The Neurobiology Of Trauma And Dissociative Identity Disorder Research Paper Sample
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Dissociative disorders is a group of mental disorders characterized by the changes or disturbances of mental functions - consciousness, memory, feelings of personal identity, continuity of awareness of the own identity. Usually these functions are integrated in mind, but when dissociated, some of them are separated from the stream of consciousness and become independent to a certain extent. Thus, it may be observed the lost of the personal identity and arising of a new multiple personality, as in the case of DID. The term ‘dissociation’ was proposed in the late 19th century by the psychologist and physician P. Janet, who noticed that the complex of ideas can be cleaved from the basic personality and exist independently and outside the mind (but can be returned to consciousness with the help of hypnosis). People with dissociative identity disorder often have the early onset of severe chronic childhood trauma and show high levels of trauma on the Rorschach, although some or all of the alternate identities are characterized by the complete amnesia for childhood history, including mental trauma. DID is caused by the biological, psychological and social factors
Chronic trauma is a risk factor for the psychotic disorders as dissociative identity disorder (DID). The most common concept of the existence of DID today is based on several initial assumptions: 1) the basis of DID is trauma associated in most cases with a history of the sexual abuse by an adult (often a family member, and most of all - the father) in patient’s childhood: 2) this event traumatizing psyche is forced out of consciousness, because its content is so appalling for the child, which makes it impossible to ‘face the truth’; 3) forced out of consciousness psycho-trauma generates the symptoms; 4) the patient can not arbitrarily remember the trauma and ‘return the memories’; 5) the restoring of the ‘forgotten’ traumatic events relieves the patient from the symptoms of DID. Thus, the neurobiology of trauma and DID if the highly relevant and actual issue to be written about and to be studied in detail.
Dissociative identity disorder (definition, mechanism, diagnostics)
Dissociative identity disorder (also multiple personality disorder, personality split) is very rare mental disorder from the group of dissociative disorders, in which a person's personality is divided, and it seems that the body of one person contains several different personalities (ego states) (Vermetten, 2006). In this case, at certain moments in a person it occurs a ‘switch,’ and one personality is changed by another. These ‘individualities’ may have different gender, age, nationality, temperament, intelligence, philosophy, as well as they could respond differently to the same situation. After the ‘switching’ currently active person can not remember, what happened while the other person was active (Bisson, 2008).
According to DSM-IV, dissociative identity disorder is diagnosed if the following criteria are present: the patient has two or more distinct identities or personality states; at the same time each of them has a stable model of perception of the world, their own outlook and attitude towards reality (Bob, 2008); at least two of these identities alternately take control over the behavior of the patient; the patient can not recall important information about himself, and it goes far beyond the normal forgetfulness; this condition does not come as a result of the use of alcohol and other toxic substances, or by disease (e.g., due to the complex partial seizures). In children, it is also highly important not to confuse these symptoms with the games using imagination (Dorahy, et al., 2014).
North American studies show that 97-98% of adults with dissociative identity disorder describe the situation of violence in childhood and that the fact that violence can be documented in 85% of adults and 95% of children and adolescents with multiple personality disorder and other similar forms of dissociative disorders. These data indicate that the violence in childhood acts as the main cause of the disorder among North American patients, whereas in other cultures a big role can be played by the consequences of war or natural disaster. Some patients may not experience violence, but to survive the early loss (e.g., death of a parent), serious illness or other extremely stressful event (van der Kolk, 2003).
Causes of DID and Trauma
The causes of this disorder are severe emotional trauma in early childhood, repeated extreme physical, sexual or emotional abuse (Kolk, Bessel, 2003). This disorder is an extreme manifestation of dissociation, which is a psychological defense mechanism, in which a person is able to protect himself from some situation as if they were happening to someone outsiders (Vermetten, 2006). This mechanism is quite useful, as it allows the person to be protected from the excessive, unbearable emotions, but in cases of excessive activation of this mechanism it appears the dissociative disorders. Contrary to the popular belief, dissociative disorders are not associated with schizophrenia (Bisson, 2008).
I have found that the important pathogenic factors include the genetic predisposition, living conditions in early childhood, neurobiological disorders, psychological and social interaction. Currently it has been actively investigated the neurobiological mechanisms of the disease, but a single organic cause has been not yet established. This is thoroughly confirmed be the number of researchers, especially by E. Vermetten (Vermetten, 2006). The main cause of dissociative personality disorder is a past trauma or strong moral shock. The causes of the disease also include: continuous physical, sexual or psychological violence; psychological trauma of childhood and adolescence; psychological instability to stress and stressful situations; violence in childhood or adolescence; consequences of natural disasters, war, loss of property; transferred deadly disease; traumatic brain injury; the presence of other mental disorders; using alcohol, drugs and certain medicinal drugs (Bisson, 2008).
Dissociation (split) is a mechanism that allows the mind to separate or divide into parts the specific memories or thoughts of the ordinary consciousness. These split subconscious thoughts are not erased. They can re-emerge spontaneously in the mind. They enliven the triggers; triggers can serve as the objects and events surrounding the man during a traumatic event (Vermetten, 2006). It is believed that the dissociative identity disorder is caused by a combination of several factors: the unbearable stress, the ability to dissociate (including the ability to separate memories, perceptions or identity of consciousness), the manifestation of the defense mechanisms in ontogenesis and - during childhood - a lack of care and concern in relation to the child traumatic experience or lack of protection from subsequent undesirable experience (Bob, 2008). Children are not born with a sense of the unified identity, the latter is developed basing on a variety of sources and experiences. In critical situations, child development encounters the obstacles, and many parts of what was supposed to be integrated into a relatively unified identity remain to be segregated (Hersen, Beidel, 2011).
Treatment of DID
The main methods of treatment of the disease include: hypnotherapy; cognitive therapy; family therapy; psychodynamic therapy; antidepressants and tranquilizers in the presence of anxiety and depression; other symptomatic drug therapy. However, there is no treatment, which is able to completely solve the problem of the disease, but the psychotherapeutic treatment can weakens the clinical manifestations of the DID (Bisson, 2008).
Dissociative disorders are often exhibited under the age of 40 years. First of all it is necessary to eliminate the possibility of the traumatic circumstances or to mitigate their impact. Sometimes the change of pace has a positive effect (Bisson, 2008). The main place in the treatment of dissociative disorders is particularly given to the rational psychotherapy. The patient should be gently explained that the symptoms are not caused by the physical illness, but by the mental health reasons, for example, it can be said to the patient that he's all right, that all the painful symptoms will disappear over time and he needs the help of the psychological treatment methods (Vermetten, 2006).
Neurobiology of DID and Trauma
Usually there is a significant degree of conscious control over the memory and sensations that can be selected for the immediate attention and on movements to be executed. It is assumed that in dissociative disorders this conscious and selective control is disrupted to such an extent that it can be changed from day to day and even from hour to hour. It is usually difficult to assess the degree of loss of function, which is under the conscious control (Hersen, Beidel, 2011).The origin of disorders may be connected with a role of biological, psychological and social factors. Biological factors include heredity and constitutional importance of personality traits (Vermetten, 2006). Past illnesses also make an impact; disorders often occur in times of crisis, the age of puberty, as well as in menopause. Psychological factors include demonstrative traits in pre-morbid, experienced in childhood trauma and deprivation, heightened suggestibility and sexual disharmony of the married couples (Dorahy, et al., 2014).
In addition, it is proved by the research of E. Vermitten (2006) that the psychology of dissociative disorders includes a mechanism for the conditional pleasantness and desirability of the symptom - the person receives some gain due to the illness, for example, by holding of the love object. The social factors include the dissociated education, including the conflicting demands of mother and father to the child, the desire of the individual to the rental guideline. Dissociative states which persisted for 1-2 years before going to a psychiatrist, are often resist to the therapy (Dorahy, et al., 2014).
Researchers argue that it is needed to mention the dissociative amnesia and stupor while talking about DID. Dissociative amnesia in DID: the main feature is the memory loss, especially in the important recent developments, which is not caused by the organic mental disorder, and is too pronounced to be explained by the ordinary forgetfulness or fatigue. Amnesia is usually centered on the traumatic events, such as a misfortune, accident or sudden bereavement, and is usually partial and selective (Dorahy, et al., 2014). Dissociative stupor in DID is diagnosed on the basis of a pronounced decrease or absence of the voluntary movements and normal responses to the external stimuli such as light, sound, touch, but the examination shows no apparent physical cause. In addition there is a clear evidence of the psychogenic causes in a form of the recent stressful situations or problems (Hersen, Beidel, 2011).
Patients with DID can be divided into three groups. Patients in group 1 have mainly dissociative symptoms and posttraumatic symptoms and generally function well and fully recover through the treatment. Patients of group 2 have dissociative symptoms in combination with the symptoms of other disorders such as personality disorders, mood disorders, eating disorders, disorders associated with the substance use. Such patients recover more slowly; the treatment is less successful or more prolonged and severe experienced by the patient. Patients of the third group have only severe symptoms of other mental disorders, but may persist the emotional attachment to the persons alleged to have committed the violence against them. These patients often need a long-term treatment, the aim of which in the first place is to help to control the symptoms, rather than the achieving of integration (Petrucelli, 2010).
According to the scientific work 'Hippocampal And Amygdalar Volumes In Dissociative Identity Disorder' in American Journal of Psychiatry, Vermetten made a special study of neurobiology of DID using MRI method, in which it was investigated the size of the hippocampus and amygdalar in patients with dissociative identity disorder and trauma and in healthy people. Thus, the results showed that in patients with and dissociative identity disorder and trauma, the hippocampus’s and amygdalar’s size is significantly smaller than in healthy people. Thus, the current understanding of the psychological trauma is more complex neuro-psychological process, in which the psychological processes influence the neurobiological mechanisms and vice versa (Dorahy, et al., 2014).
Trauma is the damage (by someone or something) of psyche, leading to a significant disruption of its normal functioning. Trauma is the local mental damage by the blows of life. In psychological trauma there are no disorders of the psyche - a person remain to have an opportunity to be adequately and successfully adapted to the environment. And if there are extreme circumstances (fire, flood, earthquake), at the time of these events, all traumatized save themselves with the same vigor that not injured people. However, as soon as these events disappear, the traumatized people reminisce about their problems and return to their problem state (Blevins, Weathers, Witte, 2014). Definitely, there are some people predisposed to the psychological trauma (as well as to the DID), leading a lifestyle, which attract the psychological traumas.
Thus, in my opinion, exactly what a man injured in an early stage of development of the individual is the cause of the formation of the structure of personality around the negative attractor, around the injury and the ways to avoid or to compensate it. This occurs primarily because the injury is the most charged attractor. That is, the child does not have stronger feelings than this attractor. The psyche organizes itself around the most charged attractors and they also define the direction of the psychological development of individual. It turns out that the injury determines the direction of the development of the child. This thesis could be proven by Blevins, Weathers and Witte (2014), Bob (2008) and van der Kolk (2003).
Fixation, which appeared as a result of trauma, becomes to be the direction vector of the psyche, and then the whole individual system is built around this fixing, layering layer by layer in the formation of the human personality. The psyche can be formed around the negative attractor in the form of a compensatory mechanism that avoids negative (Bob, 2008). In this case, human life for the most part is directed to the avoidance of the experience with similar traumatic attractors. Negative attractors (injury) create a compensatory mechanism - a set of beliefs and strategies that should help to avoid the negative attractor (Blevins, Weathers, Witte, 2014). The meaning of the traumatic reaction is to block the physiological mechanisms of regulation of stress in the brain and the human psyche. In the ancient structures of the brain (the limbic system) it occurs a failure, and the state of stress (trauma) is fixed as a permanent situation of ‘here and now.’ From that moment, a man by some part of him remains to be constantly ‘deserted’ in the same situation, not being able to react and to complete it (Blevins, Weathers, Witte, 2014).
Nervous system, in turn, constantly reacts to a stressful situation by the increased arousal. The excess portion of the energy, produced by the body once in order to cope with stress, for some reason became to be blocked and frozen, remaining locked in the human nervous system and, not being able to be realized on purpose, constantly undermines it (Blevins, Weathers, Witte, 2014). In this case, the body does not only block part of its energy, but also constantly spends it to contain this block, which depletes the physical and mental resources of the human organism (van der Kolk, 2003). Thus, the psychological trauma can lead to the dissociative identity disorder. Almost all patients with dissociative personality disorder (rather 97-98%) report about the severe childhood traumatic experiences (Bob, 2008).
According to the above mention it could be summed up the followings. Dissociation process is a serious and long process with a wide range of actions. If the patient is observed with the dissociative disorder, it does not mean that it is a manifestation of his mental illness. The moderate degree of dissociation may occur as a consequence of stress; in people who have spent a long time without sleep, received a dose of ‘laughing gas’ during the dental surgery or suffered a minor accident often get short dissociative experiences. Another simple example of dissociative disorder is when a man is sometimes entirely interested in a book or movie that the world and the time pass him by. It is known that the dissociation is associated with hypnotic, which in turn includes a temporary change in the state of consciousness. Moderate or complex forms of dissociation are observed in persons with the traumatic experiences of abuse in childhood, among combatants, armed attacks, torture or transferring natural disaster, accidents.
Bisson, J. 'Traumatic Dissociation: Neurobiology And Treatment'. The British Journal of Psychiatry 193.2 (2008): 174-174. Web. 4 Mar. 2015.
Blevins, Christy A., Frank W. Weathers, and Tracy K. Witte. 'Dissociation And Posttraumatic Stress Disorder: A Latent Profile Analysis'. Journal of Traumatic Stress 27.4 (2014): 388-396. Print.
Bob, P. 'Dissociation And Neurobiological Consequences Of Traumatic Stress'. Activitas Nervosa Superior 50.1-2 (2008): 9-14. Print.
Dorahy, M. J. et al. 'Dissociative Identity Disorder: An Empirical Overview'. Australian & New Zealand Journal of Psychiatry 48.5 (2014): 402-417. Web. 3 Mar. 2015.
Hersen, Michel, and Deborah C. Beidel. Adult Psychopathology and Diagnosis. Hoboken: John Wiley & Sons, 2011. Print.
Petrucelli, Jean. Knowing, not-knowing, and sort-of-knowing psychoanalysis and the experience of uncertainty. London: Karnac Books, 2010. Print.
van der Kolk, Bessel A. 'The Neurobiology Of Childhood Trauma And Abuse'. Child and Adolescent Psychiatric Clinics of North America 12.2 (2003): 293-317. Web. 4 Mar. 2015.
Vermetten, Eric. 'Hippocampal And Amygdalar Volumes In Dissociative Identity Disorder'. American Journal of Psychiatry 163.4 (2006): 630. Web. 1 Mar. 2015.
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