To understand DID, it is first necessary to understand the definition of dissociation. This is a mental process whereby there develops a lack of connection between the individual’s thoughts, emotions and actions, often known as ‘splitting’, at a sub-conscious level. Dissociation may be seen as something that happens on a continuum; at the lower end daydreaming to the extent that a person forgets driving from ‘A’ to ‘B’ and DID is at the extreme opposite end of the spectrum.
What is DID?
Dissociative Identity Disorder (formerly known as Multiple Personality Disorder), is defined in the DSM IV- TR as a condition where a single individual shows evidence of two or more distinct identities or personalities, each with its own pattern of perceiving and interacting with the environment and at least two of these identities or personality states recurrently take control of the person’s behaviour. It also includes an inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. The host or main personality usually is totally unaware of the alternate personalities (alters) and they may or may not have awareness of the others. Each alter is designed to do a job e.g. to deal with anger, fear or joy. It is endowed with characteristic traits which the original personality would have taken on, if it were in charge.
DID is developed during childhood, usually before the age of seven, as this is a crucial time for the formation of a person’s personality. The first effect is dissociation of the ‘intellectual self’ from the ’emotional self’, thus allowing the original personality to abdicate executive control over the physical body. It may be seen as an adaptive, healthy reaction to intolerable situations; a creative survival technique that ultimately, becomes a spontaneous reaction to any stressful situation wherein intense emotions may be experienced.
Many people with DID are able to live normally functioning lives but others are incapable of interacting with other people for a period of time, with dissociating.
DID is a controversial diagnosis, as while dissociation is a demonstrable psychiatric condition linked to several different disorders, especially those involving early childhood trauma and anxiety, the manifestation of multiple personalities remains in dispute amongst many psychiatrists.
What are the Causes?
- Ongoing and severe emotional, physical and/or sexual abuse
- Severe trauma such as war, natural disasters or witnessing the death of a parent
- Ritual or Satanic abuse, deliberately induced to ensure compliance and amnesia
What are the Symptoms?
- Inability to recall large portions of one’s childhood
- Loss of time (blackouts) NOT related to consumption of alcohol, drugs or a neurological disorder e.g. seizures
- Sudden and obvious changes in the person’s mood, behaviour and appearance
- Flashbacks in which they appear to be reliving the traumatic experiences
- The appearance of new objects or clothes without the person knowing where they came from
- Auditory and visual hallucinations
- Spontaneous trance states where the person may talk to themselves
- Many physical complaints that cannot be attributed to an obvious cause
- Abuse of drugs or alcohol
- Eating disorders
- Sleep disorders
- Suicidal ideation or self harm
- Other mental health problems such as depression and extreme mood swings
- Most people diagnosed with DID also have Post Traumatic Stress Disorder (PTSD)
NB: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.
Dissociative Disorder is often difficult to diagnose and research has shown that many people living with DID have been misdiagnosed for up to seven years and treated for a wide range of mental health problems before receiving an accurate diagnosis and treatment. Medication has not generally proved to be very effective and therapy is long term, intense and specialised. Hypnosis is a common treatment that is used to allow the client to relive the traumatic experiences in a safe environment and also to access the alters in order to integrate them.