What is dissociative identity disorder? Many people do not recognize this name. Instead, they are more familiar with its former label, multiple personality disorder.
Dissociative identity disorder (DID) is a complex, multifaceted disorder. The essential feature of DID is the presence of two or more different personality states. It can affect people of all ages, ethnicities, locations and socioeconomic statuses.
Why might someone have DID? Often times dissociation is seen as a response to a traumatic, stressful event. Emotional, physical or sexual abuse in children may contribute to an identity disorder such as DID. Dissociation is a way for individuals to protect themselves from trauma or a serious stressor. Following the initial trauma, stressful situations may exacerbate or worsen the symptoms of this identity disorder.
According to the American Psychiatric Association, certain diagnostic criteria must be met for a person to have DID. The most significant criterion includes possessing two or more distinct personality states. The individual has disruption in their sense of self and may have differences related to their behaviors, memories, consciousness, or affect depending on which personality state is present. Individuals may report these differences themselves, but the symptoms are most commonly observed by other people.
Another substantial diagnostic criterion is the experience of lack of recall of everyday events. For instance, an individual with DID may forget important personal information or extremely traumatic events that typically would be hard to forget.
The symptoms associated with DID must cause significant impairment in the individual’s life in order for that person to receive a diagnosis of DID. Their social or occupational functioning may be severely altered due to the presence of these symptoms. People of all ages may fit criterion for the diagnosis of DID. Children may experience symptoms of DID, but fantasy play or “imaginary friends” do not substantiate a diagnosis of DID.
DID is a somewhat controversial diagnosis. Diagnostic criteria are highly disputed, as are causes. Some experts believe that DID is caused by traumatic stress while others believe DID symptoms are produced artificially by psychiatrists using poor psychotherapeutic practices to manipulate individuals with DID (Gillig, 2009). Thus, the legitimacy or accuracy of the diagnosis is called into question. However, according to Brand, Loewenstein and Spiegel (2014), “The claims that DID treatment is harmful are based on anecdotal cases, opinion pieces, reports of damage that are not substantiated in the scientific literature, misrepresentations of the data, and misunderstandings about DID treatment” and the way people experience DID.
According to Floris and McPherson (2015), providers’ skepticism of the diagnosis may contribute to individuals’ uncertainty of their trauma and their own experience with this symptoms of DID. Some individuals have difficulty trusting their providers due to the field’s doubt of the diagnosis. Doubt and uncertainty plagued these individuals’ minds that were left wondering about the truth of their past trauma and whether their symptoms were simply “in their head.”
However, other individuals find hope in finding a diagnosis that fit with the symptoms they were experiencing (Floris and McPherson, 2015).
Many individuals with DID present with a comorbid disorder. Many times, the comorbid disorder is the problem being treated by a mental health professional, and dissociative identity disorder is recognized later. The identity disorder diagnosis is very serious and needs to be treated along with any other psychological issues the individual may possess. If the identity disorder remains untreated, the individual may incur further disability and debilitation.
Post-traumatic stress disorder (PTSD) is commonly found in individuals with DID. Many trauma-related and stress disorders are prevalent in this population. Other disorders most commonly seen in individuals with DID are depressive disorders and personality disorders, especially avoidant personality disorder and borderline personality disorder. Conversion disorders, somatic symptoms, eating disorder, substance-related disorders, obsessive-compulsive disorders and sleep issues are also generally reported. Because the individual with DID is experiencing alterations in their identity, their memory and consciousness may affect how they present these other symptoms of comorbid disorders.
Treating DID: Myths and Facts
Treatment, such as psychotherapy and medication, is available for people with DID. Given the field’s doubt over the validity of the disorder, some treatment is seen as ineffective and even harmful. Unfortunately, some providers even believe individuals with DID pose too much of a suicidal risk to treat; others providers are somewhat disturbed by the “bizarre, unsettling clinical presentation” (Gillig, 2009). Because of the difficulty of following the different identities, some providers believe that they cannot offer effective treatment for DID.
However, it is a common misconception that a diagnosis of DID holds no hope an individual. In fact, psychotherapy can be extremely beneficial for an individual diagnosed with DID. The provider has the power and ability to integrate the different identities into one therapeutic conversation with the individual. It is common for individuals to choose different names for their different identities. If a client is presenting as her “Sarah” identity, a provider may say something like, “What could Jennifer do to make it easier for her to manage her feelings of sadness?” Integrating the client’s identities or different clinical presentations can be helpful way to find ways of managing traumatic memories or flashbacks.
According to Brand, Loewenstein and Spiegel (2014), trauma-focused psychotherapy is most effective in treating people with DID. Meanwhile, “memory recovery” is not an effective method in treating this population. In fact, providers who delve into the history of the client with DID’s traumatic past actually report worsened symptoms. Effective treatment actually focuses on the opposite. Learning to self-regulate and contain the traumatic memory seems to be most effective in treating people with DID. Clients with DID are typically flooded with intrusive traumatic thoughts and difficult flashbacks. Mastery over traumatic flashbacks or memories and learning how to contain these thoughts and memories can help to reduce the client’s need to dissociate. All in all, there is hope for individuals who struggle with dissociative identity disorder.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.
Brand, B. L., Loewenstein, R. J., & Spiegel, D. (2014). Dispelling myths about dissociative identity disorder treatment: An empirically based approach. Psychiatry: Interpersonal And Biological Processes, 77(2), 169-189.
Floris, J., & McPherson, S. (2015). Fighting the whole system: Dissociative identity disorder, labeling theory, and iatrogenic doubting. Journal Of Trauma & Dissociation, 16(4), 476- 493. doi:10.1080/15299732.2014.990075
Gillig, P. M. (2009). Dissociative Identity Disorder: A Controversial Diagnosis. Psychiatry (Edgmont), 6(3), 24–29.