What are the symptoms of dissociative identity disorder?
The two essential symptoms which distinguish dissociative identity disorder (DID) from other diagnoses are:
- Memory gaps
- Disruption of identity
For a person to be diagnosed with DID, these two symptoms must be present. However, perhaps because of their traumatic pasts, people with DID complain of a wide range of distressing symptoms. In fact, people with DID who see their doctor for diagnosis often complain of other symptoms; for example, depression, anxiety, self-harm, drug or alcohol addiction, eating disorders.
Only on closer questioning do they describe the two essential symptoms. As a consequence, accurate diagnosis can be a challenge and it may be that DID is more common than we think. A common feeling in DID is shame. Shame colours much of the affected person's experience. Along with shame, there is often a desire for privacy and secrecy. The combination of shame and secrecy can leave DID hidden, sometimes even from close family, for many years. It only becomes obvious when it gets too much to maintain the appearance of a normal life. It is not always the case that DID creates the unusual symptoms with which it has been associated in the past. In fact, it can remain hidden and undetected, with people who have the condition often able to maintain the appearance of a normal life, despite DID.
What is disruption of identity?
Identity means a sense of who we are: our age, gender, sexuality, temperament, personality. It has memories and experiences of its own and an understanding of itself. Whilst everyone can feel and behave differently depending on what they are doing, they always have a sense of a constant self, regardless of who they are with and what they are doing. This is not the case in dissociative identity disorder (DID). In DID, individuals have several different identities, each one being different from the rest. They can switch between identities instantly, even without intending to. They might have no awareness of switching, although it can be apparent to the people around them. Particularly when under stress, their identity can switch to one which might be very different. It might even have a different age or gender. It might have its own set of memories - memories which are not shared by the other identities within the person.
The person with DID can have no recollection of switching identity. This is because the identity switch comes with dissociation, so the person is not consciously aware of the identity change. They may not be aware of anything that happens whilst in a different identity. Minutes or hours may pass without their knowing; occasionally even longer. The person with DID might only aware of 'coming to' when no longer in the dissociated identity. They may find evidence of their actions whilst functioning in a dissociated identity, like new clothes they have no memory of buying, for example. This can be confusing and embarrassing for the person with DID. There can be several different identities within one person, but these are not complete and fully formed extra personalities, as was once thought. In fact, in DID, it is as if the person's identity has been broken up into several different identity fragments, each having a different role in helping the person function.
As well as episodes of full dissociation with memory gaps and identity changes, people with DID can experience many other symptoms too. These other symptoms are often a result of the trauma endured during their childhoods and the difficult attachments to the people in their lives. They can cause a wide variety of distressing symptoms - for example, flashbacks, physical pain, fearfulness, depression, self-harm, eating disorders, addictions and relationship problems. Individuals may also hear voices or see images which are not there. These experiences can be very intrusive. They can be disorientating and distressing to the person with DID. They can happen frequently, too, interfering with a person's ability to live a normal life.
What are memory gaps?
When in a fully dissociated state, an individual's thoughts, feelings and behaviours are beyond their conscious awareness. In dissociative identity disorder (DID), these dissociations are coupled with a change in identity. When functioning from one of the fragmented identities, whilst being fully alert and able to complete complex tasks, this functioning is pinched off from the individual's consciousness. Time can pass without the individual being aware of it. This apparent loss of time is experienced by the person with DID as memory gaps. It is these memory gaps which are typical and diagnostic of DID. This loss of time and memory is often highly distressing to the person with DID. They may be presented with evidence of actions carried out whilst in a dissociated identity. They may be aware of 'coming to' with no recall of what happened.
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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