Dissociative identity disorder (DID), previously referred to as multiple personality disorder (MPD), is a mental illness that involves a breakdown of memory, identity, awareness and/or perception. DID is a diagnosis that falls into a group of conditions, known as dissociative disorders. Someone diagnosed with dissociative identity disorder is said to have a split personality, which is the result of the dissociation. Dissociation is a mental process that produces a lack of connection in the persons memories, thoughts, feelings and/or sense of identity.
What are Dissociative Disorders?
The definition of dissociative disorders in the DSM-5 is broken down into several categories that consists of a variety of mental illnesses including dissociative amnesia, derealization disorder and/or depersonalization disorder. One of the primary features of the dissociative disorders is the dissociation process, which is described as a coping mechanism a person uses in an attempt to disconnect or separate themselves from a traumatic or stressful situation. When a child is faced with overwhelming and continued traumatic situations where they cannot physically escape, they “go away” in their head. The dissociation process allows them to separate themselves from the thoughts, memories, pain and feelings associated with the experience, allowing them to function as though the traumatic experience had never occurred.
The dissociation severs as a defense mechanism against both the emotional and the physical pain that may occur during a stressful and/or traumatic experience. It is often described as a type of self-hypnosis or a temporary mental escape away from the pain and fear associated with the trauma. When the dissociation is continually repeated, such as in the case of repeated abuse, the dissociated mental state may begin to take on its own separate identity, also known as dissociative identity disorder.
What Exactly is Dissociative Identity Disorder?
Dissociative identity disorder is the most severe form of the dissociative disorders. Someone with DID has two or more different personality mental state, which are often referred to as “alters” (alternative personality states). Each alter takes control over the persons behavior, actions and thoughts at some point. Each alter typically has distinct traits, ways of thinking about things relating to the surrounds and a personal history. Alters often have his or her own name, may be of a different gender than the host (the person diagnosed with DID) and may have distinct preferences and/or mannerisms.
The individual who is living with dissociative identity disorder may have as many as 100 different alters. The alters often become stable and continue to play a specific role in the hosts life for several years. The individual alters may eventually take on their own identity and will often change, depending on the situation, the changing of alters is known as switching.
When the host is under the control of an alter, they are typically unable to remember most of the events that happened while the other “personalities” were in control. Along with the different mannerisms and behaviors, the alters may also present different physical differences than the host, such as being left or right handed, having allergies or needing prescription eyeglasses.
Dissociative Identity Disorder Symptoms
A diagnosis of dissociative identity disorder is primarily characterized by the presence of two or more split identities or distinct personality states that continually have control over the persons behavior. The person is also unable to recall specific personal information and they have distinct memory variations. Many of the symptoms of DID are similar to several other mental and physical disorders, including seizure disorder, substance abuse and/or post-traumatic stress disorder. Along with the distinct personality splits, other symptoms may include:
- A change in level of functioning
- Severe headaches
- Pain in various parts of the body
- Mood swings
- Anxiety/panic attacks and/or nervousness
- Sleep disorders, such as night terrors, insomnia and/or sleep walking
- Substance abuse
- Auditory and/or visual hallucinations
- Eating disorders
- Rituals and compulsions
- Repeatedly meeting people who seem to know them, but they do not recognize
- Self harm/self-mutilation
- Suicidal tendencies and/or attempts
Causes of Dissociative Identity Disorder
Dissociative identity disorder can effect persons of any age, ethnic group and income level. However, there have been numerous studies done on the cause and effect of DID and more than one study has shown that the disorder affects women more than men.
DID is thought to be the effect of severe trauma that occurred during early childhood. Typically the trauma was extreme and involved repetitive emotional, sexual and/or physical abuse. The individual learns to dissociate as a coping mechanism during when situations or experiences are extremely violent, painful and traumatic.
Treatment of Dissociative Identity Disorder
Fortunately, there are a variety of treatment methods available for treating individuals who have been diagnosed with DID. The primary goal of treatment of dissociative identity disorder is to integrate the different personalities into a single personality. Unfortunately, integration is not always possible. In a situation where the different personalities cannot be integrated, the goal of treatment is for the person to be able to maintain a harmonious interaction among the various personalities in order for the host to have more “normal” functioning. Other goals of treatment include ensuring the safety of the individual, developing new life and coping skills, improve relationships and to restore memory functions. Some of the treatment methods may include:
- Psychotherapy, which consists of various psychological techniques designed to improve and encourage communications and to have a greater insight into the problem. Psychotherapy is usually emotionally painful, because the person eventually recalls the traumatic memories that were being blocked by the dissociations. Psychotherapy is intensive and may require several sessions per week for several years. In some situations, the individual may need to be in a psychiatric hospital to help them through the difficult memories.
- Cognitive therapy is used to help the individual learn ways to change dysfunctional thinking patterns.
- Family therapy is used to help educate the families about DID, its causes and to help the family members recognize symptoms of a dissociative recurrence.
- Creative therapies, such as music therapy and/or art therapy are often used to help the person express their thoughts and feelings in a creative and safe way.
- Hypnosis is often used to help with relaxation and concentration and to help focus attention to an altered state, which allows the person to learn the feelings, thoughts and memories that may have been hidden from their conscious mind, such as during the switch of an alter.
- Medications are not used to treat the dissociative identity disorder itself, but to help with some of the symptoms associated with the disorder. For example, if the person is depression or anxious, medications such as antidepressants or anti-anxiety medications may be prescribed.
During therapy, the therapist will attempt to make contact with as many of the alters as possible in an attempt to understand their roles in the persons life. The therapist also attempts to form a relationship with any of the personalities that may be responsible for self-destructive and/or violent behavior in order to help curb the behavior. The therapists also tries to establish communication with the personalities that are able to recall the memories of any traumatic events in the persons life.
Prognosis of Dissociative Identity Disorder
The prognosis of someone with dissociative identity disorder depends on a variety of factors, including the features and symptoms of the diagnose that the individual has. For example, if the person has other serious mental illness disorders, such as mood disorders, substance abuse and/or eating disorders, the prognosis is typically poorer. Treating the additional mental illnesses may interfere with the mental and physical well-being of the host, due to the fact that some of the other illnesses, such as substance abuse may be the result of an alter. So, treating a diagnosis that an alter displays symptoms of may interfere with the treatment of the DID for the host.
Fortunately, someone with dissociative identity disorder will typically respond well to treatment. Some of those diagnosed with DID may be reluctant to integrating the different personalties, because the various identities are what help them cope with their surroundings. It is important to treat other problems, such as depression and/or anxiety; however, it is extremely important that the individual be monitored during treatment to prevent an alter from interfering with the hosts treatment. Some of the complications associated with DID can be serious, chronic and may lead to problems with their daily functioning and/or disability. Someone with dissociative identity disorder is typically at a high risk of suicide attempts, violence, self-injuries, substance abuse and victimization by others.
Is Prevention Possible?
It is not known exactly if dissociative identity disorder can be prevented, since the disorder is typically associated with childhood trauma, the only logical prevention would be the elimination of the abuse. So, prevention may not be an option, however, seeking treatment in addition to an immediate intervention following traumatic events, may help to significantly reduce the risk of the person developing a dissociative disorder. The disorder is often referred to as an extremely creative technique for survival, because the disorder allows the person to endure a traumatic event, while preserving some for their healthy functioning.
Over time, a child who is repeatedly emotionally, sexually and/or physically assaulted, the defensive dissociation becomes a conditioned and reinforced defense mechanism for survival. In many situations the dissociative escape is so well practiced that the child will be able to automatically use it whenever they feel anxious or threatened, even if the situation is not an abusive one. If you suspect a child may be experiencing abuse of any nature, it is critical that you contact the proper authorities as soon as possible. If you suspect you or someone you know may be displaying the symptoms of dissociative identity disorder, it is important to contact a mental health professional as soon as possible. In some situations, treating the outlining physical and/or mental illnesses, such as depression may require hospitalization in order to closely monitor the individual, especially if the host is depressed, but one or more of the alters display other illnesses, such as substance abuse. During hospitalization, the person will have access to a full staff of mental health professionals. It is extremely important to not try to force the alters to “come out” without medical supervision, as this can be extremely dangerous for the host.