Understanding Dissociative Identity Disorder (DID): Causes, Symptoms, and Treatment

Dissociative Identity Disorder (DID), formerly known as "Multiple Personality Disorder" and often referred to as "Split Personality", is one of several recognized dissociative disorders in the field of mental health.

What is Dissociation?
Dissociation means disconnection, and dissociative disorders are characterized by various degrees of disconnection from reality. DID is considered the most extreme and severe among them. However, due to its ambiguous symptoms, which vary significantly from person to person, its exact prevalence is unknown. Some researchers even question whether DID exists as a standalone disorder, suggesting that its symptoms may instead represent aspects of other mental health conditions.

A DID diagnosis is generally made when the following conditions are present:

• The individual expresses themselves as having multiple personalities- at least two distinctly different identities. Sometimes one identity is aware of the other, and at others they are completely disconnected. The core issue is a lack of continuity in the person’s sense of self, often accompanied by changes in memory, perception, awareness, cognition, and even sensory or motor function.

• The person experiences significant memory gaps involving important personal information or traumatic events that cannot be explained by normal forgetfulness.

• The symptoms cause substantial distress and impair the person’s social, occupational, or other important areas of functioning.

• The symptoms are not part of a religious or cultural practice, nor can they be explained in children by imaginative play or fantasy.

• The symptoms are not due to substance use (such as drugs or alcohol) or medical conditions.

What Causes DID?
Research in this field consistently indicates that DID develops as a response to trauma, especially abuse. The more severe and the earlier in life the abuse occurs, the higher the risk for developing DID. It is believed that a child subjected to extreme abuse copes by mentally splitting off into different states of being to bridge emotional and cognitive gaps.

Because it stems from extreme trauma, DID often appears alongside other disorders such as PTSD, OCD, schizophrenia, psychogenic amnesia, bipolar disorder, and more. This makes diagnosing DID particularly complex.

Its symptoms can also be mistaken for other conditions. For example, sudden shifts between personalities may be misdiagnosed as mood swings between mania and depression (bipolar disorder). However, medications that are effective for bipolar disorder usually do not improve symptoms of DID, often signaling a need to reassess the diagnosis.

How Is DID Treated?
DID must be diagnosed by a psychiatrist, ideally one with expertise in dissociative disorders. The psychiatrist will conduct an interview and ask specific questions to determine whether the patient has DID or another mental condition.

The primary treatment for DID is psychotherapy, and in many cases, it is the only treatment required. Medication may be prescribed to manage certain symptoms but does not replace therapy- it supports the patient in being more emotionally available for psychotherapeutic work.

In severe cases, especially where one of the identities poses a danger to the individual or others, hospitalization may be necessary. It is important to note that individuals with DID have a high risk of suicide. When there is concern for the person’s safety, immediate psychiatric intervention and possible hospitalization are critical.