Dissociative Identity Disorder – Causes, Signs and Symptoms

Dissociative Identity Disorder

Also called: DID, Multiple Personality Syndrome, Multiple Personality Disorder, Split Personality Disorder

Summary

Previously known as multiple personality disorder (MPD), dissociative identity disorder (DID) is a very rare dissociative disorder in which two or more distinct identities (alters) control a patient’s thoughts and behaviors. DID is thought to result from a failure or inability to integrate identity, memory and consciousness. Patients with this condition have gaps in memory or an inability to remember important personal information. A patient’s passive identities have less complete memories than their aggressive personalities.

Dissociation is a psychological defense mechanism in which anxiety-provoking thoughts, emotions or physical sensations are separated from the rest of the psyche. Patients with DID may have 100 or more identities, although about half of all patients experience 10 or fewer identities. Just one personality controls a patient’s behavior at any given time, each distinct personality may have its own name, personal history and self-image. Psychosocial stress often triggers the transition from one identity to another. In most cases, these changes take just seconds, although the transition can be more gradual.

Childhood trauma (e.g., from physical, sexual or emotional abuse) is believed to be the chief trigger of DID. Patients with DID are frequently unaware that they have the condition and may seek medical help because of unexplained episodes of memory loss. A physician will perform a complete physical examination and compile a thorough medical history while trying to determine the cause of this memory loss.

During the physical evaluation, patients will be asked to recount a complete history of symptoms, including when they started, how long they have lasted and how severe they are. It is also noted whether the patient has had these symptoms before and, if so, whether and how they were treated. In addition, other tests and questioning may be performed to rule out other conditions – such as schizophrenia, bipolar disorder, anxiety disorders or factitious disorders – that may be the source of symptoms.

Psychotherapy is the primary treatment for DID. In most cases, patients are encouraged to remember any trauma they may have repressed and to gradually work through it. There are no medications specifically intended to treat DID. However, some medications used to treat other disorders (e.g., antidepressants, anti-anxiety medications) may be helpful.Because DID is so closely associated with childhood trauma, the best prevention method is helping children avoid situations where they might be physically, emotionally or sexually abused. In addition, parents should take their child to a physician soon after the child experiences any significant trauma.

About dissociative identity disorder

Dissociative identity disorder (DID) is a very rare dissociative disorder in which a person has at least two distinct personalities that control their behavior at different times. Previously known as multiple personality disorder (MPD), it often leaves patients with an inability to recall important recent and past personal information. It involves dissociation, a psychological defense mechanism in which anxiety-provoking thoughts, emotions or physical sensations are separated from the rest of the psyche.

An individual’spersonality is made up of lasting patterns of perceiving, relating to and thinking about oneself and the surrounding environment. People with DID may present as though they have more than one personality state and may switch suddenly from one of these identities to another. These identities – known as alters – may vary tremendously. For example, one alter may be quiet and shy whereas another is loud and boisterous. In some cases, patients may have alters of different genders and various ages. Despite having multiple alters, it is important to remember that these various alternate states are all manifestations of one single person.

Patients with DID may believe they have up to 100 or more distinct personalities. About half of all patients experience 10 or fewer personalities. Each personality has its own personal history, self-image and identity (including a name). These personalities may be aware of one another, but just one personality controls a patient’s behavior at any given time.

Most patients develop DID during childhood, although the disorder is not always recognized during the childhood years. It is diagnosed three to nine times more frequently in women than in men, and women tend to have more identities (15 or more) than men (who average approximately eight identities). Many patients with DID report a history of childhood abuse (e.g., sexual abuse). Some patients do not have history of abuse, but have experienced a significant early loss (e.g., death of a parent), serious medical illness, or other very stressful events. Symptoms of DID may appear less frequently in patients who reach their late 40s and beyond, but may re-emerge during times of stress, trauma or substance abuse. Stress often triggers the transition from one personality to another.

In recent years, a rise in the number of DID cases has been reported in the United States. Some believe that a greater awareness of DID among medical professionals has contributed to a higher number of diagnoses of the disorder. Others believe the condition is becoming over diagnosed. Patients with DID may also exhibit post-traumatic symptoms (such as nightmares or flashbacks), or be diagnosed with post-traumatic stress disorder.

Potential causes of dissociative identity disorder

Childhood trauma, such as physical, sexual or emotional abuse, is believed to be the chief trigger of dissociative identity disorder (DID). Other stressors that can trigger the condition include combat, natural disasters, kidnapping, torture and invasive medical procedures. In addition, genetic components may be a factor. Studies have shown that DID is more common in people who have a first-degree relative with the disorder.

Children who experience extreme stress,such as those who have been abused, may develop DID as a means of coping with the trauma. Children also have a greater ability than adults to step outside themselves and observe trauma in a third-person fashion. Children who dissociate in this way as a means of coping may continue to use the practice as adults whenever they are confronted with stress or anxiety-producing situations. Patients usually develop DID before adulthood. However, it is not unusual for a patient’s DID to go undiagnosed for years until they reach adulthood.

Signs and symptoms of DID

The chief symptom of dissociative identity disorder (DID) is the presence of multiple personalities, each of which controls the patient’s behavior at one time. Typically a patient’s primary identity has the person’s own given name and is passive, dependent, guilty and depressed. Meanwhile, other personalities – or alters – that surface at different times are more likely to be hostile, controlling and self-destructive.

The symptoms of DID include behavioral changes in the patient. These changes depend on which personality is in control. For example, the person may appear quiet or boisterous, male or female, or even right-handed or left-handed depending on the personality that is in control. In some patients, alters may have a different vocabulary, possess different general knowledge, have allergies or need eye glasses.

Patients who are under the control of one alter may not remember events that occurred when another alter was in control. Some alters may be aggressive toward certain people or toward other alters. People may exhibit up to 100 or more different identities. However, about half of all patients experience 10 or fewer personalities.

People with DID often experience episodes of amnesia or time loss. They may be greeted by people they do not remember meeting or find possessions they do not recall purchasing. Patients with DID may also suffer from depression or thoughts of suicide. Self-injury is commonplace among patients with DID and many patients have abused psychoactive substances at some time. About one-third of patients with DID may experience auditory or visual hallucinations, according to theNational Alliance on Mental Illness(NAMI). Children with DID have many of the same symptoms as adults, although symptoms are often less distinctive than they are in adolescents and adults. Children may also experience anxiety, difficulty paying attention in school and/or behavioral problems.

Diagnosis methods for DID

Patients with dissociative identity disorder (DID) are often unaware of the condition when they first visit a physician. Instead, they are likely to seek help because of unexplained episodes of memory loss. A physician will perform a complete physical examination and compile a thorough medical history while trying to determine the cause of this memory loss.

In addition, a physician may ask questions such as:

  • Are they unable to recall previous events?
  • Do they sometimes meet unfamiliar people who claim to know them?
  • Have they found themselves at a location without knowing how they got there?
  • Have they found any items they do not recall purchasing?
  • Are they depressed? Do they engage in self-injurious behavior or have suicidal thoughts?
  • Do they experience auditory (hearing) or visual (seeing) hallucinations?

A general physician may refer a patient to a psychiatrist. Because DID is closely associated with childhood trauma, the physician will attempt to obtain enough information from the patient to create a clear outline of the patient’s trauma history. The physician will also inquire about symptoms of post-traumatic stress disorder (PTSD) – such as flashbacks and nightmares – because the condition is often associated with DID. In addition, other tests and questioning may be performed to rule out other conditions – such as schizophrenia, bipolar disorder, anxiety disorders or factitious disorders – that in some cases may be the primary source of symptoms.

DID is diagnosed when a patient has at least two distinct personalities(or alters), each of which has a lasting pattern of sensing, thinking about and relating to the self and the environment. At least one of the alters must also come to the fore to control a patient’s behavior, and a patient’s inability to remember cannot be explained by ordinary forgetfulness. In addition, other factors – including substance abuse or a medical condition (e.g., complex partial seizures) – cannot be responsible for the patient’s unusual behavior.

Diagnosing DID in children can be difficult. Symptoms are often less distinct in children than they are in adolescents or adults. In addition, DID should not be diagnosed if symptoms can be attributed to imaginary friends or other fantasy play. The average time from first symptom to DID diagnosis is between six and seven years.

Treatment and prevention of DID

Psychotherapy is the primary treatment for dissociative identity disorder (DID). In most cases, patients are encouraged to remember any trauma they may have repressed and to work through it. Two types of therapy are particularly effective in treating conditions such as DID. Cognitive behavioral therapy helps patients to replace negative thoughts and behaviors with more positive alternatives. Creative art therapy teaches people to use outlets such as dance, art, drama, music and poetry to express thoughts and feelings and cope with trauma.

There are no medications specifically intended to treat DID. However, some medications, including antidepressants, anti-anxiety medications and tranquilizers may help with some specific symptoms such as anxiety and depression, but do not affect the disorder itself.  Because DID is so closely associated with childhood trauma, the best prevention method is helping children avoid situations where they might be physically, emotionally or sexually abused. In addition, parents should take their child to a physician soon after the child experiences any significant trauma.

Questions for your doctor regarding DID

Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions related to dissociative identity disorder (DID):

  1. What is DID?
  2. What causes DID?
  3. How common is DID?
  4. Do I have any symptoms of DID?
  5. I have frequent periods of amnesia. Does this mean I have DID?
  6. Are you certain that my symptoms are not caused by another mental health condition?
  7. How many personalities can a person with DID have?
  8. How many personalities do you suspect that I have?
  9. What are my treatment options?
  10. Which type of treatment will likely be most effective for me?
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