“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
As well, DID includes a range of dissociative symptoms. Identity alteration accounts for the existence of alters, and dissociative amnesia accounts for unawareness of the individual's trauma history as well as amnesia between alters (inter-identity amnesia). DID also involves high levels of identity confusion (being unsure who one is), depersonalization (feeling disconnected from aspects of oneself, including one's emotions, thoughts, memories, physical sensations, body or parts of one's body, or identity), and derealization (feeling disconnected from one's environment or feeling like nothing is real). Individuals with DID may also experience: trance states, in which they show minimal awareness of or ability to respond to their surroundings; perceptual disturbances, such as feeling as if sounds are coming from far away; and somatic symptoms, such as stomachaches, headaches, or joint pain in response to emotional stress (Dell, 2006)2. DID is so strongly associated with dissociative symptoms that a diagnosis of DID renders any other dissociative disorder diagnoses unnecessary.
Individuals with DID also often experience memory problems beyond simple inter-identity amnesia. They might hear "voices" that they might not at first understand are originating from their alters. They often find themselves doing or saying things that they didn't plan to do or say, or they might have the urge to act in a specific manner; both of these can indicate that an alter is present and has either taken some control over the body or is imposing their desires on the host part. Similarly, an individual with DID might have thoughts or feelings that originate from alters and so do not feel like their own. Their skills and abilities might fluctuate, as might their knowledge. They might find evidence of their amnesia, such as unfamiliar objects in their possession or being approached by unknown individuals (Dell, 2006)2. Many individuals with DID feel like they're losing their mind! Most try to hide their symptoms, function like everyone around them, and suffer in silence. Unfortunately, this isn't always possible. Over 70% of individuals with DID have attempted suicide, and self harm is also common (APA, 2013)1.
No one can choose to have alters or what their alters are like. Alters' creation is entirely unconscious and is the result of failed integration of thoughts, memories, emotions, learned behaviors, traits, and similar (Hart, Nijenuis, & Steele, 2006)3. This is very different from fantasy processes. Individuals who create characters or write stories may sometimes feel like they're not consciously deciding what actions their characters take in all situations or may be able to imagine conversations with their characters, but this is still not the same as alters taking actions that are perceived as independent. Most alters have their own sense of identity. While an individual may be able to forcefully regain control over an alter's activities, they cannot actually control the alter. As well, for individuals with DID, alters have some degree of inter-identity amnesia between them (APA, 2013)1.
That said, it must be noted that alters are not completely separate people. An individual with DID has one brain and one body. Dissociative barriers between alters are not literal boundaries, and knowledge, memories, skills, preferences, and traits may bleed through. As well, there may be many commonalities between alters due to shared underlying factors. An important part of treating DID is helping individuals to realize that all of the alters present in a system experienced the same trauma, they are all responsible for what their body does, all of their opinions and needs are equally important, and they must all work together in order to function and thrive.
Individuals with other specified dissociative disorder subtype 1 (OSDD-1) often have no amnesia for their alters' activities. This is one of the potential defining differences between DID and OSDD-1.
As well, it must be noted that DID is not faked at exceptionally high rates. Studies have found rates of factitious or malingered dissociative disorders to be between 2% and 14%, with higher rates being found in inpatient and expert consultant settings. This is comparable to general rates of malingering, which range from 7% to 17% with higher rates found in forensic settings, and factitious disorders, which range from 0.5% to 6% in the general population (Brand, McNary, Loewenstein, Kolos, & Barr, 2006)7.
A study of 173 individuals with dissociative disorders found that dissociative, posttraumatic, emotion dysregulation, depressive, or substance use symptoms cannot predict criminality in this population. This is somewhat in contrast with the general population, in which substance use disorders are the most common mental illnesses among violent offenders, emotion dysregulation is a mediator for violent behavior among individuals with BPD, and dissociation among inpatients is associated with sexual aggression, general aggression, and intergenerational abuse. Only 3% of the individuals in the study had been charged with an offense within the past 6 months, 1.8% had been fined, and 0.6% had been incarcerated. No convictions or probations were reported. A handful of older studies specifically on individuals with DID found that the majority are not violent and do not have violent alters; the exceptions were a 1990 study of 11 individuals with DID and another small 1990 study of only males with DID that found higher rates of violent alters and incarceration. A newer and large 2014 study found that only 3.5% of individuals with DID had engaged in any form of interpersonal violence. Another more recent international study reported that only 2% of clinicians had patients with DID or OSDD who had sexually coerced or assaulted a partner; 3.5% of patients were reported by their therapists to have engaged in any physical or sexual abuse of their partners. In contrast, high rates of internally directed violence (ie, suicidal alters) have been found, and a study found that 26.1% of individuals with DID are at risk of being assaulted. Unfortunately, mentally ill individuals are often aware of others' perceptions of them as potentially violent, and this can worsen their isolation, negative emotions, and treatment adherence (Webermann & Brand, 2017)11.
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 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.
4 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.
5 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).
6 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
7 Brand, B. L., McNary, S. W., Loewenstein, R. J., Kolos, A. C., & Barr, S. R. (2006). Assessment of genuine and simulated dissociative identity disorder on the Structured Interview of Reported Symptoms. Journal of Trauma & Dissociation, 7(1), 63-85. doi:10.1300/j229v07n01_06
8 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
9 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.
10 Mosquera, D., Gonzalez, A., & Hart, O. (2012). Borderline personality disorder, childhood trauma and structural dissociation of the personality. Revista Persona, 11(1), 44-73.
11 Webermann, A. R. & Brand, B. L. (2017). Mental illness and violent behavior: The role of dissociation. Borderline Personality Disorder and Emotion Dysregulation, 4(2). doi: 10.1186/s40479-017-0053-9
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This website was last updated 6/10/2023.
This page was last updated 10/1/2017.