What is dissociative identity disorder?
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 DID diagnosed?
If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. While there are no laboratory tests to specifically diagnose dissociative disorders, the doctor might use various diagnostic tests—such as X-rays and blood tests—to rule out physical illness or medication side effects as the cause of the symptoms. Certain conditions—including brain diseases, head injuries, drug and alcohol intoxication, and sleep deprivation—can lead to symptoms similar to those of dissociative disorders, including amnesia. In fact, it is amnesia or a sense of lost time that most often prompts a person with DID to seek treatment. He or she might otherwise be totally unaware of the disorder.
If no physical illness is found, the person might be referred to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and personality assessment tools to evaluate a person for a dissociative disorder.
How is DID treated?
The goals of treatment for DID are to relieve symptoms, to ensure the safety of the individual, and to "reconnect" the different identities into one well-functioning identity. Treatment also aims to help the person safely express and process painful memories, develop new coping and life skills, restore functioning, and improve relationships. The best treatment approach depends on the individual and the severity of his or her symptoms. Treatment is likely to include some combination of the following methods:
This kind of therapy for mental and emotional disorders uses psychological techniques designed to encourage communication of conflicts and insight into problems.
This type of therapy focuses on changing dysfunctional thinking patterns.
There is no medication to treat the dissociative disorders themselves. However, a person with a dissociative disorder who also suffers from depression or anxiety might benefit from treatment with a medication such as an antidepressant or anti-anxiety medicine.
This kind of therapy helps to educate the family about the disorder and its causes, as well as to help family members recognize symptoms of a recurrence.
Creative therapies (art therapy, music therapy)
These therapies allow the patient to explore and express his or her thoughts and feelings in a safe and creative way.
This is a treatment technique that uses intense relaxation, concentration and focused attention to achieve an altered state of consciousness or awareness, allowing people to explore thoughts, feelings and memories they might have hidden from their conscious minds.
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.
- National Alliance on Mental Illness. Information Helpline. Dissociative Identity Disorder. nami.org Accessed 4/18/2012
- Nurcombe B. Chapter 24. Dissociative Disorders. In: Ebert MH, Loosen PT, Nurcombe B, Leckman JF, eds. CURRENT Diagnosis & Treatment: Psychiatry. 2nd ed. New York: McGraw-Hill; 2008. www.accessmedicine.com Accessed April 18, 2012
- International Society for the Study of Trauma and Dissociative Disorders. Frequently Asked Questions: Dissociation and Dissociative Disorders. www.isst-d.org Accessed 4/18/2012
- Mental Health America. Dissociation and Dissociative Disorders. www.mentalhealthamerica.net Accessed 4/18/2012
- American Psychological Association www.apa.org Accessed 4/18/2012
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