What Is Dissociative-Identity Disorder (DID)?

Dissociative-identity disorder, also known as DID or DID disorder, is a complex psychological condition, in which a person develops one or more alternate personalities typically as a coping mechanism for extreme trauma or abuse that occurred in early childhood. DID is sometimes referred to as multiple-personality disorder. A person with dissociative-identity disorder has the ability to switch personalities, often without warning, leading to changes in behavior, appearance, mannerisms, and even self-identity. The person’s original or “core” personality can coexist with these alternate personalities, or “alters,” while remaining unaware of them.

DID is a rare condition but one associated with very real costs in personal wellbeing. It is more common in women than in men. If someone you know is demonstrating dissociative-identity behaviors, the health-care experts at Baptist Health may be able to help.

Symptoms

DID disrupts the normal operation of the mind in several ways. There are five psychological traits that define it:

• Amnesia: An extensive loss or blocking out of memory. This may occur in conjunction with the childhood trauma that led to the dissociative state or the lack of awareness when switching personalities. Memories of life events are sometimes divided up or compartmentalized among the alters.
• Depersonalization: The psychological sense of being detached from, or outside of, one’s own life. Depersonalization is sometimes described as viewing one’s self from someplace outside or above the body.
• Derealization: A persistent feeling that the world is unreal.
• Identity confusion: Uncertainty about who one is, including beliefs, interests, life goals, and even sexual orientation.
• Identity alteration: The creation of alternate personalities, or alters, that intermittently take over from one’s core personality.

More specifically, dissociative-identity disorder symptoms include:

• Sudden headaches and body pains
• Depression and mood swings
• High levels of anxiety
• Drug and alcohol abuse
• Eating disorders
• Troubled sleep or insomnia
• Sexual dysfunction
• Behavioral variation, ranging from hyper-efficiency to sloth and incompetence
• Hallucinations
• Self-injury or violent behaviors.

Persons with DID are considered a suicide risk. In fact, seven persons out of ten with DID attempt suicide at some point during their lives.

Examples of Dissociative Behavior

Persons with dissociative-identity disorder often experience unusual and highly dramatic changes in behavior:

• Personality switches: An individual who is normally polite and reserved might, without warning, start behaving in a loud, aggressive, or antisocial manner. 
• Out-of-body experiences: Some persons with DID observe themselves engaging in reckless or destructive activities, without any sense of identification with what they’re observing. 
• Amnesia: It is not uncommon for people with DID to experience total memory loss for actions they took during particular spans in their life. 

Dissociative disorders share characteristics with other psychological mechanisms for dealing with trauma, including acute stress disorder and post-traumatic stress disorder (PTSD).

Causes

DID appears to be a complex psychological mechanism for dealing with extreme childhood trauma, usually occurring before age six. It has been estimated that more than 90 percent of all cases involve some form of serious abuse or neglect. The nature of this abuse can vary, being physical, sexual, or psychological, or it can result from social or environmental disruptions, such as warfare or natural disasters. DID “solves” the issue of traumatic memory by hiding it from consciousness, often in one or more alternate personalities.

Personality switches may be linked to feelings of stress or uncertainty. What seem to be relatively trivial occurrences – getting a parking ticket, for instance – can result in over-reactive responses as an assertive personality takes over from a shy or mild-mannered one.

Diagnosis

Because DID shares symptoms with other psychological disorders, your physician or mental-health provider may find diagnosing this condition complicated. Here are some steps he or she is likely to take:

• Physical exam: An exam is an important means for ruling out an underlying physical or medical cause for your condition.
• Lab work: Your exam may involve blood tests and other forms of lab work, with the goal of further eliminating illness or medication side effects as a cause.
• Psychological evaluation: In the absence of illness, you may be referred by your physician to a mental-health provider. The latter will want to discuss and document your thoughts, feelings, personal history, and patterns of behavior. He or she will use this information, in accordance with the criteria published by the American Psychiatric Association in the Diagnostic and Statistical Manual of Mental Disorders, or DSM, to make a diagnosis.

The DSM-5 criteria are:

• Presence of two or more distinct personalities in one individual
• Periodic episodes of amnesia
• The condition is a source of dysfunction and disruption
• The condition is not correlated with a cultural or religious practice
• Symptoms cannot be blamed on physical illness, substance abuse, or medication side effects.

Treatment

Several different therapies are used with DID. Their goal is three-pronged: symptom relief, reduced risk of violence or self-injury, and integration of the core and alternate personalities into a single, healthy identity. 

Treatment Options for Dissociative-Identity Disorder:

• Psychotherapy: Also called talk therapy, psychotherapy is the primary method for treating DID. There are several versions of psychotherapy, including cognitive-behavioral and dialectic-behavior therapy, each with a specialized approach to dealing with dissociative behaviors.
• Family therapy: This form of psychotherapy involves family members, helping them understand the nature and risks of DID, and how they can assist a loved one in treating it.
• Creative therapy: Art and music therapy can be safe outlets for DID patients to express their feelings, fears, and concerns.
• Hypnosis: Hypnosis is a tool that mental-health providers use to access alternate personalities directly, which enables them to explore the sources of a person’s fragmented identity.
• Meditation and relaxation techniques: Techniques such as these allow persons with DID to recognize and better address the anxieties that underlie their condition.
• Eye Movement Desensitization and Reprocessing (EMDR): This is a specialized technique for dealing with the flashbacks and nightmares experienced by people with traumatic memories.
• Anti-depressant and anti-anxiety medications: Medications can’t cure DID but they can treat some of the associated symptoms, especially those related to high levels of anxiety.