Introduction
Primal fear is an investigative movie, which tries to unravel the murder of a famous Bishop in Chicago. A young altar boy (Aaron) has been arrested for his murder. Aaron looks like an innocent kid, who stutters, and he is represented by Vail, who is a famous attorney. Vail believes that Aaron is innocent. In the middle of the trial, Vail finds out that Aaron has a disorder. With the disorder Aaron acts differently, he is a foul mouthed, violent, and obnoxious. Vail finds a sex tape that shows Aaron, another altar boy and a girl having sex, and they are being directed by the bishop. Vail now understands why Aaron has the disorder because of his troubled past. In the middle of trial, the prosecutor provokes Aaron, who turns into Roy and attacks the prosecutor. In the end, he is sent to a mental institution for psychiatric evaluation.
Step I: Discuss your diagnosis and provide justification using the DSM-V and at least one additional relevant source
DID is characterized by two or more distinct personalities in an individual. Aaron is a timid boy, who cannot even communicate well. However, when he turns into Roy he is violent, loud and foul mouthed. His lawyer believed that he was innocent because he did not recall murdering the bishop. Aaron seems to forget how he acts when he turns into Roy, and this kind of forgetfulness is not normal. When he turns into Roy, he is a totally different person. Roy has a distinctive character from Aaron; Roy is loud, violent and obnoxious.
When he switches back to Aaron, we can see that he portrays symptoms of dissociative identity disorder. Aaron seems like a depressed young boy, who cannot even communicate well. He has mood swings, and he also seems anxious. Given his past, we can easily understand why Aaron seems depressed. He experienced time loss when he switches to Roy, and “out of body experience” as he does not remember what he does when he switches to Roy. Violence is another symptom of DID that shows in various occasions. Roy is a violent person, and there are two episodes where he is violent towards his lawyer and prosecutor. Symptoms shown by Aaron/ Roy points to DID shows he has distinct personalities and does not remember what happens when he switches to Roy. DSM V describes DID as a condition characterized by two or more personalities that recurrently take control of a person’s behavior. Aaron’s inability to recall what Roy does is a justification for his condition.
Step II: Discuss your diagnosis and how it would be done using the DSM-V and at least one additional relevant source
When diagnosing a disorder, it should be guided by DSM-V. DSM-V gives us the criterion for distinguishing DID from other disorders.
According to DSM-V, DID is diagnosed as following:
Diagnostic criterion A: Pre occupation with somatic symptoms
The identity of a person is characterized by more than one distinct personality. When there is a disruption in the normal personality, there is a discontinuity in the sense of self, and behavior is altered. A person’s affect, behavior, memory, perception and cognition is totally altered such that the person seems totally different from “self.” The above symptoms are observed by others, and the victim reports some of symptoms such as time lapses.
Diagnostic criterion B: Forgetting
According to criterion B, people with DID have recurrent gaps when they try to recall events, or important personal information. Their past is usually marked with traumatic events that are not marked with normal forgetting.
Diagnostic criterion C: Distress/ impairment
The symptoms of DID adversely affects a person socially, occupation wise and other aspects of his/ her life.
Diagnostic criterion D: Distinction from cultural/ religious practices
The switch of personality is not normal. It is not a part of accepted religious or cultural rituals. In small children, the different personalities are not associated with fantasy play or imaginary playmates, because the child will adopt a totally different personality.
Diagnostic criterion E: distinctions from other conditions
Symptoms of DID are not attributed to effects of substance abuse such as black outs or chaotic behaviors during intoxication. Symptoms are also not attributed to other conditions such as partial seizures.
The second criterion talks about forgetting. Aaron has no account of what Roy does. He does not remember murdering the bishop, though all evidence points to him. When his lawyer shows him the sex tape, his personality changes abruptly, and he becomes violent. Eventually, he gets back to his senses, he does not seem to remember being violent towards his lawyer.
The third criterion shows that the disorder causes distress to a person’s life. Aaron is not living a normal life. His disorder has affected him mentally such that when he is normal, he is a shy, stuttering kid. When his personality switches, he is foul-mouthed and violent. He displays erratic behavior as Roy, and when he is back to himself he seems depressed. The condition has definitely affected his social life badly because he ended up in jail for murder.
The fourth criterion for diagnosis of DID is a distinction between symptoms of DID and those presented in certain cultural and religious rituals. In as much as Aaron was an altar boy, his DID is not related to religion. He presents symptoms of DID when he is asked about painful aspects of his past.
The last criterion is differentiating symptoms of DID with other conditions. Aaron’s symptoms are not like those experienced in partial seizures or black outs because of intoxication. Aaron’s symptoms are triggered when he is questioned regarding painful aspects of his past. When his lawyer asked him about the sex tape, he became violent. He also turned violent when the prosecutor priced about his past.
Step III: Discuss your prognosis and provide justification using the DSM-V and at least one additional relevant source
Research on DID shows that people with DID can lead normal lives if they receive the right treatment. Treatment for DID should be comprehensive since it presents many symptoms. DID is common in individuals who have a history of sexual abuse or disorganized attachment. Patients with DID are also vulnerable to drug abuse disorders. DID is an extreme way in which people cope with victimization. People with DID have a poor quality of life because of the debilitating effects of DID. Such people are usually depressed and violent when they switch identities; hence they cannot maintain good relationships.
If left untreated, DID is recurrent. Trauma memories should be processed as it offers the best prognosis for DID. Psychotherapy for DID patients takes years as it involves integrating various parts of the different personalities so that they can operate as a unified self. In the case of Aaron, his symptoms are limited to just DID symptoms mainly because of his traumatic childhood as shown in the DSM-V. In this case, full recovery is the prognosis if he receives the right treatment. DID patients with symptoms of other disorders have a worse prognosis; hence they will undergo a longer and slower recovery process. Patients who remain in contact with their abusers have a bad prognosis. Aaron has a good prognosis given the fact that he only has DID symptoms and is not in touch with his abuser.
Step IV: Discuss your treatment and provide justification using the DSM-V and at least one additional relevant source.
Psychotherapy is considered the best component of the complementary DID treatment process. The treatment plan usually encompasses various aspects in particular, psychotherapy, hypnosis and administration of medication.
Since patients with DID have impaired social lives, therapists help such patients to improve their relationships and to experience feelings they are not usually comfortable with. DID is usually caused by traumatic events, and when patients are questioned about such events, they become violent and switch to other personalities. Psychotherapy involves procedures that will make patients with DID open up about events and feelings they are not comfortable with in their past. This procedure will help the victim not to encounter DID symptoms in the future because he will be comfortable talking about those traumatic experiences (Kluft, 285).
Through psychotherapy, mental health professionals will guide patients on how to make those different personalities/ identities work together. The professionals will also come up with ways of preventing the negative identity from taking over the normal identity. In the case of Aaron, the therapist will pry into his past, events and feeling that usually drive him crazy. The therapist will talk about his relationship with his parents, his abuse in the hands of the bishop and help him reconcile with his traumatic past. The goal of the treatment is to achieve coexistence among the multiple personalities and to get rid of the destructive symptoms such as violence. In the end, a patient should have one identity.
Cognitive behavioral therapy (CBT) approach can also be used. The therapy involves effective communication with the different identities (alters). By communicating to both alters, a patient will be equipped on how to handle stressful situations, instead of just switching personalities. CBT involves relaxation exercises that will help the patient to gain control over distortions of self and world. Therapists will come up with the best CBT model after analyzing an individual to determine the severity of DID.
Hypnosis will be a part of the comprehensive treatment plan. Hypnosis will help the patient know more about his conditions. Aaron could not recall what happened when he was Roy. Through hypnosis, he will have more information regarding his actions so that he can control his actions. Through hypnosis, a patient will have enhanced aspect of communication with the different personalities, such that he will have a glimpse of what happens when he takes another identity. Through eye movement desensitization and reprocessing (EMDR), the traumatic memories are integrated into a patient’s resources. This enhances information processing, such that patients will be fine when they are asked about their past.
Since patients with DID present depressive symptoms, anxiety, anger and impulse control issues, they will be under medication to control such symptoms. The treatment plan should be executed well so that patients will not feel they are being controlled/ traumatized again.
Axis V: Discuss your diagnosis and the best theoretical perspective and provide justification using the DSM-V and at least one additional relevant source
Research and abnormal psychology theories give us a theoretical perspective on DID. Researchers who acknowledge the validity of DID diagnosis claim that exposure to situations of extreme ambivalence and abuse as a child cause DID. Such people live in denial, and they end up believing that the traumatic events happened to someone else. When children are young, they believe in imaginary companions, and they could end up having dissociated identity so as to cope with the pain (APA).
Patients with DID usually experience lack of familial support. Disoriented attachment coupled with child abuse leads to the development of DID. When children experience abuse, they need close parenting so as to help them heal. Parenting style also affects patients with DID. Patients with DID usually experienced parents who were authoritarian, or grew up in a dysfunctional family.
There has been controversies regarding diagnosis of DID. Some researchers do not acknowledge it because of its similarities with Borderline Personality Disorder (BPD). Patients with BPD can experience dissociation but cannot be compared to the dissociation in DID. Dissociation in DID is marked by different identities, unlike the extreme mood swing changes in BPD.
In conclusion, people with DID can lead a normal life when they receive proper treatment. A comprehensive treatment plan will read all the symptom of DID seen in the DSM-V, and a patient will eventually lead a normal life.
Works cited
American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM- 5 5th Edition, 2013. Print
Hart, Carolyn. Held in mind, out of awareness. Perspectives on the continuum of dissociated experience, culminating in dissociative identity disorder in children. Journal of Child Psychotherapy Vol. 39, No. 3., 2013
Kluft RP. Dealing with alters: a pragmatic clinical perspective. Psychiatr Clin North Am. 2006; 29 (1):281–304
