What Is Dissociative Identity Disorder?
Dissociative identity disorder (DID), previously known as multiple personality disorder, is a complex psychological condition caused by many things. These include severe trauma during early childhood (usually extreme, repetitive physical, sexual, or emotional abuse). It's also known as split personality disorder.
DID is a severe form of dissociation, a mental process that produces a lack of connection in your thoughts, memories, feelings, actions, or sense of identity. The dissociative aspect is thought to be a coping mechanism -- you literally shut off or dissociate yourself from a situation or experience that's too violent, traumatic, or painful to assimilate with your conscious self.
When you have DID, you have two or more separate identities called “alters.” They control your behavior at various times. Each alter has its own personal history, traits, likes, and dislikes.
Types of Dissociative Disorders
DID is one of three types of dissociative disorders. The others are:
Dissociative amnesia. This happens when you can’t remember essential information about your life. This may be limited to specific areas of your life or it may include your life history and identity.
Three types of amnesia associated with DID are:
- Localized: This is the most common type of amnesia. You can’t remember an event or period of time.
- Selective: This is where you can’t remember details of events within a certain time frame.
- Generalized: This is the least common type. You can’t remember anything about your identity and life history.
Depersonalization/derealization disorder. When you have this, you feel detached from your thoughts, feelings, body (depersonalization), and environment (derealization).
The cause of DID is likely a psychological response to interpersonal and environmental stresses, particularly during early childhood years when emotional neglect or abuse may interfere with personality development. As many as 99% of people who develop dissociative disorders have recognized personal histories of recurring, overpowering, and often life-threatening disturbances or traumas at a sensitive developmental stage of childhood (usually before age 6).
Dissociation may also happen when there has been persistent neglect or emotional abuse, even when there's been no overt physical or sexual abuse. Findings show that in families where parents are frightening and unpredictable, the children may become dissociative.
DID is rare. It affects about 1% of the population. Women are more likely than men to have DID.
Traumas linked to DID include:
- Repeated physical, mental, or sexual abuse
- An accident
- A natural disaster
- Military combat
- Being a victim of a crime
Symptoms of DID
DID is characterized by two or more distinct or split identities or personality states that continually have power over your behavior. There's also an inability to recall key personal information that's too far-reaching to be explained as mere forgetfulness. DID also includes highly distinct memory variations, which may fluctuate.
Not everyone with DID experiences it the same way. For some, their "alters" have their own age, sex, or race -- plus their own postures, gestures, and distinct ways of talking. Sometimes the alters are imaginary people; sometimes they're animals.
As each "alter" or personality reveals itself and controls your behavior and thoughts, it's called "switching." Switching can take seconds, minutes, or days. You might seek treatment with hypnosis, where your different "alters" may be responsive to your therapist's requests.
Other symptoms of DID can 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).
If you have DID, you may find yourself doing things you wouldn't normally do, such as speeding, reckless driving, or stealing money from your employer or friend. But you feel compelled to do these things.
Some people with DID describe feeling like a passenger in their body rather than the driver. In other words, they believe they have no choice.
Some main ways DID changes the way you experience living are:
- You feel detached from your body. It's often referred to as an "out-of-body" experience. This is called depersonalization.
- You feel that the world isn't real, or it looks foggy or far away. This is called derealization.
- You have amnesia where you can't recall significant personal information that's so extensive it can't be blamed on ordinary forgetfulness. You can also have micro-amnesias where the discussion you're engaged in isn't remembered, or the content of a meaningful conversation is forgotten from one second to the next.
- You have a sense of confusion about who you are. This is called identity confusion or identity alteration. An example of identity confusion is when you have trouble defining the things that interest you in life, your political or religious or social viewpoints, your sexual orientation, or your professional ambitions. In addition, you may experience distortions in time, place, and situation.
It's now acknowledged that dissociated states aren't fully mature personalities, but they represent a disjointed sense of identity. With the type of amnesia typically associated with DID, different identity states remember different aspects of your identity. There's usually a "host" personality who identifies with your real name. Your host personality is usually unaware of your other personalities.
Making the diagnosis of dissociative identity disorder takes time. Experts estimate that people with dissociative disorders spend about 7 years in the mental health system before getting a diagnosis of DID. This is common because the list of symptoms that cause a person with a dissociative disorder to seek treatment is very similar to those of many other psychiatric diagnoses. In fact, many people who have dissociative disorders also have coexisting diagnoses of borderline or other personality disorders, depression, and anxiety.
The DSM-5 provides the following criteria to diagnose dissociative identity disorder:
- Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.
- Amnesia must occur, defined as gaps in the recall of everyday events, important personal information, and/or traumatic events.
- The person must be distressed by the disorder or have trouble functioning in one or more major life areas because of the disorder.
- The disturbance is not part of normal cultural or religious practices.
- The symptoms cannot be due to the direct physiological effects of a substance (such as blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (such as complex partial seizures).
The distinct personalities may serve diverse roles in helping the individual cope with life's dilemmas. For instance, there's an average of two to four personalities present when the patient is initially diagnosed. Then there's an average of 13 to 15 personalities that can become known over the course of treatment. Environmental triggers or life events cause a sudden shift from one alter or personality to another.
What Other Mental Health Conditions Can Occur With DID?
Along with the dissociation and multiple or split personalities, people with dissociative disorders may have a number of other psychiatric problems, including symptoms like:
- 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
Are There Famous People With DID?
Famous people with dissociative identity disorder include Marilyn Monroe, Roseanne Barr, Adam Duritz, and Herschel Walker.
Walker wrote a book about his struggles with DID, along with his suicide attempts, explaining he had a feeling of disconnect from childhood to the professional leagues. To cope, he developed a tough personality that didn't feel loneliness, one that was fearless and wanted to act out the anger he always suppressed. These "alters" could withstand the abuse he felt; other alters came to help him rise to national fame. Treatment helped Walker realize that these alternate personalities are part of dissociative identity disorder, which he was diagnosed with in adulthood.
Treatment for DID
There are no formal, evidence-based guidelines to treat DID. Many treatments are based on case reports or are controversial.
Though there's no cure for dissociative identity disorder, long-term treatment can be helpful if the patient stays committed. Effective treatment includes:
Psychotherapy: Also called talk therapy, this is designed to help you work through your DID triggers. The goal is to help “fuse” your separate personality traits into one consolidated personality who can control your triggers. This therapy often includes participation of your family members.
- Cognitive behavioral therapy (CBT). This is a structured, goal-oriented type of psychotherapy. CBT helps you unlearn negative thoughts and behaviors and adopt healthier thinking patterns and habits.
- Dialectical behavior therapy (DBT). This works well if you experience emotions intensely. The goal is a balance between validation (acceptance) of who you are, your challenges, and the benefits of change. Your therapist will help you learn skills for emotion regulation.
Hypnotherapy. Used in conjunction with psychotherapy, clinical hypnosis can be used to help access repressed memories, control some of the problematic behaviors that accompany DID, as well as help integrate the personalities into one.
Adjunctive therapy. Therapies such as art or movement therapy have been shown to help people connect with parts of their mind that they have shut off to cope with trauma.
EMDR therapy. Eye movement desensitization and reprocessing (EMDR) therapy involves moving your eyes in a certain way while you process traumatic memories. EMDR helps you heal from trauma. Compared to other therapy methods, EMDR is newer.
There are no established medication treatments for dissociative identity disorder, making psychologically-based approaches the mainstay of therapy. Treatment of co-occurring disorders, such as depression or substance use disorders, is fundamental to overall improvement. Because the symptoms of dissociative disorders often occur with other disorders, such as anxiety and depression, medicines to treat those co-occurring problems are sometimes used in addition to psychotherapy.
Therapy can be difficult and painful, but it can significantly help your symptoms in the long term.
Can DID Be Cured?
There's no cure for DID. You have to manage it for the rest of your life. But treatments can reduce your symptoms and help you function better at work, home, and your community.
- Dissociative identity disorder (DID) was previously known as multiple personality disorder. It's sometimes called split personality disorder.
- DID is a severe form of dissociation, a mental process that produces a lack of connection in your thoughts, memories, feelings, actions, or sense of identity. The dissociative aspect is thought to be a coping mechanism.
- When you have DID, you have two or more separate identities called “alters.” They control your behavior at various times. Each alter has its own personal history, traits, likes and dislikes.
- There's no cure for DID, but treatment is available.
- With treatment, it's possible to manage DID and live a normal life.
Can you live a good life with DID?
Yes. It's possible to live a normal life with DID if you get treatment from trained mental health specialists.
How do I know if I am dissociating?
The symptoms aren't the same for everyone. But you might feel disconnected from yourself and the world around you; forget about periods of time, events, and personal information; or feel unsure about who you are.
What are three key features of dissociative identity disorder?
- The existence of two or more distinct identities
- Permanent lapses in your memory about everyday and traumatic events, as well as your personal information
- Your symptoms cause problems in your social, work, and personal life