Dissociative identity disorder is one of four mental disorders that are recognized as part of the dissociative disorders classification of mental illnesses. Formerly and still popularly known as multiple personality disorder, people with diagnosed dissociative identity disorder possess two or more essentially distinct identities, also referred to as personality states. The disorder greatly affects a person’s ability to remember personal information and, according to the DSM, “reflects a failure to integrate various aspects of identity, memory, and consciousness.” In most cases, the identity using the person’s given name serves as the person’s primary identity, with alternative identities having names and characteristics that are distinct from the primary identity. Though the number of identities reported in people diagnosed with DID ranges from 2 to more than 100, half of all cases involve individuals with 10 or fewer identities. Females tend to have twice as many identities as males with the disorder.
A feature commonly found in people with the disorder is a history of severe childhood sexual and/or physical abuse, and people with DID are at greater risk of having adult relationships that involve physical and sexual abuse. Dissociative identity disorder shares many symptoms with post-traumatic stress disorder (PTSD)—including frequent nightmares, flashbacks, and startle responses—and it is common for people with DID to be concurrently diagnosed with PTSD. Individuals with DID often have symptoms of mood, sexual, eating, sleep, or substance-related disorders as well. Impulsivity, self-mutilation, and volatile interpersonal relationships are traits and behaviors frequently found in people diagnosed with DID that may lead to a co-diagnosis of borderline personality disorder. Though they may have symptoms in common, personality disorders are Axis II disorders and distinct from dissociative disorders, including DID.
Other symptoms someone with DID might exhibit include mood swings, suicidal tendencies, anxiety attacks, phobias, self-persecution and self-sabotage, compulsive rituals, auditory and visual hallucinations, and memory loss. Gaps in memory tend to be greater among the more passive identities in people with the disorder, while the more dominant identities possess more complete memories. Amnesia may affect both events and biographical information, and some identities may retain memories that are lost in other identities. The person’s primary identity tends towards passivity, guilt, dependency, and depression, while the alternative identities—often more powerful, aggressive, and hostile in nature—emerge sequentially depending on the situation. Sometimes the different personality states will interact and even display confrontational attitudes towards one another; in other cases, the alternate identities display little or no awareness of each other.
Treatment for dissociative identity disorder may last months or even years. Medication is not generally used to treat DID; instead, the individual modality of psychotherapy is the preferred form of treatment for this disorder. This approach attempts to integrate the patient’s various identities into a single, cohesive personality. The personality reflects the sum of the person’s identities, which splintered off from each other at various points in the patient’s past, usually following a traumatic event (or multiple traumatic events). The attempt to create a single identity has been found to be less effective than developing peaceful co-existences between the various personality states, as patients reported feeling as if their therapists were trying to kill off parts of them using the former technique. Hypnosis may also aid in the treatment process by helping the patient develop a greater understanding of his or her different identities and facilitating communication between them. Medication can be used to treat concurrent disorders and symptoms if the patient has multiple diagnoses but is not recommended as a means to treat DID per se.
Dissociative identity disorder has been portrayed in the 1957 film The Three Faces of Eve, which was based on a book detailing the real life experiences of a woman with DID, Chris Costner. The iconic 1960 film Psycho centers around the character Norman Bates, a psychopath who had come to inhabit the identity of his deceased mother while retaining his primary identity. Adapted from the best-selling book of the same name, Sybil, a made-for-television film first broadcast in 1976, depicts the life of Shirley Ardell Mason (renamed Sybil Dorsett in the book and film), who was diagnosed with multiple personality disorder by Dr. Cornelia Wilbur in 1954. The film starred Joanne Woodward, who played the lead in The Three Faces of Eve, and Sally Field, who won an Emmy for her performance as the title character. The veracity of Mason’s diagnosis, like dissociative identity disorder itself, has been challenged in recent years.
By: Greg L.
Filed under: Conditions and Disorders, Mental Illness · Tags: co-diagnosis, depression, Dissociative identity disorder, dual diagnosis, mental illness, multiple diagnoses, multiple personalities, post traumatic stress disorder, PTSD, Treatment