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 personalities. Sufferers of this rare condition are usually 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. 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, yet 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, that is, they have arisen in response to therapists' suggestions. Brain imaging studies, however, have corroborated identity transitions in some patients. 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.

DID reflects a failure to integrate various aspects of identity, memory and consciousness in 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.

Symptoms

  • 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).
  • The reported range of identities is from 2 to more than 100. Half of the reported cases include individuals with 10 or fewer.
  • At least two of these identities or personality states recurrently take control of the person's behavior. Each may exhibit its own distinct history, self-image, behaviors, and, physical characteristics, as well as possess a separate name.
  • Particular identities may emerge in specific circumstances. Alternative identities are experienced as taking control in sequence, one at the expense of the other, and may deny knowledge of one another, be critical of one another or appear to be in open conflict. Transitions from one identity to another are often triggered by psychosocial stress.
  • Frequent gaps are found in memories of personal history, including people, places, and events, for both the distant and recent past. Different alters may remember different events, but passive identities tend to have more limited memories whereas hostile, controlling or protective identities have more complete memories.
  • Symptoms of depression, anxiety, passivity, dependence and guilt may be present.
  • In childhood, problem behavior and an inability to focus in school are common.
  • Self-destructive and/or aggressive behavior may take place.
  • Visual or auditory hallucinations may occur.
  • The average time that elapses from the first symptom to diagnosis is six to seven years.
  • The disturbance is not due to the direct psychological effects of a substance or of a general medical condition.

Causes

Why some people develop DID is not entirely understood, but they frequently report having experienced severe physical and sexual abuse, especially during childhood. Though the accuracy of such accounts is disputed, they are often confirmed by objective evidence. Individuals with DID may also 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.

Sources

  • American Psychiatric Association
  • National Institute of Mental Health
  • Handbook of Psychology, Vol. 8 (John Wiley)
Last reviewed 11/24/2014