What is dissociative identity disorder?
A person with dissociative identity disorder (DID) often has a "main personality," which may be passive, dependent, and depressed.
Their alternative personalities or "alters" may be a different age and gender and exhibit different moods and preferences.
These alternative personalities are believed to take turns being in control. When a personality is not in control, it dissociates or detaches and may be unaware of what is happening.
The impact DID symptoms have on a person's quality of life can vary depending on the number of alters they have, their social situation, and whether they have any other health conditions.
Symptoms of DID include confusion, feelings of detachment, and memory gaps.
Symptoms of DID in adults include:
- a sense of "losing time"
- exhibition of two or more personalities (alters)
- feelings of detachment (dissociation)
- memory gaps
- out of character behavior
Out-of-character behavior is the result of alternate identities being in control.
Children who have experienced emotional neglect, sexual abuse, and violence are at an increased risk of developing DID.
Symptoms in children include:
- having distressing dreams and memories
- being unresponsive or "zoning out" (dissociating)
- mental distress to trauma reminders (triggering)
- physical reactions to trauma or memories, such as seizures
- showing unexpected changes in food and activity preferences
DID is believed to develop in childhood, and symptoms may become more severe over time.
Causes and risk factors
Dissociation or detachment is a common coping mechanism for extreme stress and trauma, especially in childhood. DID is one of several dissociative disorders.
People of any age, ethnicity, gender, and social background can develop DID, but the most significant risk factor is physical, emotional, or sexual abuse during childhood.
Dissociation, or detaching from reality, can be a way of shielding the main personality from a painful mental or physical experience.
In this way, a different personality experiences the trauma instead, leaving the person with little or no memory of the event.
Other dissociative disorders include:
If someone is diagnosed with DID, they will most likely be referred to a mental health specialist.
Both adults and children are diagnosed using criteria from the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5).
A doctor will also ask the person or a child's caregiver about the symptoms they are experiencing, and will usually refer them to a mental health specialist.
To be diagnosed with DID, a person must:
- Display two or more personalities (alters) that disrupt the person's identity, behavior, awareness, memory, perception, cognition, or senses.
- Have gaps in their memory of personal information and everyday events, as well as past traumatic events.
- Have symptoms that cause significant distress in working and social environments.
- Experience disturbances that cannot be considered part of any accepted cultural or religious practices. For example, in children when imaginary friends or playing pretend cannot explain the symptoms.
- Have amnesia or exhibit chaotic behavior that is not caused by alcohol or drug use.
Some of the tests used for diagnosis include the dissociative disorder interview schedule and the Rorschach Inkblot method.
Once a person receives a correct diagnosis, treatment is an integral part of learning to live with DID.
DID is usually treated with psychotherapy (talking therapy) and focuses on:
- educating a person about their condition
- increasing awareness and tolerance of emotion
- working on controlling a person's impulses
- preventing further dissociation
- managing current relationships, stressors, and daily functioning
One study found significant improvement over time in people with DID who received treatment.
The goal of treatment is not to reduce all the personalities to one or to eliminate extra personalities.
Instead, the goal is to help all the personalities live and work together harmoniously, and help a person identify what triggers the personalities to switch so that they can feel prepared.
Living with DID
People living with DID often refer to themselves as having alters or multiples. DID can have a significant impact on mental health, relationships, and a person's ability to work.
Living with DID can be frustrating, scary, and isolating. Many people do not get diagnosed until they are adults, meaning they might experience years of frightening symptoms without knowing why.
A person's alternate personalities may not always cooperate with each other. When another personality takes control, a person may "wake up" in an unfamiliar place with no memory of how they got there.
However, the personalities may also work well together and help a person cope with everyday situations.
Other people may not notice the shifts between personalities, as some people with DID may not display noticeable outward changes.
Some people with DID may also suffer from social stigmas. Many people are only familiar with DID from what they have read in fiction or seen in movies. People with DID do not inherently have a violent alternate personality — in fact, this is rare.
Watch this TED educational video to learn about how an individual with DID developed the condition and managed it:
DID often takes a long time to diagnose, and may be accompanied by other mental health conditions.
The social stigma around DID may lead to anxiety, guilt, shame, and depression.
People with DID have an increased risk of self-harm and suicide. The right diagnosis and prompt treatment are essential and can be life-saving.
With treatment, people with DID may have significant improvements in their quality of life and a reduction in other mental health issues.