Understanding dissociative identity disorder (DID)

Dissociative identity disorder (DID) is a complex mental health condition. It has a long history of being misunderstood by the public and mental health professionals alike. 

DID is a formally recognized mental health condition with a set of signs and symptoms that greatly impact people with the condition. Fortunately, DID can be treated with a combination of medication and talk therapy. 

What is dissociative identity disorder?

Dissociative identity disorder is one of three dissociative disorders recognized by the American Psychiatric Association (APA). DID was previously referred to as “multiple personality disorder” or “split personality disorder.”

Dissociative disorders can cause people to experience problems across various areas of their daily functioning. Some aspects disrupted by dissociative disorders include:

• Memory 
• Identity and sense of self 
• Feelings and emotional responses
• Perceptions of the world
• Actions and behaviors

In DID specifically, a person may present with a completely different personality suddenly and without warning. The personality changes typically bring about a drastic shift in behavior, memory, and thinking that can be obvious to those around them. While some people are aware of their identities, many people don’t know when a new identity takes over. When a new identity steps in, they may not remember some events because another personality experienced them. This causes gaps in memory called “amnesia.”

When a person shifts between personalities, they may have different ways of dressing and speaking. They may also have completely different personal preferences. They may even have a different gender or sexual orientation during these periods of dissociation. When the personality shifts back, the individual may have no understanding of what the other personality said or did.

Dissociation symptoms interrupt the way people commonly experience their lives, their surroundings, and even themselves. When these symptoms are present, a person may struggle to understand who they are, how they should behave, and how to manage their feelings. A person with DID could find it challenging to maintain steady employment or consistent and healthy relationships.

Symptoms of dissociative identity disorder

DID has a defined set of symptoms that mental health professionals use to guide the assessment and diagnostic process. If a person shows a combination of the following symptoms, they may have dissociative identity disorder.

1. Identity alterations and characteristics

People with DID have two or more “entities” inside of them. These alternate personalities, which are frequently called “alters,” could bear little resemblance to the person. 

The alter could differ in terms of:

• Age
• Gender
• Sexual orientation
• Voice
• Interests
• Mannerisms
• Style of dress

There could be one alter or dozens. And though these shifts may seem like a wholly different person, they all stem from the individual person experiencing DID. 

2. Memory loss and amnesia

Memory loss and amnesia are common problems with DID, as the experiences of one personality may not transfer to the others. So if an alter is present during an event, for example, the primary personality may have no awareness of what happened. The person may report no memory of their thoughts, feelings, and behaviors during this time. 

3. Detachment and disconnection

Detachment, disconnection, and dissociation are central to any dissociative disorder. When present, these symptoms can lead to people feeling removed and separated from themselves, the people around them, and the setting they’re in. It could feel like they are having an “out-of-body” experience or like their surroundings aren’t real.

4. Hallucinations and flashbacks

People with DID sometimes experience hallucinations. Symptoms like hallucinations and flashbacks are common. For example, they may report hearing voices and having flashbacks to events that they don’t remember. In these cases, the experiences may have occurred during an altered state. It could be nearly impossible for the individual to distinguish between what’s real, what’s fiction, and what happened during disassociation.

5. Loss of time and awareness

As a person with DID slips between their primary personality and alters, they may report a loss of time. For example, they could be sitting in their home watching TV and come back to awareness in a new and unfamiliar place hours or days later when a shift occurs. This experience can be jarring for both the person with DID and the people around them.

6. Suicidal thoughts and self-harm

The risk of suicidal thoughts and actions* is extremely high in people with DID. According to the APA, more than 70% of those with the condition attempt suicide. Suicide and self-injury add an extra layer of danger to an already difficult condition.

*If you or a loved one is experiencing suicidal thoughts or thoughts about harming themself or others, please call or text 988 on any phone for the Suicide & Crisis Lifeline, contact a local crisis line, or head to the emergency room immediately. Any of these resources will ensure that the person in crisis receives support right away. For more information on getting help, go to 988lifeline.org

If you or someone else is experiencing a life-threatening emergency or you need immediate help, please call 911. 

Causes and risk factors

There is no single cause of DID, but there’s a strong correlation between the condition and having a history of trauma or abuse. Ongoing or chronic sexual abuse seems to have the strongest connection to dissociative identity disorder. Growing up with a supportive caregiver reduces the likelihood that a person will experience mental health conditions. Having no (or reduced) adverse childhood experiences also lowers your chances of having mental health conditions, including DID. 

Complications and co-occurring conditions

DID often co-occurs with other mental health conditions. Someone who has the condition could also be at high risk for many other physical and mental health diagnoses, like:

• Post-traumatic stress disorder (PTSD)
• Depressive disorders
• Bipolar disorder
• Obsessive-compulsive disorder (OCD)
• Personality disorders
• Substance use disorders
• Eating disorders
• Sleep problems

Treatment and management

Although DID can be challenging to treat, there are professional interventions and treatment options that can improve symptoms and work to greatly improve a person’s functioning. Options to improve DID symptoms include therapy and medication management.

Therapy options

For people living with DID, therapy from a trained and experienced professional can be an invaluable tool for the recovery process. Some therapy options for DID include:

• Cognitive behavioral therapy (CBT): CBT involves exploring the connection between someone’s thoughts, feelings, and behaviors to understand the influence on symptoms.
• Dialectical behavioral therapy (DBT): DBT places an emphasis on mindfulness, emotional regulation, distress tolerance, and communication to address symptoms.
• Eye movement desensitization and reprocessing (EMDR): EMDR is an intervention aimed at reducing the negative impact of trauma with the goal of improving DID by resolving the impact of past abuse.

Role of medications

There are no specific medications approved to treat DID, but having an evaluation with a psychiatric provider could be a helpful way to address connected symptoms and conditions. It’s always best to speak with a medical professional about medication options. 

Find care with Rula

People living with DID typically require professional treatment to reduce their symptoms and improve their quality of life. Despite being a challenging condition that involves different personalities, loss of time, and detachment from reality, there is hope for people with DID, and Rula can help.

Rula’s therapist-matching platform can help you find a therapist who takes your insurance in just a few clicks. Our extensive network of providers means you can schedule your first appointment as soon as tomorrow, and be seen in a convenient online appointment from the comfort of home. 

Get started with Rula today