Understanding Dissociative Identity Disorder

DID is a mental health condition in which the person's identity fragments into distinct states or "alters," each with its own feelings, thoughts, and behaviors. Often, alters have their own names, mannerisms, and voices.

DID is considered a dissociative disorder and differs from schizophrenia and other psychotic disorders that may involve split personalities. Multiple myths surround this condition, including that it is a fad, overly diagnosed, or that people pretend to have these symptoms to get attention. However, DID is a severe condition that is linked to trauma, and it can be managed with effective treatment.

DID can develop after any significant trauma at any age, but it is often associated with childhood trauma. These can include abuse or neglect or other overwhelming events, like the death of a parent or serious physical illness. Someone who has these experiences may disassociate as a way to protect themselves by creating alternate identities to compartmentalize emotions and memories surrounding the event.

Children are still developing their identities, and if they experience an overwhelming trauma, parts of their identities that should have blended remain separate, keeping memories, perceptions and emotions of their experiences segregated. Over time, they develop the ability to escape their mistreatment or emotions by detaching themselves from their trauma and retreating into their own mind.

Symptoms of DID may include:

• Amnesia: People with DID may experience memory gaps, being unable to recall certain periods of their youth. They may temporarily forget how to perform well-known skills, like using a computer or driving a car, and may discover evidence that they have done something that they have no recollection of doing.
• Multiple identities: Someone with DID will display alternate identities that are easily recognizable to friends, family, and other observers.
  • These alters act and speak differently than the person usually does, indicating that another alter has taken over. People with DID may refer to themselves as "we" or in the third person (he, she, they), and they may not understand why they are doing so. Some alters may be more aware than others.
  • For example, alter A may know about alter B's activities, while alter B may not know about alter A. Personalities can interact with one another, and the person may report hearing voices.
• Dissociative symptoms: People with DID may experience depersonalization, which is feeling detached from oneself, or derealization, which is feeling detached from reality.
• Other symptoms: Other symptoms may include depression, anxiety, headaches, substance use disorders, suicidal behavior, and self-mutilation. They may experience hallucinations, but these are not the same as those that occur in psychotic disorders. In DID, hallucinations come from another identity inside their head, trying to interact with them in some way.

Diagnostic criteria for DID include having two or more distinct personalities, with each having unique behavior, memory, sense of consciousness, and perception of the outside world. They experience amnesia, memory gaps, and recollections of events. These symptoms can also not be directly related to substance use or part of their cultural norms, and they must cause an interruption to daily functioning.

In addition to structured interviews, clinicians may use multiple assessment tools to diagnose DID, including the Dissociative Experiences Scale, Dissociation Questionnaire, and Difficulties in Emotion Regulation Scale (DERS).

The primary treatment for DID is psychotherapy, and the goal of therapy is to help people with this disorder process their trauma and learn to integrate their identities.

Two common approaches to treatment include cognitive-behavioral therapy (CBT) and dialectical behavior therapy (DBT), which use techniques to help improve emotional regulation, develop coping strategies, and manage other symptoms. Other therapies, like eye movement desensitization and reprocessing (EMDR) and art therapy, can also help support people with this disorder as they work through their trauma.

There are also techniques that someone with DID can use to stay in the present and manage periods of dissociation, like mindfulness and grounding exercises. Examples can include digging your heels into the floor to remind yourself that you are connected to where you are, clenching and releasing your fists, or visualizing a safe and calm place.

Building a strong support network is also vital for someone with DID, including friends, family, and mental health professionals. As mentioned, this condition is often misunderstood, and having people who understand as support can be crucial to management and recovery.

It can also be beneficial to create a plan for managing triggers that can help prevent switching between identities or dissociating. Working with a therapist can help someone with DID learn more about their triggers and techniques to manage them.

Media depictions of DID are often inaccurate and can be harmful to people living with the condition.

Depictions of people with this condition in movies and television usually play into the idea that one identity is violent or that having DID can be entertaining. It is crucial to remember that DID is a severe mental disorder that can occur when someone, in many cases a child, experiences significant trauma. Taking the time to learn about DID and being empathetic toward people who are living with it can help break the stigma.

People who experience significant memory gaps, unexplained time loss, or confusion about their identity should consider seeking help from a mental health professional. Symptoms may wax and wane but DID does not resolve on its own.

Treatment requires an individualized and specialized approach; seek out mental health professionals who are experienced in treating people with this mental illness.

It can be crucial to recovery for friends and family members of people with DID to be compassionate and understand the complexities of this condition. Friends and family can help by educating themselves on the nature of DID, including understanding the presence of alters as well as grounding and safety techniques to help the person when they encounter a trigger.

People with DID can recover with effective treatment, learning to process their trauma, reintegrate their identities, and lead fulfilling lives.