A BRIEF INTRODUCTION

7.7 billion people are living on our planet Earth today and someone would say there are also 7.7 billion different personalities. After all, there are no 2 persons who are the same, not even identical twins.

But is it true that each person has only one personality, only oneself?

Up until the 1970s, many people would say yes.

However, in the 1970s, after the publication of a very popular book “Sybil,” a disorder which was known as hysterical neurosis brought many people with what would later be multiple personality disorder and finally dissociative identity disorder (DID) to light.

An official definition does not exist, but DID is most often described as a complex psychological condition which develops as a consequence of experiencing a great trauma in early childhood. The word dissociation means a

“disconnection between a person’s thoughts, memories, feelings, actions or sense of who he or she is”.

There are three types of dissociative disorders:

  1. Dissociative identity disorder
  2. Dissociative amnesia
  3. Depersonalization/Derealization disorder

In this text, we will focus on DID, and as we go through it, we will learn about DID’s history, causes, diagnosis, management and treatment and finally the prognosis.

WHAT IS DISSOCIATIVE IDENTITY DISORDER?

As we have already said dissociation means a “disconnection between a person’s thoughts, memories, feelings, actions or sense of who he or she is”.

This process is completely normal, and we experience it quite often, sometimes every day in the process of mild dissociation, such as daydreaming, looking at one spot and losing touch with the reality, getting lost in a book, or a movie, etc..

However, there are horrible times when disassociation becomes a way of survival because the reality is too much to bear.

In these situations, a person disassociates the memory of the event, feelings about it, the place where it happened and feels as if though disconnected from it altogether.

It feels like a mental escape from the horror and pain.

When trauma happens once, such as a car crash and to an adult, dissociation may happen in order not to remember it fully.

However, when a continuous severe trauma keeps happening to a child who is between 0 and 6 years old, that causes a dissociative identity disorder in its full capacity.

Dissociative identity disorder leads to having several personalities called alters in one human being due to exposure to those severe traumas, resulting in having a disconnected personality.

Those alters are all parts of one “self” with different traits and behaviors who “wake up” thanks to different triggers and situations.

These alters serve to protect a person and deal with the situations that they can’t.

A BRIEF, AMAZING HISTORY OF DISSOCIATIVE IDENTITY DISORDER

It is said that DID existed in Paleolithic which lasted for around 2 million years up until 10,000 years B.C and was shown in different cave images of shamans.

Others say that what we know as DID was known as demonic possession in the Middle Ages.

Opinions are different, but what we know for sure is that the first time it was written about this disorder was in 1791 and it was about the case of a 20-year-old German young woman who had two personalities- the German one and the French one who knew nothing about each other.

There were a lot of studies about this phenomenon between the 1880s and 1920s, and they dropped drastically since other diagnoses such as schizophrenia appeared.

Then, in the 1970s, the above-mentioned book “Sybil” was published, and suddenly many cases of DID were reported.

As their number rose, the number of alternate personalities rose as well – from the original two in the cases reported in 1944 to a few dozen, with an average of 15.7 personalities in all of the cases that were documented later on in 1997.

The names of this disorder changed through the last decades until its final name Dissociative Identity Disorder came to be: In 1995 it was thought to be a state in which anxiety is either “directly felt and expressed or . . . unconsciously and automatically controlled” by various defense mechanisms, then in 1968, it got the name hysterical neurosis, dissociative type, in 1994 the name was multiple personality disorder and then finally dissociative identity disorder.

CAUSES OF DISSOCIATIVE IDENTITY DISORDER

As we have already said, this disorder develops as a consequence of experiencing a great trauma in early childhood, such as physical, mental and sexual abuse, strong deprivation and or any other molestation with which a child cannot cope with.

These traumas can be so severe, that the children being alone, scared, and even fearing for their life detach themselves from the body to not feel anything.

This way, they feel as if those horrible things are happening to someone else; it is not them who are hurting, and this is how multiple, different personalities are born.

Each one of them is a type of coping mechanism and has traits that the child doesn’t, helping them to deal with the situation in the best way possible.

The number of alters differs from person to person and can be 2 of them, but also 100 when a person is not even aware of each one of them.

What is fascinating is the fact that these alters are often not human beings.

Now, why is this?

Since we are talking about children, who are between 0 and 6 years old, we know that in that period their imagination flourishes and that by listening to fairytales and watching tv shows they start to believe in beautiful fairies, dragons, who are symbols of strength, mermaids and other creatures and this is exactly why some of their alters take these creatures’ shapes and traits.

All of that happens to make the children stronger, more resilient, calmer, more patient, etc..

This is a way of their brain to protect them from whatever situation they are in and help them survive with the least pain possible.

SYMPTOMS OF DISSOCIATIVE IDENTITY DISORDER

The main characteristic of DID is the presence of two or more split identities that have control over the body.

These identities are very different from each other, and some of the differences are age, sex, race, sexual orientation, interests, hobbies, gestures, postures, etc.

What is very interesting is the fact that these identities can have different allergies, which has been reported in several cases – for example one alter has strong gluten allergy, but the other one enjoys eating bread quite a bit, or even more mind-boggling differences such as the diabetes presence, where one alter is a diabetic which is shown by the different tests, and the other one isn’t, having the negative tests.

The most common symptom is the amnesia which cannot be blamed on an everyday forgetfulness.

We often cannot recall what we ate for breakfast a few days ago, or when exactly we had a certain activity, which is normal since our brain absorbs huge amounts of information every day and needs to erase some of them in order to make space for the new ones.

However, if we often can’t recall what we did for the past few days, where we’ve gone, whom we’ve seen and if we feel like having a black hole instead of a memory, then we are certainly dealing with a problem.

This is the problem that people suffering from DID deal with often daily.

What actually happens is the following: since there are different, often numerous alters who “wake up” and take control of the body, they go on about their activities and create the memories, meet new people, create friendships, and so on, so when another alter wakes up, they don’t remember those things, nor does the “original” person.

When alters are numerous and their switches regular, the person has constants bigger or smaller amnesias and realizes that something is going on.

These switches can take seconds, minutes and sometimes days.

What is another sign of DID is an “out of body experience” when a person feels detached from their body, feeling as if sitting in a passenger’s seat in its car.

They are aware of a certain activity but don’t understand why they are doing it.

For example, someone with DID can start doing things they don’t normally do, such as being violent, yelling, stealing, reckless driving, and they feel like having no control of the body.

An interesting fact is that people with DID report that their alters can choose if they will let them be “co-conscious” with them, or if they will shut them out completely.

The first case means the above mentioned: the person is conscious of the things being done, but doesn’t have control over them.

This co-consciousness can have different levels: the person can hear and see everything but is a mere spectator, they can hear, but can’t see anything, or they can’t hear nor see what the alter is doing, but they feel that something is happening and that the body is moving.

The latter case means total amnesia, the alter chooses the to shut the “original” person out, and when the person wakes up, they have no idea about what happened and where they have been.

As we said, alters are very different among themselves, however, they are not fully mature personalities, but parts of one dissociated identity.

A creation of one complete identity is also something that has root in an early and later childhood.

When we are born, we have no personality, and our wishes and activities are very disconnected. However, as we grow, see and realize the world around us, learn every day, our identity is created, and everything comes together like a puzzle.

This is what happens in a calm, normal, serene childhood.

However, when childhood is disrupted with different traumas, that formation fails to happen, leaving the pieces of one personality by themselves.

These are called alters. They all keep different aspects of autobiographical information.

There is usually the above mentioned “original” or “host”, which is a personality connected with person’s real name and often the host is unaware of the alters and doesn’t know about them for a long time, or doesn’t understand what is happening.

Some of the most common symptoms of dissociative identity disorder are:

Depersonalization:  It is the above mentioned “out-of-body” experience when a person feels detached  from its body and loses control over it.

Amnesia: The inability to remember major and important details about one’s life and experiences, such that it can’t be blamed or regular forgetfulness.  Since switches can be very often, this amnesia can be a micro one, and the person doesn’t remember a meaningful conversation or they can last for days and be very scary.

Derealization: It is described as the feeling that the world is not real, and sometimes it is connected with the depersonalization.

Identity confusion or identity alteration: This is the feeling of deep confusion. The person is unable to define important things such as interests in life, hobbies, sexual orientation, ambitions, political, religious and social viewpoints, etc. This is all due to the presence of several alters, which all have their above-mentioned viewpoints, ambitions, thoughts, etc..

HOW IS DISSOCIATIVE IDENTITY DISORDER DIAGNOSED?

Diagnosing the dissociative identity disorder is usually not an easy process, and it takes time.

There is an estimate that people who have DID have already spent around 7 years in the mental health system before its diagnosis.

This is because this disorder never exists on its own, but has a lot of other symptoms which are characteristic for other psychiatric diagnoses. People who have DID are usually diagnosed with 5 to 7 similar disorders.

Because of their overlapping symptoms, the diagnosis may include schizophrenia, normal and rapid-cycling bipolar disorder, epilepsy, borderline personality disorder, autism spectrum disorder, anxiety, and depression.

It is important to measure all of the aspects of the possible DID diagnosis to be sure that it is DID, and not something similar.

The therapist(s) need to make sure how persistent and consistent the person’s identities are in their behavior, how common amnesia is, they need to measure dissociation, and what is very important – listen to family members and other close people about their experiences with the person and their identity changes.

The DSM-5 (The Diagnostic and Statistical Manual of Mental Disorders) gives the following criteria for diagnosing dissociative identity disorder:

  1. There are at least two or more personality states, ”each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.”
  2. Amnesia must happen, defined as “gaps in the recall of everyday events, important personal information, and/or traumatic events”
  3. The person must have problems with functioning and everyday living due to this disorder, it must be distressed altogether by it
  4. This disturbance is not in any way connected with what is believed to be normal cultural and religious practices
  5. These symptoms mustn’t be an effect of any substance (such as having no control during alcohol intoxication, having hallucinations after using certain drugs) or a general medical condition (such as having seizures)

Besides the main symptoms, there is a variety of side ones that can be associated with dissociative disorders, such as:

DISSOCIATIVE IDENTITY DISORDER TREATMENT

Dissociative identity disorder doesn’t have a “cure”; it is a state with which people live their whole lives. It requires commitment and long-term treatments.

What is necessary in the beginning is that the person who is diagnosed with the DID accepts that fact that it has it and that many people in the world (1% of the population) have it, thus is not alone.

Even though it sounds scary to know that they have alters who can control the body, they shouldn’t be afraid.

There is plenty of people who learned how to live with DID and who even came to meet their alters either through writing a diary together and reading each other’s thoughts and experiences or through their friend’s stories, since alters usually have different friends.

In general, there is a lack of consensus in the treatment of DID, but thanks to numerous case studies and researches on possible therapies, three of them were found to be very effective:

  • Psychotherapy: it is also called “talk therapy”. The therapist is there to talk to the patient and carefully listen to their stories and experiences and see what the triggers are. Their goal is to put different personalities as much together as possible and fuse them. Another goal is to help the patient control the triggers and with that their life as well. This therapy is sometimes even more effective when it includes family, friends and significant others. The psychotherapy has a variety of techniques, such as cognitive-behavioral therapy (CBT), insight-oriented therapy, dialectical behavioral therapy (DBT), and eye movement desensitization and reprocessing (EMDR).
  • Hypnotherapy: The hypnosis was found to be very helpful since it is used to enter the unconsciousness and repressed memories and feelings. Very often people with the DID don’t even remember their childhood and horrific details and feelings since they have been repressed and “lived by their alters”. Thanks to the hypnosis these memories are relived and that way the person has a chance to heal and deal with that new information. It can also help control any problematic behavior and triggers. All of this leads to the integration of multiple personalities.
  • Creative therapy: It includes therapies such as the movement and art ones, which bring relaxation and helps people reconnect with the parts of their mind that have been shut off. Those are the parts that keep the memories of the trauma.

PROGNOSIS

People diagnosed with dissociative identity disorder usually react very well to their therapy.

Those who have only dissociative and posttraumatic symptoms are given a better prognosis than those who have other disorders as well, especially those who are still in touch with their abusers.

The latter ones usually have a much longer treatment, which requires much more effort and will.

It is very common that people suffering from DID have suicidal thoughts, failed suicide attempts and self-harm happens often.

Since every DID patient is a different case, their treatment type, duration, success rate, and other statistics differ quite a bit, and no one can say for sure.

Some of the important factors in every treatment include patient’s will to tackle the problem and goals, which vary from only improving the communication and cooperation inside the system (all alters together make up a system), lowering amnesia occurrence, to the most ambitious one, and that is overall alter integration.

Another very important factor is the patient’s feeling of being safe. That feeling is something they were deprived of in their early childhood, which ultimately led to multiple alter creation, thus is linked with their switches.

The less safe the person is, the more regular alter switches will be to protect them.

This is why a person with DID must feel relaxed, safe, free from fear for their life – all of this calms the alters and they stop appearing that often.

DID treatment is a long and complicated process, which requires years, a lot of patience, and most importantly, an adequate psychiatrist who has the much need knowledge and expertise in this field.

FINAL WORD

Taking into consideration the whole text and so much new information, I hope that it gives a clear picture of the dissociative identity disorder which remains unclear to many people.

It is a disorder that requires so much more work, analysis, case studies, and deeper research to fully understand it, if ever.

Even though most of us don’t know anyone with this disorder, or like to think so, it is pretty common, with 1-2% of the population being diagnosed with it.

That is 75-150 million people with the DID, but what is with the cases who remain hidden?

Dissociative Identity Disorder (Multiple Personality Disorder) Guide (Causes, Symptoms, Treatments)

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