Dissociative identity disorder (DID): Causes, triggers, treatment options, and more

Dissociative identity disorder is perhaps the best-known, but most misunderstood dissociative disorder. It’s marked by the presentation of alternate personalities, commonly referred to as “alters.” These alters often differ drastically from one another and can change the affected person’s voice, body language, speech patterns, handwriting, and more. 

Dissociative identity disorder can be highly disconcerting to those who have it and others, especially when a person begins “switching,” or moving between their alters. This transfer can create memory gaps, confusion, and fear. Dissociative identity disorder often develops after traumatic experiences, usually in childhood.

What Is Dissociative Identity Disorder?

It may sound like a personality disorder, but dissociative identity disorder doesn’t belong to this subgroup of mental health conditions. Instead, it’s one of several dissociative disorders, in which the individual has two or more distinct identities or personalities. Those who suffer from this disorder experience significant distress, impairment in important areas of functioning, and memory loss.

Dissociative identity disorder is characterized by identity fragmentation, not an army of separate personalities or characters. This is precisely why the name was changed from multiple personality disorder 23 years ago to better reflect the grounds for the disorder and what the sufferers experience. 

The following criteria, as set forth by the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), must be met in order for a diagnosis of dissociative identity disorder to be made:

• The individual must experience two or more distinct personality states, each of which has a specific way of perceiving and thinking about the environment and self.
• This identity disturbance includes changes in behavior, consciousness, cognition, memory, and motor function.
• There are regular gaps in memories of personal history, for both the far-gone and recent past. These include memories about specific people, places, and events.
• The above symptoms cause clinically significant distress or impairment in everyday functioning.

What Are the 3 Main Symptoms of Dissociative Disorders?

The three most common symptoms of dissociative disorders are: 

• Memory loss (amnesia)
• A sense of feeling detached from one’s self, others, and the environment 
• The existence of at least one or more alters

Someone who is coping with a dissociative disorder may also have difficulty describing or feeling attached to one’s personality, and hold distorted views of reality which are not always evident to the sufferer. People with dissociative disorders may not always realize what they are experiencing, which can be frustrating and confusing for them as well as those around them. 

Even more daunting is that many people with dissociative identity disorder may feel as though their alters are in control, and not themselves. These symptoms are treatable with the assistance of a mental health professional, but first, the provider will need to identify which dissociative disorder the client is suffering from. 

What Are the 4 Types of Dissociative Disorders?

The DSM-5 currently recognizes four types of dissociative disorders: dissociative identity disorder, dissociative amnesia disorder, depersonalization/derealization disorder, and other specific dissociative disorder — the foremost of which is dissociative identity disorder. Here’s more information about the other three: 

Dissociative amnesia disorder: An distinct inability to recall important life events, highlights, or personal stories, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. The necessary criteria are as follows: 

• The amnesia symptoms must cause clinically significant emotional distress or impairment in the client’s social life, work, or other important areas.
• The disturbances are not attributable to a substance such as alcohol or other drugs, or a neurological or other medical condition such as a traumatic brain injury.
• The disturbance is not better explained by another mental health condition disorder.

Depersonalization/derealization disorder is the persistent experience of depersonalization and derealization episodes. The difference between these experiences is explained below. Depersonalization is the feeling of being an outside observer in regard to one’s thoughts, feelings, sensations, body, or actions. 

Derealization causes an individual to experience other people, objects, the environment, and certain situations as unreal, dreamlike, foggy, lifeless, or visually distorted. 

A person meets the criteria for depersonalization/derealization disorder only if:

• During the depersonalization or derealization experiences, reality testing remains intact. (Reality testing is the ability to recognize unrealistic thoughts from rational ones.)
• The symptoms cause clinically significant distress or impairment to the client’s social life, work performance, and interpersonal relationships. 
• The disturbance is not attributable to the effects of a pharmacological substance such as a recreational drug or prescribed medication, or another medical condition such as seizures or serotonin syndrome.
• The disturbance is not better explained by another mental health condition disorder, like schizophrenia, panic disorder, or PTSD. 

Other specified dissociative disorder may be diagnosed when dissociative symptoms are causing clinically significant distress or impairment in functioning, but do not meet the full criteria for any of the disorders listed above. To be diagnosed with this disorder, the client must be experiencing:

• Recurrent dissociative symptoms such as identity disturbances, alterations of identity, or episodes of possession by an alter, with no reported dissociative amnesia.
• Identity disturbances due to extreme circumstances, such as brainwashing, indoctrination, torture, political imprisonment, cult membership, or forced entry into a terror organization.
• Short-term, acute dissociative reactions to a stressful event or events. This sort of reaction typically lasts less than 1 month, and sometimes for only a few hours or days after the event.

What Are Some Examples of Dissociative Identity Disorder?

It’s important to remember that mental health conditions can affect each individual differently. But with this in mind, there are certain common experiences or behaviors among those who have dissociative identity disorder. For example, someone may: 

• Take part in a conversation that they don’t remember
• Act impulsively
• Speak in a different language or with an unusual tone of voice
• Display uncharacteristic body language 

And in some cases, it’s even possible to observe someone “switching” between personalities. This may entail involuntary muscle spasms; rapid eye movements; and changes in mood, handwriting, or dress. 

What Triggers Dissociative Identity Disorder?

It’s not always clear why some people develop the disorder, but oftentimes, the individuals report having been physically or sexually abused: 90% with the disorder in the U.S., Canada, and Europe, report having been abused as a child. 

But beyond post-adolescence and childhood, some of the common triggers of dissociative identity disorder in adults include: 

• Chronic stress and anxiety
• Alcohol and drug use
• Sleep deprivation
• Long-term sexual abuse or exposure to physical violence
• Combat, whether in a domestic self-defense situation or military operation
• Prison conditions, especially solitary confinement

When the symptoms of dissociative identity disorder are triggered, the temporary escape from reality doesn’t solve the root of the issues — the triggers of dissociative experiences must be addressed and resolved. 

Can Emotional Neglect Cause Dissociative Identity Disorder?

Research shows that emotional neglect plays perhaps the largest role in the development of dissociative states. However, severe and particularly prolonged trauma can have a lasting impact on psychological well-being at any age. The extreme stress of some situations can cause someone’s personality to splinter, creating alters in an attempt to escape the reality of a situation or event. 

It’s also important to remember that emotional neglect can take on many forms, and factors such as sexual and physical abuse are also contributors to dissociative disorders in many cases. 

Can You Have Dissociative Identity Disorder and Not Know?

It’s definitely possible. Often, people with mental health conditions may experience symptoms for years before receiving a diagnosis from a clinician. Typically, individuals eventually encounter some form of dysfunction in their life that prompts them to receive the expertise and professional evaluation skills of a therapist or psychiatric care provider.  

How Is Dissociation Treated? What Sorts of Treatments Are Most Effective Within the DID Population?

Dissociative disorders need to be diagnosed before treatment can begin. This process starts with a clinician assessing and evaluating the client’s presenting symptoms and ruling out other conditions that could be causing dissociation and depersonalization experiences. 

Evaluation for dissociative identity disorder and other dissociative disorders may include:

• A preliminary physical exam: Your provider may refer you to a doctor who can first test for head injuries, brain diseases, or other health issues which could cause symptoms such as memory loss, hallucinations, or other psychological symptoms. 
• A psychiatric evaluation: Your provider will ask questions about your thoughts, feelings, and behavior in the past as well as the present. If you allow them to, they may also gather information from your family members or partners in order to get a better idea of your situation and psychological history. They will likely compare your symptoms to the DSM-5 criteria, as listed above.

The two most successful forms of treatment for dissociative disorders are talk therapy and psychiatric prescription medications.

• Talk Therapy from a Therapist 

Talk therapy is the primary treatment for dissociative disorders, and helps you begin talking about your disorder and related issues with a mental health professional. A therapist with advanced experience, or who specializes in helping people work through trauma is a great option. 

Some of the most popular forms of talk therapy are: 

• Cognitive behavioral therapy (CBT) 
• Dialectical behavior therapy (DBT) 
• Psychodynamic therapy 
• Humanistic therapy

Talk therapy can offer you new understanding of your condition, and teach you more effective ways to cope and move forward with your life. These conversations between you and your therapist are confidential, empathetic, and will move at your own pace. 

• Medication from a Psychiatric Provider

Even though there aren’t any medications that specifically treat dissociative disorders, a psychiatric provider may prescribe to you one or more: 

• Antidepressants
• Anti-anxiety medications
• Antipsychotic drugs 

These medications could help you control the mental health symptoms associated with your dissociative disorder.

Adults are encouraged to reach out for support and professional guidance if it seems that they’re struggling with the effects of dissociative identity disorder or another dissociative disorder. Parents, caregivers, and teachers should also watch for the signs of dissociative disorders in young children. If treatment happens soon enough after episodes of abuse or trauma, this could prevent a child’s dissociative symptoms from worsening.