Dissociative Identity Disorder
Dissociative Identity Disorder (DID), previously called Multiple Personality Disorder, is characterized by the fragmentation of a person’s identity into two or more distinct personalities. Multiple personalities exist within one person and alternate taking control of his or her conscious awareness. Dissociative Identity Disorder is a type of dissociative disorder that involves feelings of detachment from self, often described as an out of body experience. It can cause problems with memory, perception, emotion, and identity. The development of DID is often associated with severe trauma.
What Is Dissociative Identity Disorder?
Dissociative Identity Disorder (DID) is a complex mental health condition in which a person experiences severe disassociation from their feelings, behavior and/or identity. Although many people have experienced the sensation of being in a “dreamlike” state, or feeling outside of themselves, disassociation related to DID is much more severe and causes disruption in daily life. Connections between memory, behavior, emotions, and sense of self is disrupted, usually as a coping mechanism to deal with situations or experiences that are too traumatic or violent for the individual’s conscious self.
Prior to 1994, Dissociative Identity Disorder was known as Multiple Personality Disorder. The most commonly accepted opinion at that time was that multiple personalities developed as separate identities within an individual, rather than developing from a fragmented single identity.
Current thinking, however, is that different personalities represent parts of an identity that have failed to integrate, rather than multiple intact identities inhabiting one person. In other words, it isn’t that several people are living inside one body, but that several parts of one person’s identity are operating independently. Since the parts do not function together to create a unitary sense of self, they create multiple selves that embody separate parts of the whole. Each part might have a different age, sex, history, and may hold subtle differences that set it apart from the others and change the way they relate to or perceive the world. Different personalities alternate control over the person’s conscious awareness and behavior, often causing lapses in memory that far exceed, and are very different from, typical occurrences of forgetfulness.
Types of Dissociative Disorders
Dissociative disorders involve a disconnection between a person’s memories, thoughts, behavior, emotions, consciousness, and identity. This disconnection generally results in a sort of involuntary break from reality in response to a traumatic event or situation.
- Dissociative amnesia occurs when a person cannot remember certain important facts and information about events, him or herself, or the people in his or her life. The dissociation maybe localized, where an individual is unable to remember a specific event or period of time—usually a traumatic event like abuse, military combat, or extreme pain or violence. It may be selective dissociation, illustrated by the inability to remember a specific aspect of a single event, or a set of events that took place within a particular period of time. Or it may be generalized disassociation, which is the complete loss of one’s identity and life history. Generalized dissociation is rare.
The onset of dissociative amnesia tends to be sudden and can last for a few minutes, several hours, days, and in rare cases for months or even years. It also can happen at any age and may occur several times over the course of a person’s life.
- Depersonalization/Derealization Disorder occurs when a person experiences episodes of either depersonalization or derealization, or both. Depersonalization is characterized as feeling detached from self, mind, or body. People who experience depersonalization sometimes describe it as an “out of body experience,” where they feel outside of their bodies, watching events as they happen to them.
Derealization is described as feeling detached from one’s surroundings or environment, as if other people or things are not real. During episodes, time may be sped up or slowed down. These incidents can be distressing, because people who experience derealization are aware of reality and that their feelings of detachment are unusual. During episodes of derealization, an individual may appear to lack emotion or be unreactive, even though he or she is experiencing significant distress. Incidents may last a few moments and may occur intermittently over a period of years. Usually, symptoms of derealization begin to appear in childhood, with the average age of onset at 16.
Less than 20 percent of people who suffer from depersonalization/derealization disorder develop the first symptoms after the age of 20.
Facts And Statistics
Whether called Dissociative Identity Disorder or Multiple Personality Disorder, controversy surrounds this mental health issue. Though it is a recognized mental health disorder, medical professionals and scientists still debate whether DID is a subset of another disorder or its own issue. It is hard to identify, diagnose, and treat. And research is often inconsistent in its focus and findings. However, it is estimated that almost half of American adults experience at least one episode of disassociation, but only about two percent meet the criteria for official diagnosis per the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
Women are more likely than men to be diagnosed with Dissociative Identity Disorder. And symptoms generally develop in response to a severe traumatic event, like military combat, extreme violence, life-threatening events, or long-term, repeated abuse. About 90 percent of people who have DID have been abused. The average number of personalities present is between 8 and 15, but some extreme cases have had up to 100 personalities present.
Self-injurious behavior is common with people who suffer from Dissociative Identity Disorder, and nearly 70 percent of people with DID have attempted suicide.
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Symptoms And Diagnosis Of Dissociative Identity Disorder
DID can be difficult to diagnose, because the symptoms can often look like other mental health issues. But the DSM-5 sets forth specific requirements to help identify the specific characteristics of the disorder. There must be:
- Two or more distinct personalities present that embody their own memories, behaviors, sense of self, and methods of thinking, perceiving and relating to the environment
- Amnesia that appears as gaps in memory of daily events, specific traumatic events, memories of important personal information and/or information relating to people in the individual’s life
- Significant distress or disruption in daily functioning in one or more major life areas
- Disturbances that are not a part of a cultural or religious practice
- Symptoms that are not related to the physiological effects of substance abuse, or other medical conditions
Other symptoms of Dissociative Identity Disorder can range from mild to severe and include:
- Mood swings
- Sleep Disorders like sleep walking, insomnia, and night terrors
- Anxiety, panic attack and phobias
- Auditory and visual hallucinations
- Suicidal tendencies and suicide attempts
Causes and Risk Factors
The development of Dissociative Identity Disorder is not different from how Multiple Personality Disorder was originally characterized. It is most commonly associated with significant trauma, extreme violence, repeated life-threatening events, and long-term, repeated and severe sexual and physical abuse, particularly during childhood. The theory is that personal identity has not yet formed in childhood, so severe traumas can interrupt that development of identity. This also makes it easier for children to disassociate and “step outside of themselves”—to observe the trauma as if it were happening to someone else.
Risk factors include an ability to easily dissociate, not having safe and nurturing resources available to help deal with abuse or trauma, and the development of a coping style, which helps alleviate distress during traumatic events and that also uses “splitting” of the identity as a survival skill.
Since girls and women experience physical and sexual abuse more than men, at a rate of about 10-to-one, women are more at risk for developing Dissociative Identity Disorder than are men.
Physical and sexual abuse are not necessarily the only forms of abuse that can put a person at risk for developing DID. Persistent neglect and/or emotional abuse can also be a factor. It has been observed that children could become dissociative in families where the parents were persistently unpredictable, frightening, and oppressive.
Dissociative Identity Disorder often co-occurs with borderline personality disorder, depression, anxiety, and post-traumatic stress disorder. The symptoms overlap in several areas and can often create difficulty in diagnosis. For instance, feelings of sadness and emptiness could be related to depression at one time, but in another moment may be a personality reliving an event that was sad. Symptoms may come and go depending on the situation, making it difficult to identify the root cause.
People with co-occurring DID and other disorders are often misdiagnosed and do not receive effective treatment. Additionally, people with co-occurring disorders often experience more severe symptoms and greater trauma because of the disorder. In fact, incidents of self harm, risky behavior, sexual dysfunction, and suicidal tendencies significantly increase when Dissociative Identity Disorder co-occurs with other mental health issues.
It is important to seek diagnosis and treatment in order to better manage DID, particularly if it co-occurs with another mental health disorder.
Treatment and Prognosis of Dissociative Identity Disorder
DID will not just go away on its own—in fact, symptoms often become worse over time, particularly if other disorders are also co-occurring.
With treatment, many people see a significant improvement in their ability to function in daily life. How well a person responds to treatment depends largely on the severity of their symptoms and the quality and duration of their treatment.
Treatment for Dissociative Identity Disorder is similar to that for treatment for most mental health disorders: a combination of psychotherapy and medication.Several types of talk therapy are used with the goal of deconstructing the separate personalities and reunifying them as one.
Long-term, residential care with a therapist who has advanced training or specializes in helping people who have suffered trauma can be very beneficial treating Dissociative Identity Disorder.
When other disorders co-occur with DID, treating those disorders is also important for overall improvement.
There are no medications that specifically treat Dissociative Identity Disorder. Generally, medications are used to treat symptoms associated with other mental health disorders. The most common are anti-anxiety medications to treat anxiety, antidepressants to treat depression, and antipsychotics to treat auditory or visual hallucinations.