What are the other Names for this Condition? (Also known as/Synonyms)

• DID (Dissociative Identity Disorder)

What is Dissociative Identity Disorder? (Definition/Background Information)

• Dissociative Identity Disorder, previously referred to as multiple personality disorder, is characterized by the presence of two or more distinct and separate personalities within an individual. Although multiple personalities can exist within a single person, only one personality is manifested at any given time
• Dissociative Identity Disorder falls into the category of dissociative disorders, which are conditions that result in a breakdown of consciousness (mind), and cause confusion in memory, awareness, identity, or perception
• Individuals may develop Dissociative Identity Disorder primarily due environmental factors, since this disorder is triggered following extreme or persistent psychological stress, such as physical/emotional abuse, trauma, or violence
• Dissociative disorders are generally treated using a combination of psychotherapy and medication. Psychotherapy is the primary method of treatment for all dissociative disorders. Medication can be used to control mental health symptoms associated with these disorders such as depression and anxiety
• If left untreated, individuals often develop suicidal thoughts or behaviors. One may also take to alcoholism and substance abuse, or be affected by depression and anxiety disorders
• Multiple factors may influence the prognosis for Dissociative Identity Disorder, although with stable medical treatment and a strong support system, the affected individuals can lead a healthy life

Who gets Dissociative Identity Disorder? (Age and Sex Distribution)

• In general populations, the estimated prevalence of Dissociative Identity Disorder ranges from 1%-5%
• Although both genders may be affected, the condition occurs more frequently in females
• Dissociative Identity Disorder can manifest at all ages, with initial manifestations occurring between ages 5-10 years, which continues as the individual grows older
• Dissociative Identity Disorder is observed across all racial and ethnic groups

What are the Risk Factors for Dissociative Identity Disorder? (Predisposing Factors)

The risk factors for developing Dissociative Identity Disorder, as well as other dissociative disorders, are as follow:

• Immense or ongoing psychological stress, such as abuse, trauma, or violence
• Certain behavioral traits, such as denial or difficulty adapting to situations

It is important to note that having a risk factor does not mean that one will get the condition. A risk factor increases ones chances of getting a condition compared to an individual without the risk factors. Some risk factors are more important than others.

Also, not having a risk factor does not mean that an individual will not get the condition. It is always important to discuss the effect of risk factors with your healthcare provider.

What are the Causes of Dissociative Identity Disorder? (Etiology)

• Dissociative Identity Disorder (DID) primarily develops as a coping mechanism to trauma.
• Some situations that cause the development of DID include:
  • Children subjected to long-term physical, sexual, or emotional abuse
  • Overwhelming psychological stress, caused by traumatic events such as war, violence, accidents, or disasters
• The observed disturbances are not a consequence of substance use (drug addiction and/or alcohol addiction) or a general medical condition (such as epileptic seizure)

What are the Signs and Symptoms of Dissociative Identity Disorder?

Based on the criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the following signs and symptoms for Dissociative Identity Disorder are known to be observed:

• Multiple personalities:
  • Display of two or more distinct identities or personalities, each identity with its own pattern of perceiving, thinking, and relating to oneself and the world
  • Referring to oneself in plural (“we” instead of “I”)
• Memory loss: Consistent gaps in memory of everyday events, skills, and important personal information that are too extensive to be explained by ordinary forgetfulness
• Impaired functioning: Difficulty functioning in one’s social and occupational lives
• Mental health problems
  • Depression and anxiety
  • Suicidal thoughts and behaviors
  • Mood swings
  • Sleep disorders
• Physical health problems
  • Headaches 
  • Generalized body pain

How is Dissociative Identity Disorder Diagnosed?

Dissociative Identity Disorders may be diagnosed using a combination of the following physical and psychiatric methods, as follow:

• Complete physical and psychiatric examination
• Extensive evaluation of medical history to factor in any medication or substance use that may be the cause of the dissociative symptoms 
• Assessment of the signs of symptoms based on the criteria listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association
• Laboratory tests
• Imaging studies
• Biopsy studies, if necessary
• Differential diagnosis, to rule-out any other conditions that may manifest with similar signs and symptoms

Many clinical conditions may have similar signs and symptoms. Your healthcare provider may perform additional tests to rule out other clinical conditions to arrive at a definitive diagnosis.

What are the Complications of Dissociative Identity Disorder?

The complications of Dissociative Identity Disorder are as follows:

• Aggressive tendencies
• Poor social skills; difficulty in maintaining personal and social relationships
• Loneliness or social solitude
• Sexual dysfunction
• Substance use and abuse (alcohol or drug dependence)
• Deterioration of existing mental disorders or development of new ones such as:
  • Depression and anxiety 
  • Sleep disorders including nightmares, insomnia, and sleep walking
  • Eating disorders
  • Post-traumatic stress disorder (PTSD)
  • Personality disorders
• Self-mutilation
• Suicidal thoughts and behaviors

How is Dissociative Identity Disorder Treated?

The treatment for Dissociative Identity Disorder is based on the severity of the signs and symptoms present in each affected individual. The focus of treatment is to identify the source of the symptoms and to help one to reconnect with their surroundings.

The treatment options include a combination of the following methods:

• Psychotherapy, the primary form of treatment, may be applied using different techniques
  • Cognitive-behavioral therapy (CBT) to help change negative and dysfunctional thought patterns, feelings, and behaviors
  • Eye movement desensitization and reprocessing (EMDR) to treat nightmares or flashbacks, such as in the cases of post-traumatic stress disorder (PTSD)
  • Dialectical behavior therapy (DBT) to address those who have undergone abuse or trauma
  • Family therapy to educate the family of the disorder
  • Art therapy or music therapy
• Meditation and relaxing techniques, including hypnosis
• Medication for associated anxiety and depression

How can Dissociative Identity Disorder be Prevented?

It is generally difficult to prevent the onset of Dissociative Identity Disorder. However, the following steps may be taken to reduce the risk and/or slow down the progression of the condition:

• Early intervention after signs and symptoms become apparent
• Seeking professional help following any psychological trauma in one’s life
• Speaking with a trusted friend or family member to help cope with stress
• Avoiding substance use, as alcohol and drug dependencies can aggravate the symptoms of Dissociative Identity Disorder

What is the Prognosis of Dissociative Identity Disorder? (Outcomes/Resolutions)

The prognosis of Dissociative Identity Disorder may vary based on each individual’s signs and symptoms

• Those with symptoms that are mainly post-traumatic can function well and make a full recovery with regular treatment
• Individuals with symptoms alongside other coexisting disorders, such as personality or mood disorders, may require a longer course of treatment
• The recovery process of Dissociative Identity Disorder requires a combination of clinical treatment along with a strong support system to ensure that affected individuals can lead a healthy lifestyle

Additional and Relevant Useful Information for Dissociative Identity Disorder:

• Other types of dissociative disorders include dissociative amnesia and depersonalization/ derealization disorder
• Some cultures may perceive the experience of Dissociative Identity Disorder to be possession
• DID was formerly referred to as multiple personality disorder

The following DoveMed website link is a useful resource for additional information:

https://www.dovemed.com/healthy-living/emotional-well-being/