Dissociative identity disorder (DID), formerly called multiple personality disorder, is one of a group of conditions called dissociative disorders. Dissociative disorders are mental illnesses that involve disruptions or breakdowns of memory, awareness, identity and/or perception.
When one or more of these functions is disrupted, symptoms can result. These symptoms can interfere with a person’s general functioning, including social activities, work functions, and relationships.
People with DID often have issues with their identities and senses of personal history.
Dissociation is a key feature of dissociative disorders. Dissociation is a coping mechanism that a person uses to disconnect from a stressful or traumatic situation or to separate traumatic memories from normal awareness.
It is a way for a person to break the connection between the self and the outside world, as well as to distance oneself from the awareness of what is occurring.
Dissociation can serve as a defense mechanism against the physical and emotional pain of a traumatic or stressful experience.
By dissociating painful memories from everyday thought processes, a person can use dissociation to maintain a relatively healthy level of functioning, as though the trauma had not occurred.
Dissociation can be described as a temporary mental escape (similar to self-hypnosis) from the fear and pain of the trauma.
Even after the trauma is long past, however, the leftover pattern of dissociation to escape stressful situations continues.
When dissociation is done repeatedly—as in the case of prolonged abuse—these dissociated mental states can take on separate identities of their own.
A person with DID, the most severe type of dissociative disorder, has two or more different personality states—sometimes referred to as “alters” (short for alternate personality states)—each of whom takes control over the person’s behavior at some time.
Each alter might have distinct traits, personal history, and way of thinking about and relating to his or her surroundings.
An alter might even be of a different gender, have his or her own name, and have distinct mannerisms or preferences.
The person with DID may or may not be aware of the other personality states and might not have memories of the times when another alter is dominant.
Stress or a reminder of the trauma can act as a trigger to bring about a “switch” of alters. This can create a chaotic life and cause problems in work and social situations.
What causes DID?
It is generally accepted that DID results from extreme and repeated trauma that occurs during important periods of development during childhood.
The trauma often involves severe emotional, physical or sexual abuse, but also might be linked to a natural disaster or war.
An important early loss, such as the loss of a parent, also might be a factor in the development of DID. In order to survive extreme stress, the person separates the thoughts, feelings and memories associated with traumatic experiences from their usual level of conscious awareness.
The fact that DID seems to run in families also suggests that there might be an inherited tendency to dissociate. DID appears to be more common in women than in men. This might be due to the higher rate of sexual abuse in females.
What are the symptoms of DID?
Symptoms of DID are similar to those of several other physical and mental disorders, including substance abuse, seizure disorder and post-traumatic stress disorder.
Symptoms of DID can include the following:
- Changing levels of functioning, from highly effective to nearly disabled
- Severe headaches or pain in other parts of the body
- Depersonalization (episodes of feeling disconnected or detached from one’s body and thoughts)
- Derealization (perceiving the external environment as unreal)
- Depression or mood swings
- Unexplained changes in eating and sleeping patterns
- Anxiety, nervousness, or panic attacks
- Problems functioning sexually
- Suicide attempts or self-injury
- Substance abuse
- Amnesia (memory loss) or a sense of “lost time”
- Hallucinations (sensory experiences that are not real, such as hearing voices)
A person with DID might repeatedly meet people who seem to know him or her, but whom he or she does not recognize. The personal also might find items that he or she does not remember buying.
How is dissociative identity disorder diagnosed?
There is no specific definitive test, like a blood test, that can accurately assess that a person has dissociative identity disorder.
Therefore, practitioners conduct a mental health interview that gathers information, looking for the presence of the signs and symptoms previously described.
The diagnostic criteria for dissociative identity disorder are as follows:
The presence of two or more distinct identities or personality states (each with its own relatively persistent pattern of perceiving, relating to, and thinking about him or herself and the world)
At least two of the identities or personality states repeatedly take control of the person’s behavior.
Inability to recall important personal information that is too severe to be explained by ordinary forgetfulness
The illness is not the result of the direct physiological effects of a substance (for example, blackouts or other abnormal behavior during alcohol or other drug intoxication) or a general medical condition (for example, seizures).
In children, the symptoms are not caused by imaginary playmates or other fantasy play.
Professionals usually gather facts about the individual’s childhood and ask questions to explore whether the symptoms that the client is suffering from are not better accounted for by another mental disorder, dissociative or otherwise.
Other types of dissociative disorders include depersonalization disorder (feeling detached from themselves or surroundings), dissociative amnesia (memory problems associated with a traumatic experience), dissociative fugue (abandonment of familiar surroundings and memory lapse for the past), and dissociative disorder, not otherwise specified (episodes of dissociation that do not qualify for one of the specific dissociative disorders just described).
As part of the assessment, mental health professionals also usually ask about other mental conditions and ensure that the person has recently received a comprehensive physical examination so that any physical conditions that may mimic symptoms of DID are identified and addressed.
Dissociation, a major symptom of DID, is known to occur in a number of other mental illnesses.
For example, an individual with this disorder may seek to relieve overwhelming memories of trauma by engaging in the self-mutilation that tends to be found in those with borderline personality disorder.
Also, feelings and behaviors that may appear to be caused by dissociation, but are not, make it all the more difficult to distinguish DID from other conditions.
Somatization disorder, psychogenic amnesia, psychogenic fugue, conversion disorder, and schizophrenia are just a few such disorders.
Rape and other adult trauma victims have been found to be quite vulnerable to developing dissociative symptoms.
The controversy about whether DID exists, as well as the overlap of symptoms it has with a number of other conditions, sometimes results in misdiagnosis.
Symptoms of some other mental disorders may be mistaken for dissociation.
The wide changes in emotions associated with bipolar disorder or experienced by individuals with narcissistic personality disorder when triggered by minor slights are two such examples.
Blackouts that can be related to substance abuse or dependence are other instances of an individual being unaware of his or her surroundings that mimics dissociation.
DID often co-occurs with other emotional conditions, including posttraumatic stress disorder (PTSD), borderline personality disorder (BPD), and a number of other personality disorders, as well as conversion disorder.
DID is sometimes feigned by individuals who may be seeking attention, as in Munchausen’s syndrome.
It has also been appropriately diagnosed as well as feigned in individuals involved in the criminal justice and civil or family court systems (for example, forensic cases).
Adding to the diagnostic difficulty is that people like pedophiles and other sex offenders, as well as people with antisocial personality disorder, may legally stand to gain from having DID.
While some of those individuals may feign the diagnosis in an effort to benefit legally, others genuinely suffer from significant dissociative symptoms, as well as full-blown DID.
In cases where there may be an ulterior motive for being diagnosed with DID, studies show that using a structured interview tool may be the best way to determine if the person truly suffers from this condition.
What are the treatment methods for dissociative identity disorder?
Psychotherapy is generally considered to be the main component of treatment for dissociative identity disorder.
In treating individuals with DID, therapists usually try to help clients improve their relationships with others and to experience feelings they have not felt comfortable being in touch with or openly expressing in the past.
This is carefully paced in order to prevent the person with DID from becoming overwhelmed by anxiety, risking a figurative repetition of their traumatic past being inflicted by those very strong emotions.
Mental health professionals also often guide clients in finding a way to have each aspect of them coexist, and work together, as well as developing crisis-prevention techniques and finding ways of coping with memory lapses that occur during times of dissociation.
The goal of achieving a more peaceful coexistence of the person’s multiple personalities is quite different than the reintegration of all those aspects into just one identity state.
While reintegration used to be the goal of psychotherapy, it has frequently been found to leave individuals with DID feeling as if the goal of the practitioner is to get rid of, or “kill,” parts of them.
Hypnosis is sometimes used to help increase the information that the person with DID has about their symptoms/identity states, thereby increasing the control they have over those states when they change from one personality state to another.
That is said to occur by enhancing the communication that each aspect of the person’s identity has with the others.
In this age of insurance companies regulating the health care that most Americans receive, having time-limited, multiple periods of psychotherapy rather than intensive long-term care provides what may be another effective treatment option for people with DID.
Eye movement desensitization and reprocessing (EMDR), a treatment method that integrates traumatic memories with the patient’s own resources, is being increasingly used in the treatment of people with dissociative identity disorder.
It has been found to result in enhanced information processing and healing.
Medications are often used to address the many other mental health conditions that individuals with DID tend to have, like depression, severe anxiety, anger, and impulse-control problems.
However, particular caution is appropriate when treating people with DID with medications because any effects they may experience, good or bad, may cause the sufferer of DID to feel like they are being controlled, and therefore traumatized yet again.
As DID is often associated with episodes of severe depression, electroconvulsive therapy (ECT) can be a viable treatment when the combination of psychotherapy and medication does not result in adequate relief of symptoms.
What are the complications of DID?
DID is serious and chronic (ongoing), and can lead to problems with functioning and even disability. People with DID also are at risk for the following:
- Suicide attempts
- Substance abuse
- Repeated victimization by others
What is the outlook for people with DID?
People with DID generally respond well to treatment; however, treatment can be a long and painstaking process.
Some people with DID are reluctant to reconnect their separate identities because these different identities help them to cope.
To improve a person’s outlook, it is important to treat any other problems or complications, such as depression, anxiety or substance abuse.
Can DID be prevented?
Although it may not be possible to prevent DID, it might be helpful to begin treatment in people as soon as they begin to have symptoms.
In addition, an immediate intervention following a traumatic event can help reduce the risk of a person’s developing dissociative disorders.