Reviewed by Melinda (Santa) Gladden, LCSW
Dissociative Identity Disorder (DID), previously known as Multiple Personality Disorder, is not a condition that a person is born with. Rather, individuals with dissociative disorders develop the condition over time, and therefore, the disorder can be confusing, and sometimes frightening to address.
To understand DID, and its causes, it is first important to understand the different types of dissociative disorders and their terminologies.
What are the types of dissociative identity disorders?
There are three primary types of dissociative disorders:
- Dissociative Amnesia: Shown in the form of major memory loss, dissociative amnesia will cause a person to forget important facts about themselves. It’s even further categorized into the different ways it presents itself:
- Depersonalization-Derealization Disorder:
- Depersonalization is the sensation of having an “out of body” experience. For those with the disorder, there is an added component of emotionlessness. Depersonalization is a dissociation from one’s body, mind, and emotions.
- Derealization is similar to depersonalization but in the context of a person’s environment. Derealization is the alarming detachment and distortion of that person’s surroundings.
- Dissociative Identity Disorder: Like the other two dissociative disorders, DID encompasses a detachment from memory, self, and surrounding. However, it is done in the form of adopting and embodying at least one other distinctly different personality.
“Dissociative identity disorder” was coined by the Diagnosis and Statistical Manual of Mental Disorders (DSM-IV) in 1994 because “multiple personality disorder” gave the impression that a person with DID is capable of voluntarily conjuring multiple personalities whenever they want. That is not the case.
A person with DID instead experiences a splintering from his or her own identity under situations specific to that person’s trauma. The breakdown of DID types is even further categorized by covert, or overt.
- Dissociative Identity Disorder Covert:Covert, meaning hidden, or “not openly acknowledged,” is used in DID to describe a person that is relatively unaware of their condition. They might experience bouts of forgetfulness, or amnesia, and have strong feelings of “not being themselves,” but the extent to which their DID is present is more concealed.
- Dissociative Identity Disorder Overt:Opposite to the previous categorization, DID Overt is the acknowledgment and embracement of other personalities. There is a level of awareness of their alters’ traits, and ideally an oneness with the system.
Are you new to some of the terminology? Here is a helpful glossary.
When discussing dissociative disorders, it is important to recognize some of the common terminology, as we know them today:
- Core: The original personality.
- Host: The presenting personality.
- Alter: The alternative personalities sometimes referred to as “parts.”
- Switching: Because of their temporary nature, cases of dissociation are called “episodes,” or “switching.”
- System: A person with DID might refer to the combination of their body, and alters as a system.
- Co-Conscious:Awareness of the presence of the alter during the switch.
Depending on the severity or class of Dissociative Identity Disorder, a person’s alter(s) can be a fully realized personality, with a different name, different opinions, a different age, different gender orientation, or sexual orientation.
Contrary to popular belief, DID does not make a person dangerous. Having a realized alter is not indicative of aggressive, dangerous, or impulsive behavior. Realistically, a dissociative disorder can be more dangerous for the person with it, given the amnesic state the person might experience while going through an episode.
What causes DID?
The causes of DID vary, but they are always rooted in some sort of trauma, typically from childhood. For a person with DID, in most cases, a form of abuse was present during that person’s development and frequently was a recurring trauma.
A person with DID will not develop the disorder after the age of six or seven years old. The trauma that occurs to cause DID happens early enough in childhood for consciousness and memory to be significantly affected.
Some people can understand what it might feel like to block a memory out of consciousness, for the sake of moving forward. However, a person with a dissociation disorder might have trouble remembering large portions of their childhood or struggle to recall significant events.
Under this circumstance, the brain intervenes in the form of dissociation.
Situations of sexual abuse, physical abuse, and/or emotional abuse are usually the cause for a dissociative disorder, thereby using a different facet of the personality to protect against that pain and suffering.
What triggers DID?
A dissociative identity disorder episode/switch can be triggered by situational stress similar to the root trauma. The mind is so keen to protect itself that it might switch just at the sight, sound, smell, or touch of someone, or something that reminds that person of their trauma, even if the memory is subconscious.
Episodes can also be triggered by actions that cause emotional heights (ie. anger, fear, sadness, worry). They can also be triggered by something seemingly harmless, such as an object, a time of year, the action of completing a form, or just by being in the literal dark.
Though typically more temporary, an episode of DID can last for hours, weeks, months, and on the rare occasion, years.
An alter is meant to help. Alters will take over during a seemingly dangerous, confusing, or stressful situation when the core personality cannot handle it.
The concept of dissociation is complex, to begin with, and often difficult for an average person to understand. However, the disorder afflicts more people than the public knows.
Although DID is caused by an event from childhood and manifests as such, the average person with DID does not show dissociative identity disorder symptoms until later in life. The disorder is more frequently diagnosed in women, specifically usually in the person’s 20s or 30s.
DID symptoms can include but are not limited to:
- Struggle to keep track of time
- Amnesia, or gaps in memory
- Uncharacteristic behavior
- Physical reactions to stress or potential trauma
- Unexplained changes in mood, food preferences, and routines
- General confusion
- Presence of 2 or more personalities (covert, or overt)
Dissociative Identity Disorder is not as rare as the public perceives it to be. Though the exact number of DID diagnosis/DID prevalence is unknown, it is estimated that 1% of the general participating population is diagnosed with DID. Though 1% looks small, in the grand scheme of things, 1% still makes up thousands of people.
To better understand what a person with DID experiences; let us discuss what happens during a dissociative episode.
What happens when you dissociate?
A dissociative episode will look different for each individual, especially considering whether they are covert, or overt.
A person might not be co-conscious during an episode. In which case, a person with DID might experience somewhat of an amnesia state during the switch, and not necessarily know what happened during the episode.
Have you ever woken up from a sound sleep and forgotten you had gone to bed in a different place? That is more or less, what it can be like to dissociate. However, the person with DID does not know how they arrived at that place. Dissociating unconsciously can be scary, and likely happens more to those experiencing severe trauma in the present, or who experience covert DID.
Disassociating co-consciously means the person is relatively aware of their condition. This can occur for people with overt DID, and essentially, it means they can “see” what is happening when an alter takes over.
A dissociative episode is when the core personality steps back from full personhood participation.
For some, dissociative episodes can be frequent. For others with more mild DID, episodes might be fewer, and further between.
Though it is under-researched, there seems to be a consensus that addressing other co-occurring disorders can help curb the symptoms of dissociative identity disorder.
Frequently Associated Conditions
According to the National Center for Biotechnology Information (NCBI), only 60.4% of clinicians in the United States correctly diagnose DID. Rather, clinicians will often mistake DID for Post-Traumatic Stress Disorder (PTSD), Schizophrenia, or Major Depression.
Though they are NOT interchangeable, it is possible to have both dissociative identity disorder AND:
- Bi-Polar Disorder
- Various other mental health disorders
Those with DID can also be at risk for substance abuse, in an attempt to numb or avoid the condition.
DID vs. Schizophrenia
Dissociative Identity Disorder has for years been confused with schizophrenia. Though some of the symptoms or behaviors can look similar, there are a few important distinctions.
A person with schizophrenia has hallucinations of voices, and/or objects that are not present in reality. They also experience delusions and thought disorders. Additionally, schizophrenia is commonly understood as being primarily genetic, whereas DID is not.
To the untrained eye, episodes of detachment from self or reality can look similar between a person with DID vs. a person with schizophrenia. However, they are different and should be treated as such.
DID is not treatable by medicine (yet), but therapies and diagnosis of all mental health issues can help with the management process. For all guidance regarding treatment, please consult a licensed medical professional.
Recognizing, and understanding the symptoms of DID is important, and can lead to the treatment of co-occurring mental health struggles.
Dissociative Identity Disorder is not only under-researched, but there is also still a lot of worldwide skepticism about the validity of the disorder.
Many modern physicians are still coming to terms with the real-life implications of DID, and therefore, general knowledge is lacking. Seeking assistance can be difficult, especially when it comes to finding accessible, available experts in the field.
That said, methods to manage DID are becoming more widespread, as the disorder becomes more normalized.
If you think you are struggling with DID, click the link below for a free, short, confidential assessment.
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.