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The Nursing Care of the Dissociative Identity Disorder

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Dissociative identity disorder, also called multiple personality disorder, may be a very rare disorder, but by no means is it one that should be overlooked. It has a history of being doubted and it took several decades before the medical community accepted it as a real psychiatric condition worth taking seriously. The symptoms include extreme dissociation, and as the name implies, the development of multiple personalities within the mind of the sufferer. Since it is relatively new as a accepted disorder there is less research and data on this disorder compared to other psychiatric disorders. This disorder is as mysterious as it is interesting, surrounded by myths and mistruths, contributed in part by false and exaggerated portrayals for entertainment purposes. This paper will discuss the details of the disease. It will also discuss the incidence and prevalence of the disorder on a national and state level, and the role of the nurse in creating solutions for this particular health care problem.

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Dissociative disorder is a complicated disease. By many psychiatrist it wasn’t accepted as a real disorder until the last few years. There has been many studies done in an effort to determine if it was a disorder of imagination or a real disorder. One controlled MRI perfusion study compared neural activity for individuals with DID and non-DID simulating controls suggest that the resting-state features of the personality in DID are not due to imagination. This study is one of many pieces of evidence that dissociative identity disorder is a real disease.

DID means the person has two or more distinct personalities, these are called alters. The alters have the ability to take control of the mind and body and make decisions for the person. It is not uncommon for the person to black out during these times when they not in control and have no memory of the actions they performed while under the control of the “alter”. For the most part, dissociative disorder is associated with severe childhood trauma or neglect, though there have been cases where no trauma was found. DID is a coping strategy the brain uses to deal with the circumstances the person has been put into. The alter will be developed due to a specific traumatic situation and the alter will help the person through it. In addition, it has been observed that the alter can become stronger overtime with more exposure to the circumstance in which the alter is able to help. Multiple personality disorder affects about .01-2% of the American population. Though multiple personality itself is very rare, there are other less severe forms of dissociative disorders that are more common, effecting up to 20% of the American population according to studies. (DID)

How are nurses able to help with this seemingly complicated disorder? For the most part, nursing textbook information and tips are limited on the topic of DID. Of course, there is a lot of work done between the psychiatrist and the patient, but what can the nurse do? The most important aspect of rehabilitating a person with DID is consistency within the therapeutic milieu. Not only does the therapist need to be very consistent, but the nurse can be consistent. The nurse needs to pay attention to things like coming to the room when they said they would be there, and taking part in creating a kind, caring, predictable environment, and one that focuses on reward rather than punishment. There are a few things to be noted when caring for a patient with DID. Sometimes, an alter will try to manipulate you or trick you because it doesn’t believe the host needs treatment. They may even be violent, or threaten suicide. Risk of suicide is always first priority whether that be others on the unit or the patient themselves. By thinking about how the disorder works and the ability of the alters to take control of the person, even during treatment, nurses and staff will be able to stay therapeutic in their interactions with the dissociative patient. (Stafford)

DID is a complicated, misunderstood disorder in which the brain splits in to multiple personalities as a form of coping in the face of severe trauma. The incidence and prevalence is relatively low, when in comparison to other psychiatric disorders. Sufferers of this disease deserve and need to be treated with compassion, and consistency. The goal of treatment is to increase the level of trust. Even small successes contribute to the rehabilitation of the patient.

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