Dissociative identity disorder (DID) is a psychiatric diagnosis characterised by two key symptoms: memory gaps and fragmented, multiple identities.
Dissociative identity disorder (DID) is a rare condition, diagnosed more often in women than in men. It is hard to be absolutely certain how common DID is, as accurate diagnosis can be difficult. Also, individuals with DID symptoms may choose not to see a psychiatrist for diagnosis. However, it is now becoming more frequently diagnosed.
What are the symptoms?
Dissociative identity disorder (DID) causes distressing symptoms which can affect a person's family life, social life and employment. Symptoms can occur all through the adult life of a person with the condition, getting worse at times of greater stress. There are two main symptoms: disruption of identity and memory gaps.
Disruption of identity
Normally, people will act differently depending on what they are doing and who they are with, but they will always feel like they are the same person. This isn't the case for people who have DID, who can have several, fragmented and completely separate identities.
People are forgetful from time to time but the memory gaps in DID feel like more than just occasional forgetfulness. The memory gaps can be very upsetting and happen again and again. They can interfere with a person's work and home life and cannot be explained away by any other cause - for example, drug use, drinking alcohol or other medical conditions.
Along with these two key symptoms, it is not unusual for people who have DID to experience periods of depression, anxiety, post-traumatic stress disorder (PTSD) and self-harm.
Learn more about symptoms of DID.
What are the causes?
This has been the subject of much debate and there are different theories as to what causes dissociative identity disorder (DID). A popular theory is that it is a result of overwhelming childhood trauma. The kind of trauma which might result in DID is often severe and repeated many times - for example, physical or sexual abuse by a family member throughout a person's early life. This trauma results in dissociation.
What is dissociation?
We know that, when someone is faced with trauma, the distress it causes can become too much for the person's mind to take in. Rather than being overwhelmed, the mind can automatically switch into a different way of thinking and feeling. This is called dissociation. Dissociation is way of managing extreme feelings. It can happen automatically, without a person meaning to dissociate.
Dissociation and DID
It is thought that dissociation is the root of DID. As well as switching off from distress, people who have the condition develop fragments of different identities during times of dissociation. As the traumas keep happening, so the identities keep developing. It can be thought of as a survival strategy which helps the person cope with severe trauma again and again. Once the mind has learned to cope by using dissociated identities, it keeps on doing so, even into adulthood when the traumas have stopped.
Along with dissociation, some people have speculated that DID can be induced or worsened in susceptible people by hypnosis and suggestion. This may even be at the hands of an inexperienced psychotherapist. Many people who do not have symptoms of DID can have a feeling that they have lots of different parts to their personalities; for example a critical, parental part or a timid little child part. Unlike DID, these are still felt as if they are part of the same self - the same identity. It has been speculated that DID could be induced in susceptible clients by a therapist's suggestion that there are separate identities present.
What is the treatment?
In order to plan the best treatment, it is vital to get an accurate diagnosis, and GPs can refer to specialists with experience in diagnosing dissociative identity disorder (DID).
There is no medication which has been shown to work in treating DID; however, sometimes medication is used to treat some of its consequences. Living with DID can be a struggle those who have the condition often see their doctor complaining of depression and anxiety symptoms. Medication can be helpful in combating these.
Treatment for DID itself is with psychotherapy. As with all psychotherapy, it is important to find the right therapist. This should be a person who has experience in dealing with DID, and also someone who feels like the right fit for the client; therapy is a very personal journey and it is important to feel comfortable with the therapist. Therapy can take some time and can be costly. It requires commitment from both the client and the therapist.
Discover more about treatment for DID.
What is the outlook?
Whilst treatment can be challenging, psychotherapy can produce positive results. It can help people to live with dissociative identity disorder (DID) and help them on the road to recovery.
Read more about prognosis for DID.
Further reading and references
International Society for the Study of Trauma and Dissociation (2011); Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, Journal of Trauma & Dissociation, 12:2, 115-187
Brand BL, Sar V, Stavropoulos P, et al; Separating Fact from Fiction: An Empirical Examination of Six Myths About Dissociative Identity Disorder. Harv Rev Psychiatry. 2016 Jul-Aug24(4):257-70. doi: 10.1097/HRP.0000000000000100.
Reinders AA, Willemsen AT, Vos HP, et al; Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states. PLoS One. 20127(6):e39279. doi: 10.1371/journal.pone.0039279. Epub 2012 Jun 29.
Brand, B. L., Myrick, A. C et al. A Survey of Practices and RecommendedTreatment Interventions Among Expert Therapists Treating Patients With Dissociative Identity Disorder and Dissociative Disorder Not Otherwise Specified. Psychological Trauma:Theory, Research, Practice, and Policy. Advance online publication. doi: 10.1037/a0026487 (2011)
Cronin E, Brand BL, Mattanah JF; The impact of the therapeutic alliance on treatment outcome in patients with dissociative disorders. Eur J Psychotraumatol. 2014 Mar 65. doi: 10.3402/ejpt.v5.22676. eCollection 2014.
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