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This article will cover:

• What is DID?
• How and why does it develop?
• How can DID be treated?
• The controversy surrounding DID

What is DID?

Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder, is characterised by the presence of at least two distinct personality states within a single individual, that control their behaviour [1]. DID is a rare disorder, affecting approximately 1% of the worldwide population [3, 8]. Additionally, it is often comorbid with other psychiatric illnesses such as depression, anxiety disorders, eating and sleep disorders or psychotic-like symptoms [3].

The person’s usual identity is referred to as “core” while the others are known as “alters” [5] and they are typically not aware of each other [2]. The alters can differ in gender, age, can have unique characteristics, mannerisms, voice, personal history and sometimes even physical qualities such as bad eyesight [5, 10]. For most people, switching between alters is involuntary and can be caused for example by stress or reminders of trauma [2, 5, 12].

People with DID often also have dissociative amnesia [10]. Dissociative amnesia is a type of memory loss that is much more severe than regular forgetfulness. The person is unable to recall information about themselves, usually from the time surrounding a traumatic experience. Furthermore, a person with DID can experience memory loss caused by another alter “taking over”. That means that they have gaps in memory from the time period when another identity was “in charge” [5]. Lastly, other symptoms might include depersonalisation: a sense of being detached from one’s own body, or derealisation: feeling like the world is not real [3, 7]. The symptoms and experiences are very subjective, so can vary from one person to another. This is why it is also important not to generalize them across every individual that lives with DID. 

How and why does it develop?

Trauma-based or fantasy-based? This is an ongoing debate among professionals studying DID and it has not been fully resolved yet. These two models are depicted below [6].

Some researchers propose that DID is an extreme response to severe and inescapable traumatic experience, typically during childhood [4, 11]. Hence, dissociation is a form of coping mechanism that the person develops to deal with a trauma, such as sexual or physical abuse. Indeed, research suggests that around 90-99% of people diagnosed with DID report experiencing severe disturbances or traumas during early childhood [3, 5]. The severity of dissociation is correlated with the severity of the traumatic experience [6]. Separating trauma from “normal” awareness helps the person maintain a regular level of functioning [3, 12]. The dissociation may continue even after the trauma has ceased and the alternate identities fail to integrate into one over time, resulting in DID [8]. 

On the other hand, the proponents of the fantasy model argue that dissociation is not causally related to experience of trauma [6]. They believe the reports of traumatic experiences by people with DID are simply false memories mediated by suggestion (e.g. hypnosis in therapy), cognitive distortions, sociocultural influences and by being fantasy-prone. Consequently, a person might unconsciously act as if they have multiple personalities not as a result of trauma but as the result of suggestion during treatment [4]. 

How can it be treated?

Currently, there are no specific evidence-based guidelines for treatment of DID because their effectiveness has not been studied extensively [3]. Moreover, there is no ultimate cure. The specific treatment varies per individual depending on severity of symptoms and the type of trauma/triggers.

The most typical treatment approach is psychotherapy, usually Cognitive Behavioral Therapy (CBT) [5]. It focuses on identifying the traumatic triggers of DID in hopes to integrate the separate identities into a single one. The treatment also helps to develop coping strategies other than alternate personalities, so to regain normal everyday functioning.

Hypnosis is another type of treatment that might be used for patients with DID [2]. The goal of hypnosis is to recover traumatic experiences that lead to development of DID. However, this type of treatment is highly controversial due to the reasons mentioned previously – it might lead to false memories of trauma [4].

The controversy surrounding DID

As previously mentioned, there is an ongoing debate regarding the origins of DID and findings are split. For example, researcher Dalenberg [6] argues that there is more evidence supporting the trauma-based approach than the fantasy-based one. On the contrary, researcher Lynn and colleagues [9] argue that Dalenberg [6] mistakenly interpreted correlational evidence as causal, and that while trauma might play a role in development of DID, it is not as central as the trauma approach posits. In conclusion, researchers are still unable to reach a consensus regarding the aetiology of this disorder.

Related to this is the question – should DID even be considered a legitimate diagnosis? [4]. Some researchers believe that DID is a diagnosis and agree with its inclusion in the DSM-V. Some believe that while it might be a legitimate diagnosis, it is over-diagnosed. On the other hand, even despite empirical evidence for its existence, some professionals do not believe that DID is a separate diagnosis and thus think it should be removed from DSM-V. They believe that the symptoms might be explained by a different mental disorder such as borderline personality disorder or that the symptoms only emerged as a result of therapy [4, 14].

Naturally, these controversies perpetuate the stigma around DID. 

Extra sources:

1. You Tube video - What it’s like to live with DID? https://www.youtube.com/watch?v=A0kLjsY4JlU

2. Article - Myths about DID https://www.therecoveryvillage.com/mental-health/dissociative-identity-disorder/related/did-myths/

References

1. American Psychiatric Association. (2013). Diagnostic criteria and codes. Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

2. Better Health. Dissociation and Dissociative Disorders. Retrieved on May 2, 2021 from https://www.betterhealth.vic.gov.au/health/conditionsandtreatments/dissociation-and-dissociative-disorders#dissociative-identity-disorder

3. Bhandari, S. (January 2020). Dissociative Identity Disorder (Multiple Personality Disorder). Retrieved on May 2, 2021 from https://www.webmd.com/mental-health/dissociative-identity-disorder-multiple-personality-disorder

4.     Boysen, G. A., & VanBergen, A. (2013). A review of published research on adult dissociative identity disorder: 2000–2010. The Journal of nervous and mental disease, 201(1), 5-11. doi: 10.1097/NMD.0b013e31827aaf81

5. Cleveland Clinic. Dissociative Identity Disorder (Multiple Personality Disorder). Retrieved on May 2, 2021 from https://my.clevelandclinic.org/health/diseases/9792-dissociative-identity-disorder-multiple-personality-disorder

6.     Dalenberg, C. J., Brand, B. L., Gleaves, D. H., Dorahy, M. J., Loewenstein, R. J., Cardena, E., ... & Spiegel, D. (2012). Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychological bulletin, 138(3), 550. https://psycnet.apa.org/doi/10.1037/a0027447

7.     Dell, P. F. (2006). A new model of dissociative identity disorder. Psychiatric Clinics, 29(1), 1-26. https://doi.org/10.1016/j.psc.2005.10.013

8.     Dorahy, M. J., Brand, B. L., Şar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas, A., ... & Middleton, W. (2014). Dissociative identity disorder: An empirical overview. Australian & New Zealand Journal of Psychiatry, 48(5), 402-417. https://doi.org/10.1177%2F0004867414527523

9.     Lynn, S. J., Lilienfeld, S. O., Merckelbach, H., Giesbrecht, T., McNally, R. J., Loftus, E. F., ... & Malaktaris, A. (2014). The trauma model of dissociation: Inconvenient truths and stubborn fictions. Comment on Dalenberg et al.(2012). https://psycnet.apa.org/doi/10.1037/a0035570

10.  Mayo Clinic. (November 2017). Dissociative Disorders. Retrieved on May 2, 2021 from https://www.mayoclinic.org/diseases-conditions/dissociative-disorders/symptoms-causes/syc-20355215

11.  Ross, C. A., & Ness, L. (2010). Symptom patterns in dissociative identity disorder patients and the general population. Journal of Trauma & Dissociation, 11(4), 458-468. https://doi.org/10.1080/15299732.2010.495939

12.  Sane Australia. Dissociative Identity Disorder (DID). Retrieved on May 2, 2021 from https://www.sane.org/information-stories/facts-and-guides/dissociative-identity-disorder

13.  Vissia, E. M., Giesen, M. E., Chalavi, S., Nijenhuis, E. R., Draijer, N., Brand, B. L., & Reinders, A. A. (2016). Is it Trauma‐or Fantasy‐based? Comparing dissociative identity disorder, post‐traumatic stress disorder, simulators, and controls. Acta Psychiatrica Scandinavica, 134(2), 111-128. https://doi.org/10.1111/acps.12590

14.  Tracy, N. (May 2015). Dissociative Identity Disorder Controversy: Is DID real? Retrieved on May 2, 2021 from https://www.healthyplace.com/abuse/dissociative-identity-disorder/dissociative-identity-disorder-controversy-is-did-real