Definition

Dissociative Identity Disorder (DID) is a severe condition in which two or more distinct identities, or personality states, are present in -- and alternately take control of -- an individual. The person also experiences memory loss that is too extensive to be explained by ordinary forgetfulness. The disturbance is not due to the direct psychological effects of a substance or of a general medical condition, yet as this once-rare disorder has become more common, the diagnosis has become controversial. Some believe that because DID patients are easily hypnotized, their symptoms are iatrogenic, that is, they have arisen in response to therapists' suggestions. Brain imaging studies, however, have corroborated identity transitions in some patients. DID was called Multiple Personality Disorder until 1994, when the name was changed to reflect a better understanding of the condition -- namely, that it is characterized by a fragmentation, or splintering, of identity rather than by a proliferation, or growth, of separate identities.

DID reflects a failure to integrate various aspects of identity, memory and consciousness in a single multidimensional self. Usually, a primary identity carries the individual's given name and is passive, dependent, guilty and depressed. When in control, each personality state, or alter, may be experienced as if it has a distinct history, self-image and identity. The alters' characteristics -- including name, reported age and gender, vocabulary, general knowledge, and predominant mood -- contrast with those of the primary identity. Certain circumstances or stressors can cause a particular alter to emerge. The various identities may deny knowledge of one another, be critical of one another or appear to be in open conflict.
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Symptoms

* The individual experiences from 2 to more than 100 different identities. Half of the recorded cases, however, report 10 or fewer.
* The various personality states exhibit distinct histories, behaviors and even physical characteristics.
* Transitions from one identity to another are often triggered by psychosocial stress.
* Frequent gaps are found in memories of personal history, including people, places, and events, for both the distant and recent past. Different alters may remember different events, but passive identities tend to have more limited memories than hostile, controlling or protective identities.
* Symptoms of depression or anxiety may be present.
* In childhood, problem behavior and an inability to focus in school are common.
* Self-mutilation and suicidal and/or aggressive behavior may take place.
* Visual or auditory hallucinations may occur.
* The average time that elapses from the first symptom to diagnosis is six to seven years.

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Causes

The disturbance is not due to the direct psychological effects of a substance or of a general medical condition. Why some people develop DID is not entirely understood, but they frequently report having experienced severe physical and sexual abuse, especially during childhood. Though the accuracy of such reports is disputed, they are often confirmed by objective evidence. Individuals with DID may also have post-traumatic symptoms (nightmares, flashbacks, and startle responses) or Post-traumatic Stress Disorder. Several studies suggest that DID is more common among close biological relatives of persons who also have the disorder than in the general population. As this once rarely reported disorder has grown more common, the diagnosis has become controversial. Some believe that because DID patients are highly suggestible, their symptoms are at least partly iatrogenic, that is, prompted by their therapists' probing. Brain imaging studies, however, have corroborated identity transitions.
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Treatment

The primary treatment for DID is long-term psychotherapy with the goal of deconstructing the different personalities and uniting them into one. Other treatments include cognitive and creative therapies. Although there are no medications that specifically treat this disorder, antidepressants, antianxiety drugs or tranquilizers may be prescribed to help control the mental health symptoms associated with it.

Sources:

* American Psychiatric Association
* National Institute of Mental Health
* Handbook of Psychology, Vol. 8 (John Wiley)

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