15th Feb 2023
Dissociative identity disorder, or DID, is a mental health condition that can occur as a result of severe childhood trauma. Symptoms of dissociative identity disorder include the presence of two or more distinct identities or personality states. These identities interfere with every life and may cause significant impairments in daily functioning. This disorder is typically treated by a mental health professional who specializes in DID.
Dissociative identity disorder, also referred to as multiple personality disorder, is a psychiatric condition characterized by the presence of several identities, each functioning independently, with potentially differing personas, views, and mannerisms .
These identities are often referred to as alters or parts, each of whom is usually assigned their own name and may dress, behave, and think differently from one another . The collective group of identities is often referred to as a system, with one as the main or host identity .
Someone with DID might switch identities regularly and may be fully aware of their condition and each individual identity, may be aware of some but not all identities, or may have no awareness of them at all, which can cause a great deal of distress and confusion .
DID is part of a spectrum of dissociative disorders, typically caused by traumatic experiences in childhood. DID happens when the brain responds to traumatic stress by dissociating as a defense mechanism . Without the ability to process experiences of abuse and trauma, people retreat internally to escape from abusive situations, creating this dissociative state .
Often DID is diagnosed in adulthood, following several years of symptoms that may be missed or diagnosed as other conditions . Historically it has been poorly understood, although more recent research into the condition has helped to improve understanding and allowed for developments in diagnosing and treating DID .
Symptoms of dissociative identity disorder vary but may include :
Dissociative identity disorder is most often caused by severe and prolonged childhood trauma and abuse .
Research shows that up to 90% of people with a diagnosis of DID have experienced sexual, physical, or emotional abuse in childhood, involving repetitive and severe traumatic experiences . The likelihood of developing DID is also increased if this abuse began before the age of five .
Dissociation occurs as a result of this trauma, as a way of retreating or escaping from reality by becoming disconnected from the self and current experiences, thus prompting a splitting in the self and the creation of new and distinct identities .
This typically occurs in those who had a lack of support and stability in their environment, with no means of preventing or avoiding abusive situations, thus requiring attempts at self-soothing and self-protection during and following these traumatic events, resulting in dissociation .
Studies suggest that there may be a genetic component to the development of dissociative disorders, that causes an increased likelihood of responding to trauma with dissociation .
In some cases, dissociative identity disorder may be caused by exposure to other traumatic events, such as natural disasters or war, also as a means of psychological defense .
People with dissociative identity disorder are often misdiagnosed with other conditions, such as borderline personality disorder, posttraumatic stress disorder, or psychotic disorders, due to overlapping or similarities in symptoms, or a reluctance to discuss dissociative symptoms and childhood trauma because of feelings of shame or fear .
Many people with DID require professional intervention due to self-harming injuries or suicide attempts and may therefore utilize mental health services for several years before receiving a diagnosis of DID .
If DID is suspected, the doctor must rule out the presence of any physical conditions that could cause similar symptoms, such as tumors, brain injuries, or substance abuse . They will then likely make a referral to a mental health specialist who can make an appropriate diagnosis.
To diagnose DID, diagnostic criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5)  will be used, which include:
To gather appropriate information a thorough history will be taken, including details of presenting symptoms relating to self-identity, loss of memory, or control; childhood experiences and trauma; family mental health history; and any other information provided by family members or people involved with the individual, that may be relevant for diagnosis .
Questionnaires may be used to help ascertain relevant information, such as the Dissociative Disorders Interview Schedule and the Structured Clinical Interview for Dissociative Disorders .
Typically, those who go on to develop DID do not have access to supportive or caring environments in childhood, while enduring prolonged abuse. As DID is often not diagnosed until adulthood, children and adolescents commonly experience symptoms of the condition for many years without appropriate professional support .
Where possible, removing children from abusive circumstances and ensuring that they have access to a support system and a safe environment, or by providing appropriate therapeutic support and treatment to those with traumatic experiences as early as possible, is the only way in which to potentially prevent prolonged and pervasive psychological impact .
Treatment for dissociative identity disorder requires a multidisciplinary approach, with input from experienced professionals, such as experienced physicians, psychiatrists, and mental health professionals who specialize in treating trauma .
Treating DID requires strong therapeutic relationships to provide safe and trusting environments in which to process and recover from trauma . Treatment involves first attempting to stabilize mood and ensure the safety of the individual. Next, the therapist and client will process, grieve, and resolve the trauma. Then, finally, the therapist and client will work to integrate the identities and increase normal daily functioning .
This may involve the use of various interventions, such as behavioral therapy, EMDR, medication, hospitalization, or family therapy.
Cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) can be utilized prior to initiating trauma therapy to first mitigate harmful behaviors and ensure safety. CBT and DBT can help to regulate emotions, tolerate distress, improve functioning, and reduce negative emotions, while teaching helpful coping strategies .
Eye movement desensitization and reprocessing (EMDR) is a specialized therapeutic treatment designed to help individuals overcome distress caused by traumatic experiences.
EMDR can be retraumatizing if the individual has not already undertaken therapeutic intervention to stabilize and manage their emotions with positive coping strategies, so should only be provided to those who have learnt to tolerate some level of distress .
Traumatic memories are revisited, gradually desensitizing the individual to the negative thoughts and feelings associated, which are eventually adapted to form more positive beliefs about the self in relation to the traumatic memories, thereby reprogramming the response to these experiences and reducing symptoms of dissociation .
There are no approved medications specifically for the treatment of dissociative personality disorder, but medications may be prescribed to treat symptoms of associated conditions, such as antidepressants or mood stabilizers .
If possible or appropriate, family therapy and education can be useful in the treatment of DID, as it can help to improve understanding and acceptance of the condition and symptoms and provide information and guidance on helping the individual to manage their symptoms and maintain their safety .
If the safety of the individual or others is at risk, it may be necessary to provide treatment in hospital, with a view to discharge the individual back into the community once they are stabilized .
If you have dissociative identity disorder, you can manage your symptoms by :
Left untreated, dissociative identity disorder can cause severe social, mental, and physical complications, including:
Various studies report that dissociative identity disorder affects around 1-1.5% of the population and is believed to more commonly diagnosed in females than males .