Dear Dr. Roach: What is dissociative identity disorder? There are a lot of movies and TV shows about it. -- Anon.
Answer: Most people will be more familiar with dissociative identity disorder's former name: multiple personality disorder. DID is a complex psychiatric disorder that has been frequently mischaracterized in the media. The hallmarks of the disorder are memory problems (gaps in recall of personal events or information) and two or more distinct personality states, which are sometimes called "alters." The different personalities are very seldom dramatically different from each other in the way the media frequently portrays.
However, the different personality states are often perceived by the person or by others as having different abilities and behaviors, and sometimes include perceived age, gender and sexual orientation differences. Still, the different personalities in a person with DID are better thought of as different facets of the person than as different people living in the same body. It is uncommon but not rare; estimated to occur in about 1% of the population.
The majority of people with DID have a history of abuse during childhood, especially sexual or physical abuse. But it can be some other type of severe trauma during childhood, usually before the age of 6.
A person with DID frequently experiences hours-long gaps in their memory. During this period of time, others may report a marked change in mood or behavior, including angry outbursts. DID is frequently misdiagnosed or never diagnosed, and this is more confusing because many people with DID may also have other psychiatric illnesses, such as post-traumatic stress disorder or borderline personality disorder.
Depression, sometimes with suicidal behavior, is common in DID. However, the media portrayals of a person with DID as being violent are incorrect and unfair. People with DID are not more likely to be violent than anyone else.
Dissociative identity disorder is a complex condition that is difficult to diagnose, resulting from severe trauma. People with this condition need compassion from friends and family, and skillful care from knowledgeable practitioners, who can be hard to find.
You can read more about dissociative disorders here: www.isst-d.org/public-resources-home.
Dear Dr. Roach: My problem is canker sores. I have had them occasionally in the past, but now I have one or two in my mouth constantly. This has been going on for the past year or more. I have seen my dentist, cardiologist, dermatologist and my family physician. I've gotten no real help except for pain control ("magic mouthwash" and Chloraseptic). I gargle a salt solution every three or four hours. My question: Is there a doctor that I should be seeing that covers mouth canker sores? This condition has caused eating and sleeping problems. -- L.P.
Answer: Canker sores are known technically as aphthous ulcers. They are completely different from cold sores, which are caused by herpes simplex viruses, although an exam by an experienced doctor is sometimes needed to tell them apart. It's not clear what causes them. They may be related to abnormalities in the immune system. Stress can trigger them.
Many people note an association between canker sores and a common toothpaste ingredient called sodium lauryl sulfate. And if your toothpaste has that, stopping it in favor of an SLS-free toothpaste may dramatically help your symptoms. Lysine (an amino acid) supplements are often advised but have poor data supporting their use. However, many of my readers have told me it's effective for them.
Steroid creams (such as Kenalog) applied on the sore speed healing. A dermatologist often has expertise in this problem.
Dr. Roach regrets that he is unable to answer individual letters, but will incorporate them in the column whenever possible. Readers may email questions to ToYourGoodHealth@med.cornell.edu or send mail to 628 Virginia Dr., Orlando, FL 32803.
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