What is Dissociative Identity Disorder?
What is Dissociative Identity Disorder? Many people do not recognize this name; they are more familiar with its former label, multiple personality disorder. Dissociative Identity Disorder (DID) is a complex, multifaceted disorder. The essential feature of this disorder is the presence of two or more different personality states. DID may affect people of all ages, ethnicities, locations, and socioeconomic statuses. Often times dissociation is seen as a response to a traumatic, stressful event. Severe emotional, physical, or sexual abuse in children may contribute to an identity disorder, such as DID. Children who experience severe abuse may use dissociation as a defense mechanism so they are not "present" for the traumatic incident. Unfortunately, this defense mechanism may stay with them throughout their lives when it is not needed. This is why stressful or triggering situations often exacerbate or bring up dissociation.
According to the American Psychiatric Association, certain diagnostic criteria must be met for a person to have DID. The most significant criterion includes possessing two or more distinct personality states. Some cultures may view this as “possession.” The individual has disruption in their sense of self and may have differences related to their behaviors, memories, consciousness, or affect depending on which personality state is present. The individual may report these differences, but the symptoms are most commonly viewed by other people. Another substantial diagnostic criterion is the experience of lack of recall of everyday events. For instance, an individual with DID may forget important personal information or extremely traumatic events that typically would be hard to forget. The symptoms associated with DID must cause significant impairment in the individual’s life. Their social or occupational functioning may be severely altered due to the presence of these symptoms. People of all ages may fit criterion for the diagnosis of DID. Children may experience symptoms of DID, but fantasy play or “imaginary friends” do not substantiate a diagnosis of DID.
DID is somewhat of a controversial diagnosis. This controversy stems from various sources; some professionals believe these clients pose too much of a suicidal risk to treat, and others are somewhat disturbed by the “bizarre, unsettling clinical presentation” (Gillig, 2009). The clinical presentation of these clients may include changing voices, posture, and attitudes while switching from one identity to the next. It may be difficult to follow what the client is saying or what the client means. But, it is important to remember these different identities are cultivated as a coping mechanism to protect from past trauma. Finally, this diagnosis carries a controversial tone due to some mental health professional’s belief that these clients are “highly hypnotizable” and very suggestible (Gillig, 2009). Thus, the legitimacy or accuracy of the diagnosis is called into question.
Moreover, according to Floris and McPherson (2015), doctors’ skepticism of the diagnosis may have contributed to clients’ uncertainty of the trauma and their own experience with this identity disorder’s symptoms. Some clients have difficulty trusting their therapist or doctor due to the field’s doubt of the diagnosis. Doubt and uncertainty plagued these individuals’ minds that were left wondering about the truth of their past trauma and whether their symptoms were simply “in their head.” Other clients found hope in finding a diagnosis that fit with the symptoms they were experiencing. Funding and mental health resources help solidify the gravity of this diagnosis for these clients.
Common misconceptions include that a diagnosis of DID holds no hope for the client, treatment is scarce, and different identities cannot be integrated into treatment. Because of the difficulty of following the different identities, it may be believed that a therapist or psychologist cannot treat the diagnosis. In fact, psychotherapy can be extremely beneficial for an individual diagnosed with DID. The clinician has the power and ability to integrate the different identities into one therapeutic conversation with the client. It is common for clients to choose different names for their different identities. If a client is presenting as her “Olivia” identity, a clinician may say something like, “What could Jennifer do to make it easier for her to manage her feelings of sadness?” Integrating the client’s identities or different clinical presentations can be a helpful way to find ways of managing traumatic memories or flashbacks.
Many individuals with DID present with a comorbid disorder. Many times the comorbid disorder is the problem being treated by a mental health professional, and the dissociative identity disorder is later recognized. The identity disorder diagnosis is very serious and needs to be treated along with any other psychological issues the individual may possess. If the identity disorder remains untreated, the individual may incur further disability and debilitation. Comorbid disorders are very common in people with this type of identity disorder. Usually, the criteria for Post-Traumatic Stress Disorder (PTSD) are met. Many trauma-related and stress disorders are prevalent in this population. Other disorders most commonly seen in individuals with DID are depressive disorders and other personality disorders, including avoidant and borderline. Conversion disorders, somatic symptoms, eating disorder, substance-related disorders, obsessive compulsive disorders, and sleep issues are also generally reported. Because the individual with DID is experiencing alterations in their identity, their memory and consciousness may affect how they present these other symptoms of comorbid disorders.
Treatment, such as psychotherapy and medication, is available for people with DID. Given the field’s doubt over the truth of the disorder, some treatment is seen as ineffective and even harmful. It is known that there is a lack of empirical evidence that shows this treatment is unsuccessful. According to Brand, Loewenstein, and Spiegel (2014), trauma-focused psychotherapy is most effective in treating people with DID. “Memory recovery” is not an effective method in treating this population. It is important to find a trauma-informed therapist. Learning to self-regulate and contain the traumatic memory seems to be most effective in treating people with DID. Clients with DID are typically flooded with intrusive traumatic thoughts and difficult flashbacks. Mastery over traumatic flashbacks or memories and learning how to manage these thoughts and memories can help to reduce the client’s need to dissociate. All in all, there is hope for clients who struggle with Dissociative Identity Disorder.
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. Washington, D.C: American Psychiatric Association.
Brand, B. L., Loewenstein, R. J., & Spiegel, D. (2014). Dispelling myths about dissociative identity disorder treatment: An empirically based approach. Psychiatry: Interpersonal And Biological Processes, 77(2), 169-189.
Floris, J., & McPherson, S. (2015). Fighting the whole system: Dissociative identity disorder, labeling theory, and iatrogenic doubting. Journal Of Trauma & Dissociation, 16(4), 476- 493. doi:10.1080/15299732.2014.990075
Gillig, P. M. (2009). Dissociative Identity Disorder: A Controversial Diagnosis. Psychiatry (Edgmont), 6(3), 24–29.