What is dissociative identity disorder (DID)?

Dissociative identity disorder (DID) was formerly called multiple personality disorder. People with
DID develop one or more alternate personalities that function with or without the awareness of the
person’s usual personality.
DID is one of a group of conditions called dissociative disorders. Dissociative disorders are mental
illnesses that involve disruptions or breakdowns of memory, consciousness or awareness, identity
and/or perception — mental functions that normally work smoothly.
When one or more of these functions is disrupted, dissociative symptoms can result. These
symptoms can be mild, but they can also be severe to the point where they interfere with a person’s
general functioning, both in personal life and at work.
What are the symptoms of DID?
A person with DID has two or more different and distinct personalities, the person’s usual (“core”)
personality and what are known as alternate personalities, or “alters.” The person may experience
amnesia when an alter takes control over the person’s behavior.
Each alter has distinct individual traits, a personal history, and a way of thinking about and relating
to his or her surroundings. An alter may be of a different gender, have a different name, or a distinct
set of manners and preferences. (An alter may even have different allergies than the core person.)
The person with DID may or may not be aware of the other personality states and memories of the
times when an alter is dominant. Stress, or even a reminder of a trauma, can trigger a switch of
alters.
In some cases, the person with DID may benefit from a particular alter (for example, a shy person
may use a more assertive alter to negotiate a contract). More often DID creates a chaotic life and
problems in personal and work relationships. For example, a woman with DID may repeatedly meet
people who seem to know her but whom she does not recognize or remember ever meeting. Or she
may find items around the home that she does not remember buying.
DID shares many psychological symptoms as those found in other mental disorders, including:
 Changing levels of functioning, from highly effective to disturbed/disabled
 Severe headaches or pain in other parts of the body
 Depersonalization (feeling disconnected from one’s own thoughts, feelings, and body)
 Derealization (feeling that the surrounding environment is foreign, odd, or unreal)
 Depression and/or mood swings
 Anxiety
 Eating and sleeping disturbances
 Problems with functioning sexuality
 Substance abuse
 Amnesia (memory loss or feeling a time distortion)
 Hallucinations (false perceptions or sensory experiences, such as hearing voices)
 Self-injurious behaviors such as “cutting”
 Suicide risk — 70% of people with DID have attempted suicide
What causes DID?
A history of trauma is a key feature of dissociative identity disorder. About 90% of the cases of DID
involve some history of abuse. The trauma often involves severe emotional, physical, and/or sexual
abuse. It might also be linked to accidents, natural disasters, and war. An important early loss, such
as the loss of a parent or prolonged periods of isolation due to illness, may be a factor in developing
DID.
Dissociation is often thought of as a coping mechanism that a person uses to disconnect from a
stressful or traumatic situation, or to separate traumatic memories from normal awareness. It is a
way for a person to break the connection with the outside world, and create distance from an
awareness of what is occurring.
Dissociation can serve as a defense mechanism against the physical and emotional pain of a
traumatic or stressful experience. By dissociating painful memories from everyday thought
 processes, a person can use dissociation to maintain a relatively healthy level of functioning, as
though the trauma had not occurred.
Episodes of DID can be triggered by a variety of real and symbolic traumas, including mild events
such as being involved in a minor traffic accident, adult illness, or stress. Or a reminder of childhood
abuse for a parent may be when their child reaches the same age at which the parent was abused.
How common is DID?
Instances of true DID are very rare. When they occur, they can occur at any age. Females are more
likely than males to get DID.
How is DID diagnosed?
If symptoms are present, an evaluation will be done with a complete medical history and physical
examination. Although no laboratory tests can diagnose dissociative disorders medically, various
diagnostic tests such as blood tests or imaging (X-rays, CT scans, or MRIs) may be used to rule out
physical illness or medication side effects.
If no physical illness is found, the person might be referred to a mental health professional such as a
psychiatrist, psychologist, or psychiatric social worker who is specially trained to diagnose and treat
mental illnesses. They will perform a clinical interview to get a full picture of the person’s past
experiences and current functioning. Some psychiatrists and psychologists may employ specialized
tests (for example, the Dissociative Experiences Scale—DES) or a standard interview such as the
Structured Clinical Interview for Dissociation (SCID-D).
How is DID treated?
The goals of treatment for DID are to relieve symptoms, ensure the safety of the individual and
those around him or her, and “reconnect” the different personalities into one integrated, well-
functioning identity.
Treatment also aims to help the person safely express and process painful memories, develop new
coping skills and life skills, restore optimal functioning, and improve relationships. The best
treatment approach depends on the individual, the nature of any identifiable triggers, and the
severity of the symptoms. Most likely treatment will include some combination of the following
methods:
 Psychotherapy: Sometimes called “talk therapy,” psychotherapy is the main treatment for
dissociative disorders. This is a broad term that includes several forms of therapy.
 Cognitive-behavioral therapy: This form of psychotherapy focuses on changing
dysfunctional thinking patterns, feelings, and behaviors.
 Eye Movement Desensitization and Reprocessing (EMDR): This technique was designed to
treat people with persistent nightmares, flashbacks, and other symptoms of post-traumatic stress
disorder (PTSD).
 Dialectic-behavior therapy (DBT): A form of psychotherapy for people with severe
personality disturbances, which can include dissociative symptoms that often occur after an
experience of abuse or trauma.
 Family therapy: This helps teach the family about the disorder as well as helping family
members recognize symptoms of a recurrence.
 Creative therapies (for example art therapy, music therapy): These therapies allow patients
to explore and express their thoughts, feelings, and experiences in a safe and creative environment.
 Meditation and relaxation techniques: These help people to better tolerate their
dissociative symptoms and become more aware of their internal states.
 Clinical hypnosis: A treatment method that uses intense relaxation, concentration, and
focused attention to achieve an altered state of consciousness, allowing people to explore thoughts,
feelings, and memories they may have hidden from their conscious minds.
 Medication: There is no medication to treat dissociative disorders themselves. However,
people with dissociative disorders, especially those with associated depression and/or anxiety, may
benefit from treatment with antidepressant or anti-anxiety medications.
What is the outlook for people with DID?
People with DID generally respond well to treatment. However, treatment can be a long and
painstaking process. This usually begins by identifying and empowering all personalities to help
integrate them into a full-functioning whole. To improve a person’s outlook, it is important to treat
any other problems or complications, such as depression, anxiety, or substance abuse.