“As an undergraduate student in psychology, I was taught that multiple personalities were a very rare and bizarre disorder. That is all that I was taught on ... It soon became apparent that what I had been taught was simply not true. Not only was I meeting people with multiplicity; these individuals entering my life were normal human beings with much to offer. They were simply people who had endured more than their share of pain in this life and were struggling to make sense of it.”
― Deborah Bray Haddock, The Dissociative Identity Disorder Sourcebook
Dissociative identity disorder (DID) is often covert and difficult to notice, with only 5-6% of individuals with DID having a more florid presentation. Switching between alters is rarely accompanied by dramatic shifts in personality that are highlighted by changes in clothing, preferences, and accent. In contrast, systems often go to great lengths to hide their condition and will deny and downplay their symptoms as much as possible once diagnosed. Alters frequently manifest through passive influence instead of completely taking executive control, and many individuals with DID are amnesiac for their own amnesia and do not notice even when a full switch has occurred.
According to the DSM-5, individuals who are diagnosed with DID often first present to clinicians with comorbid posttraumatic stress disorder, depressive disorders, anxiety disorders, personality disorders such as borderline personality disorder or avoidant personality disorder, conversion disorder, somatic symptom disorder, feeding and eating disorders, substance-related disorders, obsessive compulsive disorder, sleep disorders, self injury, or psychogenic non-epileptic seizures (PNES) (American Psychiatric Association, 2013).1
Their symptoms might be mistaken for mood disorders (such as bipolar disorders or major depressive disorder), personality disorders (such as borderline personality disorder), psychotic disorders (such as schizophrenia), other dissociative disorders (such as other specified dissociative disorder or dissociative amnesia), posttraumatic stress disorder alone, conversion disorder, seizure disorders, obsessive-compulsive disorder, paranoia, or cognitive disorders. DID often becomes more visible with age or when the disordered individual is removed from the traumatic situation, when the individual has children reach the age at which the individual was traumatized, or when the individual’s abuser(s) die(s) or contract(s) a terminal illness (American Psychiatric Association, 2013).1
The DSM-5 warns that over 70% of outpatients with DID have attempted suicide. That some but not other alters may self harm or have suicidal thoughts or urges complicates treatment (American Psychiatric Association, 2013).1
1 American Psychiatric Association. (2013). Dissociative Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). http://dx.doi.org/10.1176/appi.books.9780890425596.dsm08