“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
Myth: Dissociative identity disorder (DID) is the same thing as schizophrenia.
Fact: Schizophrenia is a spectrum of disorders characterized by delusions, hallucinations, paranoia, flat affect, disorganized thoughts, speech, and movements, catatonia, and social withdrawal. It does not involve alters and often does not involve dissociation. In contrast, those with DID are not delusional or hallucinating their alters (American Psychiatric Association (APA), 2013)1. While both those with schizophrenia and those with DID may hear voices, the voices that those with DID hear are usually the internal projections of their alters. Schneiderian first-rank symptoms that occur in those with DID are different from those that occur in
schizophrenic individuals, and while individuals with DID may experience dissociative or reactive psychosis, this is not the same as an organic psychotic disorder (Dell, 2006)2.
Myth: DID is the same thing as bipolar disorders.
Fact: Bipolar disorders are mood disorder characterized by depressive, manic, or mixed states. They have nothing to do with alters or dissociation. Those with DID may appear to be rapid cycling when they switch, but this is because their alters might have different moods (APA, 2013)1 or because of a trigger. The two disorders are not actually similar.
Myth: DID is the same thing as borderline personality disorder (BPD).
Fact: There are many similarities between dissociative identity disorder and borderline personality disorder. Both disorders are thought to be caused (or often caused) by childhood trauma and insecure/disorganized attachment and can be explained through the theory of structural dissociation. Those with DID experience themselves as having multiple distinct parts whereas those with BPD experience their identity as being poorly defined and possibly fragmented. DID is a dissociative disorder while BPD often involves dissociative features. Both DID and borderline personality disorder may involve trouble forming or maintaining healthy attachments. However, BPD does not involve fully differentiated parts, and while individuals with BPD may rarely experience dissociative trance or fugue states, this is not the same as inter-identity amnesia as is found in those with DID. Those with DID are less likely to view the world and others in all black and white or have an intense fear of abandonment. BPD and DID can be and often are co-morbid, but they are not the same disorder (Mosquera, Gonzalez, & Hart, 2012)3.
Myth: DID is incredibly rare.
Fact: Between 0.1% and 2% of the population has DID. The DSM-5 places this prevalence at 1.5% (APA, 2013)1. That's almost 3.2 million Americans, 0.65 million citizens of the United Kingdom, or 71 million people worldwide!
Myth: DID is an American phenomenon.
Fact: DID has been found in all of the countries in which it has been sought, and some very forward-thinking research regarding DID comes from the Netherlands, Turkey, Puerto Rico, and New Zealand.
Myth: DID didn't exist before Sybil.
Fact: The first known case of DID was that of Jeanne Fery in 1584 (van der Hart, Lierens, Goodwin, 1996)4. Sybil brought awareness to DID and so allowed for an increasing number of diagnoses to be made as more funding went towards DID education and research, but DID did not begin with Sybil (nor with Eve, who came before Sybil).
Myth: DID is obvious and easy to notice in those who have it.
Fact: Only 5-6% of those with DID are overtly inflicted with the disorder. The other 94-95% cannot be casually identified as having the disorder. Individuals who have DID are more likely to be thought to have 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 (APA, 2013)1.
Myth: Those with DID are dangerous killers!
Fact: Like other mentally ill populations, those with DID are no more likely to be dangerous or abusive than anyone else. However, DID forms because of chronic childhood trauma, and individuals with DID are highly likely to be re-traumatized and so be victims of further abuse and violence. Contrary to popular belief, it's not common for those with DID to have an "evil" alter.
Myth: DID is easy to fake.
Fact: While non-professionals may not be able to distinguish between those who do and do not truly have DID, professionals are trained to recognize the difference between DID and disorders that may present similarly (such as complex-posttraumatic stress disorder or borderline personality disorder) or between DID and factitious disorders or malingering. Diagnoses done using the "gold-star" Structural Clinical Interview for Dissociative Disorders are very likely to be reliable (Welburn et. al, 2003)5.
Myth: DID is caused by therapists / the media / thinking oneself into it.
Fact: There is an abundance of evidence that supports that DID is due to long term or repeated childhood trauma. Research supports that iatrogenic/sociocognitive DID (DID resulting from therapeutic or social influences) is not the same as genuine DID.
Myth: DID is caused by severe child abuse.
Fact: DID is caused by long term or repeated childhood trauma. Child abuse fits this criteria and is the most common cause of DID, with around 90% of individuals with DID having experienced child abuse or neglect. However, other forms of childhood trauma that are associated with DID include repeated medical and surgical procedures, war, human trafficking, and terrorism (APA, 2013).1 Disorganized attachment plays a role, as well.
Myth: DID can form in adults.
Fact: DID cannot form in an individual who has a fully integrated personality, and chronic childhood trauma is necessary to disrupt normal personality development (Spring, 2012)6. It is generally accepted that this must occur before ages 6 to 9. Age 6 is considered a critical period for the integration of one's sense of self and self history because of the maturation of the hippocampus and prefrontal cortices at this time (Nijenhuis, Hart, & Steele, 2010)7. This is addressed in more depth here.
Myth: Alters are just ego states / moods with names attached / are imaginary friends.
Fact: Alters are dissociated self states that can be highly differentiated from each other. They can have unique names, ages, gender identities, sexualities, memories, skills, abilities, and ways of viewing and interacting with the world (Hart, Nijenuis, & Steele, 2006)8. They can have different psychological disorders or physiological markers and reactions to stimuli, including "differences in visual acuity, medication responses, allergies, plasma glucose levels in diabetic patients, heart rate, blood pressure readings, galvanic skin response, muscle tension, laterality, immune function, electroencephalography and evoked potential patterns, functional magnetic resonance imaging activation, and brain activation and regional blood flow using single photon emission computed tomography and positron emission tomography among others" (International Society for the Study of Trauma and Dissociation, 2011)9. For individuals with DID, alters have some degree of inter-identity amnesia between them (APA, 2013)1.
Myth: Individuals with DID are never aware that they have alters.
Fact: It is common for individuals with DID to have awareness of their alters, to hear their alters communicating, and to have knowledge of at least some of their alters' activities (Dell, 2006)2. Many individuals with DID have been aware of signs of their alters since their childhood. They may once have known that they contained other "people" or known their alters personally but may have begun to ignore, forget, or reject this knowledge as they became older and realized that having alters isn't "normal." Many with DID are aware that their memory is often unreliable, that they do things without remembering having done them, and that they sometimes act highly out of character without being able to stop or control their actions. It's not uncommon for those with DID to hear the voices of their alters but not understand what this means or to think that it's a sign of impending insanity. Sometimes, individuals with DID will piece together that they have DID based on the growing availability of relevant information regarding the disorder, and of course individuals who are diagnosed with DID will then be aware that they have DID!
Myth: Individuals with DID are never aware of what their alters do.
Fact: While all individuals with DID experience some degree of amnesia towards their alters, many can remain co-conscious with at least some of their alters (Dell, 2006)2. Co-consciousness is the ability for two or more alters to remain aware of each other or the outside world at the same time.
Myth: Individuals with DID can choose to get rid off, kill off, or immediately integrate their alters.
Fact: Alters are dissociated parts of the self. They cannot be gotten rid of or killed any more than one's traits, flaws, or other mental health symptoms can be magically be gotten rid of or cured. Integration, or lowering dissociative barriers between alters until all alters own all parts of the personality and only one individual remains, is possible, but it takes time and effort. Alters are formed by trauma and remain separate due to an internal failure to integrate and due to having experienced different events and so having developed and differentiated themselves as individuals. Integration is not the right choice for all systems, and it is a personal choice. In many cases, increased communication and cooperation among alters is more desirable, though it may lack some of the benefits of complete integration. Even when a system has integrated, treatment should continue until the individual has become more used to integrated life (International Society for the Study of Trauma and Dissociation, 2011)9.
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
2 Dell, P. F. (2006). A new model of dissociative identity disorder. Psychiatric Clinics of North America, 29(1), 1-26. doi:10.1016/j.psc.2005.10.013
3 Mosquera, D., Gonzalez, A., & Hart, O. (2012). Borderline personality disorder, childhood trauma and structural dissociation of the personality. Revista Persona, 11(1), 44-73.
4 Van der Hart, O., Lierens, R., & Goodwin, J. (1996). Jeanne Fery: A sixteen century case of dissociative identity disorder. The Journal of Psychohistory, 24(1).
5 Welburn, K. R., Fraser, G. A., Jordan, S. A., Cameron, C., Webb, L. M., & Raine, D. (2003). Discriminating dissociative identity disorder from schizophrenia and feigned dissociation on psychological tests and structured Interview [Abstract]. Journal of Trauma & Dissociation, 4(2), 109-130. doi:10.1300/j229v04n02_07
6 Spring, C. (2012). What causes dissociative identity disorder? Retrieved from http://www.pods-online.org.uk/index.php/information/articles/faqs-dissociation/what-causes-dissociative-identity-disorder
7 Nijenhuis, E. R. S., van der Hart, O., & Steele, K. (2010). Trauma-related structural dissociation of the personality. Activitas Nervosa Superior, 52(1), 1-23.
8 Hart, O., Nijenhuis, E. R. S., & Steele, K. (2006). The haunted self: Structural dissociation and the treatment of chronic traumatization. New York: W.W. Norton.
9 International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115-187.