Psychology

Dissociative Identity disorder is a complex disease and the people who are living with the patient or the persons involved in the medication and therapy of the patient have a complex task at hand.

Most common cause of dissociative identity disorder is a traumatic experience in the childhood which can be sexual abuse or other form of abuse of the child through a near relation.

A combination of therapy and medication is used to treat patient. The therapist and family that is providing care to the patient have to work together as a team. Gradually the patient is able to trust the therapist and his anger and hurt subside enough to let him rely on his therapist and family for comfort and understanding.

Thus dissociative identity disorder patient not only requires therapy and medication for his treatment but constant support from family members is also crucial for their recovery.

The topic of this research paper is to study the role and responsibilities of caregiver either professional or personal in the life id a person diagnosed with Dissociative Identity Disorder. Dissociative Identity disorder is a complex disease and the people who are living with the patient or the persons involved in the medication and therapy of the patient have a complex task at hand of looking after a person suffering from Dissociative personality disorder. What should be the behavior of these care providers and what techniques they should apply while handling a dissociative identity disorder patient These areas shall be explored in detail to provide guidance for immediate and extended family members to effectively look after a dissociative identity disorder patient.

Dissociative Identity Disorder
Overview

Dissociative Identity Disorder (DID) formerly termed as multiple personality disorder describes the condition of the patient where one or more personality routinely takes possession of the patients body besides his primary personality. Most of the time this personality switch is not known by the person himself and the patient when under the influence of another personality may exhibit behavior and conduct totally opposite to his actual personality. Some times these behavior may be violent even suicidal which is a cause for great concern when tending to such patients. In a person with dissociative identity disorder, personalities other than the host personality exist (Butcher, Mineka and Hooley, 2010)

Symptoms
A person having Dissociative identity disorder may exhibits symptoms from an early age. Therefore immediate family members like parents or siblings can identify the Dissociative identity disorder in a child and treatment can start to control the symptoms even at child level.
These are some common symptoms that are indicative of dissociative identity disorder disease in children

Severe headache and other kinds of pain.
Memory loss
Burst of anger
Mood swings
Anxiety and depression
Sleep disorders

Adults may have some more matured symptoms like

Amnesia  patient may forget major events or may not remember long periods of his life
Depersonalization  Patient may not be able to feel real and think of his life events as watching a movie. He has an out of body feeling.

Derealization- Patient may not perceive the outside world as real. He may perceive the external world as distorted and lacking stable existence (Butcher, Mineka and  Hooley, 2010)

Identity disturbance- Patient may not remember his own personality traits or have confusion about his own identity.

Nervousness or panic attacks leading to violence or suicidal instincts.

Causes
Most common cause of dissociative identity disorder is a traumatic experience in the childhood which can be sexual abuse or other form of abuse of the child through a near relation. Other causes include severe shock from an incident of death of a near relation or army dislocation etc. In all these cases the child experiences a continual shock and fear which is not handled by the child and he experiences a split in his personality to cope with the situation. Usually the helpless personality is the host and the helper personalities are alters that may be violent to vent out the anger inside the child which the helpless personality fails to do. When the child experiences any stressful condition later in his life, these alters come alive inside him and gain control, handling the situation for the helpless host.

Treatment
Many treatments are available for dissociative identity disorder patients and a combination of these therapies can help the individual to lead a better life.

Individual Psychotherapy Usually the therapy is targeted to the host personality and efforts are made to integrate the alters in the host personality so that all may become one. It is a time consuming procedure and different kind of therapies may be involved for over 5 to 7 years.

Family Therapy It is very important to educate the family regarding the behavior of a dissociative identity disorder patient so that they may know what to expect.

Group Therapy A group therapy with many dissociative identity disorder patients is sometimes helpful in venting out the hate and anger from the patients as each of them belong to the same sphere. Group therapy may be useful, particularly if it is psycho-educational in orientation (Brand, 1998 Silberg et al., 1997). Promoting positive peer interactions may help build in long-term resiliency for patients.

Hypnosis Hypnosis may also be used along with therapy to relax the patient and get information about traumatic experiences in the past.

Medication Sleep medications may also be used to get desired results. It will help calm the patient and keep their emotional level down. Medications like anti-depressants or tranquilizers are a very common treatment method because the personalities may have anxiety or mood disorders and the medications may help control the mental health symptoms associated with the disorders.(Viarni,2010)

Role of therapist

The therapist plays a vital role in the betterment and recovery of dissociative identity disorder patients. Therapy is a slow and time consuming process and therapist have to move very cautiously when dealing with DID patients, as these patients have the tendency to get violent and fatal. Sometimes even the life of therapist may be in danger when dealing with a dissociative identity disorder patient. That is why Hypnosis and medications are used to relax the patient otherwise getting to terms with the painful experiences of the past may wake an angry alter in the patient and patient may display violent behavior towards the therapist. Gradually over a time period of years the patient is able to trust the therapist and his anger and hurt at the painful experiences subside enough to let him go the support of the alters and rely on his therapist and family for comfort and understanding. Then only can he begin to regain his normal life control his emotions and balance them. Therapists are advised to be
open-minded to a variety of approaches and take the best from each in dealing with the challenges of any individual child or adolescent (Silberg, 2003).

Role of immediate family

Living with a dissociative identity disorder patient is a difficult task. Taking care of such a person whose actions are completely unpredictable may pose great threat to the caregiver person or family members. In this case the primary caregivers must be thoroughly educated to the behavior of a dissociative identity disorder person (Waters, 1998) and they may be trained to respond accordingly to the patients mood swings especially when he is in an aggressive and violent mood. Family can set designated times to discuss unpleasant memories so that these do not interfere with daily functioning (waters, 1998). Effort should be made not to make the patient unhappy or stressed because this is the time when the alter personality comes to the aid of the host because the alter thinks that host is incapable of handling a stressful situation. The patient may change his personality from meek and helpless to violent and dangerous in the blink of an eye. These are the situations that must be avoided.

The patient should be kept happy and satisfied, if he feels down the family should assure him of their love and support so that he may not feel lonely and turn inside himself to seek aid, instead he may grasp the extended hands of the family member and feel loved. In this way, slowly the patient will learn to trust the family and rely on them for his needs (Waters, 1998). On the part of family members like parents and siblings lies a tough job of constantly bearing with the patients mood swings, his dependability and trying to keep him as comfortable and satisfied as possible so that he may not need to fall back on his alters at the time of distress. Parents have to help by engaging the patient in constructive activities speaking to the patient softly soothing his hurt and healing his wounded soul.

Even when an alter takes over the host parent should maintain eye contact with the patient and try to calm him down giving medication to relax and eventually sleep so that the anger does not build up inside the patient. Slowly he should be made to relate to the experience of the past, to talk them over with relation or therapist to let out the anger and hurt stored in him all these years. Once the patient comes to terms with the emotional imbalances then only can he start his journey to the road of recovery.

Role of extended family

The role of extended family like maternal or paternal relations or grand parents may also come in useful at this time lending a helping hand to the exhausted parents whenever possible. The idea is to make the patient feel loved and get him to trust his family again which was shattered in the past. Once the patient regains this trust his stress and loneliness would vanish and he would be in peace with himself and the rest of the world. His anger and frustrations would subside and he would be able to lead a better life than before. All this would happen gradually but in time and with constant effort on the part of therapist and family members, the dissociative identity disorder can come back to the semblance of normal life and can regain his normal self.

Conclusion

Thus dissociative identity disorder patient not only requires therapy and medication for his treatment but constant support from family members is also crucial for their recovery. The therapist and family work together as a unit to bring him back from the hole of depression and destruction that the patient has fallen into. The therapist, family near or far may work as a team to help the patient (Silberg, 2003)
For this, family members and care givers be it close family or distant relation all can help and extend support. More effort is required to educate individuals regarding this disease so that parents may identify the symptoms at an early age in children and help cure their children of this hazardous disorder.