Many people with DID experience depression. We spoke with experts for professional and personal insights into what it’s like to live with both conditions.
Childhood trauma can increase the risk for numerous mental health conditions, including major depressive disorder, schizophrenia, and post-traumatic stress disorder (PTSD).
Perhaps one of the most direct responses to childhood trauma is dissociative identity disorder (DID). The disorder usually arises in response to severe trauma.
In fact, the American Psychiatric Association reports that about 90% of people with DID report having experienced at least one form of childhood abuse and neglect.
The majority of people with DID also live with depression, which can complicate and exacerbate both disorders.
There are three major dissociative disorders listed in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR):
- dissociative amnesia
- depersonalization-derealization disorder
- dissociative identity disorder
DID — previously known as multiple personality disorder — is the most severe form of these disorders. It’s a complex condition characterized by the presence of two or more distinct personality states (alters) in one body.
These alters may appear when the brain is unable to process and integrate traumatic experiences, memories, and feelings. In other words, DID is an extreme self-protective response to childhood trauma.
Although DID is listed in the DSM-5-TR it is still a highly controversial diagnosis, and there are many differential diagnoses for this disorder.
However, in the DID population, depression is extremely common. A 2019 study reports that over 80% of people with DID have experienced major depressive episodes.
Still, depression may not be particularly easy to detect in people with DID.
“Just like it is hard to sometimes identify depression generally, it may be even harder to identify [it] in someone with DID,” says Stephanie Rickey, PsyD, program director of the Hill Center at McLean Hospital in Belmont, Massachusetts.
“Alterations in experience and the inherent ability to compartmentalize emotional and physical experiences may make it more challenging for the individual and others to identify [depression].”
In addition, Rickey notes that it can be difficult to determine whether certain symptoms are coming from depression or DID. For instance, a loss of energy, having trouble making decisions, or feelings of hopelessness or guilt can be seen in both disorders, making a diagnosis more complicated.
“Depression may also exacerbate the symptoms of DID or lead to more discomfort or confusion that may, in turn, lead to an increase in dissociative periods,” says Rickey.
“I think DID and depression go hand-in-hand,” says Crystalie Matulewicz who lives with both DID and depression.
“While I do have periods of severe depression, especially around trauma anniversaries when I dissociate more, my general affect is just melancholic,” she says.
Like many people with dissociative depression, Matulewicz’s depression has not responded to medication.
“I spent many years, worked with several doctors, took part in several (very good) programs to try to find a medication that would help with the depression. But after trying more medications than I could count on my fingers and toes, we realized that my depression was treatment resistant.”
Matulewicz tries to work through her depression by staying busy.
“I work as much as I can — probably too much. Part of that is to avoid my issues, but part of that is also to avoid the depression. I can’t focus on how bad I’m feeling if I’m too busy focusing on work.”
Matulewitz also adds that a lot of her depression and dissociation triggers are date-related, so she tries to plan ahead.
“If I know a bad date is coming up, I’ll map out a plan. Do I need to work that day to distract myself? Do I need to take the day off to take care of myself?”
“I’ll plan out the day. Going to the movies is a big one for me. I can do it myself, other parts can enjoy it as well, it’s entertaining, and it takes up a good chunk of time out of the day,” she says.
DID and depression can complicate and exacerbate one another.
Dissociative depression seems to be its own complex form of depression — and it’s often treatment-resistant. In fact, some experts suggest that dissociation in itself could be a reliable marker that a person has treatment-resistant depression.
“Having DID and depression adds extra complexity to treatment,” Matulewicz says. “While depression is commonly treated with talk therapy, medication, or a combination of the two, these treatments don’t always work so easily when DID is involved.”
“Depression in DID is often rooted in trauma, so medication isn’t as effective because it’s more than just a chemical imbalance involved.”
“Therapy for DID is long and focused on working through trauma, using coping skills and the like, so that treating depression often gets put on the back burner until other issues are addressed.”
“Then throw in the reality that multiple parts of you can have depression. Not only that, but each part’s depression can have a different cause, different triggers, and different symptoms. So then it becomes more than just treating one person’s depression — you’re treating multiple forms of depression for multiple people all within the same body,” says Matulewicz.
Does depression affect each alter differently?
“Depression is experienced by the full person. It is not possible for one alter to have major depression while another does not,” says Rickey.
Still, it’s important to note that individuals with DID may experience a sense of separation or unawareness of emotions and thoughts between alters.
“As a result, it is possible that this compartmentalization may lead to a subjective sense of one alter having depression while another does not,” says Rickey.
Matulewicz explains that alters can experience any mental health disorder, including depression, in varying severities.
“For me, some of my parts are severely depressed to the point of being suicidal,” she says. “These parts have emerged from specific traumas and aren’t present very often, but can come out around trauma anniversaries or when triggered in a certain way.”
She notes that her other alters are “functionally depressed.” This means “they feel the typical symptoms of depression like anyone else with depression would, but focus more on what their purpose is.”
Matulewicz also shares that some of her other parts don’t experience depression at all. “They are completely closed off from any trauma we’ve experienced and don’t suffer many negative emotions at all,” she says.
If you’re experiencing suicidal thoughts, help is available
You can access free support right away with these resources:
- 988 Suicide and Crisis Lifeline.Call the Lifeline at 988 for English or Spanish, 24 hours a day, 7 days a week.
- The Crisis Text Line.Text HOME to the Crisis Text Line at 741741.
- The Trevor Project. LGBTQIA+ and under 25 years old? Call 866-488-7386, text “START” to 678678, or chat online 24/7.
- Veterans Crisis Line.Call 988 and press 1, text 838255, or chat online 24/7.
- Deaf Crisis Line.Call 321-800-3323, text “HAND” to 839863, or visit their website.
- Befrienders Worldwide.This international crisis helpline network can help you find a local helpline.
Depression is very common in people with DID, with more than 80% having experienced major depressive episodes. When both disorders occur together, it makes things more complicated, but treatment can still be effective.
If you are experiencing dissociation and depression, you’re not alone. Consider reaching out to a trusted healthcare professional today. Getting started on the right treatment can make a significant difference in your well-being and quality of life.
Want to learn more about starting therapy? Psych Central’s How to Find Mental Health Support resource can help.