Kaplan & Sadock’s Pocket Handbook of Clinical Psychiatry

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Treatment Psychotherapy

Psychotherapy helps patients to incorporate the memories into their conscious state. Hypnosis is used primarily as a means to relax the patient sufficiently to recall forgotten information. Pharmacotherapy Drug-assisted interviews with short-acting benzodiazepines may be used to help patients recover their forgotten memories. Barbiturates like amobarbital (sodium amytal) and pentobarbital also known as truth serum have also been employed to interview patients though information extracted under their influence has never been accepted in court. One reason is that people may be more suggestible under their influence. In addition, some case studies suggest ketamine may be helpful. Dissociative Identity Disorder This condition, formerly known as multiple personality disorder, is usually the result of a traumatic event, most often physical or sexual abuse especially in childhood. This disorder involves the manifestation of two or more distinct per sonalities (often referred to as “alters”), which, when present, will dominate the person’s behaviors and attitudes as if no other personality existed. Symptoms may be covert and rarely resemble the dramatic transformations common in The 12-month prevalence of DID is believed to be between 1% and 2% but oc curs in 5% of patients with psychiatric disorder at nearly equal rates for men and women. Onset is most common in late adolescence and young adulthood, although symptoms may be present for 5 to 10 years before diagnosis. DID is more common in first-degree biologic relatives with the disorder. Comorbidity As DID tends to follow a traumatic experience, patients may also develop PTSD or another trauma- and stressor-related disorder. DID is also highly comorbid with depressive disorders, obsessive-compulsive disorder, substance-related disorders, conversion disorder, somatic symptom disorder, eating disorder, and sleep disorders. Comorbid personality disorders, particularly avoidant or border line personality disorders, are fairly common. Alterations in identity may affect the presentation of symptoms associated with comorbid disorders. Etiology DID is associated with severe sexual and psychological abuse in childhood and a lack of support from attachment figures or significant others. Severe psycho logical and physical abuse leads to a profound need to distance the self from horror and pain. Each personality expresses some necessary emotion or state (eg, rage, sexuality, flamboyance, competence) that the original personality dares not express. During abuse, the child attempts to protect themselves from trauma by dissociating from the terrifying acts, becoming, in essence, another person or fiction and film. Epidemiology

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