Dissociative identity disorder is an often misunderstood and stigmatized condition, and the symptoms can be confusing. That said, the stigma is beginning to shift as more people understand the condition.

Dissociative identity disorder (DID) used to be called multiple identity disorder, but this term is no longer used by doctors or therapists.

DID has a long history in popular culture, including in movies like “Sybil,” “Split,” “Psycho,” and countless others.

While films like these may entertain, they largely lack accuracy and stigmatize all people with DID as violent and dangerous, which is not the case.

Representations of DID in media have arguably improved — but if you’re looking for information on the reality of DID, it’s probably best to turn away from the horror movies and keep reading here.

DID is a dissociative disorder characterized by a disruption of or discontinuity in:

  • consciousness
  • memory
  • identity
  • perception
  • behavior
  • sense of self

DID is usually associated with adverse experiences in the past. Almost all people with DID experienced trauma or abuse in childhood. Dissociation, a major symptom of DID, is a defense mechanism used to reduce awareness of such overwhelming trauma.

Dissociation is a disconnection between a person’s thoughts, feelings, or sense of self and surroundings. That includes a mild case of daydreaming as you look out the car window or a more severe dissociative event brought on to help cope with a traumatic event.

Dissociative identity disorder is more common than many people think, with research suggesting that it affects around 1% of the public and between 5% and 20% of people in psychiatric hospitals.

Some studies indicate that DID is actually underdiagnosed. In a 2018 study, people with DID receive an average of four prior diagnoses before having their condition correctly identified.

This is likely because of overlapping symptoms with different disorders like schizophrenia and post-traumatic stress disorder (PTSD).

Some clinicians may remain skeptical about whether DID is a “valid” diagnosis, but as scientists learn more about it, the skepticism is decreasing.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), diagnosis of DID requires:

  1. the presence of two or more distinct personality states or an experience of possession
  2. recurrent episodes of amnesia, or gaps in short- or long-term memory, including personal information, learned skills, or past traumatic events

The various personality states, often called “alters,” have distinct characteristics. These can include:

  • age
  • name
  • gender
  • skills
  • memories
  • demeanor
  • behavior

The alters may or may not be aware of each other and often emerge involuntarily in response to different stressors, like additional traumatic experiences, the death of a past abuser, or consumption of drugs or alcohol.

Changes in alters, while accompanied by a clear change in sense of self, may not always be obvious to other people.

The symptoms of DID are often characterized as being either “positive” or “negative.”

“Positive” symptoms include:

  • intrusive thoughts, emotions, or impulses
  • fragmentation of identity
  • depersonalization, or feeling detached from your body and mind
  • derealization, or feeling detached from the world around you

“Negative” symptoms include:

  • inability to access information
  • loss of agency over mental functions
  • amnesia

Many people with DID also experience:

  • difficulties in social, occupational, or personal functioning
  • self-harm and/or suicidal ideation
  • extreme shifts in mood
  • depression
  • anxiety
  • insomnia
  • flashbacks
  • drug and alcohol abuse
  • non-epileptic seizures

Self-injury and suicidality are common in people with DID. According to the American Psychiatric Association (APA), more than 70% of outpatients with DID have attempted suicide.

DID impacts every person differently, ranging from little influence on everyday functioning to complete disruption of personal and professional life. It’s common for people with DID to downplay or hide their symptoms, making diagnosis and treatment more complicated.

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There are three types of dissociative disorders. Along with DID, these include dissociative amnesia and depersonalization/derealization disorder.

Dissociative amnesia involves a lack of ability to recall personal information or experiences. Like DID, it’s strongly tied to past trauma or stress. Amnesia can be:

  • Localized. An inability to remember events or a period of time.
  • Generalized. An inability to remember personal identity and life history.
  • Fugue. An inability to remember travel or how you got to a location, and loss of most or all personal information.

As the name suggests, depersonalization/derealization disorder involves:

  • Depersonalization. A detachment from your actions, feelings, thoughts, sense of self, and/or physical sensations, like an out-of-body experience.
  • Derealization. A detachment from your surroundings or feeling like the world around you isn’t real.

It’s important to note that everyone experiences degrees of dissociation or small experiences of dissociation. For instance, when you’re traveling in a car and you “zone out” or start daydreaming, you might end up not remembering the journey. While this is a form of dissociation, this alone doesn’t signal a dissociative disorder.

The APA estimates that about 90% of people with DID experienced repetitive abuse or neglect in childhood. Traumatic early life events, like multiple medical procedures or exposure to war, have also been reported in people with DID who didn’t experience physical or sexual abuse.

Ongoing abuse later in life, co-occurring mental health or physical conditions, and delay in treatment increase the likelihood of developing DID.

Dissociation plays a role in protecting you against the overwhelm of trauma. When you dissociate during a traumatic event, it might feel as if someone else is having that experience. You might feel disconnected, like you’re watching from a distance.

It’s a quite successful mechanism at the time, but it causes problems further down the line when it becomes a coping mechanism that permanently alters the way you experience and relate to the world.

DID in men is often triggered by combat, prison conditions, or sexual abuse. Women are much more likely to be diagnosed with a dissociative disorder than men. Still, some clinicians believe that shame and denial about past trauma partially explain why DID rates appear higher in women.

Studies have also identified physiological and neurobiological differences between people with DID and the general population.

Research from 2021 indicates that the hippocampus, the part of the brain that deals most with stress, is smaller in people diagnosed with DID.

Though more investigation is certainly needed, some researchers have even found differences in brain activity between one dissociative person’s alters.

If you or a loved one have DID or have experienced dissociative symptoms, treatment may help you manage or even remedy your condition. DID is unlikely to resolve without treatment.

Talking with your doctor or mental health professional is a good first step if you’re experiencing symptoms. If you’re worried about a friend or loved one, gently encourage them to seek help.

Patience is difficult but key, as it may take visiting multiple clinicians or long-term treatments to bring about real positive change.

Studies have shown that people who stick with treatment for 30 months or longer experience fewer dissociations, reduced depressive symptoms, and improved daily functionality.

The most common and effective course of action for treating DID is psychotherapy. The main goal of therapy is to integrate the alters, merging their memories and identities into a single “personality” reflective of the person’s true self.

The therapy process can be long and painful, involving reliving and confronting past trauma, but it’s crucial for reducing symptoms.

There are no medications specific to dissociation, but medication can help treat other symptoms of DID. For instance, some people take antidepressants or antipsychotics to manage co-occurring depression and stabilize their mood.

You can learn more about treatments for DID here.

Learning to identity what triggers switches in alters and avoiding those stressors can help reduce dissociative events.

For more information about DID or help to find treatment, you can visit the International Society for the Study of Trauma and Dissociation (ISSTD) website.

For further support, you can call The National Alliance on Mental Illness (NAMI) HelpLine at 1-800-950-6264 or email at info@nami.org.