What Is Dissociative Identity Disorder (DID)?
Dissociative identity disorder (DID) is a condition marked by the presence of two or more distinct personality states within one individual. Each of these personality states may have a unique name and characteristics, including a different voice, gender, and set of mannerisms.
This mental health condition, which used to be called multiple personality disorder, is one of the dissociative disorders listed in the “Diagnostic and Statistical Manual of Mental Disorders” (DSM-5).
Symptoms
The main symptom of DID is experiencing the presence of two or more distinct identities or personality states, sometimes known as “alters.” The shifting of identities happens involuntarily and is described as being undesirable, causing severe distress or impairment to a person with DID.
Other symptoms may include:
Feelings of being disconnected or detachedExperiencing a feeling of being outside of one’s own bodyThe inability to recall specific events, people, or timesAn inability to recall childhood memories or a personal historyThoughts of self-harm or suicide
Diagnosis
As with other mental disorders, a doctor will make a diagnosis of DID based on the criteria defined in the most recent edition of the DSM.
An in-depth history is taken to assess the person’s symptoms, and the symptoms are compared to the criteria that must be present to justify the specific diagnosis of DID. These criteria include:
There is a disruption of identity involving two or more distinct personality states. The signs and symptoms of the disorder may be observed by others, or they may be reported by the person having the symptoms. There are ongoing gaps in memory that involve forgetting personal information, day-to-day events, and/or traumatic events of the past. The person experiences significant distress or has problems functioning—such as on the job or socially—as a result of symptoms such as memory loss. The symptoms are not part of a cultural, spiritual, or religious practice involving altered states of consciousness. The symptoms are not the result of substance use or a medical condition.
Causes
Although having a history of experiencing a traumatic event is not required as part of the DSM-5 criteria for being diagnosed with DID, trauma is almost always associated with the disorder.
In fact, some studies report about 90% of the cases of DID involve some history of trauma. Trauma can include:
Severe emotional, physical, or sexual abuseA natural disaster (such as a tornado or earthquake)WarsA substantial loss early in life (such as the loss of a parent)Long periods of isolation early in life (such as social isolation that occurs during a long-term illness)
Treatment
Although there isn’t one specific type of medication to treat DID, medication may be useful in managing co-occurring mood, anxiety, and other symptoms.
The main treatment for DID involves the use of various therapeutic approaches. Some of the forms, or modalities, that have been proven effective include:
Psychotherapy: Psychotherapy, or talk therapy, can help people with DID process emotions and gain control over their symptoms. A goal of psychotherapy is to integrate the separate personality states into a more cohesive sense of self. Behavioral Therapy: Two behavioral treatment modalities found to be successful for people with DID are cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT). These modalities focus on a person’s thoughts and behaviors and managing distressing and overwhelming affects (feelings, emotions, or moods). Hypnosis: Rather than being used to unearth repressed memories in people with DID (as hypnosis is historically known for), hypnosis may be used to help manage symptoms such as flashbacks from post-traumatic stress disorder, or PTSD.
Risk Factors
Because of the high rate of suicide in people with DID, part of an effective treatment plan is to watch for signs and symptoms of increased suicidal risk. More than 70% of people diagnosed with DID who participated in outpatient treatment have attempted suicide.
Coping
There are many nonmedical coping strategies that reportedly help people with DID. These include:
For more mental health resources, see our National Helpline Database.
Working to overcome blaming yourself: Keep in mind that any trauma that occurred in the past is not your fault. Also, having a mental health diagnosis is not the result of something you did to deserve having the condition. Psychotherapy and support groups can help you work through undeserved feelings of self-blame. Doing your research: Educating yourself about your disorder can help empower you in making treatment decisions, such as whether to try hypnosis, if you would benefit more from group or individual therapy—or both—and more. Learning self-calming techniques: This will help you manage disturbing thoughts and other symptoms on your own. Take advantage of the many types of therapy (such as CBT and DBT) that teach these practical and effective tools to help improve symptoms. Creating a calm outer environment: Work to de-clutter your home, office, or other areas while practicing tools to improve interpersonal relationships with friends, coworkers, and family members. Planning ahead and staying organized: With a condition like DID, it’s vital to keep track of things such as when to take your medications and to plan for an unforeseen period of amnesia. Forming a support network: Having a good support system is crucial to coping with a mental illness such as DID; it’s best to have a variety of people in your network that you feel comfortable sharing your feelings with, such as family members, close friends, and healthcare providers.
