Dissociative identity disorder (DID) — previously known as split or multiple personality disorder — is “a disruption of identity characterized by two or more distinct personality states or an experience of possession,” according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).
While you may have seen Hollywood’s depiction of DID in movies like Fight Club and Sybil, the reality of the condition is a lot different in real life.
This article will cover what that controversy stems from, common signs, symptoms, and causes of DID, and available treatment options.
This is according to the majority of scientific literature and the psychiatric community.
“Dissociative identity disorder has been reported in studies across cultures and across different countries, and that just adds to the point that is not culturally just specific to North America or Western culture,” says Arman Fesharaki-Zadeh, MD, a behavioral neurologist and neuropsychiatrist at Yale Medicine.
Not only that, it’s been included in the DSM for over 40 years. (The DSM or Diagnostic and Statistical Manual of Mental Disorders is the gold standard for outlining and diagnosing disorders.)
That being said, if you’ve done even a basic Google search for DID, you’ll have noticed there’s quite a bit of doubt and uncertainty surrounding the condition.
Some common reasons for skepticism include that DID is primarily diagnosed in North America and that a handful of psychiatrists are responsible for the majority of diagnoses.
Opponents often believe that DID is actually a misdiagnosis of borderline personality disorder and that the DID diagnosis is ultimately harmful to the person.
We should say that a 2016 report debunked these claims.
Like we said earlier, the way DID is portrayed in movies isn’t necessarily what it looks like in real life.
For example, although a person with DID can have multiple personalities with distinct names, backstories, voices, mannerisms, etc., this isn’t always the case. Many times, the condition causes distinct “states of being.”
It’s important to remember, people with DID can’t remember what happened while they were experiencing one of these alternative states.
The main symptoms of DID are:
- dissociating or feeling detached from reality or yourself
- feeling unsure of your own identity
- experiencing memory gaps about specific periods of time or personal information
- visual and auditory hallucinations
- mood changes
Although not present in everyone, the following symptoms are also associated with DID:
- sexual dysfunction
- substance use disorder
No one knows the exact cause of DID but it’s considered a post-traumatic developmental disorder (meaning it’s caused by events in young childhood).
According to Fesharaki-Zadeh, DID may be a reactive maladaptive protective mechanism which results in the fracturing of oneself. As one study put it, it’s “an elaborate form of denial so that the child believes the event to be happening to someone else.”
While it’s common for people with DID to block out memories of the trauma in their past, they generally remember bits and pieces (it usually isn’t completely erased from memory).
Some types of trauma that may cause DID include:
- sexual abuse
- emotional abuse
- physical abuse
Only a professional can diagnose you with DID. While you can learn a lot from reading the research, it’s important not to self-diagnose. There are many symptoms of DID that mimic other conditions and in order to get effective treatment, you need to be diagnosed correctly.
If you want more information on your experience, you can try this questionnaire: The Dissociative Experience Scale (DES), which is used widely by clinicians to help diagnose DID. But keep in mind, this doesn’t equal a formal diagnosis.
A clinician makes the DID diagnosis based off of reported and observed symptoms in combination with a detailed account of the person’s history.
They may also run lab tests to rule out physical injuries — head injuries, for example — that could explain the neurological symptoms like memory loss and hallucinations.
Some providers may use the Dissociative Experiences Scale (DES) that we mentioned above or a standard interview such as the Structured Clinical Interview for Dissociation (SCID-D).
However, Fesharaki-Zadeh mentions that DID can be tricky to diagnose since the criteria isn’t as clear cut as it is for other mental health conditions. He adds that it typically isn’t diagnosed right off the bat in one session. Providers generally need to spend a lot of time getting to know the person before a diagnosis can be made.
The good news is that, once diagnosed, people with DID generally respond well to treatment. Unfortunately, since misdiagnosis is common, it often takes a long time to get to reach the point of treatment.
According to the National Alliance on Mental Illness, dissociative identity disorder treatment may include:
- cognitive-behavioral therapy (CBT)
- dialectical behavioral therapy (DBT)
- eye movement desensitization and reprocessing (EMDR)
The type of medication prescribed depends on the other symptoms from co-occurring conditions, such as depression or anxiety, says Fesharaki-Zadeh. Antidepressants are commonly the medication of choice for treating DID. There isn’t one specific type of medication for treating DID itself.
Dissociative identity disorder is a legitimate mental health condition believed to be a result of trauma in childhood. The disorder can severely impact someone’s day-to-day life, but help is available. With the right diagnosis and treatment, relief from the disorder is possible.