Dissociative identity disorder (DID) is a mental illness that involves the sufferer experiencing at least two clear identities or personality states, also called alters, each of which has a fairly consistent way of viewing and relating to the world.
This disorder was formerly called multiple personality disorder (MPD) and is often referred to as split personality disorder.
Some individuals with DID have been found to have personality states that have distinctly different ways of reacting, in terms of emotions, pulse, blood pressure, and blood flow to the brain.
Statistics regarding this disorder indicate that the incidence of DID is about 3% of patients in psychiatric hospitals and is described as occurring in females nine times more often than in males. However, this female preponderance may be due to difficulty identifying the disorder in males. Also, disagreement among mental-healthprofessionals about how this illness appears clinically, and if DID even exists, adds to the difficulty of estimating how often it occurs.
Some professionals continue to be of the opinion that DID does not exist. The nature of this skepticism is sometimes due to questions about why many more individuals who have endured the stress of terrible abuse as young children do not develop the disorder, why more children are not diagnosed as having DID, and why some DID sufferers have no history of tremendous trauma.
One explanation for what some believe to be these inconsistencies is that given the highly complex and unknown nature of the human brain and psyche, many of those whom one would expect to develop dissociative identity disorder are spared due to their resilience.
Another concern about the diagnosis of DID involves having to rely on the traumatic memories of those who suffer from this disorder. That DID is significantly more often assessed in individuals in North America compared to the rest of the world, for the most part, leads some practitioners to believe that DID is a culture-based myth rather than a true disorder.
As with many other mental-health issues, symptoms of the same disorder in children look very different than in adults. Studies that verify the presence of DID using multiple resources add credibility to the diagnosis. Research on individuals with DID that have little to no media exposure to information on the illness lends further credibility to the reliability of this diagnosis.
Although there was a case study of DID as early as 1906, movies about DID first became well known in the United States since the 1950s. The 1953 movie The Three Faces of Eve tells the story of Chris Sizemore, a real-life woman with the disorder. She was thought to develop DID in reaction to witnessing several terrible accidents at a young age.
That movie described three personalities that were successfully merged or integrated into one within one year. More accurately, the person depicted in that movie reportedly had to contend with 22 personalities that took more than 45 years to be able to coexist in a functional way.
A television miniseries about DID was Sybil. The character of Sybil Dorsett portrayed the life story of Shirley Ardell Mason, who experienced severe physical, emotional, and sexual abuse that was inflicted by her mother. She was thought to develop 16 distinct identities. As with the diagnosis in general, the veracity of the story of Sybil remains a controversy, with claims that the illness in general, and Sybil specifically, is a hoax.
The severe dissociation that characterizes patients with DID is currently understood to result from a set of causes:
- an innate ability to dissociate easily;
- repeated episodes of severe physical or sexual abuse in childhood;
- lack of a supportive or comforting person to counteract abusive relative(s);
- influence of other relatives with dissociative symptoms or disorders.
The primary cause of DID appears to be severe and prolonged trauma experienced during childhood. This trauma can be associated with emotional, physical or sexual abuse, or some combination. One theory is that young children, faced with a routine of torture, sexual abuse or neglect, dissociate themselves from their trauma by creating separate identities or personality states.
A manufactured alter may suffer while the primary identity "escapes" the unbearable experience. Dissociation, which is easy for a young child to achieve, thus becomes a useful defense. This strategy displaces the suffering onto another identity. Over time, the child, who on average is around six years old at the time of the appearance of the first alter, may create many more.
As stated, there is considerable controversy about the nature, and even the existence, of dissociative identity disorder. One cause for the skepticism is the alarming increase in reports of the disorder since the 1980s. An area of contention is the notion of suppressed memories, a crucial component in DID.
Many experts in memory research say that it is nearly impossible for anyone to remember things that happened before the age three, the age when some DID patients supposedly experience abuse, but the brain's storage, retrieval, and interpretation of childhood memories are still not fully understood.
The relationship of dissociative disorders to childhood abuse has led to intense controversy and lawsuits concerning the accuracy of childhood memories. Because childhood trauma is a factor in the development of DID, some doctors think it may be a variation of post-traumatic stress disorder (PTSD). In both DID and PTSD, dissociation is a prominent mechanism.
Psychotherapy is generally considered to be the main component of treatment for dissociative identity disorder. In treating individuals with DID, therapists usually try to help clients improve their relationships with others and to experience feelings they have not felt comfortable being in touch with or openly expressing in the past.
This is carefully paced in order to prevent the person with DID from becoming overwhelmed by anxiety, risking a figurative repetition of their traumatic past being inflicted by those very strong emotions. Mental-health professionals also often guide clients in finding a way to have each aspect of them coexist, and work together, as well as developing crisis-prevention techniques and finding ways of coping with memory lapses that occur during times of dissociation.
The goal of achieving a more peaceful coexistence of the person's multiple personalities is quite different than the reintegration of all those aspects into just one identity state. While reintegration used to be the goal of psychotherapy, it has frequently been found to leave individuals with DID feeling as if the goal of the practitioner is to get rid of, or "kill", parts of them.
Hypnosis is sometimes used to help increase the information that the person with DID has about their symptoms/identity states, thereby increasing the control they have over those states when they change from one personality state to another. That is said to occur by enhancing the communication that each aspect of the person's identity has with the others.
In this age of insurance companies regulating the health care that most Americans receive, having time-limited, multiple periods of psychotherapy rather than intensive long-term care provides what may be another effective treatment option for people with DID.
Medications are often used to address the many other mental-health conditions that individuals with DID tend to have, like depression, severeanxiety, anger, and impulse-control problems. However, particular caution is appropriate when treating people with DID with medications because any effects they may experience, good or bad, may cause the sufferer of DID to feel like they are being controlled, and therefore traumatized yet again.
As DID is often associated with episodes of severe depression, electroconvulsive therapy (ECT) can be a viable treatment when the combination of psychotherapy and medication does not result in adequate relief of symptoms.