What is Dissociative Identity Disorder (Multiple Personality Disorder)?
Previously known as multiple personality disorder, dissociative identity disorder, or DID, is a mental condition wherein the affected person develops at least two clearly identifiable personality states or identities. These identities are also referred to as alter egos or alters. These alters will have a defined way of looking at things and relating to the sufferer’s surrounding environment and world. Therefore, these states of personalities have clearly defined characteristics and ideologies (the way in which they view the world) that are often completely separate from the person’s usual (original) personality.
Some sufferers with dissociative identity disorder have alters that have clearly distinct ways in which they react and function on both a psychological and physiological level, manifestations of these personalities wherein they take control of an individual can cause notable changes in emotions, blood pressure, pulse rate and even the blood flow to the person’s brain. Some people and doctors may refer to dissociative identity disorder as split personality disorder.
To explain this condition further, the mental illness (DID) involves the affected person switching between alters, wherein a specific personality takes control. The sufferer may feel as though these alters are distinct people, living and talking inside of their head, sometimes even feeling possessed by them.
Each one of the identities may have their own unique name, characteristics, gender (regardless of the patient’s gender), mannerisms, voice and physical qualities, for example, one of them may need to wear glasses as he or she suffers from visual impairment. There are also clear differences as to how familiar the identities are with each other. Some may be good friends, others may be enemies.
People suffering from dissociative identity disorder may also have dissociative amnesia (memory loss that is more severe than typical forgetfulness and cannot be explained by an underlying medical condition) and dissociative fugue (a form of dissociative amnesia that may result in the affected person wandering away or travelling away from their everyday life for a period of days or even years). These conditions will be explained further in the sections that follow in the article.
DID is seen to occur in the same number of girls as boys in childhood and adolescence, but women have been diagnosed far more commonly (nine times more) than men. This may be due to the difficulties associated with identifying the disorder in men which includes their reluctance to enter therapy, denial of symptoms and history of trauma or in some cases, due to the higher incarceration rates of males1.
There is an ongoing debate among mental-health professionals regarding whether this specific illness is clinically real and actually exists or not.
What are the types of dissociative disorders?
The term ‘dissociative’ refers to a disconnection from one’s life including memories, thoughts, actions, identity and surroundings.
People suffering from dissociative mental disorders experience a disconnection from the above-mentioned areas in their lives as and lack a sense of continuity. Those who have a dissociative disorder will escape their reality through a number of unhealthy and involuntary ways which often results in several issues in functioning in their everyday life.
When the sufferer is going through stressful situations in their life, this can often make their symptoms progressively worse and more evident to those around them.
Psychotherapy is often the preferred method of treatment and a number of patients are able to live productive and healthy lives through effective means of diagnosis and treatment.
In total, there are three main dissociative disorders that have been defined by the American Psychiatric Association and published and defined by the organisation in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders).2
These disorders are as follows:
This condition involves memory loss that is far more severe and evident than everyday forgetfulness. This memory loss cannot be justified or explained by an underlying medical condition. The person is unable to recall information about themselves, events or people in their lives, particularly if these memories took place during a traumatic time.
Dissociative amnesia may occur during specific events at a certain time, for example, intense combat or witnessing a murder. In some cases, the patient may lose all memory of who they are. This condition is often associated with travelling away from one’s life or wandering away in a confused state, this is known as dissociative fugue. The term fugue refers to a period in which a person who suffers from memory loss will sometimes begin a new life and not remember anything from their amnesic Episodes of amnesia will often occur suddenly, without warning and are able to last anywhere between a few minutes to even hours. In rarer instances, the patient may suffer from amnesia that lasts for a few months or years.
Depersonalisation - This condition consists of an episodic or ongoing sense of dissociation or detachment from oneself. The affected individual often feels as though they are observing their feelings, thoughts, actions and themselves from outside of their own body as though they were watching someone else operate inside of their body, or watching a film of themselves. This condition is often described as an ‘out-of-body’ experience and is accompanied by the affected person not being able to recognise themselves in the mirror.
Derealisation - Things and people around the person may feel dreamlike, foggy or detached, time may appear to slow down or speed up, the world may even feel unreal, this is known as derealisation. With derealisation, objects may also change colour or shape and the environment feels unreal to the affected person.
The sufferer may experience either one of these conditions (depersonalisation or derealisation) or both at the same time. The above symptoms can put the patient in a state of distress and can last for a few moments or for a number of years.
To simply explain the difference between the above-mentioned conditions, depersonalisation refers to feeling detached from oneself, feeling as though the individual is seeing him or herself through someone else’s eyes. Derealisation refers to seeing one’s environment in a distorted way that appears unreal and dream-like.
Dissociative identity disorder (DID)
This disorder, as previously mentioned, is characterised by the patient ‘switching’ between different personalities or alternate identities. The patient often feels possessed by these ‘alters’, with each one having their own gender, characteristics and unique identity. Those with this condition may also suffer from dissociative amnesia and dissociative fugue.
Is dissociative identity disorder a real condition?
As previously mentioned, the debate as to whether or not dissociative identity disorder (DID) is a real condition, is one that is ongoing among medical communities and experts. Understanding the cause and development of a condition wherein a person suffers from multiple personalities, each with their own characteristics, and in some instances, medical conditions such as vision problems or high blood pressure issues, is often difficult to comprehend, even for a number of medical and mental health experts.
The diagnosis of the condition remains one that is controversial, some experts even believe that DID is more of an ‘offshoot’ phenomenon of a different psychiatric condition, one of these being BPD (borderline personality disorder) or the results of intense difficulties experienced when coping with stresses.
BPD is a severe mental illness that is characterised by patterns of ongoing instabilities experienced in one’s mood, behaviour, and functioning. A person suffering from borderline personality disorder may also suffer from intense episodes of depression, anger and anxiety. These episodes can last a few hours or even days.
While borderline personality disorder and dissociative identity disorder often occur together, the diagnostic criteria for these disorders are different and they are therefore treated as separate conditions by most professionals.
Psychologists who do support the existence and diagnosis of DID often use techniques to address the alter or identity that currently has control of the patient’s mind and body. Many of these experts have noted a clear difference between mannerisms and traits exhibited between the different personalities and suggest that dissociative identity disorder is in actual fact a real condition and one that is needed to be explored and researched further.
These experts have noted that there may be significant findings from studies done on different identities and their ability to change the patient’s biological makeup. To explain this simply, one alter within the patient may suffer from high blood pressure, whereas another may need a hearing aid or glasses. This may create a platform in which the body’s ability to alter and change its natural state can be studied and open the door for mind-blowing findings as to how the mind plays a significant and vital role in the functioning and ability of the body, noting the brain to be an amazing asset which we may be able to learn more about when studying those who suffer from DID.
To simply answer the question of whether dissociative identity disorder is real or not, a number of experts believe that DID is an offshoot from another personality disorder or mental condition. And on the other hand, there are several experts who recognise the disorder as a real condition.
What is the difference between dissociative identity disorder, bipolar and schizophrenia?
A number of people may confuse bipolar disorder (this is also referred to as manic-depression), schizophrenia and dissociative personality disorder (DID). This confusion stems from the media commonly using these terms. However, these disorders have very little in common apart from them being stigmatised by the media and society. We will explore these in detail below.
This is a relatively common mental illness. Bipolar disorder is generally well understood by experts and is treated and managed through an effective combination of psychotherapy and medications.
Bipolar is characterised by the individual suffering from episodes of depression and mania, alternating between these two states and their baseline personality. Sometimes these states can last a number of weeks or even months.
Individuals who are manic will experience high levels of energy accompanied by irrational and impulsive behaviour. They can also seem to talk faster and believe they can accomplish more work or tasks than is realistically plausible. After episodes of mania, the individual can often ‘crash’ or ‘fall’ into a state of depression. This state is marked by lethargy, sadness and a feeling of emptiness. Sleep problems often arise during both of these mood states.
Bipolar disorder affects both women and men equally, although women are more likely than men to suffer from bipolar type II (hypomania), mixed episodes and rapid cycling3.
The condition can be challenging treat initially as a person who is taking antidepressants (antidepressants form a vital part of the treatment plan for bipolar disorder) may have their depressed mood alleviated but feelings of euphoria are often also reined in. This can leave the patient feeling ‘emotionless’ and many miss the euphoric moods they experienced when unmedicated, making it difficult for a number of patients to adhere to their medication.
Regardless of this, there are still many with this condition who are able to function in society and lead healthy and productive lives even when they are not on their medication, though it is not recommended for most patients to completely abandon their prescribed treatment regimen as medication can aid in controlling mood swings associated with the disorder.
The main difference between bipolar and dissociative personality disorder is that bipolar refers to the patient suffering from mood alterations involving episodes of depression and euphoria, or mania. Dissociative personality disorder, on the other hand, refers to the sufferer experiencing multiple personalities, not just variations in mood.
This condition is often confused with dissociative personality disorder, however, there are vital differences between the two conditions. Bipolar disorder is more commonly seen than schizophrenia.Schizophrenia is marked by the patient suffering from delusions and hallucinations.
Delusions occur when someone believes in something that is not true. People experiencing these will believe in their delusion regardless of the reality of the situation being evident.
Hallucinations involve tasting, smelling, hearing, feeling or seeing things that do not exist but appear to be real, often leading to irrational thoughts and beliefs. Most people suffering from schizophrenia will experience voices and sounds that are not there.
A delusion is a false belief or idea, such as feeling as though someone is spying on the affected person or believing they are a famous person. Whereas a hallucination is seeing or hearing something that does not exist and is, therefore, more than just an idea or feeling as the individual physically experiences these hallucinations.
The main difference between schizophrenia and dissociative personality disorder is that DID is an identity issue resulting in the person suffering from multiple personalities or identities (often referred to as ‘split personalities’), schizophrenia, on the other hand, results in the sufferer experiencing a ‘split mind’ as a result of psychosis which splits them from reality.
Schizophrenia can be difficult to treat as a number of sufferers do not function easily in society and often have issues with maintaining the treatment plan. Treatment will typically include psychotherapy and medications, however, some patients with more severe forms of this condition may need to be institutionalised or enrolled in a day program to assist with coping and care.
Due to the nature of schizophrenia and its symptoms, a number of patients may also discontinue treatment because a voice in their head told them to do so (such instances are known as hallucinations and are not indicative of another personality existing within the psyche) and often battle to hold a job or maintain relationships.
Suicide is a common risk amongst those with schizophrenia, as well as those suffering from DID (dissociative identity disorder). However, individuals with multiple identities may have a history of suicide attempts that is higher than those with schizophrenia with more than 70% of outpatients suffering from DID have attempted suicide.
What are the symptoms of dissociative identity disorder?
The symptoms of DID (dissociative identity disorder) have been known to include:
- The presence of different identities or personalities – A DID sufferer will have at least two, but often more clearly different identity or personality states which take control of their behaviour recurrently. This will be clearly different from a person’s usual mood variations and these identities will be distinct, exhibiting differing mannerisms, way of speaking, thinking and acting.
- Memory issues - Lapses in one’s memory, this is known as dissociation and is specifically experienced with regard to important life events such as weddings, birthdays and the loss of a loved one. DID patients may often have people tell them they are lying when in actual fact they do not remember specific events occurring or can’t recall being told specific things. These lapses in memory cannot be explained by another underlying medical condition, or drug abuse (although drug abuse is often a complication of DID).
- Blackouts – Suffering from blackouts which often ends up with the individual not knowing how they got to a certain place.
- Confusion of identities – The individual may encounter people whom another alter or identity has met before, but the identity now present and ‘in control’ has never met and therefore regards them as strangers. This makes it confusing for those who believe to have met the DID sufferer before, but in reality, they would have met another personality within them. This can also lead to name confusion wherein the individual may be called names that are unlike their birth name or even their nickname, as these are often the names of other personalities who have made an appearance during the time of meeting a specific person. The degree to which personalities will be aware of one another varies and as such, the affected person may or may not be familiar with the name/s others call them in addition to their actual given name at birth.
- Changes in handwriting – The person suffering from DID may often find notes or lists written by them but in a different hand writing (presumably when another personality is in control).
- Hearing voices – The individual may hear voices in their head that are not their own.
- Derealisation – Not feeling real
- Depersonalisation – Feeling as though they are watching themselves in a movie or from someone else’s eyes.
- Feeling unrecognisable – Not being able to recognise onesself in the mirror.
- More than one person – Feeling as though they are not just one person.
What are the causes of dissociative identity disorder?
To date there has been no proven scientific cause of dissociative identity disorder. The main psychological theory regarding the cause of DID is that the condition develops as part of a reaction to severe childhood stress and trauma.
More specifically, experts believe that a way in which young children react to trauma is to wall or block off altered states of their consciousness. Simply put, they attempt to dissociate themselves from these memories.
When this reaction of dissociation becomes more extreme, then dissociative identity disorder may be the result. Therefore, the trauma and blocking off of these memories creates a platform of dissociation in which dissociative identity disorder can form.
As is the case with a number of other mental conditions, one’s risk of developing DID is significantly increased if the individual has a direct family member with it. This, however, indicates some form of vulnerability to the development of the mental condition, but this doesn’t mean that the condition is hereditary.
Those who have suffered from long-term sexual, emotional or physical abuse during childhood often have the greatest risk of developing dissociative identity disorder and other dissociative disorders.
Adults and children who have experienced other stressful and traumatic events, for example, kidnapping, war, torture, natural disasters or stressful medical procedures, are also susceptible to developing this condition.
Individuals who have been diagnosed with dissociative identity disorder have their risk for a number of complications, as well as other associated disorders increased. These include:
- Suicidal thoughts and/or behaviour
- Drug and alcohol abuse
- Personality disorders
- Anxiety and depression disorders
- Eating disorders
- PTSD (post-traumatic stress disorder)
- Sleep disorders (insomnia, sleep walking, nightmares)
- Significant difficulties and issues in work and personal (social) relationships
- Sexual dysfunction
How is dissociative identity disorder diagnosed?
Due to dissociative identity disorder being such a complex condition and each case having its own unique traits (with exception to the obvious similarities between alters and behaviour), there is currently no specific test that guarantees a definitive diagnosis. Therefore, a mental health professional such as a psychiatrist, psychologist or psychoanalyst will need to conduct an in-depth interview of the patient in order to examine their personality and disorder further through attempting to detect any of the previously mentioned symptoms.
The difference between the mental health professionals mentioned above is explained below:
This is a physician who works with patients who are mentally ill. Psychiatrists, being Doctors of Medicine (MD), are able to prescribe medication to the patient and because of this, they typically wok with individuals who have clinical issues and conditions such as manic-depression and DID that need prescription medication for the ongoing management of these disorders.
Psychologists, on the other hand, are not Doctors of Medicine and will typically work with patients suffering from emotional rather than clinical issues. One example may be a person who is dealing with low self-esteem or social anxiety, this individual does not have anything physically wrong with them, they are rather looking for someone to talk to about their emotions in order to find coping mechanisms for them.
Psychologists and psychiatrists often work together on a number of patients. For example, a psychiatrist may diagnose a patient with dissociative identity disorder and prescribe them medication in order to keep their emotions or alters under control (to an extent). A psychologist may then work with the same patient to help them in developing coping mechanisms and strategies to recognise their illness and deal with it appropriately.
Simply put, a psychiatrist deals with a patient who suffers from a chemical imbalance in their brain and a psychologist deals with the emotional side of patients as opposed to the physical and medical issues which cause these.
A psychoanalyst will follow the theories of Freud which suggest that there are painful childhood memories that are contained in the patient’s subconscious which are the root cause of the mental condition.
Psychoanalysts are similar to psychologists in the way they tend to deal with the emotional issues of the patient without prescribing medication.
However, the approach of a psychoanalyst is normally different than that of a conventional psychologist.
The method of psychoanalysis involves searching through the individual’s subconscious memories of their childhood and past in order to try and find the source of the current issues they are facing, as opposed to focusing on the memories of the conscious.
A psychoanalyst will also typically meet far more often with their patients. For example, a psychologist will meet with their patient once a week or even once every second week, whereas a psychoanalyst may want to meet with their client three to six times a week.
The criteria needed for the diagnosis of DID (dissociative identity disorder) to be confirmed include the below:
- The existence of at least two personality states of distinct identities with each alter having its own relatively determined and persistent pattern of thinking, relating to and perceiving her or himself and the outside world (ideologies).
- Two or more of the alters or personality states take control of the individual’s behaviour and mind at different times on a repeated basis.
- The individual cannot remember vital information about themselves or others, with this forgetfulness being too severe or chronic to be explained by another underlying medical condition or ordinary memory issues associated with forgetfulness.
- The mental condition is not caused by any psychological effects of any substances such as drug abuse or alcohol intoxication that may have an effect on one’s personality. The illness is also not the result of any other medical condition in general, such as seizures. In children, mental healthcare professionals need to be sure that the child’s symptoms are not the result of any imaginary friends or fantasy play.
Mental healthcare professionals will normally gather any information they can regarding the patient’s childhood and interview the individual in order to explore the symptoms further and determine whether or not the symptoms expressed are due to another mental condition, albeit dissociative or not.
As previously mentioned, the other types of dissociative disorders include:
- Depersonalisation disorder – The patient feels detached from their surroundings or themselves
- Dissociative amnesia – The patient suffers from memory issues that are associated with a previous traumatic experience
- Dissociative fugue – The patient feels a sense of abandonment and dissociates from surroundings that were once familiar or suffers from memory lapses relating to their past
- Dissociative disorder – This classification refers to episodes of disconnection, also known as dissociation that are not specified for one of the aforementioned disorders
The issues that may arise when diagnosing DID
The mental health professional involved in the assessment of a DID case will interview the individual evaluating them for a number of other mental conditions in order to ensure that other possibilities are rule out and the patient receives the correct diagnosis. The mental healthcare professional will also see to it that the patient has recently received a thorough physical examination and any other appropriate medical testing in order for any number of physical conditions that may be able to mimic the symptoms of dissociative identity disorder are either ruled out or accurately identified and treated and/or addressed.
Dissociation, being the prominent symptom associated with dissociative identity disorder, also occurs in several other mental conditions. To give an example, a patient suffering from dissociation may look for relief from their overwhelming memories of trauma through self-harm and mutilation, these forms of self-destructive behaviours are often seen another mental condition known as BPD (borderline personality disorder).
**My Med Memo - Borderline personality disorder is a condition that is marked by a chronic pattern of instability in one’s mood. Someone who suffers from this condition will not typically experience happiness or euphoria and constantly battle with their emotions and behaviour as they feel as though their personal life is in turmoil.
In some cases, the patient may be expressing behaviours and feelings that seem to be the result of dissociation. However, the underlying condition is in actual fact another mental illness. Some examples of other mental conditions that have similarities to dissociation include:
- Conversion disorder – This is a condition where the patient suffers from paralysis, blindness or other neurological conditions that are not the result of another illness but rather psychological conflict often after an extremely stressful or traumatic experience.
- Schizophrenia – This is a mental condition that is marked by hallucinations and/or delusions accompanied by abnormal social behaviour where the individual is unable to determine what is real and what is not.
- Somatisation – This refers to the conversion of mental symptoms and issues into physical symptoms. Therefore, the patient manifests their psychological symptoms through bodily issues and seeks help for them from healthcare professionals.
Those who have suffered from adult forms of trauma such as rape or other forms of emotional and physical abuse have also been found to be susceptible to the development of dissociative symptoms.
The debate as to whether or not DID is a real condition and the overlapping of certain symptoms with other mental conditions can sometimes result in a misdiagnosis.
The symptoms of several other mental conditions such as the obvious impulsivity or the evident mood swings associated with both bipolar disorder or narcissistic personality disorder (a condition that is marked by the inflated sense of self-importance) when triggered by an event are just two examples of conditions that can lead to a misdiagnosis.
DID can also occur with another emotional condition, the most evident one includes PTSD (posttraumatic stress disorder). This disorder involves the patient suffering from anxiety and flashbacks from a previous traumatic experience, this is often seen in soldiers who have gone to war.
In other instances, DID can be expressed by patients who are seeking attention, this is often seen in Munchausen's syndrome. This is a disorder wherein the individual will pretend to be ill and attempt to manifest the symptoms of a certain medical condition or mental disorder and seek treatment for it.
Some individuals who are involved in a court case may pretend to have DID in order to bypass a death sentence, therefore legally standing to gain from being diagnosed with DID. In cases such as these, mental healthcare professionals will conduct extensive interviews with the patient, their friends and loved ones in order to determine whether the person really suffers from this condition or not.
DID is a severe condition that has requires an intense amount of effort from both the patient and the mental healthcare professional involved in order for it to be diagnosed accordingly and treated as such.
How is dissociative identity disorder treated?
Psychotherapy, which is a form of psychology, uses psychological methods that are based on the regular interaction between a mental healthcare professional and their patient. Psychotherapy is the main form of treatment for those suffering from dissociative disorders. It is also known as counselling, talk therapy and psychosocial therapy. This form of treatment will involve the patient talking about their condition and the issues related to it with a trained professional who will have had experience in working with individuals with mental health conditions as severe as dissociative identity disorder.
The therapist will attempt to lead the patient to an understanding of the underlying cause of their condition and form ways that suit them in coping with these traumatic circumstances. Eventually, the therapist will try to form a relationship of trust with their patient in order for the individual to feel comfortable in expressing their emotions.
The therapist treating a case of DID will need to have a thorough understanding of the condition in order to adequately deal with the different alters or personalities of the patient and be able to identify whom they are working with at any given session. The psychology behind these alters will be explained further in the section that follows.
Therapists will focus on trying to aid their patients in improving their relationships with loved ones and others and to feel comfortable with their emotions and how to express them. This can be conducted using family/group or individual psychotherapy. These therapy sessions will be paced carefully in order for the person dealing with DID to not be overwhelmed by strong emotions or anxiety.
A form of therapy that is used in a number of cases of DID is known as dialectical behaviour therapy (DBT). This kind of psychotherapy is a type of cognitive behavioural therapy that focuses on mindfulness and aids the patient through decreasing their negative reactions to specific stressors or triggers. Dialectical behaviour therapy focuses on the following factors:
- Identifying and labelling emotions
- Identifying any obstacles to emotions changing
- Increasing positive emotions and events
- Reducing vulnerability to specific emotions
- Increasing mindfulness to emotions currently being experienced
- Taking opposite action
- Applying techniques to aid in dealing with distress
The therapist will also guide the patient in finding a way that will allow for each of their alters to work together and coexist. As well as this, the mental health professional will also aid in developing techniques that will help to prevent crises and find ways in which to cope with memory issues and lapses that occur at periods of dissociation.
Therefore, the therapist will work towards achieving a peaceful coexistence within the individual’s different personalities. This goal is vastly different than reintegrating all of these multiple personalities into one single state of identity. While the goal of reintegration may form an integral part of the therapy sessions, this is sometimes done as an underlying goal as the patient suffering from DID may feel as though the therapist is seeking to ‘kill’ or ‘destroy’ certain parts of them and may feel attacked if this is the case.
Some professionals may also use hypnosis, though the scientific evidence to support this form of treatment is yet to be proven, there has been some research showing that hypnosis may be able to help change or ‘switch’ the patient between their different alters and give the therapist a more in-depth understanding of whom they are dealing with.
Hypnosis is also used to aid in increasing the information the patient has on their alters and increase the control they may have over these personalities.
Another form of treatment is known as EMDR (eye movement desensitisation and reprocessing). EMDR makes use of the individual’s traumatic memories and tries to reform them in a way that allows for the patient to see the distressing material in a new and enlightened way that is less disturbing. EMDR works through detecting the exact memory that is causing the dissociation and working with the individual to reimagine this in a way that does not provoke emotional distress in the present. EMDR has been seen to have positive results in improving the patient’s healing and processing of trauma.
There are currently no specific medications to treat someone with a dissociative condition, however, the medical professional working with the patient will typically prescribe medications to address a number of other health disorders that those suffering from DID often have, these include:
- Severe anxiety
- Impulse-control issues
Caution should be taken when administering medication to DID individuals as a number of these can often make the patient feel ‘numb’ and in a sense, ‘controlled’. This can cause the patient to experience a form of trauma and provoke emotions of distress.
Some medical professionals may explore the route of ECT (electroconvulsive therapy) combined with medication and psychotherapy in order to relieve the symptoms of dissociative identity disorder.
ECT is conducted under general anaesthetic. The patient will have tiny electric currents passed through their brain that will intentionally trigger a brief seizure. An ECT has been seen to result in changes to the brain’s chemistry that may be able to reverse the symptoms of a number of mental conditions.
What is the prognosis for dissociative identity disorder?
There has been research that shows that those suffering from dissociative identity disorder will have the best chance of living a healthy and productive life if they are able to undergo comprehensive treatment for their disorder. Granted, there are often a number of variables present in how different practitioners conduct their diagnostic procedure and treatment plans. These differences make it rather difficult to predict the outcomes for patients.
DID is still a largely misunderstood condition and requires a great deal of research in order for a more thorough understanding of the condition to be reached.
Can dissociative identity disorder be prevented?
Due to the fact that the cause of DID in most patients with the condition is related to the patient’s exposure to a traumatic event, the prevention of this condition lies in minimising the exposure that children have to trauma, especially in the form of physical and sexual abuse and helping the trauma survivor to deal with their past in a healthy and beneficial way.
How common is DID (dissociative personality disorder)?
Dissociation is a symptom that a number of people within the general population have said they have experienced in terms of feeling as though they are watching themselves through someone else’s eyes or as if they were in a film, this is known as the phenomenon of dissociation.
Roughly 0.01% to 1% of the general population have been diagnosed with dissociative identity disorder4. However, a number of professionals suggest that these low numbers may be due to patients not seeking treatment for their condition or acknowledging they may have it.
Experts believe that about 7% of the general population is likely to have some kind of dissociative disorder that is undiagnosed.
What effect does dissociative personality disorder have on someone’s life?
There are a number of ways that DID can change the psychological processes of an individual and therefore change the way in which someone experiences and lives their life. We have briefly touched on these psychological processes or elements earlier in the article, however, these factors have a vital role to play in the way in which an affected person will see the world and operate amongst their surroundings and will be explained as such.
These processes are described as follows:
- Depersonalisation – This refers to a sense of being detached from oneself and is often seen as or experienced as an out-of-body experience. The patient may feel distant or detached from their own body and in turn those around them.
- Derealisation – This is feeling detached from one’s surroundings and the world. Feeling as though the world is not real and reacting strangely as a way of trying to make sense of what is real and what is not.
- Amnesia – This refers to the individual’s failure to be able to recall vital personal information. Amnesia can take place in the form of micro-amnesia which involves the patient not being able to recall a previous discussion they engaged in, or when the individual loses track of the conversation in a matter of seconds.
- Identity alteration or identity confusion – These both involve the individual being confused as to who they are. For example, the individual may have issues defining what their interests are in their life or what their stance is on certain religious or political views. They may also suffer from distortions and alterations in their perception of time, situation and place.
It has recently been acknowledged that the above-mentioned states of dissociation are not referred to as full mature alters or personalities. Rather, these states represent a sense of disjointed identity. Amnesia is normally associated with DID as different states of personalities or alters will remember different parts of their autobiographical information.
Typically, there will be a ‘legal’ personality that exists within the affected person and who will identify with their birth name. Strangely enough, this host is often unaware of the other personalities and their existence within him or herself.
The different identities or alters of dissociative identity disorder explained
The following information describes the psychology behind the different personalities that are present in someone suffering from DID in order to put these and their functions into perspective.
Bear in mind, every individual with dissociative identity disorder will experience the illness differently, with each case having different alters and symptoms, although some individuals have similar personalities for certain roles.
Therefore, the therapist dealing with the patient will need a great deal of patience and expertise in terms of gaining the knowledge needed to learn about the patient, their past (which would have led to the development of DID) and most importantly, their alters.
How many identities or alters can one patient with dissociative identity disorder have?
The average patient suffering from DID will have between two and ten different alters. However, there have been some cases that have reported to have more than 100 alters.
What are the different kinds of alters one with dissociative identity disorder can have?
Those who have been diagnosed with DID may have vastly different identities. It is not uncommon for these alters to have different genders, ages, accents, nationalities or even different sexual orientations. The individual personalities, mannerisms and characteristics present are distinctly different.
Some cases have even had alters that have been aliens from space or animals.
There have also been instances in which one alter may have asthma or diabetes, and another does not. The names of the alters often have a significant meaning for the individual. For example, Melody may be a light-hearted individual who loves music. Some alters may have their role as their name, such as The Protector.
How are these different alters described or differentiated between?
It is vital to remember that these identities are the result of severe trauma and have thus been created to dilute and handle this trauma, even if the individual does not remember the specific stressful events.
Psychologists often describe the most dominant personality as the host. This is the alter who has control over the body for most of the time. The legal personality is the person suffering from the condition. Often the legal personality is not allowed to host or control the body as he or she is not strong enough to do so or is too overwhelmed to participate. It is sometimes the case where the different alters have deemed the host the strongest, with the best ability to take control of the body.
The alter that is referred to as the ‘presenting personality’ is the alter that is present during the time of treatment, this may not always be the host.
The personality that is most commonly found in those suffering from DID is that of a child who is innocent and naive. This child is often scared and remembers the time of trauma or abuse.
The alters are created as a result of the legal personality not feeling equipped to handle all the functions of their life such as maintaining a job, being a parent or any other function as a single person. Thus, the individual is divided into different components that when put together, are able to accomplish goals and meet the complex and difficult demands of daily life.
When these different personalities refer to themselves they make use of the word ‘we’. When they are referring to the group of different alters as a whole they may use words such as ‘the family’, ‘the group’ or even ‘the children’ if there is more than one child present within the identities.
Are the different alters aware of each other?
The personalities may not always be aware of each other in all cases but in some they are. The awareness between them is referred to as ‘co-consciousness’. Some of the alters may know of the other identities but have never interacted with them. However, only one personality will react with the surrounding environment at one time. During this time, the other alters may or may not perceive what is happening.
These alters often fail to understand that they share the same body as they view themselves as separate and distinct personalities. Issues of self-harm often develop because of this, some alters may disagree with each other and thus want to eliminate each other.
When an alter has control of the body they are described as being ‘out’.
Are the different personalities of dissociative identity disorder switched between at will?
Switching can be forced, triggered or consensual.
The changing between different personalities is often deemed as ‘switching’. This can take place within a few seconds or over a number of minutes. It may also be a gradual change over a few days. The switching is often brought about by stress or through psychological conflict such as brief memories of the trauma. The switching can also occur when different alters disagree about the way that relationships are conducted or who they should trust or about things like treatment and the administration of medication.
It is also possible for the individual’s surrounding environment to trigger a ‘switch’ such as a certain smell or person reminding them of their previous childhood trauma. This can often trigger the ‘child’ alter to emerge or ‘The Protector’.
During times of extreme stress, the switching between alters can be rapid and thus leave the individual confused and unaware of how they got to where they are.
During psychotherapy, switching can sometimes be brought on through the use of professional hypnosis. This allows for the therapist to access some of the alters and work with the patient’s system entirely.
What does switching entail?
There are a few internal indicators that suggest a switch is about to occur. This includes feeling ‘spaced out’ or depersonalised. Blurred vision may also accompany these signs and feel as though time is slowing down as the individual begins to feel the alter’s presence.
Some of the external indicators leading to a switch often include rapid blinking, this may resemble the actions of someone who is waking up, as well as mild muscle jerks or spasms, visible confusion, disorientation and checking their watch or a clock.
The individual may also clear their throat, change their stance and posture and even adjust their clothing slightly (in some instances, the individual may change their attire completely, though this is not always the case). These actions are done in order to allow for the new alter to come ‘out’.
It is not always necessary for the individual to undergo a full switch in terms of giving an alter the light entirely. Instead, an alter is able to exert a passive influence on the alter who is currently at the front or in control. These passive actions are often expressed through emotions, opinions, feelings and actions which often vary in their influence and strength. Thus, another alter is able to influence the alter in control to make certain decisions or voice certain opinions that the individual is unable to account for or explain.
These passive intrusions often allow for the alter in charge to gain abilities and skills they do not normally possess, one example may include the alter having the ability to speak in public when they normally suffer from social phobia and fear of public speaking.
In other cases, the alter in charge may temporarily forget loved ones as they may lose abilities or skills they normally have.
The memories that are gained through the passive influence will often fade once the passive intrusion is over, this leaves the alter in charge unable to recall what they may have previously been able to.
These forms of passive intrusions or passive influence are more commonly seen than complete switching and are often far more difficult for an onlooker to notice.
The majority of systems (combination of alters existing in an individual) will go to great lengths to hide their current condition and themselves, thus, downplaying and even denying their symptoms if and where they can.
This adds to the level of difficulty experienced when mental healthcare professionals attempt to conduct a diagnosis and find the most effective means of treatment.
What roles do the different personalities play?
These different alters or personalities often serve a number of diverse roles, as previously mentioned in the example of ‘The Protector’ or ‘The Child’. For example, there may be roughly two or four alters present at the time of an initial diagnosis. Over the course of the treatment, the therapist may begin to recognise or come to know an average of as many as thirteen to fifteen alters.
Each alter would have been created for a specific purpose and manifested as part of a coping mechanism by the individual as a reaction to a traumatic experience from their past, feeling as though they are not strong enough, as one person, to cope with everyday life and as a result create a number of facets or personalities that are equipped to handle certain situations.
- DID Research. 2016. Prevalence. Available: http://did-research.org/did/basics/prevalence.html [Accessed 23.08.2017]
- DSM Library. Dissociative Disorders. Available:http://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm08 [Accessed 23.08.2017]
- US National Library of Medicine National Institutes of Health. 2010. Is sex important? Gender differences in bipolar disorder. Available: https://www.ncbi.nlm.nih.gov/pubmed/21047158 [Accessed 23.08.2017]
- DID Research. 2016. Prevalence. Available: http://did-research.org/did/basics/prevalence.html [Accessed 23.08.2017]