Posttraumatic Stress and Dissociative Identity Disorders

Introduction

Posttraumatic Stress Disorder (PTSD)

PTSD is a psychological disorder characterized by persistent anxiety, stress, irritability, disturbed thoughts, and nightmares, which destabilize the psychological state of an individual. The major causes of PTSD are exposure to one or more traumatic events in the course of life (Ozer, Best, Lipsey, & Weiss, 2003). These traumatic events can be domestic violence, warfare, torture, sexual assault, and terrific accidents. The history of PTSD dates back to the Civil War when clinicians realized that the youth who participated in combat developed stress-related disorders. The clinicians termed these disorders as ‘shell shock’ due to intense exposure to heavy armaments (Andreasen, 2010).

Critical analysis of the mental disorders prevalent among the combatants of World War I and World War II led to the realization that they resemble the traumatic experiences they underwent during the wars. Owing to the poor understanding and the complexity of PTSD, clinicians described the apparent syndrome of mental disorders as a gross stress reaction, traumatic war neurosis, battle stress, and combat fatigue (Andreasen, 2010).

Subsequently, the prevalence of PTSD among abused women, veterans, and concentration camps led to its understanding as a psychological disorder emanating from traumatic events. According to the United States National Comorbidity Survey, the prevalence of PTSD is 7.8% among the general population with the prevalence among men (5%) being half that of women (10.4%) (Keane, Marsha, & Taft, 2006). The difference in the prevalence is due to the variation in exposure to traumatic events and the resilience amongst other subtle factors. Therefore, this essay examines the similarities and differences between PTSD and DID in the aspects of etiology, diagnosis, and treatment.

Dissociative Identity Disorder (DID)

DID is a psychological disorder characterized by the existence of at least two periodic identities and unusual absent-mindedness. The existence of different identities and forgetfulness depicts a unique psychological disorder that seizures, substance abuse, and other mental disorders cannot explain (Slogar, 2011). Fundamentally, a person with DID exhibits disconnection in actions, emotions, feelings, and thoughts resulting in dissociation of identities. Traumatic events such as sexual abuse, emotional abuse, and physical abuse during childhood are some of the factors that contribute to the occurrence of DID. The comorbid factors of DID are anxiety, substance abuse, schizophrenia, PTSD, bipolar disorder, depression, and personality disorders.

The history of DID dates back to the 16th century when a girl from Orlarch exhibited multiple personalities, and people described her as a demon-possessed girl (Burkhard, 2011). In this view, people perceived DID as a demonic condition, which required the exorcism to expel demons. Continued study of the mental disorder gave more insights as clinicians discovered that DID involve a change of personality, and thus, they termed it as ‘exchanged personality’ in the 18th and 19th centuries (Burkhard, 2011). According to Slogar (2011), the epidemiology of DID shows that its prevalence among the population is 1-5% and 90% of the people affected are women. The variation in prevalence is due to differences in the exposure and the ability to handle traumatic events among other factors.

PTSD and DID Similarities

Etiology

Regarding etiology, PTSD and DID occur due to exposure to traumatic events in the course of life. Exposure to traumatic events such as sexual abuse, warfare, domestic violence, torture, and accidents has the potential of causing PTSD and DID among people (Keane et al., 2006; Slogar, 2011). In essence, any form of trauma has the potential of triggering both PTSD and DID. An individual exposed to traumatic events is likely to develop PTSD and DID because trauma distorts memory and triggers these mental disorders. According to their study, Alisic et al. (2014) found out that 36% of children exposed to a traumatic event developed PTSD in their childhood. In this view, the finding shows that exposure to a traumatic event leads to the development of PTSD. Slogar (2011) reports that a child exposed to a traumatic event is seven times more likely to develop DID than a child without exposure. Therefore, the examination of etiology shows that both PTSD and DID occur due to exposure to traumatic events at one or more points in the course of life.

Diagnosis

The diagnosis of PTSD and DID is similar because it involves the use of The Diagnostic and Statistical Manual of Mental Disorders (DSMD). The diagnosis uses the standard criteria, which ensure that there is an accurate and effective diagnosis of these mental conditions since they have common signs and symptoms, which complicate the diagnosis. Although clinical psychologists, psychiatrists, and psychoanalysts use DSMD, the World Health Organization, the National Institute of Mental Health, the American Psychiatric Association, and the International Statistical Classification of Diseases and Related Health Problems (ICD) recommend the use of DSMD and recognize its diagnostics (Dorrington et al., 2014). Another similarity is the existence of anxiety and depression as common symptoms that individuals with PTSD and DID present. Since PTSD and DID are complex mental disorders, they share some signs and symptoms of other disorders. In this view, both disorders require differential diagnosis using predefined criteria, which effectively differentiate them from other related mental disorders.

Treatment

PTSD and DID have similar treatments for they both require psychotherapy and chemotherapy. Psychotherapy is the primary treatment because it offers safe and effective treatment of PTSD and DID. Cognitive-behavioral therapy (CBT), eye movement desensitization, and reprocessing (EMDR), and exposure therapy are three psychotherapy methods employed in the treatment of PTSD and DID (Brand, 2009). CBT aims at shaping cognitive patterns and enabling a person to develop a normal perspective of thinking and transform behavior appropriately.

As people with PTSD and DID have difficulties in coping with related traumatic events, exposure therapy simulates traumatic events and guides patients on how to cope with them, and thus, relieve traumatic memories. EMDR is an effective treatment method that employs exposure therapy and guided movement of the eyes in hastening the processing of traumatic events and relieving their psychological impacts. The use of chemotherapy is another similarity in the treatment of PTSD and DID in patients. Antidepressants are effective in the management of anxiety and depressive symptoms of PTSD and DID.

PTSD and DID Differences

Etiology

The aetiologies of PTSD and DID have some differences, which explain their occurrence among individuals. The analysis of the history that led to the discovery of PTSD shows that extreme traumatic events are the major causes. The combatants who took part in the Civil War, the First World War, and the Second World War developed PTSD because the traumatic events experienced during the war were extreme. Keane et al. (2006) argue that extreme traumatic events such as warfare threaten lives, instill intense fear, cause horror, and inflict injuries resulting in complex psychological disturbances, which result in PTSD. In contrast, mild traumatic events are common causes of DID.

Burkhard (2011) explains that mild traumatic events such as physical and sexual abuse can trigger DID among individuals. The prevalence of DID among women occurs due to domestic violence and sexual abuse, which exhibit gender bias in society. Another difference in etiology is that traumatic events are the major causes of DID while traumatic events, genetics, and drug abuse are some of the major causes of PTSD. Skelton, Ressler, Norrholm, Jovanovic, and Bradley-Davino (2012) explain that genes influence the development of PTSD by determining personality and the release of neurotransmitters and hormones involved in stress management. In summary, extreme and diverse traumatic events coupled with genetic factors and drug abuse cause PTSD while mild and less diverse traumatic such as emotional, physical, and sexual abuse trigger DID.

Diagnosis

The methods of diagnosing PTSD and DID are different because they comprise the use of different versions of DMSD. DSMD-5 and DSM-IV-RT are diagnostics methods of PTSD and DID respectively. DSMD-5 diagnoses PTSD by classifying signs and symptoms into different classes of mental disorders. Dorrington et al. (2004) assert that the identification and classification of stressors are central to diagnosis PTSD. In contrast, DSM-IV-TR is a diagnostic method of DID among individuals. Brand (2009) states that DSM-IV-TR is an effective and accurate method of diagnosing DID, according to the diagnostic criteria of dissociative disorders.

Moreover, the diagnosis of DID requires screening of individuals using structured questionnaires, such as the Structured Clinical Interview for DSM-IV (SCID), the Dissociative Experience Scale (DES), and the Dissociative Disorders Interview Schedule (DDIS), which screen individuals for DID diagnosis. The diagnosis of PTSD and DID is different in terms of the criteria employed in the differential diagnosis. The differential diagnosis of PTSD is that a person must have experienced one or more traumatic events and suffers from persistent nightmares, irritability, insomnia, hyper-vigilance, and fear of stressors. In contrast, the differential diagnosis of DID is that a person must have at least two personality states, memory lapses, change of behavior, and depression. Hence, these differential diagnoses differentiate the diagnosis of PTSD and PTSD among individuals.

Treatment

Although PTSD and DID share some treatment methods, some treatment methods that are unique to each one. The treatment of PTSD is different from that of DID because it requires the use of group therapy and critical incident stress management. Group therapy is effective in the treatment of PTSD because it incorporates social strategies, which strengthen the coping abilities of patients. These strategies empower veterans, rape victims, and disaster victims who are under extreme stressing conditions. In instances where traumatic events are extreme, critical incident management is necessary to alleviate and hasten the coping process. Contrastingly, the treatment of DID has extra treatment methods such as psychodynamically oriented psychotherapy, hypnosis, behavior therapy, and learning theory (International Society for the Study of Trauma and Dissociation, 2011).

Psychodynamically oriented psychotherapy enables patients to manage and suppress compulsive behaviors while hypnosis aid in soothing and strengthening the ego to cope with traumatic memories that persist in the mind. Behavior and learning theories act by changing the behavior of patients and enabling them to understand their conditions so that they can cope appropriately with their strengths and resources. Concerning medications, antidepressants such as Phenelzine, Paroxetine, Sertraline, Mirtazapine, and Amitriptyline are effective in the treatment of PTSD. According to the International Society for the Study of Trauma and Dissociation (2011), Clomipramine (Anafranil) and Trazadone, which have anti-obsessive effects and sedative-hypnotic effects respectively, are effective in the treatment of DID. Therefore, the treatment of PTSD and DID entails the use of different psychotherapies and chemotherapies.

Argument justification and Conclusion

PTSD and DID are psychological disorders common among individuals with a prevalence of 7.8% and 1-5% respectively, depending on race, gender, and age. Epidemiological data show that PTSD and DID are more prevalent among women than in men due to differences in coping strategies and the nature of traumatic events exposed. A critical examination of PTSD and DID shows that they are psychological disorders, which have some similarities and differences in the aspect of etiology, diagnosis, and treatment. In the aspect of etiology, it is apparent that the traumatic event is the common cause of these psychological disorders. However, the difference is that extreme and diverse traumatic events cause PTSD whereas sexual abuse and physical abuse are the leading causes of DID. In this view, it appears that PTSD is more complicated than DID due to the diversity and severity of trauma.

Further analysis of diagnosis shows that DMSD applies in the diagnosis of both psychological disorders. Nevertheless, the difference is that DSMD-5 applies in the diagnosis of PTSD whilst DSM-IV-RT is applicable in the diagnosis of DID. While the existence of persistence dreams and exposure to traumatic events define PTSD, the existence of at least two personality states and memory lapses define DID. In the aspect of treatment, cognitive behavioral therapy, exposure therapy, and EMDR are common psychotherapies of treating both PTSD and DID. Moreover, a common chemotherapy method used in the treatment of these psychological disorders is the use of antidepressants. Nonetheless, the difference in chemotherapy is the nature of drugs used. Phenelzine, Paroxetine, Sertraline, Mirtazapine, and Amitriptyline are effective in the treatment of PTSD while Clomipramine (Anafranil) and Trazadone are effective in the treatment of DID.

References

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