Dissociative Identity Disorder And Addiction

Introduction

Dissociative Identity Disorder (DID) is a complex psychological condition characterized by the presence of two or more distinct personality states, each with its own way of thinking, behaving, and feeling. Addiction is a condition where a person has a compulsive need to use a substance or engage in a behaviour despite negative consequences. There is a growing body of evidence that suggests that individuals with DID are at an increased risk of developing addiction.¹

Overview of DID and addiction

Individuals with DID are more likely to experience a range of mental health conditions, including depression, anxiety, and post-traumatic stress disorder (PTSD). These individuals may also have a history of childhood abuse, neglect, or trauma, which can lead to the development of DID.

 Addiction, on the other hand, is often seen as a coping mechanism for individuals who are dealing with stress, trauma, or emotional pain. Studies have shown that individuals with DID are at an increased risk of developing addiction due to the presence of these underlying conditions.

Understanding DID

Definition and symptoms

Dissociative Identity Disorder is a condition where a person experiences a disruption in their sense of identity, memory, and consciousness. Individuals with DID may have two or more distinct personality states, also known as alters, that take control of their behaviour at different times. These alters may have their own memories, beliefs, and behaviours, and the switch between them may be sudden or gradual. The symptoms of DID may include:^1,6

• Feeling like you are watching yourself from outside your body (depersonalization)
• Having gaps in your memory or finding items you do not remember acquiring (amnesia)
• Feeling like different parts of your body have a will of their own (somatization)
• Hearing voices or having inner conversations with different personalities (auditory hallucinations)

Causes and treatment

The exact cause of DID is unknown, but it is believed to develop in response to severe and prolonged trauma during childhood. Dissociation is a coping mechanism that helps the individual to escape from the overwhelming emotions and memories associated with the trauma. Treatment for DID may involve psychotherapy, medication, and supportive care. Psychotherapy is the most effective treatment for DID and involves helping the individual to integrate their different personalities into a single identity.

Individuals with DID are more likely to have co-occurring mental health conditions, including addiction. Addiction treatment for individuals with DID may involve a combination of therapy, medication, and support groups. In some cases, addiction treatment may need to be integrated with the treatment for DID to achieve the best outcomes.

Understanding addiction

Definition and symptoms

Addiction is a chronic brain disorder characterized by compulsive drug seeking and use despite the harmful consequences. It is a complex condition that affects an individual's behaviour, thoughts, and feelings. Symptoms of addiction may include:

• Continued use of a substance or behaviour despite negative consequences
• Loss of control over the use of the substance or behaviour
• Withdrawal symptoms when the substance or behaviour is stopped
• Increased tolerance to the substance or behaviour
• Neglect of important responsibilities and obligations
• Engaging in risky behaviour to obtain the substance or behaviour

Causes and treatment

The exact cause of DID is unknown, but it is believed to develop in response to severe and prolonged trauma during childhood. Dissociation is a coping mechanism that helps the individual to escape from the overwhelming emotions and memories associated with the trauma. 

Treatment for DID may involve psychotherapy, medication, and supportive care. Psychotherapy is the most effective treatment for DID and involves helping the individual to integrate their different personalities into a single identity.

Individuals with DID are more likely to have co-occurring mental health conditions, including addiction. Addiction treatment for individuals with DID may involve a combination of therapy, medication, and support groups. In some cases, addiction treatment may need to be integrated with the treatment for DID to achieve the best outcomes.

The link between DID and addiction

Dissociative disorders and addiction

When individuals afflicted with dissociative disorders find their disorder unable to provide the necessary respite from their traumatic experiences, they may seek solace in substances as an additional means of escape. However, the utilization of psychoactive substances comes at a cost, as it can inflict further harm and potentially give rise to a concurrent substance use disorder.

In 1999, the Journal of Psychoactive Drugs published a thought-provoking article that shed light on what is often referred to as "the forgotten relationship" between dissociative identity disorder and substance abuse. This comprehensive study revealed that substance use and dependence ranked among the most prevalent diagnoses among patients grappling with dissociative identity disorder. Notably, practitioners who primarily focus on treating individuals grappling with substance dependence and addiction may unknowingly encounter patients with dissociative identity disorder, failing to recognize the co-occurring condition.⁷

Reasons for addiction in DID

There are several reasons why individuals with DID may be at an increased risk of developing an addiction. One reason is the presence of underlying mental health conditions such as depression, anxiety, and post-traumatic stress disorder. These conditions can contribute to the development of addiction as individuals may turn to substances or behaviours to cope with their symptoms. Additionally, the different alters in individuals with DID may have different substance preferences, leading to increased substance use.

Another reason for the increased risk of addiction in individuals with DID is the presence of childhood trauma. Trauma can affect an individual's ability to regulate their emotions and cope with stress, increasing their risk of developing addiction. Trauma can also lead to the development of dissociative symptoms, which can contribute to addiction by creating a sense of detachment from reality.

Treatment for co-occurring DID and addiction^7,8,910

Individuals with co-occurring Dissociative Identity Disorder (DID) and addiction face unique challenges in treatment. The presence of both conditions requires a comprehensive treatment approach that addresses both disorders simultaneously.

Co-occurring dissociative identity disorder (DID) and substance use disorders require a comprehensive treatment approach. Accurate diagnosis is crucial, involving the assessment of the patient's psychosocial history, trauma experiences, and interviews to evaluate dissociative disorders. Substance use complicates the assessment, often requiring reevaluation after a period of abstinence to distinguish between substance-related effects and mental illness symptoms.

Psychotherapy is the primary treatment modality for dissociative disorders. It aims to address both the symptoms of the disorder and the underlying trauma that contributed to its development. Therapy allows individuals to work with trauma-informed therapists to process past trauma and acquire coping skills. 

Cognitive behavioural therapy (CBT) is commonly used and helps individuals recognize and modify negative thoughts and behaviours. Additionally, dialectical behaviour therapy (DBT) focuses on finding a balance between acceptance and change, reducing destructive behaviours and teaching emotional regulation skills. Eye movement desensitization and reprocessing (EMDR) can also be beneficial for addressing traumatic memories and negative emotional responses.

Medication may be used to manage associated conditions such as PTSD, depression, or anxiety. Antidepressants or anxiolytics can help alleviate depression and anxiety symptoms, while antipsychotics can stabilize mood and reduce intrusive symptoms, psychosis, and excessive anxiety.

Active participation in therapy sessions is vital for individuals with co-occurring disorders. It is essential to receive therapy from professionals experienced in trauma therapy and integrated treatment. Integrated treatment, which addresses both dissociative and substance use disorders concurrently, is recommended for better outcomes. By combining appropriate therapy, medication management, and a supportive treatment environment, individuals can work towards long-term well-being and recovery.

Challenges and approaches

One of the primary challenges in treating co-occurring DID and addiction is the potential for triggering dissociative symptoms during addiction treatment. This can lead to individuals feeling overwhelmed and potentially re-traumatized. Therefore, it is important for treatment providers to use trauma-informed approaches that prioritize the safety and comfort of the individual.

Another challenge is that individuals with DID may struggle with integrating the different alters into the treatment process. Treatment providers must work with all the alters to establish a collaborative treatment plan and build a therapeutic alliance with each of them.

An effective approach to treating co-occurring DID and addiction is a comprehensive, integrated treatment approach. This approach involves a combination of evidence-based therapies, including cognitive-behavioural therapy, dialectical behaviour therapy, and eye movement desensitization and reprocessing (EMDR). Additionally, medication-assisted treatment may be utilized to address both the addiction and any underlying mental health conditions.

Importance of individualized plans

Individualized treatment plans are crucial for individuals with co-occurring DID and addiction. Each individual's treatment plan should be tailored to their unique needs and preferences, taking into account their level of dissociation, triggers, and preferences for specific types of therapy.

Individuals with co-occurring DID, and addiction may require longer treatment durations and ongoing support to maintain recovery. Treatment providers must regularly assess the individual's progress and adjust the treatment plan as needed.

Summary

Individuals with co-occurring DID and addiction require a comprehensive, integrated treatment approach that addresses both disorders simultaneously. Challenges in treatment include the potential for triggering dissociative symptoms, and difficulty integrating the different alters into the treatment process. An effective approach involves individualized treatment plans that prioritize the safety and comfort of the individual. Treatment providers must regularly assess progress and adjust the treatment plan as needed to support long-term recovery.

The combination of dissociative disorders and substance use disorders can be challenging both for those experiencing the disorders and for their loved ones. But with treatment, it is possible for individuals with these disorders to learn to manage them and have great improvement in functioning.¹⁰