Dissociative identity disorder

Medical quality assurance by Dr. Albrecht Nonnenmacher, MD at July 28, 2016
StartDiseasesDissociative identity disorder

Dissociative identity disorder (DID), also called multiple personality disorder (MPD), is a condition where someone has more than one distinct personality or view of themselves, and these identities have separate control over certain events in a person's life. The condition can be managed but rarely cured. A diagnosis of this disorder is controversial in some psychological circles.

Contents

Definition & Facts

Dissociative identity disorder is defined as having two or more distinct personalities or identities within the same person. The memories of one identity may not always overlap with the memories of the other personalities or identities. Somewhere between one and five percent of Americans are believed to have this diagnosis, though the existence of the disorder is still controversial.

Not all mental health professionals believe this to be a distinct condition and think it may instead be an untreated version of a different mental disorder such as borderline personality disorder (BPD) or a lack of coping skills. Dissociative identity disorder is often confused with schizophrenia by those who are not medically trained, but they are not considered the same by the mental health community.

Popular movies that have portrayed people with dissociative identity disorder and the popularity of using the diagnosis as a criminal defense have made dissociative identity disorder both a focus of attention and debate in the psychological community.

Symptoms & Complaints

People with dissociative identity disorder will have two or more distinct personalities or identities. These personalities can differ in severe and surprising ways. Some may be female while others are male. Some may be adults while others are children. Some can be left-handed while others are right-handed.

Dissociative identity disorder involves transitioning from different personalities, and transitioning from one personality to another can take minutes to weeks. However, only one personality is in charge at a time, and only they have access to the memories that they create while in charge. 

The symptoms of this disorder are based on instances where a person lacks all memory of extended periods of time. These memory gaps are severe and cannot be explained by normal forgetfulness or intellectual disability.

Causes

The suggested causes of dissociative identity disorder are somewhat controversial. Most of the people diagnosed with dissociative identity disorder also have another mental disorder as well. This suggests that it may just be a severe and untreated version of some of these mental illnesses.

One of the most common theories posit that the cause of dissociative identity disorder is psychological trauma. This theory was especially popular from the 1970's to the 1990's when a number of studies linked the condition to a stressful upbringing or event particularly those involving childhood abuse. According to the Cleveland Clinic, 90% of people with dissociative identity disorder suffered abuse.

Another theory that some psychologists who doubt dissociative identity disorder have suggested is that individuals undergoing hypnosis will falsely convince themselves that they have additional personalities.

Diagnosis & Tests

Dissociative identity disorder can be an incredibly difficult condition to diagnose because only one personality appears at a time, and it may take months to years before additional identities present themselves. A significant indication that someone may be suffering from dissociative identity disorder or another dissociative disorder is if they do not remember significant periods of time. Though memory loss can often be attributed to a different condition like posttraumatic stress disorder (PTSD), a pattern of missing events can suggest a dissociative disorder. An official diagnosis, according to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) requires that the following conditions be met:

  • Two or more distinct personal identities or personalities, each of which perceives the world in its own unique way.
  • Memory gaps about day-to-day activities and/or major events.
  • Distress or trouble functioning in normal life as a result of the disorder.
  • The disorder is not due to cultural or religious practices.
  • The disorder is not due to substance abuse or a medical condition.

Treatment & Therapy

Dissociative identity disorder does not subside on its own. Some other mental illnesses like depression may sometimes resolve themselves without treatment if circumstances change. This is not the case with dissociative identity disorder. Hypnosis has traditionally been a popular diagnosis and treatment option, though there is not one specific protocol that is followed that will guarantee the return to one personality.

Typically, dissociative identity disorder patients will undergo a series of different treatments. Psychotherapy (talk therapy), particularly cognitive behavioral therapy (CBT), is one of the most common treatments. The management of any additional mental illnesses is a key piece in the dissociative identity disorder puzzle. Other popular treatment methods include dialectical behavioral therapy (DBT) and eye movement desensitization and reprocessing (EMDR). Family therapy and music therapy may also be employed as part of the treatment process.

For most patients who have been diagnosed with dissociative identity disorder, the hope is to get them to a point where they can function normally in life without distress. It is incredibly rare to cure this condition. There is no specific psychiatric medication for dissociative identity disorder, but medications may be prescribed to abate symptoms or to treat any other mental illnesses that may co-exist. Such medications include anti-anxiety drugs, antidepressants, and tranquilizers.

Prevention & Prophylaxis 

Since many believe dissociative identity disorder is rooted in childhood trauma, it is important to prevent child abuse - whether that abuse is physical, verbal, or sexual. Prevention programs in schools and communities that teach children their rights and empower them to report abuse may help prevent the slew of psychiatric problems such as dissociative identity disorder that can develop later on. Prevention may also include addressing, diagnosing, and treating symptoms of mental disorders promptly.