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