Dissociative Identity Disorder (DID) is a type of dissociative disorder. It most often develops in early childhood among children who experience long-term trauma, such as emotional, physical, or sexual abuse, neglect, or unpredictable caregiver behavior.
DID was called multiple personality disorder up until 1994, when the name was changed to reflect a better understanding of the condition—namely, that it is characterized by fragmentation or splintering of identity, rather than by proliferation or growth of separate personalities. Approximately 1-3% of the population is affected by DID.
The Development of Dissociative Identity Disorder
Among individuals with a psychiatric disorder, those with DID report the highest rates of childhood trauma, particularly physical, sexual, and emotional abuse that often begins before the age of six. Therefore, DID can be conceptualized as a childhood-onset posttraumatic developmental disorder. Due to exposure to trauma, the child is unable to complete the normal developmental processes involved in consolidating a core sense of self.
Along with the traumatic experiences, the child may have encountered issues with a disturbed caretaker-child attachment and parenting difficulties. These experiences disrupt the development of normal processes involved in the consolidation of a unified sense of self. Therefore, the child fails to integrate the different experiences of self that normally occur across different states and contexts.
DID has been found in children, adolescents, and adults. Unfortunately, early trauma may be a risk factor for later trauma. DID individuals report very high rates of adult rape, intimate partner violence, and other forms of exploitation, such as being a victim of trafficking. DID is often misunderstood and portrayed incorrectly in popular media. Nearly every movie or TV show that has depicted DID has incorrectly represented the condition. As a result, many people have a total misunderstanding of DID.
Recognizing Signs and Symptoms of Dissociative Identity Disorder
Most people with DID rarely show noticeable signs of the condition. Friends and family of people with DID may not even notice the switching—the sudden shifting in behavior and affect—that can occur with the condition.
Although people with DID have a strong internal sense of identity fragmentation, it is a common misconception that people living with DID display “multiple personalities.” In fact, in most individuals, the condition is hidden.
In most individuals with DID, switching/shifting of states is subtle and may occur with only subtle changes in overt presentation. In general, the individual with DID experiences himself as multiple, simultaneously overlapping and interfering states.
A diagnosis of dissociative identity disorder should be suspected if the person has received numerous different psychiatric diagnoses yet does not respond to many treatments, including multiple medications or various types of psychotherapy.
Symptoms of Dissociative Identity Disorder (DID)
For the diagnosis of DID, there has to be evidence that the person has problems with either past and/or present memory. Also, there has to be evidence supporting a division of the personality. Basically, there have to be indications that something is working behind the scenes to control the person’s thoughts, feelings, and/or behavior.
Individuals with DID often conceal, or are not fully aware of, disruptions in consciousness, amnesia, or other dissociative symptoms. Furthermore, the symptoms of DID can vary widely from person to person. Oftentimes, the individual with DID will spend 5 to 12.5 years in mental health treatment until a correct diagnosis is made.
Memory Problems
The issues with memory can manifest in several different areas of a person’s life. The individual may have difficulty remembering important events, such as graduations, birthdays, weddings, and vacations. Secondly, the person may have lapses in memory of recent events or well learned skills such as how to do one’s job, use a computer, cook, or drive. Furthermore, the individual may discover possessions that they have no memory of ever owning or purchasing
such as clothing, tools, writings, or drawings.
Individuals may also report major gaps in ongoing memory, such as experiencing time loss, blackouts, or coming to in the middle of doing something. Memory problems may be apparent to others, such as when the individual does not recall something that others have witnessed that he or she did or said, cannot remember his or her own name, or may fail to recognize spouse, children, or close friends.
Division of the Personality
Individuals with DID have experienced a structural division of the personality into multiple compartmentalized parts as a direct reaction to the experiences of trauma. The symptoms of a division of the personality may include hearing voices, strong emotions, dissociation, intrusive thoughts, feeling divided, physical symptoms, and suicidal behavior.
Hearing Voices
One of the most common symptoms of DID is hearing voices, most often within the mind. These are often experienced as having their own sense of self, such as a child’s voice, an angry voice, a caring and supportive voice, among others.
These individuals may also report experiencing perceptions of voices that comment on their thoughts or behavior. They may experience persecutory voices that call them names or tell them to hurt themselves or to hurt others.
In some cases, hearing voices is specifically denied, but the individual reports multiple, perplexing, independent thought streams over which the individual experiences no control. The person may also experience strong thoughts that don’t seem to belong to them and over which they have no control.
Emotions
The individual might experience sudden impulses or strong emotions that they don’t feel in control of or a sense of ownership. The person may also experience a change of emotion for no particular reason. They may go from being happy to feeling sad or angry that is not due to circumstances.
Conversely, the person may experience having thoughts and emotions that unexpectedly vanish. These experiences are frequently reported as being outside of their control and puzzling.
Dissociation
Individuals with DID may report the feeling that they have suddenly become depersonalized observers of their own speech and actions, which they may feel powerless to stop. Those with DID often experience dissociation in which they feel detached from their own thoughts, emotions, or sense of identity. It’s like an automatic escape from reality, often triggered by overwhelming stress or traumatic experiences. This disconnection can affect one’s perception of time, memory, and self-awareness.
Examples of this are when a person becomes so absorbed in a book or film that they lose awareness of their surroundings. The individual may drive a familiar route and arrive at their destination without any memory of how they got there. Furthermore, the person may feel disconnected from the world around them, as if seeing through a fog, or they may feel as though the world around them isn’t real. These are just some of the many examples of how dissociation can manifest in a person’s life.
Thoughts
Those with DID may experience repeated, inexplicable, sudden intrusions of thoughts, feelings, urges, or actions that one does not control. The person may experience a sudden shift in attitudes, outlooks, and personal preferences, such as food, activities, and gender identity. Conversely, the individual may experience the sudden deletion of thoughts, feelings, or behaviors that one does not control.
Feeling Divided
Some people with DID may have the experience of feeling divided with different senses of self that seem relatively independent of one another and often are in conflict or struggle. The person may at times inexplicably feel very different with varying opinions, abilities, habits, and access to memory and learned information.
Physical Symptoms
DID may produce physical symptoms in the body for which there is no known medical cause. The signs and symptoms may vary, but typically affect the person’s movement or senses, such as the ability to walk, swallow, see, or hear. Some people may experience Psychogenic Non-Epileptic Seizures (PNES), which look and feel like seizures caused by epilepsy but are caused by abnormal electrical activity in the brain. The physical symptoms can vary in severity and may come and go or be persistent. However, the person can’t intentionally produce or control
their symptoms.
Suicidal Behavior
Individuals with DID have very high rates of self-destructive and suicidal behavior and often have multiple, usually unproductive, hospitalizations for mood disorders, personality disorders, and/or psychotic diagnoses.
Treatment of Dissociative Identity Disorder
DID is a treatable disorder once it is properly diagnosed. Clinicians who understand DID symptoms can diagnose DID in the clinical interview. Although there are no medications that specifically treat this disorder, antidepressants, anti-anxiety drugs, or tranquilizers may be prescribed to help control the associated psychological symptoms. But, with effective treatment from mental health providers who are trained in trauma and dissociation, people with DID can and do recover. People with DID can live full and productive lives.
If you or a loved one is struggling with DID, contact New Horizons Counseling today and start your treatment journey today!