What Is Dissociative Identity Disorder?

Dissociative identity disorder (DID) is a psychiatric condition that occurs when a person has multiple identities that function independently. These identities—also called “alters” or “personality states"—have their own consciousness, memories, and even personalities. Researchers estimate that this condition affects approximately 1.5% of the global population. 

Studies suggest that the leading cause of DID is severe and repetitive childhood trauma. Each alter (identity) often holds different traumatic memories and occasionally displays self-destructive or challenging behaviors. When people with DID switch between their alters, they experience gaps in their memory that can affect their daily functioning. 

Treatment and support can help those with DID more safely navigate their shifting alters, as well as process different traumatic memories. Healthcare providers often misdiagnose DID—and many people don’t receive a proper diagnosis until later in life. Despite media representation, people with DID are not more prone to violence than the general population, and can live fulfilling lives.

Symptoms

While people with DID have a “primary” personality state, they also have different alters that take over their consciousness. The primary personality state is often not aware of the existence of different alters, leading to distressing gaps in memory, impairments in functioning, and a host of other symptoms.

The Presence of Two or More Alters

Alters have their own identity, memories, behaviors, and even preferences (e.g., favorite foods and clothing items). Most alters often have their own name and can be of different ages and genders. The average number of alters of someone living with DID is 13, but someone can have fewer or much more.

Examples of alters include:

• A small child who cries often, wants to be comforted, and remembers specific traumatic experiences
• An angry teenager who lashes out and engages in self-destructive behavior 
• A “leader” who holds a central role and is aware of the other alters

Switching Between Altered States

People with DID involuntarily switch between alters. This switch can happen suddenly and often occurs due to triggers such as stress. Other people may not be able to observe when a switch is happening or has happened.

Signs of switching between alters include:

• Eye blinking or rolling 
• Changes in posture 
• Appearing to be in a trance

Amnesia

A person with DID typically has no memory of being in an altered state. These gaps in memory can cause distress and affect functioning, leading to the inability to recall important day-to-day information. Additionally, someone with DID might have large gaps in their childhood memories or have limited memory of the trauma they experienced.

Additional Symptoms

Aside from the hallmark symptoms of multiple alters, difficulty functioning, and memory troubles, people with DID can also experience:

• Anxiety 
• Depression 
• Symptoms associated with trauma (e.g., hypervigilance, flashbacks) 
  
• Somatic symptoms (e.g., headaches, seizures, or gastrointestinal issues)
• Self-harm
• Suicidal ideation or attempts

Causes

DID is often the result of severe and repetitive early childhood trauma, including reoccurring physical and sexual abuse. While dissociation (or, the disconnection between one’s body, thoughts, and sense of self) is a common experience for trauma survivors, researchers believe that in people who develop DID, extreme and frequent dissociation causes a breakdown of memory and sense of self.

For example, while someone might feel disconnected from their body during a traumatic event to make the experience more tolerable, a child who develops DID takes this survival mechanism a step further, dissociating into different identities (alters) to make their abuse more bearable.

It's worth noting that not every person who experiences severe childhood trauma develops DID. According to one theory, these four factors need to be present for someone to develop DID:

• An ability to dissociate
• Overwhelming traumatic experiences that distort reality
• Creation of alters with specific names and identities
• Lack of external stability, leading the child to rely on self-soothing

Other factors that may increase one's risk of developing DID include:

• Early onset of trauma (before the age of 5)
• Abuse at the hands of attachment figures (e.g., parents or guardians)
• Disorganized attachment style
• Social isolation
• Chronic stress
  

Diagnosis

On average, people wait five to 12 years before receiving a proper diagnosis. This is partially because diagnosing DID often requires multiple assessments over a long period of time, a detailed personal history from multiple sources (such as friends and family), and medical exams that rule out other possible explanations for the symptoms.

Due to gaps in memory, people with DID might have trouble accurately self-reporting their symptoms or recalling their full trauma histories. People with DID often receive a misdiagnosis for other psychiatric conditions like borderline personality disorder and may encounter healthcare providers who are skeptical or ignorant of their condition.

To diagnosis DID, there are also several assessment tools a healthcare provider might use, including:

• Dissociative Experiences Scale (DES)
• The Dissociation Questionnaire (DIS-Q)
• The Multidimensional Inventory of Dissociation Dissociative Disorders Interview Schedule (DDIS)
• Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D)
  

Treatment

The goals of DID treatment can vary from person to person. For some, the purpose of treatment is to integrate their identities and reduce or eliminate the number of alters they're experiencing. For others, the primary treatment goals are to increase cooperation between the alters and improve the person’s overall quality of life.

Most mental health professionals who treat DID use a three-phase treatment approach:

1. Establishing safety and stabilization: This phase focuses on managing life-threatening behaviors, like substance use, self-harm, or suicidal behaviors. Mental health providers help a person with DID learn emotional regulation and grounding techniques to aid them in establishing more immediate safety.
2. Confronting and working through traumatic memories: In this phase, a person might work with a provider to process past traumas. This can look like safely accessing traumatic memories by engaging with different alters. 
3. Identity integration/cooperation: During this phase, providers focus on a person’s relationship with their “whole” self. The goals of this phase are individualized and depend on the person's needs and interests for healing and recovery.

Mental health providers can also use psychotherapy (or, talk therapy) to help someone living with DID manage their symptoms and process traumatic memories. These therapies include:

• Trauma-focused cognitive behavioral therapy (TF-CBT) 
• Dialectical behavioral therapy (DBT)
• Eye movement desensitization and reprocessing (EMDR)
  

How to Prevent DID

Most people with DID have experienced repetitive and severe childhood trauma, including physical and sexual abuse, emotional neglect, and a dysfunctional home environment. Considering this, protecting children from child abuse is one way to prevent the development of DID. Early intervention and community support for children who’ve experienced early childhood trauma can also mitigate (or, reduce) the risk of developing DID and other trauma-related disorders.

While the causes of child abuse are complicated, some ways to prevent child abuse include:

• Strengthening economic support for families
• Affordable, high-quality childcare
• Mentoring programs and after-school programs
• Awareness campaigns about the signs of child abuse

Related Conditions

DID is a complicated disorder that frequently co-occurs with other health conditions. In general, childhood trauma has been tied to numerous poor health outcomes including substance use, depression, and heart disease. People who develop DID are at risk for developing other conditions related to trauma, including: 

• Post-traumatic stress disorder (PTSD)
• Substance use disorder
• Personality disorders like borderline personality disorder or narcissistic personality disorder
• Self-harm and suicidal thoughts
  

Living With DID

The prognosis (or, outlook) for people with DID is considered poor without receiving proper treatment. That being said, once someone receives an accurate diagnosis and adequate treatment, they can live fulfilling lives.

With the help of a mental health provider, people with DID can attempt to integrate their alters into one, primary identity, or work to create systems that help them safely navigate their shifting alters. For example, this can include strategies for coping with amnesia, like utilizing support systems and writing things down to remember them when their identity switches.

Treatment can be intensive and difficult and often involves processing new trauma memories and ongoing safety planning if self-harm or suicidal behaviors are involved. Becoming more familiar with their alters and gaining new information about their past can help people with DID put the pieces of their lives together—and improve their overall functioning and quality of life.