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Once this disorder occurs, it will last a lifetime if it is not treated. Generally, once this obstacle is formed, there will be no big and substantial development. A large number of DID patients also have other psychological disorders, such as drug abuse, depression, somatization disorder and borderline personality disorder, panic attacks, eating disorders and so on. Almost exclusively in western culture. ?
Multiple personalities. Why? In order to escape the situation that I can't cope with. Almost all theories about the causes of multiple personalities begin with such a hypothesis. As for some specific questions, such as how these processes happen, different theories have different answers.
1. Psychodynamic view: defense anxiety
At the end of 19, the separation barrier began to be widely studied. Pierre Janet, a French psychologist, believes that one or several psychological functions can be separated from other psychological functions and performed outside consciousness. However, Freud, who was Janet's contemporary, thought dissociative disorder was a kind of hysteria.
Freud's personality theory puts forward that our psychology can be divided into three levels: id, ego and superego. Id can be understood as the "little devil" in our hearts (primitive desire), superego can be understood as our "sage model" (judicial department specializing in morality), and the task of ego is to adjust the relationship between ID and superego. It's like we want to eat a delicious meal, Ben. When I say eat, eat, my mouth is watering. Besides, superego says that I can't lose weight recently. Give me something low in calories! Finally, it was decided after weighing: only a full meal can lose weight.
Freud believed that many basic human desires are in conflict with reality or superego, and this conflict produces painful anxiety. In order to protect the mind from anxiety, suppress these desires and try to defend them. In fact, dissociation, like all neurosis that Freud thought, is caused by extreme and inappropriate defense. The patient with multiple personalities becomes a different self, which was forbidden in the past. His ego (ego) knows nothing about all this, thus saving the individual's mind from severe and superego condemnation.
These explanations of dissociative identity disorder by classical dynamics party seem to be somewhat inadequate. Some researchers pointed out that in this obstacle, I am not unconscious, on the contrary, it is conscious. Modern psychodynamic scholars have put forward more complicated etiological explanations for dissociative identity disorder (see Alloy et al., 1996). Kruft believes that if a child has a special separation ability when facing great difficulties, that is, the ability to pay extreme attention to one thing and forget everything else, then the symptoms of separation disorder will gradually form.
For example, a little girl has an imaginary companion (many DID patients report having such a companion). When she is sexually abused and has no adult protection, she can imagine the abused experience as happening to her imaginary companion, thus finally denying that she has such an experience; She may also form a third punitive personality, and the punishment is of course aimed at the abuser; You can also cultivate a protector personality to meet her needs of being protected. Over time, these different personalities may also play a role when individuals encounter other unpleasant things. These sub-personalities may not be revealed for a long time, but when individuals encounter new major trauma, they will behave as explicit alternate personalities, that is, there will be a separation of identity barriers.
Does the patient use the defense style of division and separation to maintain a good self and a good object and separate incompatible psychological content? Separation also means removing some aspects of feeling or cognition, or changing the state of consciousness, so as to remove some events or situations from consciousness (see Wu and Xiao Zeping, 2004).
Many studies show that 97% of DID patients often suffer physical or sexual abuse in their early life (see Comer, 200 1). However, these reports are retrospective, and whether these recalled abuses are true or not is controversial among researchers (Butcher et al., 2004b). In addition, only a small number of abused children have developed into DID. In addition, the experience of childhood abuse not only appears in the reports of DID patients, but also appears in the reports of patients with borderline personality disorder, eating disorder and depression. At present, the view is that cruel abuse in childhood is not uncommon, which has a very negative impact on individual development, and may also lead to patients with isolated pathological symptoms (Butcher et al., 2004b).
2. Biological point of view: brain dysfunction
Dissociative disorders, including some psychotic symptoms, seem to be the product of neurological diseases rather than psychological processes. From the perspective of neuroscientists, some so-called dissociative disorders may simply be neuropathic disorders. There is a theory (see Alloy et al., 1996) that dissociative symptoms may be "by-products" of undiagnosed epilepsy. In the first formal clinical description of DID patients, epileptic seizures were mentioned. In addition, some epileptic patients reported dissociative experiences, such as depersonalization and possession. However, this theory is only applicable to some dissociation symptoms, and it cannot explain DID, because this disorder is far more complicated than the dissociation experience reported by epileptic patients.
Another reproducible hypothesis is that there is a rebellious sub-part in our human body, which is experiencing a different reality and living an alternative life. However, the normal brain knows how to suppress these subdivisions. When the brain that inhibits these sub-parts is damaged or changed, there will be dissociative symptoms, that is, let the rebellious part express itself. This view is supported by some studies. For example, there is a patient whose left hand often does something he doesn't like after the corpus callosum is removed, such as stealing money and unbuttoning his shirt in public. The patient uses another name to call himself the part that does these things. There is also supporting evidence that the subjective personality and primary and secondary personality of DID patients are controlled by two hemispheres of the brain respectively (see Alloy, et al, 1996).
Of course, this theory is more tentative than epilepsy theory, and neither theory excludes psychological reasons.
In addition, there is a view about the development of nerves. Kelly A. Forrest) put forward the orbital frontal model of DID on the basis of previous work. The model assumes that the orbitofrontal lobe plays a decisive role in the formation of DID through its protective inhibition on the tissue and behavioral function of the temporal lobe. In an abused environment, the concepts of "me" or "me in a relationship" are so contradictory that integrating them will destroy direct goal-oriented behavior. The developing OFC will integrate the concept of "I" or "I in the relationship" into the current optical fiber connection. However, the concept of "I" that is felt and suppressed in one situation cannot be separated in another contradictory situation that needs it to organize current behavior. In this case, through the suppression of "contradictory me", the conceptual system needed by "contradictory me" is maintained. That is to say, when a more coherent "me" or "global me" plays a destructive role in some situations of children's development, it plays a protective role in the integration of behavior in direct situations, but it sacrifices the integration of the concept of "me" at a higher level and the function of cross-situation operation (see Wu and Xiao Zeping, 2004).
As for whether DID has biological heritability, it is still unknown. However, some researchers found that in some cases, DID's parents also showed some symptoms of separation (see Comer, 200 1).
3. Behavioral and socio-cultural perspectives: the separation of social roles
Behaviorists believe that dissociative identity disorder is a learned coping style, a response to get rewards or escape from stress. In the process of separation, people adopted a social role different from their original identity, which was strengthened and fixed (see Alloy, et al,1996; Comer, 200 1). This view is similar to the psychodynamic view in that the focus is on the patient's motivation, and its motivation is to escape. The difference is that psychodynamics thinks that this process is unconscious, while behavioral view thinks that the symptoms of separation are maintained because of reinforcement.
Similar to behavioral scholars, sociocultural scholars believe that separation symptoms are the product of social reinforcement. Spanos (see Alloy, et al, 1996) put forward a theory in 1994 that dissociative identity disorder is a strategy used by people to gain sympathy and avoid taking responsibility for some of their actions. They will say that other people did these acts and they are not responsible. More interestingly, Spanos believes that while discovering and treating this disease, the therapist has also been rewarded, because he found an amazing case of this disease. As a result, this obstacle was created, and therapists and patients began to believe it because they had their own reasons for doing so.
4. Cognitive view: memory dysfunction
Cognitive psychologists believe that separation symptoms are essentially memory disorders. In each case, all or part of the patient's "autobiographical work" is separated. When this obstacle is discovered, the patient's skills (procedural memory) and general knowledge (meaningful memory) are usually intact. What is damaged is the patient's situational memory, or the record of personal experience. Besides, it is only partially damaged. One more thing, there is evidence that patients keep hidden memories of their past medical history. What the patient loses is the explicit memory of the separated materials, that is, the ability to extract these materials into consciousness.
What causes the loss of selective explicit situational memory? There are three different cognitive theories.
The first one is called "state-dependent memory". This means that if a person is in the same emotional state as the initial event, it is easier to recall (see Alloy, et al,1996; Comer, 200 1). This can explain why some serious traumatic events are forgotten, because similar extreme emotional States are unlikely to reappear. This theory can also explain the dissociative identity disorder, that is, different personalities have different emotional characteristics.
The second theory involves control factors, that is, the fact that other information is classified and can activate or inhibit the extraction of other information. Schacter and his colleagues think (see Alloy, et al, 1996) that a person's name may be the biggest controlling factor of situational memory. If you forget your name, life will be forgotten. In some cases, when a patient forgets his name, his memory will suddenly recover, which supports this theory.
The third theory is related to "self-reference". Kihlstrom (see Alloy, et al, 1996) points out in 1987 and 1990 that we extract autobiographical memories by associating them with situations representing ourselves. For example, we don't remember the high school dance alone, but remember it as something that happened to us. Other kinds of memory, such as 2+2=4, do not involve themselves. In the process of dissociative forgetting and roaming, what is forgotten is the information about oneself, that is, the so-called situational memory, because it depends on self-reference, and intellectual memory does not involve the individual itself, so it is not forgotten.
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