Dissociative identity disorder (DID) was formerly called multiple personality disorder. It is a mental illnesses that involves disruptions or breakdowns of memory, awareness, identity and/or perception
Dissociative identity disorder (DID) was formerly called multiple personality disorder. People with DID develop one or more alternate personalities that function with or without the awareness of the person’s usual personality.
DID is one of a group of conditions called dissociative disorders. Dissociative disorders are mental illnesses that involve disruptions or breakdowns of memory, consciousness or awareness, identity and/or perception — mental functions that normally work smoothly.
When one or more of these functions is disrupted, dissociative symptoms can result. These symptoms can be mild, but they can also be severe to the point where they interfere with a person’s general functioning, both in personal life and at work.Instances of true DID are very rare. When they occur, they can occur at any age. Females are more likely than males to get DID.
DID was called multiple personality disorder up until 1994, when the name was changed to reflect a better understanding of the condition—namely, that it is characterized by a fragmentation or splintering of identity, rather than by a proliferation or growth of separate personalities. The symptoms of DID cannot be explained away as the direct psychological effects of a substance or of a general medical condition.
DID reflects a failure to integrate various aspects of identity, memory, and consciousness into a single multidimensional self. Usually, a primary identity carries the individual’s given name and is passive, dependent, guilty, and depressed. When in control, each personality state, or alter, may be experienced as if it has a distinct history, self-image and identity. The alters’ characteristics—including name, reported age and gender, vocabulary, general knowledge, and predominant mood—contrast with those of the primary identity. Certain circumstances or stressors can cause a particular alter to emerge. The various identities may deny knowledge of one another, be critical of one another, or appear to be in open conflict.
In many parts of the world, possession states are a normal part of a cultural or spiritual practice. Possession-like identities often manifest as behaviors under the control of a spirit or other supernatural being. Possession states become a disorder only when they are unwanted, cause distress or impairment, and are not accepted as part of a cultural or religious practice.
You may wonder if dissociative identity disorder is real. After all, understanding the development of multiple personalities is difficult, even for highly trained experts. The diagnosis itself remains controversial among mental health professionals, with some experts believing that it is really an “offshoot” phenomenon of another psychiatric problem, such as borderline personality disorder, or the product of profound difficulties in coping abilities or stresses related to how people form trusting emotional relationships with others.
Other types of dissociative disorders defined in the DSM-5, the main psychiatry manual used to classify mental illnesses, include dissociative amnesia (with “dissociative fugue” now being regarded as a subtype of dissociative amnesia rather than its own diagnosis), and depersonalization/derealization disorder.
causes
A history of trauma is a key feature of dissociative identity disorder. About 90% of the cases of DID involve some history of abuse. The trauma often involves severe emotional, physical, and/or sexual abuse. It might also be linked to accidents, natural disasters, and war. An important early loss, such as the loss of a parent or prolonged periods of isolation due to illness, may be a factor in developing DID.
Dissociation is often thought of as 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 with the outside world, and create distance from an 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.
Episodes of DID can be triggered by a variety of real and symbolic traumas, including mild events such as being involved in a minor traffic accident, adult illness, or stress. Or a reminder of childhood abuse for a parent may be when their child reaches the same age at which the parent was abused.
Why some people develop DID is not entirely understood, but they frequently report having experienced severe physical and sexual abuse during childhood.
The disorder may first manifest at any age. Individuals with DID may have post-traumatic symptoms (nightmares, flashbacks, or startle responses) or post-traumatic stress disorder. Several studies suggest that DID is more common among close biological relatives of persons who also have the disorder than in the general population.
Once a rarely reported disorder, the diagnosis has grown more common—and controversial. Some experts contend that because DID patients are highly suggestible, their symptoms are at least partly iatrogenic—that is, prompted by their therapists’ probing. Brain imaging studies, however, have corroborated identity transitions.
SYMPTOMS
Along with the dissociation and multiple or split personalities, people with dissociative disorders may experience a number of other psychiatric problems, including symptoms:
Depression
Mood swings
Suicidal tendencies
Sleep disorders (insomnia, night terrors, and sleep walking)
Anxiety, panic attacks, and phobias (flashbacks, reactions to stimuli or “triggers”)
Alcohol and drug abuse
Compulsions and rituals
Psychotic-like symptoms (including auditory and visual hallucinations)
Eating disorders
Other symptoms of dissociative identity disorder may include headache, amnesia, time loss, trances, and “out of body experiences.” Some people with dissociative disorders have a tendency toward self-persecution, self-sabotage, and even violence (both self-inflicted and outwardly directed). As an example, someone with dissociative identity disorder may find themselves doing things they wouldn’t normally do, such as speeding, reckless driving, or stealing money from their employer or friend, yet they feel they are being compelled to do it. Some describe this feeling as being a passenger in their body rather than the driver. In other words, they truly believe they have no choice.
A person with DID has two or more different and distinct personalities, the person’s usual (“core”) personality and what are known as alternate personalities, or “alters.” The person may experience amnesia when an alter takes control over the person’s behavior.
Each alter has distinct individual traits, a personal history, and a way of thinking about and relating to his or her surroundings. An alter may be of a different gender, have a different name, or a distinct set of manners and preferences. (An alter may even have different allergies than the core person.)
The person with DID may or may not be aware of the other personality states and memories of the times when an alter is dominant. Stress, or even a reminder of a trauma, can trigger a switch of alters.
In some cases, the person with DID may benefit from a particular alter (for example, a shy person may use a more assertive alter to negotiate a contract). More often DID creates a chaotic life and problems in personal and work relationships. For example, a woman with DID may repeatedly meet people who seem to know her but whom she does not recognize or remember ever meeting. Or she may find items around the home that she does not remember buying.
DID shares many psychological symptoms as those found in other mental disorders, including:
Changing levels of functioning, from highly effective to disturbed/disabled
Severe headaches or pain in other parts of the body
Depersonalization (feeling disconnected from one’s own thoughts, feelings, and body)
Derealization (feeling that the surrounding environment is foreign, odd, or unreal)
Depression and/or mood swings
Anxiety
Eating and sleeping disturbances
Problems with functioning sexuality
Substance abuse
Amnesia (memory loss or feeling a time distortion)
Hallucinations (false perceptions or sensory experiences, such as hearing voices)
Self-injurious behaviors such as “cutting”
Suicide risk — 70% of people with DID have attempted suicide
How Does Dissociation Change the Way a Person Experiences Life?
There are several main ways in which the psychological processes of dissociative identity disorder change the way a person experiences living, including the following:
Depersonalization. This is a sense of being detached from one’s body and is often referred to as an “out-of-body” experience.
Derealization. This is the feeling that the world is not real or looking foggy or far away.
Amnesia. This is the failure to recall significant personal information that is so extensive it cannot be blamed on ordinary forgetfulness. There can also be micro-amnesias where the discussion engaged in is not remembered, or the content of a meaningful conversation is forgotten from one second to the next.
Identity confusion or identity alteration. Both of these involve a sense of confusion about who a person is. An example of identity confusion is when a person has trouble defining the things that interest them in life, or their political or religious or social viewpoints, or their sexual orientation, or their professional ambitions. In addition to these apparent alterations, the person may experience distortions in time, place, and situation.
Treatment
The primary treatment for DID is long-term psychotherapy with the goal of deconstructing the different personalities and integrating them into one. Other treatments include cognitive and creative therapies. Although there are no medications that specifically treat this disorder, antidepressants, anti-anxiety drugs, or tranquilizers may be prescribed to help control the psychological symptoms associated with it. With proper treatment, many people who are impaired by DID experience improvement in their ability to function in their work and personal lives.
