Dual Diagnosis: Dissociative Identity Disorder and Addiction
Medically reviewed byJennifer Cousineau MSCP, LPCI, NCC
February 22, 2019
There is a clear link between many psychiatric disorders and addiction. While the severity and signs of these types of addiction can vary, many instances of addiction can be traced back to a psychological disorder, like dissociative identity disorder, especially when left undiagnosed and untreated.
With dissociative identity disorder, this connection with addiction is measurable. Dissociative identity disorder, or DID, can often be triggered by a traumatic event early on in life such as abuse or neglect as a child. Substance abuse or addiction can also be traced back to childhood traumas as a coping mechanism for the mental effects these traumas have caused.
What Is Dissociative Identity Disorder?
Previously known as multiple personality disorder, dissociative identity disorder is a psychological disorder in which an individual can develop two or more distinct identities. You may have felt a slight sense of dissociation before, likely in the form of a daydream in which you imagined you were someone else or a different version of yourself. With this type of dissociation, it is easy for you to differentiate imagination from reality and you are able to bring yourself back to the ‘true you’ in a split-second.
With DID, however, this dissociation can become a completely separate identity. These identities can have control over an individual’s behavior and personality and can take on wildly varying attributes that have very little to do with the affected individual’s true identity. For example, identities can be of different age, race, culture, and even gender than the other identities.
It is widely believed that DID is underdiagnosed in the United States. Some argue this is due to the stigmatization of the disorder, as it is often presented to the public as an illness that can be violent in nature. Hollywood and other entertainment outlets tend to perpetuate this stereotype. Others attribute the underdiagnosis of DID to lack of widespread belief in the disorder in the psychiatric community.
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What Causes Dissociative Identity Disorder?
Dissociative identity disorder is controversial in the psychiatric community. While some clinical professionals believe the disorder to be independently diagnosed and treated disorder, others believe it could be a subset of problems caused by other psychiatric conditions. Just as the categorization of this disorder can be argued on, so can the underlying causes.
A popular hypothesis for the cause of DID has been linked to extensive and repetitive childhood abuse or extreme stress. When an individual with a developing mind, such as a child, suffers from this type of abuse or stress, there are often disruptions or alterations of those memories. This disruption in memory can be seen as an initial coping mechanism for the child.
Through this coping mechanism, the child can dissociate his/herself from a traumatic event that is literally too difficult to associate with their own memories. This dissociation can turn into a psychological disorder if left untreated as other dissociation can follow, eventually manifesting into separate identities.
Another hypothesis for the cause of DID revolves around it stemming from the treatment of other psychological disorders. Hypnosis, for example, has been blamed for causing DID in patients whose traumatic memories were altered by the act itself. Those who support this hypothesis believes the hypnosis causes a similar disruption or alteration in memory as childhood trauma can, eventually leading into a split of one or more identities.
Signs And Symptoms Of DID
When a person is struggling with DID, the most noticeable symptom is the emergence of two or more distinct personalities. During the time that one of the other personalities has taken over, the individual is likely to have no memory of the events or feel as if someone else is “driving” their body.
The amnesia that occurs with DID can also lead to a person being unable to recall personal information or historical or current events. The individual may also feel as if their own behaviors, feelings, emotions or even their own body does not belong to them and they cannot control them.
Other signs and symptoms of DID include:
- gaps and lapses of time that are beyond normal forgetfulness
- lapses in dependable memory (how to drive, use a computer, do their job)
- “waking up” in a different location with no memory of how they got there
- non-epileptic seizures
- uncharacteristic behaviors
- strong impulsive behaviors
- shifts in attitudes, outlooks and personal preferences
- foggy sense of identity
- inability to cope with stress
- mental health problems (anxiety, depression, self-harm)
- visual or auditory hallucinations
- alcohol or drug abuse
- post-traumatic stress disorder
- sleep disorders
The Link Between DID And Addiction
Alcohol and drug dependencies are not uncommon among those with dissociative identity disorder. DID can be a debilitating disorder that leaves individuals suffering with confusion, irritability, and the inability to control many thoughts or actions. For those who feel overcome by the inability to control their alternate identities, drugs and alcohol may be seen as a welcome escape.
As dissociative identity disorder can be seen as an individual’s coping mechanism for past trauma, drugs are often used as another coping mechanism to deal with traumatic events. Because of this phenomenon, it is sometimes unclear which came first: the addiction or the dissociation.
It is clear, however, that both conditions can feed into each other. Treatment and therapy for DID can be set back or even overpowered by a substance dependence, most likely because the substance addiction can alter an individual’s state of mind to a level where they temporarily struggle to recognize their own identity.
Individuals suffering from substance addiction often turned to it as a desperate attempt to block or numb some of the feelings they were struggling with from DID. While the use of drugs may be able to temporarily calm the anxiety and mental fear they experience from dissociative identity disorder, they can complicate the treatment of the disorder and make it more difficult for an individual to admit they need treatment or therapy in the first place.
The Relationship Between Drug Use And Mental Illness
The prevalence of drug use among individuals diagnosed with a mental illness is staggering. According to the National Alliance on Mental Illness, about 33% of individuals who experience symptoms of mental illness also suffer from substance abuse. This number increases to 50% when considering those with ‘severe’ mental illness.
These numbers could be grossly underestimated when considering how common it is for a mental illness to be left undiagnosed due to stigmatization, fear, of lack of belief in mental illnesses. Men are more likely than women to live with an undiagnosed mental illness, which could be one reason why men are also more likely to suffer from substance abuse with a mental illness than women are.
Depending on the individual, either substance abuse or mental illness can present itself first. It is not uncommon for someone suffering with mental illness to turn to drugs to help cope with some of the symptoms of their illness. Alternatively, it is not unheard-of for someone with a drug dependence to develop a mental illness as a result of the long-term effects some drugs can have on an individual’s thoughts, mood, or personality.
Treatment For Dissociative Identity Disorder
As the exact cause of DID has been an element of controversy in the psychiatric community, so is its treatment. Like other mental illnesses, the best treatment will vary based on the patient’s exact symptoms and other diagnoses (such as substance addiction).
A ‘phased’ approach to treatment is often focused on when it comes to dissociative identity disorder. This can allow therapy to intensify in a series of stages, helping the affected individual to work through their thoughts and feelings associated with DID in a gradual treatment plan. Some common treatment methods include:
- Behavioral therapy
- Exposure therapy (reliving traumatic memories)
- Some medications
- Inpatient rehab
These treatment options can become complicated with the introduction of another diagnosis such as substance abuse. This is also referred to as dual diagnosis. Dual diagnosis is coexistence of two or more disorders or illnesses that affect an individual’s mental health. It is important that any treatment plan prescribed to an individual with dual diagnosis addresses all aspects of that individual’s illnesses.
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Especially in individuals that display signs and symptoms of mental illness, seeking help with substance addiction is essential to getting on the road to recovery. Finding a treatment plan that can focus on all aspects of an individual’s mental health as well as their substance addiction is often the key to success.
Our rehab centers are focused on treating all aspects of addiction and can be customized to fit the needs of individual patients. Give us a call today to discuss treatment options for yourself or a loved one suffering from dual diagnosis.Article Sources
National Alliance on Mental Illness - Dual Diagnosis
Substance Abuse and Mental Health Services Administration - Mental and Substance Use Disorders
U.S. National Library of Medicine - Neurodevelopmental Biology Associated With Childhood Sexual Abuse
U.S. National Library of Medicine - Psychotherapy and Pharmacotherapy for Patients with Dissociative Identity Disorder
American Psychiatric Association - What Are Dissociative Disorders?