Also from the ISSD site: </font><blockquote><div id="quote"><font class="small">Quote:</font>
What are identity confusion and identity alteration?

Identity confusion is a sense of confusion about who a person is. An example of identity confusion is when a person sometimes feels a thrill while engaged in an activity (e.g., reckless driving, drug use) which at other times would be repugnant. Identity alteration is the sense of being markedly different from another part of oneself. This can be unnerving to clinicians. A person may shift into an alternate personality, become confused, and demand of the clinician, “Who the dickens are you, and what am I doing here?” In addition to these observable changes, the person may experience distortions in time, place, and situation. For example, in the course of an initial discovery of the experience of identity alteration, a person might incorrectly believe they were five years old, in their childhood home and not the therapist’s office, and expecting a deceased person whom they fear to appear at any moment (e.g., Fine, 1999; Maldonado et al., 2002; Spiegel & Cardena, 1991; Steinberg, 1995).

More frequently, subtler forms of identity alteration can be observed when a person uses different voice tones, range of language, or facial expressions. These may be associated with a change in the patient’s world view. For example, during a discussion about fear, a client may initially feel young, vulnerable, and frightened, followed by a sudden shift to feeling hostile and callous. The person may express confusion about their feelings and perceptions, or may have difficulty remembering what they have just said, even though they do not claim to be a different person or have a different name. The patient may be able to confirm the experience of identity alteration, but often the part of the self that presents for therapy is not aware of the existence of dissociated self-states. If identity alteration is suspected, it may be confirmed by observation of amnesia for behavior and distinct changes in affect, speech patterns, demeanor and body language, and relationship to the therapist. The therapist can gently help the patient become aware of /these changes (e.g., Fine, 1999; Maldonado et al., 2002; Spiegel & Cardena, 1991; Steinberg, 1995).

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