The concept of someone having a split personality is one often depicted in movies and on TV. However, there is a real mental illness that leads to the development of “alters,” or separate personalities, usually prompted by a traumatic event. Read on to learn more about dissociative identity disorder.
What Is Dissociative Identity Disorder?
Dissociative identity disorder (DID), previously known as multiple personality disorder, is a rare mental illness categorized by the existence of at least two distinct personalities or identities. Dissociation involves a lack of connection from your thoughts, memories, or sense of self, and people may experience mild forms of dissociation. DID involves severe dissociation, with personalities so separate that memories do not carry over from one to the next.
Within the mental health community, there is some dispute as to whether or not DID is an actual mental illness or an offshoot of other mental illnesses. However, DID is currently listed in the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5), with five criteria required for a diagnosis.
Stages and Types of Dissociative Identity Disorder
Though people with the disorder may experience some variation in symptoms, there is only one type of dissociative identity disorder. Instead, DID is one of three different types of dissociative disorders, all of which involve some level of dissociation.
- Dissociative amnesia
- Dissociative identity disorder
- Depersonalization-derealization disorder
Dissociative identity disorder typically involves a component of dissociative amnesia. However, dissociative amnesia can be diagnosed separately and is not considered to be just a part of dissociative identity disorder.
Symptoms and Causes
The primary cause of dissociative identity disorder is believed to be trauma, especially trauma experienced during childhood. Many people with dissociative identity disorder have endured physical, emotional, or sexual abuse, and they dissociate as a means of coping with those experiences. Other traumatic events can also contribute to the development of DID. Those with a family history of DID may be more likely to develop this condition.
According to the DSM-5, there are five criteria that a person has to meet in order to be diagnosed with dissociative identity disorder.
- People must have at least two distinct personalities or identities. Any other personalities, or alters, may have different manners of speaking, memories, likes and dislikes, worldviews, or even gender identities. The DSM-5 describes it as a “marked discontinuity in sense of self and sense of agency.”
- Amnesia must be experienced regarding traumatic experiences, important knowledge regarding oneself, and typical, everyday events.
- The disorder must cause emotional distress or difficulty functioning in day-to-day life.
- The dissociative episodes and separate personalities cannot be the result of “normal cultural or religious practices,” such as children having imaginary friends.
- Symptoms are not caused by drugs, alcohol, or another medical condition.
Some of the other symptoms of dissociative identity disorder can include:
- Depression and/or suicidal thoughts or behavior
- Sleep disorders
- Out-of-body experiences
- Auditory or visual hallucinations
Prevention and Risks
Because dissociative identity disorder is usually caused by trauma, it is difficult to prevent its development, as people cannot always avoid or get out of a traumatic situation. The best means of potentially preventing DID is to seek mental health treatment if you are struggling to cope with any trauma that you have experienced so that you can process it in a healthy way.
People with a family history of dissociative identity disorder have an increased risk of developing it. This risk factor doesn’t mean that there is a genetic component, just a greater mental predisposition or susceptibility to the condition. Women are also more likely to develop dissociative identity disorder than men are.
Diagnosis and Tests
The DSM-5 outlines the necessary criteria for diagnosing dissociative identity disorder. It is considered difficult to diagnose, especially since it often involves amnesia and symptoms that are present in other mental illnesses such as depression or post-traumatic stress disorder. However, the existence of separate personalities is the main indication that psychiatrists will look for to diagnose DID. When talking to a patient who potentially has DID, there are two different tests they may use: the dissociative experiences scale (DES) and the structured clinical interview for dissociation (SCID-D). These tests can gauge how often and how severely someone dissociates and provide guidance for the psychiatrist making a diagnosis.
There are no specific medical tests that can point to a diagnosis of DID. However, blood tests and imaging tests are often used to rule out medical conditions that could be causing gaps in memory.
Treatment, Procedures, and Medication
Psychotherapy is the most effective treatment for DID, with the goal of integrating alters or simply getting to a place where those personalities can peacefully coexist. Working with a therapist can help people with DID address their trauma, learn healthy coping mechanisms, and find ways of overcoming any difficulties with interpersonal relationships or in society. One of the necessary aspects of DID is experiencing distress or difficulty functioning because of the condition; a therapist can offer assistance in dealing with these things. Some people also find hypnotherapy helpful, as well as treatments such as movement or art therapy, which are frequently recommended for people coping with trauma.
There is no medication that can treat DID. However, psychiatrists will sometimes prescribe medications to treat other aspects of dissociative disorders, such as depression, anxiety, and insomnia, to minimize those symptoms and make daily life easier. Because of the presence of multiple personalities, it can be difficult to ensure responsible prescription use, so it is important to be careful with this option.
Many people with dissociative identity disorder also find DID support groups to be beneficial.
Healthy Lifestyle Tips
The National Alliance on Mental Illness says that “self-care is a must” for people with a dissociative identity disorder. Some of their recommendations include:
- Keeping a journal. This practice can be helpful for increasing one’s awareness of their condition since they might use it while dissociating or while an alter is in control.
- Practicing mindfulness. Meditation, breathing deeply, and other mindfulness techniques can help someone get through an out-of-body feeling. Sensory experiences, such as touching something textured or smelling something with a strong fragrance, can also be beneficial.
- Letting other personalities come out. Giving alters a safe opportunity to come out can make dealing with that transition easier and give them chances you may not have had. For many people, their goal is to deal with “switches” between personalities easily and have peaceful coexistence between alters, and letting them emerge can help with that.
As with any mental illness, it is important to find a doctor whom you trust and stick with any treatment plan. Staying in good physical health as much as possible can also be helpful.
Food- and Nutrition-Based Approaches to Prevention and Management
People with dissociative identity disorder frequently have eating disorders. As with any coexisting condition, addressing this issue, however it presents, is crucial, especially since eating disorders can greatly impact physical health.
There is no specific diet that can help dissociative identity disorder. Regardless, try to eat a healthy, balanced diet with fruits, vegetables, whole grains, and vitamins. Physical health can be a significant component of mental health, and making sure you get all necessary nutrients can put you in a good frame of mind and help enable you to take care of yourself.
What Type of Doctors to See
The most important doctor to see if you have or think you have dissociative identity disorder is a psychiatrist. These professionals can make a diagnosis and prescribe any necessary medication. Many psychiatrists also offer talk therapy. Psychologists and licensed mental health counselors also provide this service. As psychotherapy is considered the primary part of treatment for dissociative identity disorder, it is crucial to find someone to talk to whom you trust.
In the process of diagnosing DID, you may also see a medical doctor to order blood tests or imaging tests to rule out any medical conditions that could be causing your symptoms.
A diagnosis like dissociative identity disorder can be a daunting one, but it is possible to live a full, healthy life with this mental illness. Work with a therapist can help you acknowledge and cope with any past trauma, as well as manage the disorder itself. Neither the illness nor any traumatic experiences have to define the rest of your life.