- People living with dissociative identity disorder (DID) experience two or more separate personality states called ‘alters’.
- The majority of people with DID have been through severe trauma in childhood, and dissociate as a way of coping with a situation that is too violent or traumatic for their conscious self to handle.
- Treatment can help people with DID lead long and fulfilling lives, and can involve psychotherapy and medication.
What is dissociative identity disorder?
Dissociative identity disorder (DID) is a rare and complex psychological condition where a person experiences two or more distinct identities called ‘alters’. It is usually a long-term condition that occurs in response to extreme trauma. DID was called multiple personality disorder until 1994, when the name was changed to reflect a better understanding of the condition.
What are the symptoms of dissociative identity disorder?
A person needs to meet the following criteria to be diagnosed with DID:
- Two or more distinct identities or personality states, each with its own way of thinking and relating.
- Amnesia and gaps in the recall of everyday events, personal information or traumatic events.
- The person must be distressed or have trouble in important parts of their life because of the disorder.
- The experiences are not part of normal cultural or religious practice, or part of childhood imaginary play. For example, a child having an imaginary friend does not mean they have a mental health issue.
- The symptoms are not because of substance abuse or other medical conditions such as epileptic seizures.
People with DID also commonly have symptoms of PTSD and other mental health issues, like:
- suicidal thoughts
- sleep problems
- obsessive-compulsive symptoms
- symptoms of psychosis.
DID looks different for each person, and people can have a range of symptoms which appear at different times. Some people have a small number of alters, while others can have dozens or hundreds. For many people, switching between alters is not a choice, while others have some control over switching.
"I have mild awareness of some Voices, like shadows I notice from time to time. Others I have complete awareness of both their sound and what I believe they look like. I am aware of their preferences, moods, attitudes, behaviours and what they are capable of."
Some people also experience ‘co-consciousness’ where they stay partly aware while different alters are dominant, while others may experience memory loss (dissociative amnesia) at these times. An episode of amnesia can occur suddenly and may last minutes, hours, or rarely, months.
Some people may also experience ‘partial’ DID. Partial DID is very similar to DID, but alters do not frequently take control of a person’s consciousness and functioning.
Despite stigmatising portrayals of people with DID and their alters in the media, there is no link between DID and violence. People with DID are safe to care for children and be part of the community and employment.
More about dissociation
People living with DID experience a form of dissociation. Dissociation is a coping mechanism that a person uses to disconnect from a stressful or traumatic situation, or to separate traumatic memories from normal awareness. Dissociation can involve feeling disconnected from thoughts, feelings, and memories. It ranges from mild detachment (such as daydreaming) to feeling that you or the world is unreal, or memory loss.
How common is dissociative identity disorder?
Estimates on the prevalence of DID vary widely, and few studies are available using up to date diagnostic criteria. In the general community, it is estimated that around 1.5% of US adults meet diagnostic criteria for DID, but other studies estimate it is more common.
What causes dissociative identity disorder?
DID is likely caused by many factors, but most people with DID have experienced severe physical, verbal or sexual abuse during childhood.
Managing dissociative identity disorder
Some people find these strategies helpful for living with DID:
- Learning more about DID – what it is, how it developed, and how your own experiences tie in.
- Acknowledging and challenging negative thinking – including working through any self-blame or self-criticism.
- Finding stress management techniques that work for you.
- Organisation and time management, including ways of communicating with alters or compensating for memory troubles. For example, keeping a diary or app to track commitments, appointments, and medications.
- Developing plans for what to do in an emergency, like creating a safety plan with emergency contact details.
Treatment and support for dissociative identity disorder
While there is no known ‘cure’ for DID, treatment and support for DID is available, including psychotherapy. It can take a long time to figure out the right treatment, but there can be significant benefits. For some people the goal for treatment may be the integration of separate alters into one single personality state. For others, the aim is to achieve a state of ‘resolution’ where alters co-exist harmoniously without impacting the person’s goals and coping, or to have better control over switching.
People with DID should see a mental health professional with experience with dissociation and trauma-informed care. Treatment for DID usually is usually long-term and involves a number of stages:
- The first stage focuses on stabilising symptoms and ensuring safety.
- The second stage involves processing traumatic memories and working with trauma-based unhelpful beliefs.
- The third stage focuses on life issues, goals, and supporting healthy relationships.
Treatment can help people with DID cope with symptoms, but can also help in other ways. For example, treatment can help people manage their emotions, improve relationships and a sense of connection, cope with stress, manage work or study, and more.
While there is no medication that can treat dissociative disorders themselves, medications may be prescribed for associated depression, anxiety or other health issues.
Caring for someone with dissociative identity disorder
If someone you love has been diagnosed with DID, you may feel overwhelmed and confused.
It can help to educate yourself as much as possible about DID. Talk to a mental health professional to get accurate information and to voice your concerns.
Treatment for DID can involve revisiting past traumatic experiences, which may be upsetting for friends and family. Make sure you look after yourself, and seek help to look after your own mental health.
Self-help strategies include:
- Make time to regularly do things you enjoy, either alone or with friends.
- Talk to other people about how you feel. Ask a health professional or contact SANE’s free counselling support for details of support groups and other services for family carers in your local area.
- Try to focus on the things that you can control, not on the things outside of your control. You cannot control the behaviour of a person with DID, but you can manage your reaction.
Experiences of DID and dissociation can be challenging, but with support a full and meaningful life is possible.
To chat with others who live with mental health issues, including DID, visit our safe and anonymous online Forums.