Dissociative Identity Disorder (DID): Symptoms, Traits, Causes, Treatment

Dissociative identity disorder (DID) is a condition marked by the presence of two or more distinct personalities within one individual. The 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, Fifth Edition (DSM-5).

Dissociative disorders all have a central feature of "dissociation,” or a disruption in the normally integrated functions of consciousness, memory, identity, and perception.

Dissociative Identity Disorder Symptoms

A person with DID will experience the presence of two or more distinct identities or personalities, also known as alters. These personalities recurrently take control of the person's behavior and they often experience a loss of memory of what happened while another personality or alter was in control.

Each alter has a distinct set of traits, personal history, and way of relating to the world. These alters may have different names, mannerisms, genders, and preferences than the individual's core personality.

Other symptoms that a person with DID may experience include:

• An inability to recall childhood memories and personal history
• Feelings of detachment or disconnection
• Flashbacks or the sudden return of previously forgotten memories
• Hallucinations
• Lack of awareness about recent events
• Losing chunks of time
• Thoughts of self-harm or suicide

Diagnosis of Dissociative Identity Disorder

The diagnostic criteria for dissociative identity disorder as described in the DSM-5 are as follows:

• The presence of two or more distinct identities or personalities, each with its own pattern of interpreting and relating to the environment. The presence of these personalities can be self-reported or observed by a therapist for diagnosis.
• Amnesia must occur, limiting how much a person can remember about both traumatic events and daily occurrences.
• The person must have difficulty in their daily functioning.
• The symptoms are not part of cultural or religious practice.
• The symptoms are not resulting from the use of any substance, such as alcohol or medication.

Although some have described DID as a rare condition, a combination of prevalence studies indicate that research has indicated that 1% to 1.5% of the population has the disorder.

There has long been controversy within the field of mental health about whether or not DID exists. There is evidence that people with DID are more susceptible to hypnosis and suggestibility. This has led some experts to argue that the separate identities experienced by people with DID may be the result of suggestion.

Other experts, however, argue that there are recent studies that refute this idea of suggestion. For example, some studies have demonstrated that the different personalities of a person with DID have different physiological profiles, including different brain activation patterns or cardiovascular responses. These studies have been used as evidence for the existence of actual alters.

Overall, DID remains a somewhat controversial diagnosis, but it is now gaining more acceptance in the mental health community.

Causes of Dissociative Identity Disorder

A history of trauma is believed to play a critical role in the development of DID. Approximately 90% of people who have dissociative identity disorder have a history of past abuse.

People with DID often report the experience of severe repeated physical and sexual abuse during childhood and also frequently have concurrent symptoms of borderline personality disorder (BPD), including:

• Self-harming behaviors
• Impulsive behaviors
• Instability in relationships

This may be related to the fact that childhood abuse is a risk factor for both conditions.

One theory about the development of DID proposes that people with DID have experienced a psychological trauma so severe that the only way to manage that trauma is to develop very strong dissociation as a coping mechanism. Over time, chronic dissociation leads to the formation of different identities or alters.

Dissociative Identity Disorder Treatment 

Treatment for dissociative identity disorder usually involves psychotherapy focused on helping the person integrate different personalities into a single, integrated identity.

Psychotherapy

Each individual's needs will be different, but therapy typically focuses on helping the person safely process traumatic memories, improve relationships with others, and develop more effective coping skills.

Forms of therapy that may be used in the treatment of DID include cognitive behavioral therapy (CBT), dialectical-behavioral therapy (DBT), and eye movement desensitization and reprocessing (EMDR). 

Medication

There is no specific medication to treat DID, but antidepressants and anti-anxiety medications may be used to address associated symptoms of depression and anxiety. 

Coping With Dissociative Identity Disorder

Learning new coping skills is an important aspect of managing symptoms of dissociative identity disorder. Some strategies that can help include:

• Meditation: Practicing meditation may help people become more aware of their own internal mental states.
• Relaxation techniques: Such strategies can help people better cope with stress and learn how to better manage dissociative symptoms.
• Mindfulness: This practice can help people gently bring themselves back to the present moment when they begin to experience flashbacks or dissociative symptoms.
• Using reminders: Writing things down can provide a useful visual reminder when people find themselves experiencing periods of forgetfulness or dissociative amnesia.