Dissociative Identity Disorder (Multiple Personality Disorder)
What is dissociative identity disorder (DID)?
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.
How common is (DID)?
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.
Symptoms and Causes
What causes dissociative identity disorder (DID)?
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.
What are the symptoms of DID?
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
- 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
Diagnosis and Tests
How is dissociative identity disorder (DID) diagnosed?
If symptoms are present, an evaluation will be done with a complete medical history and physical examination. Although no laboratory tests can diagnose dissociative disorders medically, various diagnostic tests such as blood tests or imaging (X-rays, CT scans, or MRIs) may be used to rule out physical illness or medication side effects.
If no physical illness is found, the person might be referred to a mental health professional such as a psychiatrist, psychologist, or psychiatric social worker who is specially trained to diagnose and treat mental illnesses. They will perform a clinical interview to get a full picture of the person’s past experiences and current functioning. Some psychiatrists and psychologists may employ specialized tests (for example, the Dissociative Experiences Scale—DES) or a standard interview such as the Structured Clinical Interview for Dissociation (SCID-D).
Management and Treatment
How is dissociative identity disorder (DID) treated?
The goals of treatment for DID are to relieve symptoms, ensure the safety of the individual and those around him or her, and “reconnect” the different personalities into one integrated, well-functioning identity.
Treatment also aims to help the person safely express and process painful memories, develop new coping skills and life skills, restore optimal functioning, and improve relationships. The best treatment approach depends on the individual, the nature of any identifiable triggers, and the severity of the symptoms. Most likely treatment will include some combination of the following methods:
- Psychotherapy: Sometimes called “talk therapy,” psychotherapy is the main treatment for dissociative disorders. This is a broad term that includes several forms of therapy.
- Cognitive-behavioral therapy: This form of psychotherapy focuses on changing dysfunctional thinking patterns, feelings, and behaviors.
- Eye Movement Desensitization and Reprocessing (EMDR): This technique was designed to treat people with persistent nightmares, flashbacks, and other symptoms of post-traumatic stress disorder (PTSD).
- Dialectic-behavior therapy (DBT): A form of psychotherapy for people with severe personality disturbances, which can include dissociative symptoms that often occur after an experience of abuse or trauma.
- Family therapy: This helps teach the family about the disorder as well as helping family members recognize symptoms of a recurrence.
- Creative therapies (for example art therapy, music therapy): These therapies allow patients to explore and express their thoughts, feelings, and experiences in a safe and creative environment.
- Meditation and relaxation techniques: These help people to better tolerate their dissociative symptoms and become more aware of their internal states.
- Clinical hypnosis: A treatment method that uses intense relaxation, concentration, and focused attention to achieve an altered state of consciousness, allowing people to explore thoughts, feelings, and memories they may have hidden from their conscious minds.
- Medication: There is no medication to treat dissociative disorders themselves. However, people with dissociative disorders, especially those with associated depression and/or anxiety, may benefit from treatment with antidepressant or anti-anxiety medications.
Outlook / Prognosis
What is the outlook for people with dissociative identity disorder (DID)?
People with DID generally respond well to treatment. However, treatment can be a long and painstaking process. This usually begins by identifying and empowering all personalities to help integrate them into a full-functioning whole. To improve a person’s outlook, it is important to treat any other problems or complications, such as depression, anxiety, or substance abuse.