Case Study – Dissociative Identity Disorder

Sherry has recently been given the diagnosis of dissociative identity disorder or formally known as multiple personality disorder. She has had multiple hospitalizations over the last several years, and has been given multiple different diagnoses ranging from schizophrenia (disorganized type), bipolar disorder, major depression, and borderline personality disorder. She has been placed on several different types of medications at the time of these hospitalizations depending on the diagnosis, ranging from lithium to a variety of antidepressant and antipsychotic drugs, such as Thorazine.

Upon reviewing her case further I feel that the most probable diagnosis would be the one of dissociative identity disorder, she exhibits many of the key indicators of this disorder outlined in the DSM-IV-TR. Which is the presence of two or more identities, who take control over the persons behavior along with unexplainable periods of black out that can range from several hours to months of her life; these periods go beyond any ordinary type of forgetfulness.

During one of her most recent hospitalizations Sherry became severely distressed and violent, demanding to know who has rearranged the hospital and the grounds, and kept asking to see people who did not exist, both other patients and staff members; she then became verbally and physically abusive towards the staff, shouting obscenities at them and swinging her firsts around as they made attempts to calm her. In the past, Sherry has made various attempts at suicide during these periods of black out, such as cutting her wrists and taking an overdose of tranquilizers, sometimes doing both.

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Sherry maintains a relationship with her mother and twin sister, she also was in a relationship for a period of time but they broke up after some time. For most of Sherry’s life growing up both her mother and father were physically abusive towards her and her sister. After her parents divorced and her mother remarried her stepfather also became physically abusive towards her and her sister. According to the DSM-IV-TR’s description of dissociative identity disorder I feel that her abusive childhood may be a contributing factor as to why Sherry developed this disorder.

Although these attempts have ceased for the time being, and presently I feel that she is not a threat to herself or others I cannot confidently say that if another trauma occurs that she will remain as not being a threat to herself or others. Axis 2: Personality Disorders or Mental Retardation: At this present Sherry does not present any indications of a mental retardation or a personality disorder. Axis 3: General Medical Disorders:

Currently with the present state Sherry is in I feel that there isn’t any underlying medical conditions which she is suffering from, I would recommend a physical and getting blood work done just as a confirmation that there is no underlying medical conditions that we are not currently aware of. With her sexual history I would recommend getting a sexual health scan done just to be positive that she does not have any sort of sexually transmitted disease specially because of the fact that she had been raped before and also because the statements she has made before of having woken up in strangers bed after having unprotected sex with them.

Although I am sure that she received testing done after she was brought to the hospital after she was raped I would recommend these tests just as a precaution. With Sherry’s history of self-mutilation and overdosing the blood work and other tests performed would be checking to make sure that her internal organs were not harmed during any of these suicide attempts and that she is in good physical health. Sherry has also suffered from anxiety for most of her life due to her painful and abusive childhood.

Also I would need to review the previous medications Sherry was given while she was receiving treatment for the various disorders doctors thought she was suffering from. Axis 4: Psychological and Environmental Problems: Sherry is a forty- eight year old woman who works as a nurse’s aid, she is currently single although has maintained relationships in the past. She is currently in known contact with her twin sister and her mother. When Sherry was a child she was physically abused and neglected by her mother, there are accounts of Sherry’s mother having broken Sherry’s tooth and also having bloodied her nose before she turned four.

Another account of abuse is from a hospital report stating that Sherry received second-degree burns on her chest due to her mother throwing a pot of boiling water at her in a fit of rage. Later Sherry’s parents when Sherry’s parents divorced and her mother remarried her stepfather then became physically abusive towards the girls, often beating them with a board studded with nails as the primary form of punishment. After a couple of years Sherry and her sister were then sent to move in with their father who also was abusive towards them during his alcoholic binges, when he would beat the girls with a belt buckle.

After the girls were taken away from their father and placed in the care of their mother, she sent them away to live at boarding school. Sherry was a mediocre student and felt she had no hope of getting into a good college so upon graduating she joined the Army, where for the first time in her life she was separated from her sister. It was not until this point into that Sherry began exhibiting strange behavior and began to show signs of dissociating herself from her painful and abusive past.

She would state that all of the abuse she received as a child had never actually happened to her and in turn happened to her sister, an example of this dissociation would be when Sherry claimed that her mother had never thrown the boiling water on her but on her sister instead but hospital reports and statements taken from both her mother and sister confirm otherwise. During her time in the Army where she was training as a nurse, Sherry began to notice that there were long periods of time when she was unable to recall anything that happened during that time.

During these amnesic episodes is when Sherry would make these suicidal threats, such as cutting or overdosing on tranquilizers and when Sherry would be overly promiscuous with either male soldiers on the base or with random men she would pick up in bars . This is when doctors first began treating her for a mental disorder; she was given a psychiatric discharge from the Army and began receiving treatment for schizophrenia (disorganized type). Over the next fifteen years is when the majority of Sherry’s multiple hospitalizations took place and where she was treated for the different disorders the doctors felt she was suffering from.

After discovering she had a high capacity of dissociation, was it discovered that she was probably suffering from dissociative disorder. She began receiving hypnosis treatment which uncovered “Karla”; I feel that this was important for Sherry’s recovery. This enabled the therapist she was working with at that time to begin to help her intertwine her personality with the personality of Karla. An important aspect in Sherry’s recovery would be to understand why and how these dissociations first began.

Helping Sherry to come to terms with her raumatic experiences throughout her childhood are difficult for both the patient and the therapist because rushing Sherry to face these difficult and traumatic memories could make these dissociations even worse but allowing Sherry to continue to repress these memories could perpetuate the need for the dissociations in the future. Because of Sherry’s mother constant manipulation and neglect caused Sherry to feel guilt and obligation to her mother. Although Sherry feels resent for her how her mother treated her and her sister throughout their childhood she has an undeniable dependency on her mother.

A former therapist told Sherry that it would be beneficial to her recovery if she were able to confront her mother about these things; but because of how damaged Sherry’s self-esteem is she instead repressed these feelings towards her mother. Since Sherry repressed these feelings towards her mother and was unable to confront her about it directly, she began to criticize herself for being so weak and dependent on her mother causing her repressed feelings about the situation to come out in different ways such as the personality of “Karla” and through self-mutilation.

When the therapist Sherry was working with at the time urged her to confront her mother about these things it caused Sherry to enter a severe state of depression. After this episode Sherry was placed on antidepressant medication which she responded well to and then began functioning better which helped her in her recovery. After this episode and treatment, Sherry’s therapist decided that a good way to help her recovery would be to begin attending joint-therapy sessions with her mother, her sister, and then at a later time her boyfriend.

In these sessions, Sherry’s therapist helped her find ways of being more assertive when reacting to the different interpersonal demands of these people. After Sherry was released from the hospital Sherry began attending weekly psychotherapy as an outpatient. After about three years, both personalities became recognized with each other and it was at this time that she began a relationship with her boyfriend. Her treatment as an outpatient required frequent office visits and interventions when necessary, this continued for another 2 years.

During this time, Sherry broke up with her boyfriend causing her to enter into a severe depressive episode, however during this period she made no attempts at serious suicide attempts and remained treatment as an outpatient. About three years after her treatment as an outpatient ended Sherry was raped. As previously stated Sherry was in a state of blackout when the rape occurred, and had no recollection of the event until she was taken to a hospital in a confused and agitated state.

Through therapy she was able to recall the events of her rape and was able to realize that what happened was not her fault. She was released from the hospital after two days and for the next two years has received supportive psychotherapy on and off at her own request. Although the event of Sherry’s rape is a traumatic and horrible experience, I believe that it was very helpful in getting a view of where she was in her recovery.

Although what happened what indeed a setback, the way Sherry handled the situation and was only hospitalized for a couple of days shows great progress on her behalf; although I feel that she is highly vulnerable to future dissociations especially when her mother passes away, and potentially in other highly stressful situations where financial or sexual exploitation could be a factor. Axis 5: Global Assessment of Functioning: 51 I would rate Sherry as having a GAF score of 51 because although she has made great progress in her road to recovery and that she is able to maintain a job and relationships in her life.

I think that when her symptoms are present and she enters into a dissociative or severe depressive state her life is greatly affected. This is especially prominent with her history of frequent hospitalizations, suicide attempts, and self-mutilation. I think that when her symptoms are present she could be rated at falling even lower on the GAF scale but currently I would say that her symptoms are only moderate and not serve enough to greatly affect her daily life. Treatment Plan:

The treatment plan I would suggest for Sherry would be continuing for her to take her medication and to continue to receive therapy. While reviewing her history I noticed that many of the psychological breakthroughs happened during hypnosis, I feel that she should continue to receive this style of treatment because it seems to help her recall the periods of time when she was in a state of black out; but I do not think that this should be the primary type of treatment for Sherry.

I think that a better type of treatment for Sherry would be the psychotherapy along with the joint therapy sessions with her mother and sister. I think that by continuing these weekly sessions it would be vital in helping Sherry to overcome the feelings of guilt and anger towards her mother. By having both Sherry and her mother attend these joint-sessions, I feel it will be helpful because it will allow Sherry to become more open and honest with her mother and potentially strengthen their damaged relationship.

I think that this element of Sherry’s treatment would be helpful because it would diminish some of the controlling aspect of her relationship with her mother, so when her mother eventually passes away it may make Sherry better able to deal with the separation easier. Prognosis: I think that in Sherry’s case although she has made tremendous progress in recovering from a traumatic childhood and overcoming the dissociations caused by these traumatic events she is still highly susceptible to future dissociations and severely depressive episodes.

I think that it will take a lot of treatment and therapy in order for Sherry to have a full recovery although I cannot fully say that I believe a full recovery is possible. I think that if she continues progressing like she is and does not have any future setbacks the probability of her recovery is much greater but as of now I cannot say for certain that she will ever be able to overcome all of the traumas she has faced throughout her life.

I think her outcome though is mostly positive for how she is progressing at the present. I think once her mother passes away she will fall into a severe depressive state but I think if she is able to overcome that then she will be able to progress even further in her recovery because I feel that while her mother is still alive and present in her life she still holds onto the guilt for being so dependent on her mother when she is so controlling and manipulating.

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