uncomfortable thoughts, feelings, and sensations and accept them.
Though there isn’t a cure for DID or addiction, both conditions can be effectively managed with ongoing care.
Don’t be afraid to reach out for help if you or someone you know is dealing with dissociative identity disorder and/or addiction. The sooner you get help, the sooner you can begin to have a more satisfying and rewarding life.
Sources
[1]. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
[2]. Spiegel, D. (2017). Dissociative Identity Disorder. Merck Manual.
[3]. Cleveland Clinic. (2016). Dissociative Identity Disorder (Multiple Personality Disorder).
[4]. Giller, E. (1995). The Effects of DID on Children of Trauma Survivors. The Sidran Institute.
[5]. Substance Abuse and Mental Health Services Administration. (2018). Key Substance Use and Mental Health Indicators in the United States: Results from the 2017 National Survey on Drug Use and Health.
[6]. MentalHealth.gov. (2017). Mental Health and Substance Use Disorders.
[7]. Stout, K. (2017). Integrated Treatment For Mental Illness And Substance Use. National Alliance on Mental Illness.
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