Dissociative Identity Disorder

August 30, 2011

Dissociative identity disorder (DID), formerly known as multiple personality disorder, is one of five dissociative disorders recognized by the Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV). Of the dissociative disorders, Dissociative identity disorder is associated with the most chronic and severe symptomatology.

Dissociation is a process wherein a person mentally separates oneself from reality. There are common, everyday dissociative experiences such as daydreaming or “losing oneself” in a good book, for example, but with Dissociative identity disorder, an individual has typically experienced dissociation during a traumatic event such as physical, sexual, or emotional abuse, or during times of perceived harm (e.g., invasive medical procedures, natural disasters, and so forth). The dissociation appears to serve as a protective defense mechanism and as a means of self-preservation.

The DSM-IV defines Dissociative identity disorder as follows:

  1. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self)
  2. At least two of these identities or personality states recurrently take control of the person’s behavior
  3. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness
  4. The disturbance is not due to the direct physiological effects of a substance or a general
    medical condition (American Psychiatric Association, 1994)

Most individuals who develop Dissociative identity disorder have likely been exposed to childhood trauma (usually between the ages of 3 and 9), during which time he or she mentally separates from the experience in an effort to avoid emotional and/or physical pain. The different personalities evolve over time as a means of coping with future traumas and feelings of being threatened. It seems the more severe the trauma, the greater the number of personalities that develop.

The prevalence of Dissociative identity disorder is approximately 1% of the population, although about 90% of those with the disorder are completely unaware they have it. It is more frequently diagnosed in women than men, but some data support equal gender prevalence (men may be in treatment for other comorbid diagnoses, and the Dissociative identity disorder is overlooked). And not all children who are abused or traumatized dissociate or even go on to develop Dissociative identity disorder; that seems to depend on individual predisposition and has been observed more frequently in first-degree biological offspring of persons with the disorder.

Symptoms and characteristic features include the following: time loss and inconsistencies, amnesia for events, being recognized by “strangers,” hearing voices within one’s head, flashbacks, nightmares, hypervigilance, distinct and abrupt changes in one’s behavior/personality (often forgotten by the person), finding unaccountable objects in one’s personal belongings, and referring to oneself by another name or in the third person. Also observed are depression, mood lability, anger, panic attacks, phobias, eating disorders, relational difficulties, suicidal thoughts, feelings of worthlessness, and self-injurious behaviors.

The various personality states of Dissociative identity disorder can manifest as many very different identities within one individual; “alters,” to which they are often referred, can be of both sexes, have varying ages, and even display differing medical conditions, perceived physical attributes, and unique voice and handwriting structure.

Because the disorder can be very destabilizing to one’s life and functioning, there are several recommended treatment options. Individual psychotherapy seems to be the most widely accepted and effective intervention, often supplemented with hypnosis, art and group therapies, and pharmacotherapy. Once a person with Dissociative identity disorder understands and accepts the diagnosis, the goal becomes reintegration (or unification) of the various personality states. This usually requires identification of individual personalities, with eventual communication between them. Antidepressant or anxiolytic medications are used adjunctively if necessary, as is hospitalization if self-injurious or other destructive behavior warrants such. Although the healing process can be longstanding, and at times quite painful, reintegration appears to be a vital element in facilitating recovery for the person with Dissociative identity disorder.

SEE ALSO: Depression, Eating disorders, Psychotherapy, Sexual abuse

Suggested Reading

  • American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4th ed.). Washington, DC: American Psychiatric Association. Haddock, D. B. (2001). The dissociative identity disorder sourcebook.
  • New York: McGraw-Hill. Kaplan, H. I., & Sadock, B. J. (1997). Synopsis of psychiatry (8th ed.).
  • Baltimore: Williams & Wilkins. Sinason, V. (Ed.). (2002). Attachment, trauma and multiplicity: Working with dissociative identity disorder. New York: Brunner-Routledge. Steinberg, M., & Schnall, M. (2000). The stranger in the mirror: Dissociation, the hidden epidemic. New York: Cliff Street Books.

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