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I am finally completing my series on understanding dissociation with Dissociative Identity Disorder (DID). Although DID (or Multiple Personality Disorder, the earlier term) is perhaps the most well-know dissociative disorder it is also complex and often misunderstood. Due to its complexity, I am going to discuss it over the course of several posts.
I want to start by stressing that all dissociation serves a protective and coping function. In the face of repetitive and overwhelming experiences a young child’s capacity to “not know” or compartmentalize is life saving. So as you read this, if this is an issue for you, keep in mind that your dissociation has helped you survive. That is important to acknowledge and honor indeed!
The following are the DSM-5 diagnostic criteria for dissociative identity disorder. All five of the following are true for someone with DID:
- Disruption of identity characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.
- Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.
- The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
- The disturbance is not a normal part of a broadly accepted cultural or religious practice.
- Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play.
- The symptoms are not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizure
The hallmark of DID is the existence of different parts of the mind that are separate from each other due to dissociative, or amnestic, barriers. The name change from multiple personality disorder to dissociative identity disorder occurred in part to highlight our understanding that these different parts are all manifestations of a single person and together make up the personality. In Guidelines for Treating Dissociative Identity Disorder in Adults the International Society for the Study of Trauma and Dissociation stresses the importance of this understanding:
“It is important for clinicians to keep in mind that despite the DID patient’s subjective experience, the patient is not a collection of separate people sharing the same body. The DID patient should be seen as a whole adult person, with the alternate identities sharing responsibility for life as it is now. All the alternate identities together make up the identity or personality of the human being with DID. “
It has been my experience that many clients originally present to therapy without an awareness of different personality states. There is great variability in how each person’s inner system is structured. Often there is one (or some) who are unaware of the existence of the others.
The overtness of symptoms of DID varies greatly by individual and according to other factors such as current level of stress, culture, internal conflicts and dynamics, and emotional resilience. DID most often functions to protect the individual by adapting to external settings in order to protect the person ‘s internal world. For example, very often all parts of a person are able to answer to the same name and present parts that are able to function in different settings (family, parenting, work). Many individuals with DID function well in the eyes of others and would never be identified as such. All of these factors can make it difficult to identify the presence of DID, even within the treatment setting.
This is just the beginning of the conversation about dissociative identity disorder. Let me know if there is something else you want to know more about! Future posts will address:
- what is identity disruption and how is it experienced?
- amnesia or “losing time”
- personality states vs. personalities
- what causes dissociative identity disorder?
- commonly coexisting problems
- therapy goals
Dr. Kathleen Young: Treating Trauma in Tucson 
I always thought the belief was that to have DID, your different parts had to be unaware of each other – like the classic and stereotypical version of multiple personality disorder, as portrayed in the media and such. You say that different parts can function in different settings – so is it classified as DID if these different parts are starting to gain an awareness of how they are different in different settings? I’m probably not making much sense, just trying to get my head around it. I’m only really starting to accept there are different parts of me, and it is odd thinking back to a therapy session a few weeks ago where I was a totally different person; my therapist even said last week that I was completely closed and didn’t seem to even want to be there or want her help. As confusing as this is to live with, it is a fascinating concept and I’m amazed at the minds ability.
As an aside, thank you for all your brilliant posts – they are very relevant to me and help me a lot in trying to understand.
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Thanks for your question!
My read of what DSM-5 says is that both different parts and some form of dissociative amnesia need to exist to make the diagnosis of DID. That amnesia may be for current day events, for example losing hours in a day. In my experience, when that happens it may mean that another part has been active and that there is that lack of awareness of each other you are addressing.
Certainly a goal of therapy is increase awareness of each other. While that is happening it doesn’t immediately mean someone is no longer DID. I hope the other posts I pan to write about DID will elaborate on these issues.
Thank you again for being here and your lovely words about my blog!
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I’d like to ask about how traumatic amnesia may or may not be related to DID.
I have large areas of my childhood for which I have no memories. I know many others – both male and female – who have similar experiences but who would not be considered ‘multiple’, or at least have no experiences of fugue like states or alternate personalities in adulthood. In my case, my childhood amnesia appears to be more for certain kinds of activities &/or people (e.g. babysitters) than for blocks of time. In the case of the ‘kinds of activities’ I have childhood amnesia for, many are activities for which I have triggers/dissociative responses in my current life. For instance, I have no memories of bathing, dressing, brushing teeth, etc…, and have triggers etc… for all of those activities. I get ‘lost’ when doing these activities, and have to do a kind of trigger management to find my way to ‘remember’ what the next task is. I’ve resorted to making charts for everyday activities outlining the basic steps, and when I realize I’m lost, consulting the chart to help me figure out where I am and what to do next. And when I make a push to do these things routinely regardless of how I feel I get nightmares. I know of people whose partners have to ‘remind’ them to: shower, brush their teeth, comb their hair, get dressed, etc… so I know that this probably isn’t as uncommon as I’d first believed. And I know that all of these people have similar amnesiac responses for self-care activities. And most of them can recall, or have been told about, one or two traumatic incidents around these tasks from childhood. But as far as I know none of these people are DID/multiple. They do all fit into the classic CPTSD diagnosis: nightmare, hypervigilance, flashbacks. But I’m not sure where this type of dissociation re: common routine tasks (or people from your past) would fit in to either CPTSD or DID – if at all.
I’m frankly confused re: the DSM diagnostic criteria re: dissociation &/or DID. It seems to be more confusing (or confused itself?) than helpful.
Another question I have is about how medications may play into this, and either help or exacerbate dissociative symptoms. For instance, I know that early experiences of psychadelic drugs, and prolonged meditation, can put vulnerable people into psychotics states &/or trigger schizophrenia in some individuals. I’m wondering if prolonged use of sleeping pills could have a similar effect re: amnesia or diminished recall.
My apologies if this is off-topic. Thanks for doing this series; I’m looking forward to your future articles on it.
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Great questions and not confusing at all! Although I am referencing DSM-5 in starting the conversation about DID, I find the way it describes most issues as not terribly useful. More of a snapshot than a full understanding, certainly!
I am planning to write a more in depth post about dissociative amnesia in DID. Hopefully that will shed more light!
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Thanks for describing the basics of what “makes” D.I.D, and it`s hidden-ness; particularly for the person[s] living with[in] it.
That is something we really struggled with, since several of us “functioned” (not very well; I grant you) as *a* person because our fragmented state is and was “normal” for us; we believed everyone else survived like this, too…..but they just coped better.
We are right now at a point where we are stuck between resenting having to survive by fragmenting, at the same time as having gratitude that even if we don’t understand how or why, we did work hard to keep going.
Thanks again.
Am looking forward to reading the up-coming posts, too.
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You are raising such a good point and one I planned to elaborate on: when you live something it is hard to know it is not the norm for others! I love how you phrased that DID’s ‘hidden-ness” and “living with[in] it”. Well stated!
I think it is a wonderful thing to have reached a place of any amount of gratitude for how fragmentation has served you, even if it is fleeting or unclear!
Thanks for reading 🙂
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