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Dissociative identity disorder (DID)

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Dissociative identity disorder used to be called multiple personality disorder. It is a rare and complex psychological condition where a person’s identity is fragmented into two or more distinct personality states called ‘alters’.    

The facts

  • Estimates on the prevalence of DID vary widely. Studies show it can affect anything from 0.01% to 15% of people. It is more common in areas that have experience large-scale trauma such as war or natural disasters.
  • DID is more commonly diagnosed in women than men.
  • The majority of people with DID have experienced 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.
  • DID was called multiple personality disorder until 1994, when the name was changed to reflect a better understanding of the condition.

The myths

  • Myth: People with DID have multiple personalities that they call on at will.
  • Reality: People with DID have experienced a fragmentation, or splintering, of their identity, rather than a growth of new identities. For the vast majority of people with DID, switching between alters is involuntary and can’t be identified by a casual observer at all.
  • Myth: People with DID are dangerous or violent.
  • Reality: People with DID are no more likely to be violent than anyone else. There are very few documented cases linking crime to DID. The idea of an ‘evil’ alter is not true.
  • Myth: DID isn’t real and people who say they have it are just pretending.
  • Reality: The diagnosis of DID continues to remain controversial among mental health professionals as understanding of the illness develops, but there is no question that the symptoms are real and people do experience them.
  • Myth: DID is the same as schizophrenia.
  • Reality: DID and schizophrenia are very different illnesses. Schizophrenia is a psychotic illness, where a person may experience delusions, paranoia and hallucinations. It does not involve dissociation. People with DID are not delusional or hallucinating their alters.  

Symptoms 

The following criteria must be met for a person to be diagnosed with dissociative identity disorder:

  • The person experiences two or more distinct identities or personality states, each with its own way of thinking and relating. Some cultures see these states as the experience of being possessed.
  • The person experiences amnesia and gaps in the recall of everyday events, personal information or traumatic events.
  • The person must be distressed by the disorder or have trouble functioning in their life as a result of the disorder.
  • The disturbance is not part of normal cultural or religious practice. For example, a child with an imaginary friend is not indicative of mental illness.
  • The symptoms are not due to substance abuse or other medical conditions such as epileptic seizures. 

People with DID also commonly suffer from symptoms of PTSD and trauma, like:

  • depression
  • suicidal thoughts
  • sleep problems
  • anxiety
  • obsessive-compulsive symptoms
  • psychotic symptoms.

People living with DID can have a range of symptoms which may appear at different times. Some people may have many obvious alters that they switch between throughout the day, while others may have one alter that they access only very occasionally.  

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. By dissociating painful memories from everyday thought processes, a person can maintain a level of functioning, as though the trauma had not occurred.  

Episodes of DID can be triggered by a variety of real and symbolic traumas, including mild events such as being involved in a minor traffic accident, illness, or stress. Reminders of past trauma can also trigger a dissociative episode.  

The person with DID may or may not be aware of the other personality states and memories of the times when an alter is dominant. 

People with DID typically also have dissociative amnesia, which is memory loss that is more severe than normal forgetfulness. An episode of amnesia usually occurs suddenly and may last minutes, hours, or rarely, months.   

Causes 

DID is likely caused by many factors, but many people with DID have experienced severe physical, verbal or sexual abuse during childhood, usually before the age of nine. The stress of war or natural disasters also can bring on dissociative disorders. 

A child who learns to dissociate in order to endure a traumatic experience may use this coping mechanism in response to stressful situations throughout life. 

Seeking help, diagnosis & treatment 

While treatment for DID can take a long time, it is effective. People with DID should see a mental health professional with experience with dissociation. The goal for treatment is the integration of separate alters into one unified personality. 

Treatment for DID usually takes a multi-stage approach.

  • The first stage focusses on stabilising symptoms and ensuring safety
  • The second stage involved processing traumatic memories in a safe and supportive environment
  • The third stage involves unifying the alters into a cohesive identity.

Therapy for DID is usually long-term. While there is no medication that can treat dissociative disorders themselves, medications may be prescribed for associated depression, anxiety or other health issues. 

Related: Antidepressant medication, Psychological therapies

Caring for someone with DID 

If someone you love has been diagnosed with DID, you may feel overwhelmed and confused. There are many myths and misconceptions about DID. Movie and TV portrayals of people with DID who have evil alters or violent personalities are incorrect and contribute to the stigma surrounding the disorder.  

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 the SANE Help Centre 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.
  • Caring for someone with DID can be unpredictable and tiring. It’s important to look after yourself.  

Related: Boundary-setting and mental illness, Guide for families, friends and carers

Last updated: 3 June, 2019
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