Dissociative Identity Disorder: Understanding the Causes, Signs, And Solutions

Reviewed by Melinda (Santa) Gladden, LCSW

Published 12/10/2020

Dissociative identity disorder, formerly called multiple personality disorder, is a form of dissociative disorder that affects an individual's social and mental state. As the name suggests, it is characterized by at least two personalities in an individual. This means that a person with this disorder can alternately switch personality states. Usually accompanied by memory gaps, the person shows dissociative traits in their behaviors and interactions. 

Since DID is mostly a mental process, it is thought to be a complex psychological condition caused by several factors. Some of which May likely stem from traumatic experiences like severe childhood trauma, repeated sexual abuse, physical or emotional abuse, etc. Consequently, the disorder could disrupt a person's thoughts, memories, actions, reactions, feelings, and sense of identity. Sometimes, the dissociative disorder could result from a combination of factors and ultimately affect a person's coping mechanism. 

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An overview of Dissociative identity disorder

Presently, DID is one of the major forms of dissociative disorders. Amnesia and depersonalization-derealization disorder are the other two forms. According to the National Alliance on Mental Illness, there is a report of about 2 percent of people experiencing dissociative disorders. That means that DID disorder is not peculiar to certain people, ages, or races. It can be found in all backgrounds. 

Research also states that DID may be a psychological response to interpersonal and environmental stresses. These are linked mostly to events during early childhood years when emotional circumstances or abuse have the greatest impacts on personality development. As much as 99 percent of people with dissociative disorders have records of life-threatening disturbances or traumas at developmental stages, mostly before age six. Therefore, anyone and everyone could be at risk. 

Furthermore, DID symptoms may manifest in persons who have experienced persistent neglect even when there has been no physical or sexual abuse. There is evidence to show that families where parents are unpredictable or frightening their kids have more dissociative tendencies. Instances of true DID are quite rare, and when they do occur, it could be at any age. 

Causes of dissociative identity disorder 

A history of trauma is one of the main contributing factors of dissociative identity disorder. These traumas often involve emotional, physical, or sexual abuse. However, they may also be linked to accidents, wars, deaths, natural disasters, or family problems. For example, the early loss of a parent or prolonged isolation due to illnesses could be a cause. 

According to the APA, 90 percent of people with DID in the United States, Canada, and Europe have experienced neglect or abuse during childhood. When a person has been through any stressful or traumatic event, dissociation is thought to be a coping mechanism. Such people disconnect themselves or attempt to separate the experience from present awareness. Overall, they are breaking the connection with the outside world. Therefore, for them, it is a form of defense. 

Recognizing dissociative identity disorder 

DID has the characteristics or presence of two or more split identities that continually overpowers a person's normal behavior. Therefore, this split personality disorder comes with an inability to recollect personal information, so it is attributed to mere forgetfulness, distinct memory variations, or fluctuations. 

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Although people experience DID in different ways, each person has their distinct ways of expression. The gestures, postures, and talking are peculiar to each person. Consequently, there could be a creation of alter egos or different identities. These alter egos are usually imaginary persons or even animals. When there is a personality translation, the alter egos tend to control an individual's behavior and thoughts. The process is tagged switching, and it can occur within seconds or minutes and last for days. 

Certain terms have been associated with dissociation disorders. One is switching and another Ego state. The ego state reflects behaviors and experiences united as a common sense of self. DID can be attributed to stress or disorders of attachment. However, what is expressed as post-traumatic stress disorder in adults may be DID in children due to imagination. 

Despite several types of research, including structural and functional magnetic resonance, event-related potential, and electroencephalography, about DID, it is still difficult to put a biological basis to the disorder. However, several findings exist from a trauma-based position.  

Signs of dissociative identity disorder

According to the Diagnostic and statistical manual of mental disorders, DID symptoms include two or more separate personality states accompanied by an inability to recollect information. However, other symptoms may include headache, amnesia, time loss, trances, and out of body experiences. Sometimes, people with dissociative disorders could exhibit tendencies of self-persecution, self-sabotage, self-inflicted violence, etc. 

For example, someone with DID may find themselves doing stuff they normally would not, like smoking or reckless driving. Yet, they feel as though they have been compelled to. Several psychological processes may be associated with DID. They include:

  • Depersonalization – a sense of being detached from one's body, popularly referred to as "out-of-body" experience—disconnection from own thoughts, feelings, and body. 
  • Derealization – a sense of unreal. A feeling of the world looking foggy or far away. 
  • Depression and or mood swings 
  • Eating and sleeping disturbances 
  • Amnesia – failure to recollect vital personal information – such information is so extensive that they can hardly be blamed on mere forgetfulness. There could also be episodes of micro-amnesias where a discussion is not remembered. Sometimes, the content is forgotten as soon as one or two seconds after. 
  • Identity confusion or alteration – a sense of confusion about who a person is. A feeling that two or more people are the same. Trouble defining interests, political or social viewpoints, sexual orientation, or professional ambitions. There could also be apparent alterations in time, place, or situations

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Symptoms in kids may include; 

  • Distressing dreams and memories 
  • Unresponsiveness 
  • Zoning out 
  • Mental distress to trauma reminders 
  • Physical reactions to memories, e.g., seizures
  • Unexpected changes in food or activity preferences
  • Other psychiatric illnesses that could occur with DID are; 
  • Depression 
  • Mood swings 
  • Suicidal tendencies 
  • Sleep disorders (insomnia, sleepwalking)
  • Anxiety 
  • Panic attacks 
  • Phobias
  • Alcohol and drug abuse
  • Compulsiveness and compulsions 
  • psychotic-like symptoms including hallucinations 
  • Eating disorders

Diagnosis 

Diagnosing DID could take time because the estimated period for diagnosis is as long as seven years for individuals who have been in the mental health system. This is so because a dissociative disorder's signs and symptoms are similar to those seen in people with psychiatric challenges. People with dissociative disorders may have coexisting diagnoses of depression, anxiety, and other forms of personality disorders. 

DSM-5 provides the following as criteria for diagnosis:

  • Amnesia must occur – gaps in the recall of daily events related to personal information or traumatic events
  • Two or more unique identities are present – Each has a relative pattern of perception, thinking, or relation
  • The individual in question is stressed or distressed by the disorder or has challenges functioning in one or more major aspects of their life due to the disorder
  • The disturbance is not associated with normal cultural or religious practices

Symptoms cannot be correlated with a substance's direct physiological effect, like blackouts resulting from alcohol intoxication or partial seizures from a more general medical condition.

Usually, DID is rarely diagnosed in children since the disorder's first appearance occurs after three years of age. In children, the tendencies are explained as "fantasy play or imaginary playmates." 

Mental health professionals, clinically trained to carry out such evaluations, usually carry out diagnosis. Interviews with family members, friends, and relatives could be included. This is because most symptoms are a form of self-report and may not be concrete enough. Because of overlapping symptoms, a differential diagnosis may be made. 

Differential diagnosis 

People with DID undergo five to seven diagnoses on an average because symptoms could be perceived as overlapping. For instance, delusions or hallucinations could be mistaken for speech. In addition, it helps in dissociating DID from malingering. 

Some of the tests used in diagnosis are the dissociative disorder interview schedule and the Rorschach Inkblot Method. 

The Rorschach inkblot test

The test is considered a type of projective psychological test created in 1921 by Hermann Rorschach. It utilizes personality and emotional functioning. Based on a survey, APA revealed that the test is used occasionally. The scientist Rorschach developed this approach after studying over 400 subjects, including mental patients and control subjects. With a book, he gave a detailed record of his method. 

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Here is a summary of how it works:

The test consists of 10 inkblot images on a card; white, black, gray, or colored. A trained psychologist or psychiatrist shows each of the cards to the respondent. Each card is presented one after the other. The subject is then asked to describe what they believe the card looks like. The subject can hold the card in any desired position, upside down or sideways. Responses could be taken in any way, and the respondents may also respond in any desired way, e.g., they could have an observation, no observation, or several observations. 

After observations are provided, the subject is asked additional questions to further elaborate or buttress the previous answer(s).  The expert then rates the observation based on several available variables, such as if the subject looked at the whole image or not. The observation as a whole is interpreted and compiled to form a profile of the individual. 

Interpreters consider: 

  • How the subject describes the image 
  • How long they take to respond
  • Extra or unrelated comments 
  • Originality or popularity of response 

Treatment

study found that there was a significant improvement over time in persons who received treatment. The primary form of treatment for DID is psychotherapy, also called talk therapy or psychosocial therapy. Psychotherapy focuses on the use of verbal discussions. The therapy involves talking with a trained professional. The idea is to understand individual challenges and know how to cope. Talk therapy is designed to work through triggers. The ultimate goal is a fusion of the split personality traits into one so that the trigger is controlled and changes are seen. This form of therapy could involve a family member(s). 

Hypnotherapy

Hypnosis is considered a simple process, although it is largely misunderstood and not popularly used. Based on continuous research, this mode of treatment is used to treat different conditions. A certified hypnotist or hypnotherapist helps in the process by guiding a person with DID to a state of deep relaxation (or a trance-like state). While in this state, the professional could make suggestions to help open up. Sometimes, it is used in conjunction with psychotherapy to control problematic issues and access repressed memories. 

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Adjunctive therapy 

This therapy involves art or movement shown to people to help them connect with parts of their minds. 

People with DID symptoms have a higher tendency of self-harm and suicide, and there is no regular medication associated with the treatments of the disorder currently. Therefore, psychologically-based therapies are still the most used forms of treatment. As mentioned, DID may take a while or longer to diagnose. Anyone with symptoms could consider taking an assessment test to have proper knowledge of their condition.

Final Note

The social stigma associated with DID may predispose people to anxiety, guilt, shame, or depression. However, people could record significant improvements in their quality of life and other mental challenges with treatment. Get started by taking an assessment test.

NOTES: No changes needed.

  • Does not go against what is clinically accepted.
  • Does not encourage mindsets or practices that may be harmful to the reader.
  • Is factual and up-to-date.