What is Dissociative Identity Disorder?

A controversial condition sometimes confused with BPD.

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Dissociative identity disorder, which used to be called multiple personality disorder, is one of the dissociative disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5).

Dissociative disorders all have a central feature of "dissociation,” or a disruption in the normal integrated functions of consciousness, memory, identity, and perception.

What is Dissociative Identity Disorder?

In dissociative identity disorder (DID), you may experience the presence of two or more distinct identities or personalities, also known as alters.

These personalities recurrently take control of your behavior and you often experience a loss of memory for what happened while another personality or alter is in control.

Prevalence of Dissociative Identity Disorder

Dissociative identity disorder is a very rare condition. It is so rare that it is difficult to study, so little research has been conducted on people with DID. That being said, one study found that about 1 percent of women in the community have DID—of course, more studies are needed to confirm this finding.

Interestingly, there has been a recent surge in the diagnosis of DID. However, it is not clear whether this is due to a greater awareness of the disorder by mental health professionals or to misdiagnosis.

The Dissociative Identity Disorder Controversy: Does DID Exist?

There has long been controversy within the field of mental health about whether or not DID exists. There is evidence that people with DID are more susceptible to hypnosis and suggestibility.

This has led some experts to argue that the separate identities experienced by people with DID may be the result of suggestion.

Other experts, however, argue that there are recent studies that refute this idea of suggestion. For example, some studies have demonstrated that the different personalities of a person with DID have different physiological profiles including different brain activation patterns or cardiovascular responses.

These studies have been used as evidence for the existence of actual alters.

Overall, studies on DID are limited, and it remains a controversial diagnosis. However, the diagnosis is now gaining more acceptance in the mental health community, and we are learning more about how to treat DID—a positive and hopeful development. 

Diagnostic Criteria for Dissociative Identity Disorder

The diagnostic criteria for dissociative identity disorder as described in the DSM-5 are as follows:

  • The presence of two or more distinct identities or personalities, each with its own pattern of interpreting and relating to the environment. The presence of these personalities can be self-reported or observed by a therapist for diagnosis. 
  • Amnesia must occur, limiting how much a person can remember about both traumatic events and daily occurrences.
  • The person must have difficulty in their daily functioning.
  • The symptoms are not part of cultural or religious practice.
  • The symptoms are not resulting from the use of any substance, such as alcohol or medication.

Dissociative Identity Disorder and Borderline Personality Disorder 

People with DID often report the experience of severe physical and sexual abuse during childhood and also frequently have concurrent symptoms of borderline personality disorder (BPD), including self-harming behaviors, impulsive behaviors, and instability in relationships.

This may be related to the fact that childhood abuse is a risk factor for both dissociative identity disorder and borderline personality disorder.

One theory about the development of DID proposes that people with DID have experienced a psychological trauma so severe that the only way to manage that trauma is to develop very strong dissociation as a coping mechanism. Over time, chronic dissociation leads to the formation of different identities.

While dissociation is also a symptom of borderline personality disorder, usually the dissociation seen in BPD does not happen as frequently or as severely as in DID.

That being said, someone with the symptoms of DID and BPD may receive a diagnosis of both disorders.

In addition, if you have DID, you may experience other trauma-related symptoms, including nightmares, flashbacks, or other symptoms characteristic of post-traumatic stress disorder (PTSD).

Sources:

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders DSM-5. 5th ed. American Psychiatric Publishing: Washington DC, 2013.

Reinders AA, Willemsen AT, den Boer JA, Vos HP, Veltmn DJ, Loewenstein RJ. Opposite brain emotion-regulation patterns in identity states of dissociative identity disorder: a PET study and neurobiological model. Psychiatry Res. 2014 Sep 30;223(3):236-43.

Sar V, Akyüz G, Dogan O.Prevalence of Dissociative Disorders Among Women in the General Population. Psychiatry Research. 149:169-176, 2007.

Schlumpf YR, Reinders AA, Nijenhuis ER, Luechinger R, van Osch MJ, Jäncke L. Dissociative part-dependent resting-state activity in dissociative identity disorder: a controlled FMRI perfusion study. PLoS One. 2014 Jun 12;9(6):e98795.

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