Dissociative Identity Disorder (DIS) | Knowledge Center (2023)

Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder, is a relatively common psychiatric disorder that can affect 1 to 3% of the general population. DID is characterized by a significant disruption of a unified sense of identity and continuity of experience, exemplified by two or more personality/identity/self states. In some cultures, this disruption of a unified sense of identity can be understood as an ownership experience that is not seen as congruent with that culture's spiritual/religious practices.

In addition, people with DID experienceDissociative Amnesia (AD): a disruption in the memory of important personal information, as well as current and past personal experiences, which is inconsistent with common memory problems.

This significant disruption of a unified sense of identity and memory can occur in a number of ways, including difficult-to-explain alterations and/or variability in:

• Conduct
• Thoughts
• emotions
• Memory
• perceptions
• Conscience
• Bodily sensations or functioning.

These interruptions and changes cannot be better explained by the effects of alcohol or drugs, or by a medical or brain disorder, such as epileptic seizures. These symptoms should cause significant failures.

Contrary to media portrayals, the stereotypical and "attractive" outward characteristics of DID ego states, such as different names, tone of voice, accents, clothing, hairstyles, handwriting, and more, are not essential to diagnosis. and are secondary factors to the core. DID phenomena.

The diagnostic criteria for DID mean that there are two or more relatively separate information processing centers in the mind. Each information processing center in the mind is characterized by:

• A sense of personal identity.
• a self image
• A set of autobiographical memories (state dependent)
• A sense of ownership of personal experience.
• Ability to control/enact behavior

These ego states can change, alternate, or overlap in a variety of ways leading to disruption of the ego and the continuity of the DID experience.

The individual's personality/identity/self-state are NOT separate persons. These are subjective states of mind of the individual. All the DID states together make up the complete person and the total personality of that person.

Because of this, and contrary to portrayals in the popular media, the person with DID as a whole person is responsible for the behavior, even if they experience amnesia or a sense of lack of control over their actions.

The development of dissociative identity disorder

People with DID report the highest rates of childhood trauma, particularly physical, sexual, and emotional abuse, usually beginning before age six, of patients with any psychiatric disorder. Because of this, DID can be conceptualized as a post-traumatic developmental disorder beginning in childhood, in which the traumatized child is unable to complete the normal developmental processes involved in fostering a core sense of self. Along with the disturbed bond between child and caregiver and nurturing, repeated early trauma disrupts the development of the normal processes involved in building and consolidating a unified sense of self. Therefore, the child cannot integrate the different experiences of the self that normally occur in different states and contexts.

DID has been found in children, adolescents, and adults. Unfortunately, early trauma can be a risk factor for later trauma. People with DID report very high rates of adult rape, intimate partner violence, and other forms of exploitation, such as being trafficked.

DID is both a disorder and a form of resilience. The psychological compartmentalization of traumatic/overwhelming experiences allows for a more normal development of the ability to think clearly, intellectual and creative abilities, the ability to comprehend reality, the development of a sense of humor, the ability to bond with others, and the ability to ability to perceive, all important in the psychotherapeutic treatment of DID.

Dissociative Identity Disorder (DID) Symptoms

The post-traumatic origins of DID mean that 80-100% of people with DID who receive treatment also experience symptoms of post-traumatic stress disorder (PTSD - see section on PTSD). Other disorders commonly associated with DID are depression or very rapid “mood swings” that often do not (or only very partially) respond to medications; substance abuse; and unexplained medical symptoms with repeated “negative” tests, often from apparent seizures or other neurological disorders.

One of the most common symptoms of DID is hearing voices, most often within the mind. Because of this, many people with DID are unsuccessfully treated with medications for schizophrenia or other psychotic disorders.see section on psychotic disorders).

People with DID have very high rates of self-destructive and suicidal behavior and often have multiple, often unproductive, hospitalizations for mood disorders, personality disorders, and/or psychotic diagnoses. The average person with DID spends between five and 12.5 years in mental health treatment until a correct diagnosis is made.

Having suicidal or self-destructive thoughts, impulses, plans, or behavior requires emergency treatment, including calling 911 or going to the nearest Emergency Department or Mental Health Urgent Care Clinic.

A diagnosis of dissociative identity disorder should be suspected if you or your loved one:

• You receive many different psychiatric diagnoses, but you don't respond to many different types of treatments, including various medications, types of psychotherapy, or neurostimulation treatments such as electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).

Contrary to the DID stereotype, DID symptoms are often subtle and hidden, and people with DID do not readily reveal their symptoms without careful examination by a mental health professional.

You or your loved ones may notice that the person is:

• Repeatedly very “cranky”
• Highly changeable from time to time, and
• Has difficulty remembering important personal experiences.
• This can include a variety of current behaviors and parts of life history that are not related to substance or medication use or brain injury or disease.

These difficulties in remembering important personal experiences may include:

• Significant gaps in memory for life history.
• Experiencing "blackouts" or "lost time": gaps in current life history recollection
• Lack of recall of observed complex behaviors, even positive behaviors, such as doing well on a presentation at work.
• Not remembering or having difficulty remembering important events, such as graduations, birthdays, weddings, and vacations, that other family members remember well.
• Perplexed and recurring forgetfulness of things the person has bought or created.
• Unexplained changes in skills and habits, such as forgetting that one can play a musical instrument or suddenly switching from a smoker to a non-smoker and vice versa
• Repeated unexplained trips or “getting lost” in familiar places
• Repeated rationalizations for being "forgetful" or "worried"

Other common symptoms of DID include:

• Hearing voices, particularly within the mind; these are often experienced as having their own sense of identity, such as a child's voice, an angry voice, a caring and supportive voice, among others.
• See things others don't see, such as people, faces, or visions, even seeing the "people" someone is hearing about
• Out-of-body experiences, as if you were watching yourself from afar, outside or even inside yourself, often accompanied by a feeling that you can watch but not control what you are doing.
• Feeling disconnected from the world around you, as if you are seeing through a fog. things seem unreal
• Experiencing repeated, unexplained, and sudden intrusions of thoughts, feelings, impulses, or actions that you cannot control
• Experiencing sudden and unexplained repeated withdrawal from thoughts, feelings, behavior that one does not control
• Feeling torn apart with different senses of self that seem relatively independent of each other and are often in conflict or struggle
• Feeling inexplicably very different at different times with different opinions, abilities, habits, and access to memory and learned information

Dissociative Identity Disorder Treatment

DID is a treatable disorder once it is correctly diagnosed. Clinicians who understand the symptoms of DID can diagnose DID in the clinical interview. There are also paper-and-pencil tests that can help doctors diagnose DID and other dissociative disorders.

Studies show that DID symptoms improve over time when treated with phasic trauma treatment.

Phasic Trauma Treatment

Phasic trauma treatment is a psychotherapeutic treatment consisting of three phases:

1. security and stability
2. Work on traumatic memories
3. reintegration to life

In DID treatment, working directly with DID identities is crucial to lessening symptoms and maximizing the resilience found in most people with DID. Hefirst phase, security and stability, is the most important thing. During this phase, people learn how to stabilize the symptoms of DID and PTSD, using a variety of psychotherapeutic techniques and sometimes complementary/additional medications.

It is critical that the person with DID develop safety from suicidal and self-destructive behaviors, substance abuse, eating disorders, high-risk behaviors, unsafe people, and other dangerous behaviors and situations. This is because DID develops in a childish environment of repeated insecurity and unpredictable danger.

Without security development, DID treatment will not progress.

Not all people with DID are willing to address their traumatic experiences in depth. However, if the person with DID agrees and has achieved security and stability,Level 2it focuses more on carefully and slowly recalling one's life history, which is often experienced as PTSD flashbacks. Therefore, this phase also involves continued work toward safety and further stabilization of DID and PTSD symptoms.

Nophase 3, the individual's DID and PTSD symptoms are often substantially mild, and the individual with DID may even experience a subjective fusion of some or all of the ego states, with a complete fusion of the characteristics of these subjective identities. This frees up energy to focus on living better in the present.

Adjunctive/Complementary Treatments for Dissociative Identity Disorder

Hypnotherapy:Hypnotherapy can be helpful in stabilizing the symptoms of DID and PTSD. However, hypnotherapy can only be used if the therapist has been certified in the use of hypnosis.mihas specialized training in its use in DID and other post-traumatic disorders.Be sure to ask yourvendorabout his credentials in the use of hypnosis.

Medicines:Medications are adjunctive (complementary) treatments in the treatment of DID and do not directly affect the underlying symptoms of DID. In the treatment of DID, medications do not have a significant direct effect on symptoms unless other specific disorders are present. For example, there are medications that can substantially improve PTSD symptoms, although some people cannot take them due to side effects.

Medications for depression and mood symptoms often have limited effects, but may provide some symptom relief, provided the patient and physician have carefully identified which symptoms will and will not be relieved by the medications. Medications for anxiety symptoms can be moderately helpful but need to be carefully monitored, especially in people with a history of substance abuse.

People with DID often have a chronic and complex sleep disorder, with difficulty falling asleep, staying asleep, nightmares, and even complex behaviors that seem to arise from sleep. There are medications that can help with PTSD nightmares and this can improve sleep, if the patient does not experience bothersome side effects. Sedative medications are often only partially helpful. DID-specific psychotherapy is often needed to help with fears and memories related to bed, night and sleep and dissociative nocturnal symptoms.

Other types of psychotherapy that can help with the treatment of DID

Other forms of psychotherapy, such as dialectical behavior therapy (DBT) and cognitive behavior therapy (CBT), focusing on trauma-related cognitive distortions, may be useful as an adjunct/adjunct to phasic psychotherapy for DID.

Eye Movement Desensitization and Reprocessing Therapy (EMDR):Eye movement desensitization and reprocessing (EMDR) therapy is a treatment that improves the symptoms of PTSD, usually in people who have experienced a specific adult trauma.

EMDR can significantly worsen DID symptoms, especially if used before the DID patient is stabilized on treatment. EMDR can be an adjunctive/complementary treatment if the therapist has a thorough training in EMDR and specialized training in its use in DID and other complex post-traumatic disorders.

Group Therapy:Group therapy can be helpful in stabilizing people with DID if they are in a group dedicated to patients with that diagnosis and the group is facilitated by professionals knowledgeable about DID management. People with DID generally do not do well in general therapy groups, even those that focus on PTSD and trauma, but are not designed for severely dissociative patients.

In general, DID experts DO NOT recommend the use of support groups facilitated by non-DID treatment professionals, including online support groups. Both face-to-face and online “support” groups can have a very negative impact on the person with DID and their treatment.

Family Involvement:Family treatment, usually with the patient's spouse or partner, can be useful for education and to help support the patient and family during what is often long and difficult treatment. In particular, family members are educated not to interact directly with the patient's various ego states, but to view their partner as a "whole human being" and not as a group of separate "persons." Specialized couples therapy can be helpful if the therapist is knowledgeable about dealing with childhood trauma and its impact on adult relationships.

Rehabilitation therapies:Adjunctive/complementary rehabilitation therapies, such as art therapy and occupational therapy, may be helpful if the therapist is trained in the use of these modalities in the treatment of complex post-traumatic disorders, such as DID.

For more information on dissociative identity disorder, visitThe Traumatic Disorders Program section of our websiteIt's inInternational Society for the Study of Trauma and Dissociation website.