Protecting Identity: Dissociative Identity Disorder

Once referred to as Multiple Personality Disorder, the rare mental health condition Dissociative Identity Disorder (DID) is diagnosed in less than 200,000 cases per year in the United States. A person who has experienced extreme and traumatic events may develop the condition as a way for the mind to protect (dissociate) memories and identity.

What Exactly is Dissociative Identity Disorder?

Dissociative Identity Disorder creates a splintered effect, dissociating the person’s mind and memories from traumatic memories or a series of events. This dissociation causes two or more personalities to emerge.

These personalities are fully formed with memories, backstories, motivations, and goals. They are completely separate and distinct from the person’s original personality; however, the identities are believed to be disjointed and tied to the “host” although they may be unaware that they have DID.

DID is one of the three types of Dissociative Disorders, a group that includes Dissociative Amnesia and Depersonalization/Derealization Disorder. The Diagnostic and Statistical Manual of Mental Disorders (DSM-5) from the American Psychiatric Association states that DID is the “disruption of identity characterized by two or more distinct personality states or an experience of possession.”

The person with Dissociative Identity Disorder may not remember certain events, lose gaps in time, or specific memories, including personal information. If another personality emerged during that time, the person may not have any recall of the events – it’s as if the person wasn’t there at all – only the other personality witnessed the event. Or, the person may have been “present” while another personality was in the lead, but they were unable to take control of their body.

According to the Merck Manual Consumer Version, there are two forms of Dissociative Identity Disorder: possession and nonpossession. With the possession form, the person feels that there is an outside force, such as a demon, possessing their body. However, with the nonpossession form, the individual feels a shift like they are watching and listening to their body from a faraway place.

This dissociation from reality and from the self can last for hours to weeks or even months. Without proper treatment, the person’s condition may continue to deteriorate. Help is available; however, the condition is one that is lifelong. Although the patient may opt for therapy and medication, they may need treatment for the rest of their lives to remain at a functional level, depending on the severity of the condition.

The Causes of DID

Often, the cause for DID is extreme trauma or abuse during the early childhood years. According to the Merck Manual Consumer Version, an estimated 90% of patients with the disorder in the United States, Canada, and the U.K. developed the condition due to childhood abuse or neglect. Although it is possible for people who experienced severe stress such as the loss of a loved one to develop the condition.

Who is at Risk?

Children from abusive or neglectful homes are at risk of developing DID, as well as those that lost a parent suddenly or lived through a medical crisis. As these children grow, if not nurtured and comforted by caring people, their experiences may separate and create identities to protect the child’s mind. It is mostly children that develop DID, but the symptoms may not become troublesome or apparent until they are much older.

Symptoms to Look for in Dissociative Identity Disorder

Dissociative Identity Disorder symptoms go beyond simply forgetting things. A person with DID may exhibit distinct feelings, postures, behaviors, and memories that the individual wouldn’t normally show. For example, a prim and proper young woman may start identifying herself as an older male truck driver in her behaviors and speech. She may have a back story with new memories and a change in perspective that would only be true if she were that driver. However, as the host, the young woman is probably unaware of this shift into a new and separate personality.

Other symptoms of DID include:

• Gaps in time and memory – The individual may suffer from blackouts and lose track of time. They may be unable to recall events and personal conversations and experiences although they were physically present at the time.
• Headaches – Some patients with Dissociative Identity Disorder report terrible headaches. These headaches may be due to emotional stress.
• Dissociation from their physical body – The person with DID might complain about feeling as if they are viewing their life like a movie, as an “out of body” experience.
• Violent behaviors – Although more women are diagnosed with Dissociative Identity Disorder, more men exhibit angry and violent behaviors. These behaviors might be due to unacknowledged childhood abuse or trauma.
• Self-sabotaging behaviors – Some people with DID perform self-sabotaging actions such as not going into work for days at a time, confrontations with others, binging or starving themselves, or imbibing in illegal substances.
• Harming themselves and/or others – Patients may self-harm with cutting or another type of mutilation. Or, they may become abusive to their spouses or children.
• Loss of reality – The individual may adopt a distorted view of the people and places that surround them. They may have difficulty identifying what is true and what is imaginary. Hallucinations may also increase.
• Confusion about their own identity – Although these splintered personalities may exist, the host might have trouble identifying who they personally are, including likes and dislikes. They can become confused about personal things such as sexuality.
• Anxiety and/or depression – Co-occurring mental health conditions can complicate Dissociative Identity Disorder. Anxiety and depression can combine with the dissociate disorder to create suicidal thoughts and behaviors.
• Mood swings – Since the identities are sometimes extreme compared to the personality of the host, the patient may exhibit mood swings. This may become more apparent during a shift between identities.
• Flashbacks – Flashbacks can play dual roles for a person with Dissociative Identity Disorder. Although these flashbacks are typically intrusive, they may provide the patient with a memory of an event that their alternate identity is trying to protect them from. This may open a door towards healing. Therapists may use these flashbacks to teach the host how to cope with the emotions that surface when faced with that memory.

Dissociative Identity Disorder treatment can only begin after a medical diagnosis from a licensed psychiatrist or other mental health professional. Since the symptoms of DID can mirror other conditions, sometimes it can take years before the correct diagnosis is given.

To meet the requirements for DID, the patient must have experienced time lapses or blackouts, plus two or more personalities must exist, and the disorder must have disrupted the patient’s life. The symptoms of DID cannot be from the effects of substance abuse. The blackouts and/or hallucinations must stem from the person’s mind and not from drugs and alcohol.

Available Treatments

Once a correct diagnosis is given for Dissociative Identity Disorder, the goal of the therapist is to help the patient fuse together all the splintered personalities/identities into the one belonging to the host. As time goes on, they should be able to view the memory without the emotional stress from the trigger(s) that caused the emergence of these personalities. The alternate identities would no longer be needed to protect the host.

Cognitive Behavioral Therapy (CBT) is often used to accomplish this goal. However, in some extreme cases, the therapist is unable to merge the identities into a single personality. In this case, the patient and therapist work together to find some type of harmonious relationship between the host and the separate identities.

This form of psychotherapy is beneficial and can include family members, not just the patient and the therapist. Some psychiatrists may decide to try a form of hypnosis to reveal the traumatic event and their identities. Although some patients have only two or three alternate personalities, others may act as host to dozens of distinct identities.

A psychiatrist may prescribe medication to help alleviate other mental health conditions within the patient, such as anxiety or depression. If hallucinations are present, they may try an anti-psychotic medication to help.

If your loved one suffers from Dissociative Identity Disorder, try to be as supportive as you can. Many times, they are at a loss and feel out of control. Extend grace and love to them and help them to find the best possible treatment.