Journal of Family Psychotherapy, 20:72–88, 2009 Copyright © Taylor & Francis Group, LLC ISSN: 0897-5353 print/1540-4080 online DOI: 10.1080/08975350802716566
Journal 1540-4080 0897-5353 WJFP of Family Psychotherapy, Vol. 20, No. 1, January 2009: pp. 1–25 Psychotherapy
FAMILY THERAPY AND MENTAL HEALTH, Edited by Malcolm MacFarlane, M.A.
A Systemic Approach to the Treatment of Dissociative Identity Disorder
S. Pais Systemic Treatment of Dissociative Identity Disorder
Department of Family Medicine, Indiana University, Indianapolis, Indiana, USA
Although dissociative identity disorder (DID) continues to be questioned by some clinicians, those who work with this ...view middle of the document...
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Systemic Treatment of Dissociative Identity Disorder
often alternate within an individual’s conscious awareness. At least two of these personalities repeatedly assert themselves to control the affected person’s behavior. Dissociation is the disruption of the normal integrative processes of consciousness, perception, memory, and identity, which define selfhood. DID is believed to be a result of dissociative processes, which include the splitting off from conscious awareness and control of thoughts, feelings, memories, and other mental components as a response to situations that are painful, disturbing, and unacceptable to the person experiencing them. DID indicates the fragmentation of personality with the absence of a clear and comprehensive identity (Pais, 2006). DID is increasingly understood as a complex and chronic posttraumatic psychopathology. The interaction of several factors including overwhelming stress; the ability to separate one’s memories, perceptions, or identity from conscious awareness; abnormal psychologic development; and insufficient protection and nurture during childhood have been identified in the formation of DID, although how these factors lead to a presentation of DID is unclear. DID tends to have its origin in early childhood, from 2.5 to 8 years of age and the issues often arise in early adolescence (Waseem, Aslam, Switzer, & Perales, 2007). The central component of most theories that explain DID is the protective reaction to severe childhood trauma, which is often sexual in nature but may also include physical and emotional abuse as well as neglect. Numerous studies have found an association between early severe abuse to an increased risk of psychiatric conditions including dissociative identity disorder (Putnam, Guroff, & Silberman, 1986; Sar et al., 2004). It is believed that the alternate identities are formed because a unified sense of self has failed to develop due to trauma, especially if the trauma has occurred before the age of five. Essentially the self is believed to dissociate or split into separate and distinct personalities in an effort to repress the pain and suffering from some traumatic event. The diagnosis of DID is often associated with a history of significant traumatization, usually in childhood. DID clients have a higher rate of early childhood trauma than any other clinical group (Putnam et al., 1986). Severe, repetitive trauma can produce extreme states of experiences in children and can result in the development of discrete personified behavioral states (Putnam et al., 1986). Despite skepticism there has been considerable clinical recognition of dissociative conditions in the last several years resulting in significant progress in the diagnosis, assessment, and treatment of dissociative disorders and DID. DID and dissociative disorders are not rare conditions. Clinical literature including case reports, treatment outcome studies, as well as studies of...