DISSOCIATIVE IDENTITY DISORDER

Dissociation occurs as a coping mechanism for traumatic events or stress experienced by a person. Dissociative Identity Disorder is a condition in which a person identity integrity is severely fragmented and distinct identity subsystems become evident. The individual may switch between different personalities or identities consciously or spontaneously. These sub identities often have different names, ages, genders, and behavioral characteristics.

The core symptoms of DID relate to identity and memory. Different personality states, which are self-continuous and interchangeable, co-exist in the same person, and recurrent amnesias accompany the picture. Kluft defines it as follows: Differentiated self-states, that is, (alter) personalities are mental foci of (relatively stable and ongoing) patterns of selective activation of mental content and functions. The mental content and functions in question can be clearly expressed in behavior through role-taking and role-playing dimensions. They are sensitive to intra-psychic, interpersonal, and environmental stimuli; They have their own sense of identity and mindset, and they have the capacity to initiate thought processes and actions. Each should be understood not as a part of the mind, but as a different form of organization of the mind. When alter personalities are considered as different patterns rather than a part of the whole, it is better understood why their number can be so high. A patient may have many minor parts as well as developed alter personalities. Some pieces carry only an emotion or a memory, and their emergence occurs in a flashback style. DID patients show many symptoms of borderline personality disorder. However, in these people, symptoms such as self-harm and anger outbursts occur due to the activities of the alter personalities and disappear suddenly when the relevant alter personalities merge with the host personality. For this reason, it is controversial whether a person diagnosed with DID should also be diagnosed with borderline personality or another personality disorder. Many somatic complaints are expressed. Among these, headache, migraine, and conversion symptoms are the most common and usually occur at the time of personality change or when one alter personality forces the other to take control. Trance states are observed as periods spent doing nothing and staring blankly. Supernatural experiences such as déjà vu, telepathy, seeing the future, moving objects with thoughts, being possessed by demons or other beings, and reincarnation experiences can be described.

Additionally, the most obvious symptom of those with this disease is having more than one identity subsystem. Each identity has a unique name, age, gender, language, and personality characteristics. Transitions may occur between these identities. Secondly, memory loss may occur. The individual may experience memory loss during transitions between different identities. These losses can leave a person unaware of what is happening as they transition from one identity to another. Third, individuals with DID are often unconscious when transitioning between identities. Therefore, one identity may be unaware of the consciousness of the other. Fourthly, individuals with DID may experience periods in which they forget their primary identity or true identity. This can lead to a feeling of self-alienation. Dissociative identity disorder is often associated with severe traumatic experiences, and therefore symptoms of post-traumatic stress may also often occur. DID can sometimes be associated with suicidal thoughts, especially when individuals with DID have difficulty understanding and coping with themselves.

Dissociative Identity Disorder is a complex disorder that requires treatment. Treatment may include different components, such as individualized psychotherapy, learning emotional regulation skills, and medication when necessary. Additionally, understanding and supporting this disease is an issue that needs to be raised awareness in society. Although the causes of Dissociative Identity Disorder are not fully known, some events may increase the risk. These may be due to serious childhood trauma (sexual abuse, physical abuse, emotional abuse), genetic predisposition, family history of similar disorders, or problems related to the person's mother experiencing stress during pregnancy. The only effective treatment for DID is psychotherapy which recognizes and accepts personality states and works on the trauma experienced, aiming to reverse the psychological processes that lead to their dissociation. Many methods are used together during the psychotherapy of DID. DID psychotherapy consists of three phases: stabilization, handling of traumatic experiences, and integration. It is important to establish trust and secure attachment in the initial period of treatment. Understanding the functions of altered personalities forms part of treatment. The patient must also learn to use existing support systems and social networks. The DID patient is primarily in the victim position in the trauma triangle consisting of victim, abuser, and rescuer (or bystander). He/she continues to be attached to the abuser and cannot maintain self-control. Additionally, no drug that specifically affects dissociative psychopathology is yet known. Anxiolytics, antidepressants, and sedatives can be
used symptomatically. Antidepressants may work well when depression is present. However, there are also observations that medications can worsen the condition. The effect of antiepileptics and mood stabilizers has not been demonstrated. Various medications can have varying effects on different personalities. Dissociative Identity Disorder can significantly impact quality of life, but with appropriate treatment, individuals can achieve a better quality of life. Starting treatment early and getting expert support is important in managing this disorder. 

In conclusion, Dissociative Identity Disorder is a complex psychological disorder and reflects a situation in which the integrity of a person's identity is fragmented. Although it is a treatable disorder, it requires expert help. Individuals and society must raise awareness to understand and support this disorder.

REFERENCES
BOZUKLUĞU, D. K. DİSSOSİYATİF BOZUKLUKLAR.
Öztürk, E. (2018). Travma merkezli alyans model terapi: dissosiyatif kimlik bozukluğunun
psikoterapisi. Turkiye Klinikleri Psychology‐Special Topics, 3, 31-38.