Dissociative Identity Disorder (Multiple Personality Disorder)

Dissociative identity disorder, formerly referred to as multiple personality disorder, is a condition wherein a person's identity is fragmented into two or more distinct personality states. People with this rare condition are often victims of severe abuse.

Definition

Dissociative identity disorder (DID) is a severe condition in which two or more distinct identities, or personality states, are present in—and alternately take control of—an individual. Some people describe this as an experience of possession. The person also experiences memory loss that is too extensive to be explained by ordinary forgetfulness.

DID is a disorder characterized by identity fragmentation rather than a proliferation of separate personalities. The disturbance is not due to the direct psychological effects of a substance or of a general medical condition. DID was called multiple personality disorder until 1994, when the name was changed to reflect a better understanding of the condition—namely, that it is characterized by a fragmentation, or splintering, of identity rather than by a proliferation, or growth, of separate identities. As this once rarely reported disorder has become more common, the diagnosis has become controversial.

Some believe that because DID patients are easily hypnotized, their symptoms are iatrogenic, meaning they have arisen in response to therapists' suggestions. Brain imaging studies, however, have corroborated identity transitions in some patients. 

DID reflects a failure to integrate various aspects of identity, memory, and consciousness into a single multidimensional self. Usually, a primary identity carries the individual's given name and is passive, dependent, guilty, and depressed. When in control, each personality state, or alter, may be experienced as if it has a distinct history, self-image and identity. The alters' characteristics—including name, reported age and gender, vocabulary, general knowledge, and predominant mood—contrast with those of the primary identity. Certain circumstances or stressors can cause a particular alter to emerge. The various identities may deny knowledge of one another, be critical of one another or appear to be in open conflict.

Possession-form identities often manifest as behaviors that appear as if a spirit or other supernatural being has taken control of the person. Many possession states around the world are a normal part of a cultural or spiritual practice; these possession states become a disorder when they are unwanted, cause distress or impairment, and are not accepted as part of a cultural or religious practice. 

Symptoms

The following criteria must be met for an individual to be diagnosed with dissociative identity disorder:

  • The individual experiences two or more distinct identities or personality states (each with its own enduring pattern of perceiving, relating to, and thinking about the environment and self). Some cultures describe this as an experience of possession.
  • The disruption in identity involves a change in sense of self, sense of agency, and changes in behavior, consciousness, memory, perception, cognition, and motor function.
  • Frequent gaps are found in memories of personal history, including people, places, and events, for both the distant and recent past. These recurrent gaps are not consistent with ordinary forgetting.
  • These symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning. 

Particular identities may emerge in specific circumstances. Transitions from one identity to another are often triggered by psychosocial stress. In the possession-form cases of dissociative identity disorder, alternate identities are visibly obvious to people around the individual. In non-possession-form cases, most individuals do not overtly display their change in identity for long periods of time. 

People with DID may describe feeling that they have suddenly become depersonalized observers of their own speech and actions. They might report hearing voices (a child's voice, the voice of a spiritual power), and in some cases, these voices accompany multiple streams of thought that the individual has no control over. The individual might also experience sudden impulses or strong emotions that they don't feel control or a sense of ownership over. People may also report that their bodies suddenly feel different (like a small child, huge and muscular), or that they experience a sudden shift in attitudes or personal preferences before shifting back. 

Sometimes with DID experience dissociative fugues, where they discover they have traveled but have no recollection of the experience. People vary in their awareness of their amnesias, and it is common for people with DID to minimize their amnestic symptoms, even when the lapses in memory are obvious and distressing to others. 

More than 70 percent of people with DID have attempted suicide, and self-injurious behavior is common among this population. Treatment is crucial to improving quality of life and preventing suicide attempts. 

Causes

Why some people develop DID is not entirely understood, but they frequently report having experienced severe physical and sexual abuse, particularly during childhood. Among those with the DID in the U.S., Canada, and Europe, approximately 90 percent report experiencing childhood abuse. 

The disorder may first manifest at any age. Individuals with DID may have post-traumatic symptoms (nightmares, flashbacks, and startle responses) or post-traumatic stress disorder. Several studies suggest that DID is more common among close biological relatives of persons who also have the disorder than in the general population. As this once rarely reported disorder has grown more common, the diagnosis has become controversial. Some believe that because DID patients are highly suggestible, their symptoms are at least partly iatrogenic—that is, prompted by their therapists' probing. Brain imaging studies, however, have corroborated identity transitions.

Treatments

The primary treatment for DID is long-term psychotherapy with the goal of deconstructing the different personalities and uniting them into one. Other treatments include cognitive and creative therapies. Although there are no medications that specifically treat this disorder, antidepressants, anti-anxiety drugs or tranquilizers may be prescribed to help control the mental health symptoms associated with it. With proper treatment, many people who are impaired by DID experience improvement in their ability to function in their occupational and personal lives. 

Sources

  • American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. 
  • National Institute of Mental Health
Last reviewed 02/24/2017