Dissociative Identity Disorder: Understanding Multiple Personalities

Dissociative Identity Disorder (DID), also known as multiple personality disorder, is a condition that is characterized by the presence of two or more distinct identities or personalities within a single individual. People with DID often experience gaps in memory and a sense of detachment from their thoughts, feelings, and actions.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), DID is a dissociative disorder that results from severe and persistent childhood trauma, particularly abuse. DID usually develops as a coping mechanism for individuals who have experienced extreme physical, sexual, or emotional abuse. In an attempt to cope with the trauma, the individual may dissociate or mentally detach from their experience and create alternative identities that can take over in times of distress.

Symptoms of DID

The symptoms of DID usually start to appear in childhood but may not be diagnosed until adulthood. The primary symptom of DID is the presence of two or more distinct identities, also called alters, that have their own way of perceiving, thinking, feeling, and behaving. These alters may differ in age, gender, sexuality, personality, and other characteristics. They may also have different names, voices, memories, and physical attributes.

Other symptoms commonly associated with DID include:

  • Memory lapses or blackouts
  • Feeling detached from reality or oneself
  • Depression, anxiety, or mood swings
  • Self-harm or suicidal thoughts
  • Panic attacks or phobias
  • Nightmares or flashbacks
  • Hallucinations or delusions
  • Compulsive behaviors or rituals
  • Somatic symptoms or unexplained physical complaints.

Diagnosis of DID

DID is a controversial diagnosis that is often misunderstood or misdiagnosed. The prevalence of DID is estimated to be around 1% of the general population, but the actual number may be higher due to underreporting or misdiagnosis. DID is more commonly diagnosed in women, although men and children can also have the condition.

The diagnosis of DID is made based on a thorough clinical assessment, which may include:

  • A comprehensive medical and psychiatric history
  • A psychological evaluation, such as the Structured Clinical Interview for DSM-5 (SCID-5)
  • Standardized questionnaires, such as the Dissociative Experiences Scale (DES)
  • Observations of behavior, mood, and memory function
  • Interviews with family members or caregivers
  • Review of medical records or collateral information
  • Neuroimaging or other medical tests to rule out other causes of symptoms.

The diagnosis of DID is controversial because it is often associated with legal claims, media stereotypes, and concerns about malingering or suggestibility. Some experts argue that DID is a rare and valid disorder that deserves more recognition and research, while others criticize it as a cultural artifact or a manifestation of iatrogenic effects (i.e., caused by therapy).

However, most mental health professionals agree that DID is a real and complex condition that requires sensitive and knowledgeable treatment.

Treatment of DID

The treatment of DID is challenging and requires a multidisciplinary approach that addresses the individual’s physical, psychological, and social needs. The primary goal of treatment is to help the individual integrate their alters into a cohesive and functional identity that can cope with life’s challenges.

The following are some of the treatment modalities that may be used to treat DID:

  • Psychotherapy: Different types of psychotherapy may be used to treat DID, such as cognitive-behavioral therapy, psychodynamic therapy, and trauma-focused therapy. The therapist may work with the individual and their alters to identify and resolve underlying trauma, improve emotion regulation, enhance communication and cooperation between alters, and integrate the alters into a coherent sense of self.
  • Medication: While there is no specific medication for DID, some medications may be prescribed to alleviate comorbid symptoms, such as depression, anxiety, or sleep disturbances. However, medication alone is not sufficient to treat DID.
  • Art therapy: Art therapy is a form of creative expression that can help individuals with DID to express and explore their emotions, memories, and identity in a nonverbal and symbolic way.
  • Family therapy: Family therapy may be helpful for individuals with DID who have a history of abusive or dysfunctional family relationships, as it can address family dynamics, communication patterns, and support systems.

It is important to note that the treatment of DID is a long and complex process that requires a collaborative and supportive therapeutic relationship. The therapist should have expertise in treating dissociative disorders and be familiar with the ethical guidelines and standards of care for this population. The individual with DID should also be motivated to engage in treatment and have a supportive network of friends and family.

Coping Strategies for Individuals with DID

In addition to professional treatment, individuals with DID may benefit from developing their own coping strategies that can help them manage their symptoms and improve their quality of life. Some coping strategies that may be helpful for individuals with DID include:

  • Journaling or keeping a diary to document their experiences, thoughts, and feelings and to communicate with their alters
  • Practicing relaxation techniques, such as meditation, deep breathing, or progressive muscle relaxation
  • Engaging in hobbies or activities that provide a sense of pleasure and accomplishment
  • Building a support network of trusted individuals who can provide emotional, practical, and spiritual support
  • Creating a safe space or ritual that can help them feel grounded and connected to their present reality
  • Learning about their condition and connecting with others who have similar experiences through support groups or online forums.

The coping strategies for individuals with DID should be tailored to their individual needs and preferences and should never substitute for professional treatment.

Conclusion

Dissociative Identity Disorder is a complex and controversial condition that can have a significant impact on the individual’s life. It is a coping mechanism that results from severe and persistent childhood trauma and involves the presence of two or more distinct identities or personalities that can take over in times of distress. The diagnosis and treatment of DID require a thorough clinical assessment and a multidisciplinary approach that addresses the individual’s physical, psychological, and social needs. Coping strategies may also be helpful for individuals with DID to manage their symptoms and improve their quality of life. It is important to understand that DID is a real and valid condition that deserves sensitive and knowledgeable treatment.

FAQs

What is Dissociative Identity Disorder?

Dissociative Identity Disorder, also known as DID, is a mental health condition in which a person’s identity is fractured or dissociated into two or more distinct personalities or identities. This is typically caused by severe trauma or abuse in childhood that the person was unable to cope with. Symptoms may include memory gaps, anxiety, depression, and confusion about identity.

What are the causes of Dissociative Identity Disorder?

The exact causes of Dissociative Identity Disorder are unknown, but it is believed to be a coping mechanism in response to severe trauma or abuse during childhood. The disorder typically develops as a way for the affected person to protect themselves from overwhelming emotions or memories. The disorder is more commonly seen in people who have experienced physical or sexual abuse, neglect, or other types of trauma during their childhood.

Can Dissociative Identity Disorder be cured?

There is currently no known cure for Dissociative Identity Disorder, but treatment can help manage symptoms and improve quality of life. Treatment may include psychotherapy, medication, and other supportive therapies. The goal of treatment is typically to integrate the different identities or personalities into one cohesive sense of self. It is important for people with Dissociative Identity Disorder to receive compassionate care and support from mental health professionals and loved ones.


References

1. Steinberg, M. (2019). Does Dissociative Identity Disorder Exist? Frontiers in Psychiatry, 10, 713. doi: 10.3389/fpsyt.2019.00713

2. Brown, M. & Barlow, D. H. (2019). Dissociative Identity Disorder: Overview and Current Research. Journal of Trauma & Dissociation, 20(5), 511-518. doi: 10.1080/15299732.2019.1578787

3. Spiegel, D. (2019). Dissociative Identity Disorder. New England Journal of Medicine, 380(4), 323-331. doi: 10.1056/NEJMra1703768