Editing Dissociative identity disorder (section)

=== Treatments under the trauma model ===
The [[International Society for the Study of Trauma and Dissociation]], proponents of the trauma model, have published guidelines for ''phase-oriented'' treatment in adults as well as children and adolescents that are widely used successfully in the field of DID treatment.<ref name="Dorahy2014" /><ref name="Guidelines2011" /> The guidelines state that "a desirable treatment outcome is a workable form of integration or harmony among alternate identities". Some experts in treating people with DID use the techniques recommended in the 2011 treatment guidelines.<ref name="Dorahy2014" /> The [[empirical research]] includes the longitudinal TOP DD treatment study, which found that patients showed "statistically significant reductions in dissociation, PTSD, distress, depression, hospitalisations, suicide attempts, self-harm, dangerous behaviours, drug use, and physical pain" and improved overall functioning.<ref name="Dorahy2014" /> Treatment effects have been studied for over thirty years, with some studies having a follow-up of ten years.<ref name="Dorahy2014" /> Adult and child treatment guidelines exist that suggest a three-phased approach.<ref name="Guidelines2011" />

Common treatment methods include an eclectic mix of [[psychotherapy]] techniques, including [[cognitive behavioral therapy]] (CBT),<ref name="Guidelines2011" /><ref name="Gillig" /> [[insight-oriented therapy]],<ref name="Kihlstrom" /> [[dialectical behavioral therapy]] (DBT), [[hypnotherapy]], and [[eye movement desensitization and reprocessing]] (EMDR).<ref>{{Cite journal |last=International Society for the Study |date=2011-02-28 |title=Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision |url=https://www.tandfonline.com/doi/full/10.1080/15299732.2011.537247 |journal=Journal of Trauma & Dissociation |language=en |volume=12 |issue=2 |pages=115–187 |doi=10.1080/15299732.2011.537247 |issn=1529-9732}}</ref>

Hypnosis should be carefully considered when choosing both treatment and provider practitioners because of its dangers. For example, hypnosis can sometimes lead to false memories and false accusations of abuse by family, loved ones, friends, providers, and community members. Those who suffer from dissociative identity disorder have commonly been subject to actual abuse (sexual, physical, emotional, financial) by therapists, family, friends, loved ones, and community members.<ref>{{cite journal |last1=Şar |first1=Vedat |title=The Many Faces of Dissociation: Opportunities for Innovative Research in Psychiatry |journal=Clinical Psychopharmacology and Neuroscience |date=28 December 2014 |volume=12 |issue=3 |pages=171–179 |doi=10.9758/cpn.2014.12.3.171 |pmid=25598819 |pmc=4293161 }}</ref>

Brief treatment due to [[managed care]] may be difficult, as individuals diagnosed with DID may have unusual difficulties in trusting a therapist and take a prolonged period to form a comfortable [[therapeutic alliance]].<ref name="Guidelines2011" /> Regular contact (at least weekly) is recommended, and treatment generally lasts years – not weeks or months.<ref name="Gillig" /> [[Sleep hygiene]] has been suggested as a treatment option, but has not been tested. In general there are very few [[clinical trial]]s on the treatment of DID, none of which were [[randomized controlled trial]]s.<ref name="Lynn2012" />

Therapy for DID is generally phase oriented.<ref name="Dorahy2014" /> Different alters may appear based on their greater ability to deal with specific situational stresses or threats. While some patients may initially present with a large number of alters, this number may reduce during treatment – though it is considered important for the therapist to become familiar with at least the more prominent personality states as the "host" personality may not be the "true" identity of the patient. Specific alters may react negatively to therapy, fearing the therapist's goal is to eliminate the alter (particularly those associated with illegal or violent activities). A more realistic and appropriate goal of treatment is to integrate adaptive responses to abuse, injury, or other threats into the overall personality structure.<ref name="Gillig" />

The first phase of therapy focuses on symptoms and relieving the distressing aspects of the condition, ensuring the safety of the individual, improving the patient's capacity to form and maintain healthy relationships, and improving general daily life functioning. Comorbid disorders such as [[substance use disorder]] and [[eating disorders]] are addressed in this phase of treatment.<ref name="Guidelines2011" /> The second phase focuses on stepwise exposure to traumatic memories and prevention of re-dissociation. The final phase focuses on reconnecting the identities of disparate alters into a single functioning identity with all its memories and experiences intact.<ref name="Guidelines2011" />