Mayo Clinic defines dissociative identity disorder as “a mental disorder that involves experiencing a disconnection and lack of continuity between thoughts, memories, surroundings, actions and identity”. It was earlier known as multiple personality disorder, and is the presence of at least two clear personality states or an experience of possession, which may have different reactions, emotions, and body functioning.
The disorder is thought to be an involuntary coping mechanism – the patient literally shutting off or dissociating himself from an experience or situation that is too painful, traumatic, or violent to assimilate with one’s conscious self. This escape from reality is unhealthy and causes problems with functioning in everyday life.
Signs and symptoms of dissociative identity disorder include memory lapses, feeling like more than one person, blackouts, finding strange items in one’s possessions, being frequently accused of lying, apparent strangers recognizing them as someone else, and feeling unreal. It is likely multifactorial in causation, including occurring due to severe early childhood trauma (typically extreme, repetitive emotional, physical, or sexual abuse).
The incidence of dissociative identity disorder is around 1% of all adults in the US, and 1–20% of patients in psychiatric hospitals. It is diagnosed nine times more often in females.
Individuals with dissociative identity disorder have other comorbid mental illnesses, such as post-traumatic stress disorder (PTSD), conversion disorder, and borderline and other personality disorders.
Treatment for dissociative identity disorder includes psychotherapy and medication. Although treatment can be difficult, many people with this disorder learn new ways of coping and go on to lead healthy and productive lives.
Symptoms of Dissociative Identity Disorder
In dissociative identity disorder, there is marked discontinuity in sense of self and sense of agency, accompanied by changes in emotions, behavior, perceptions, consciousness, memory, thinking and reasoning, and/or sensory-motor functioning. Thus, individuals with dissociative identity disorder can have a range of bizarre symptoms, including:
- Depersonalization or Out-of-body experiences: Feeling of suddenly becoming observers of their “own” speech and actions, which they may feel powerless to stop (altered sense of self).
- Derealization:This is the feeling that the world is not real or looking foggy or far away.
- A lack of a sense of self-identity or agency: Hearing voices (e.g., a child’s voice; crying; the voice of a spiritual being), which can be experienced as multiple, confusing, independent thought streams over which the individual has no feeling of control. Strong impulses, emotions, speech or other actions may suddenly emerge, without a sense of personal control or ownership (loss of sense of agency).
- A sense of detachment from your emotions, or emotional numbness: Altered sense of self and seeming loss of personal agency could be accompanied by a feeling that these emotions, attitudes, and behaviors—including one’s body—are “not under my control” and/or “not mine”. These can be observed by family, friends, or the clinician.
- Identity confusionor identity alteration: Outlooks, personal preferences, and attitudes (e.g., about dress, food, activities) may suddenly shift back and forth. May report that their bodies feel different (e.g., like the opposite gender, like a small child, huge and muscular).
- Significant memory loss of specific times, people and events: Amnesia in individuals with dissociative identity disorder is not limited to stressful or traumatic events; these individuals often cannot recall everyday events as well. They may report that they suddenly found themselves at the beach, in a nightclub, at work, or somewhere at home (e.g., on a bed or sofa, in the closet, in the corner) with no memory of how they came to be there. The amnesia usually manifests in three primary ways: as
- Gaps in remote memory of personal life events (e.g., periods of childhood or adolescence; some important life events, such as getting married, giving birth, the death of a grandparent)
- Lapses in dependable memory (e.g., of today’s happenings, of skills learnt in the past, such as doing a job, using a computer, reading, driving); and
- Discovery of evidence of tasks and actions they do not recollect doing (e.g., finding certain unexplained objects among their possessions or in their shopping bags, finding strange writings or drawings; discovering injuries).
- Experience of possession: Possession-form identities manifest as behaviors that make it seem as if a supernatural being, a “spirit,”, or some outside person has taken over, such that the patient begins speaking or acting in an appreciably different manner. However, the majority of these possession states are normal, usually a part of spiritual practice. The possession-form identities in dissociative identity disorder, however, are involuntary and unwanted, cause significant distress and impairment, and are not a normal part of a broadly accepted religious or cultural practice.
- Mental health problems: Mental health problems, such as anxiety, depression, substance abuse, non-epileptic seizures, and even suicidal thoughts and behaviors.
Causes of Dissociative Identity Disorder
Dissociative identity disorder is associated with overwhelming experiences, traumatic events, and/or abuse occurring in childhood. People who experience long-term emotional, physical, or sexual abuse during childhood, or, less often, a home environment that is highly unpredictable or frightening are at greater risk of developing dissociative identity disorder. Children and adults who experience other traumatic events, such as natural disasters, war, torture, kidnapping, or traumatic medical procedures are also at greater risk to develop this condition.
Diagnosis of Dissociative Identity Disorder
The DSM-5 gives the following diagnostic criteria for dissociative identity disorder:
- Two or more distinct personality states or identities are present, each with its own way of perceiving, relating to, and thinking about the environment and self.
- Amnesia or gaps in the recall of everyday events, important personal information, and/or traumatic events.
- They should have significant trouble functioning in one or more major areas of life because of the disorder.
- The disturbance is not part of normal religious or cultural practices.
- The symptoms are not attributable to substance abuse or another medical condition (such as seizures).
Treatment of Dissociative Identity Disorder
Treatment is aimed at helping the person safely express and process painful memories, develop coping skills, develop life skills, improve relationships, and restore optimal functioning. Treatment will include some combination of the following methods:
Often referred to as “talk therapy,” psychotherapy is the first-line treatment for dissociative identity disorder. It includes the following forms of therapy:
- Cognitive-behavioral therapy: This tries to change dysfunctional thinking patterns, feelings, and behaviors.
- Dialectic-behavior therapy (DBT): This form of psychotherapy is reserved for people with severe personality disturbances.
- Family therapy: This teaches the family about the disorder and helps them recognize the symptoms of a recurrence.
- Creative therapies (e.g., music therapy, art therapy): These allow them to explore and express their thoughts, feelings, and experiences in a safe and creative environment.
- Relaxation and meditation techniques: These help them better tolerate their symptoms and gain more awareness of their internal states.
- Clinical hypnosis: This technique makes use of intense relaxation, concentration, and focused attention. Thereby it leads to an altered state of consciousness, allowing them to explore thoughts, feelings, and memories that may be hidden from their conscious minds.
There is no medication to specifically treat dissociative identity disorder itself. However, anti-anxiety medications, antidepressants, or antipsychotic drugs can help control the mental health symptoms often associated with dissociative identity disorder.