Mental Health: Dissociative Identity Disorder Is Nothing to Split At

Reviewed by: Dr. Steven Knauf, D.C.

By Martha Michael

If you’ve ever found yourself zoning out, getting lost in a book, or feeling hypnotized by a long drive, you’ve experienced something akin to dissociation. Yet these everyday examples are nothing compared to the out-of-body experience caused by a split personality disorder. Brought on by traumatic events ranging from accidents to abuse, dissociative identity disorder -- formerly called multiple personality disorder -- is a grave, transformative means of coping with emotional pain, often from a personal history involving repetitive, overwhelming trauma.

What Is the Criteria for Diagnosing Dissociative Identity Disorder?

A person struggling with dissociative disorders tends to mentally detach from their memories as a coping mechanism to tolerate intense feelings of fear or pain, according to the American Psychiatric Association. It’s a form of escape from an overwhelming experience. It is marked by problems with:

• Identity
• Emotions
• Memory
• Behavior
• Perception
• Sense of oneself√

There are slight variations in the form that a patient’s dissociative state exhibits. Based on the origin and triggers associated with the behavior, there are three kinds of dissociative disorders: dissociative identity disorder, dissociative amnesia, and depersonalization/derealization disorder.

Dissociative Identity Disorder

Patients who are diagnosed with dissociative identity disorder, or DID, live with two or more personality states. They exhibit changes in memory, thinking, and behavior. It is often accompanied by significant social distress.

Symptoms of DID include loss of memory regarding:

• Past trauma
• Personal information
• Everyday activities

According to an article by WebMD, a DID diagnosis takes time. The Diagnostic and Statistical Manual of Mental Disorders handbook, or DSM-5, says that DID symptoms do not support a diagnosis if they are identified as:

• Blackouts or chaotic behavior while intoxicated
• Complex partial seizures due to a medical condition
• Hallucinations from religious practices

Dissociative Amnesia

According to WebMD, dissociative amnesia is evident when you fail to remember the most significant, essential elements of your life. The types of amnesia you may experience are:

Localized - You forget periods of time

Selective - You don’t remember details of events from a particular window of time

Generalized - The least common aspect, you lose sight of your identity and personal history

Depersonalization/Derealization Disorder

People with depersonalization disorder feel detached from their body, feelings, thoughts, and environment. Some people describe it as dream-like because this type of mental health condition feels like you’re floating outside your body, according to the Mayo Clinic. This type of dissociative disorder disrupts your ability to form and maintain relationships because the feelings are difficult to control.

People with a multiple personality disorder shift between identities involuntarily and may not even be aware they are doing it. They may suddenly change preferences in food, clothing, or activities. When distinct personalities take center stage they may feel as though they’re simply observers. Transferring from one identity to another is typically distressing for the individual.

What Causes Dissociative Identity Disorder?

DID is a rare mental disorder that affects less than 1 percent of the population, according to the Cleveland Clinic. People of any age can be diagnosed but most of them are female.

Many characteristics of the mental illness can be considered both symptoms and causes of DID, including:

• Disorientation
• Depression
• Substance abuse
• Suicidal thoughts
• Anxiety
• Delusions

An incident of sexual or physical abuse is often the reason a person needs to escape the pain through dissociation. Virtually any overwhelming incident, including a natural disaster or serious accident, can trigger the disorder. It’s worse when the victim has little social or emotional support.

Though some patients develop symptoms of DID in early childhood between the ages of 5 and 10, it’s easy to miss the signs and instead diagnose the child with attention deficit/hyperactivity disorder, or ADHD. Many times a proper diagnosis isn’t developed until adulthood. Medical testing for DID may include scans to rule out brain tumors or other head injuries. Psychiatric testing rules out other conditions before diagnosing someone with a dissociative disorder.

What Therapeutic Approaches Are Effective in Treating Multiple Personalities?

Despite the desire for a magic bullet style of treatment for DID, there is no significant, effective drug therapy available. Rather, mental health professionals seek to reintegrate the personalities to form just one identity. As individuals process their traumatic memories, they find ways to cope.

“Treatment can be very effective,” says Sam Zand, D.O., a psychiatrist in Las Vegas, Nev.. “From symptom resolution to symptom improvement, several forms of psychotherapy can help.”

Some of the most successful forms of treatment include the following.

• CBT - Cognitive behavioral therapy involves talk therapy that’s directed toward minimizing negative thinking and developing coping skills
• EMDR - Eye movement desensitization and reprocessing is a physical tool to reduce traumatic memories and reduce the effects of trauma
• DBT - Dialectical behavioral therapy uses mindfulness to change unhealthy behaviors through stronger relationships

DID may be a handful for those who must deal with it directly as a patient or a support system, but there is hope. All is not lost.

What Can Family and Friends Do for Someone Who Has Dissociative Identity Disorder?

Though it’s a rare condition, you may know someone who shows signs of dissociative identity disorder. The website Mind.org suggests you access your greatest level of patience and self-control while engaging with someone with DID. To effectively understand and influence a person who’s struggling, slow down and don’t expect a relationship to form naturally.

The following tips can make it easier to effectively deal with a person who has a dissociative disorder.

• Remember that they may not understand your intentions nor hear you and respond
• Ask them to guide you in the best ways to support them
• Accept their indecision if they don’t know how to advise you
• Listen with acceptance when you hear them describe their lives
• Discuss any forms of physical touch because they may not understand your intentions clearly

You may need to converse with different parts of their identity at various times and manage how you engage with them to relate to each personality. It also requires the ability to adjust to their sometimes angry or scared responses. Do your best to stay calm and maintain a safe, pleasant demeanor in their presence.

A person with DID may need help with the following.

• Connecting with an advocate
• Finding adequate therapy programs
• Putting in place added support from family and friends
• Creating a crisis plan they can agree to follow
• Setting up guardrails to keep them safe
• Engaging in grounding activities

Be aware of your own health and safety when caring for someone with DID. You may also need the service of a therapist to keep tabs on your own mental well-being.

Mind.org has an online community called Side by Side that provides peer support groups to connect you to others who are struggling emotionally. It is moderated from 3 a.m. to 7 p.m. (ET) seven days a week. You don’t need a diagnosis; you may be battling a psychological disorder or supporting someone else.

If you or someone you know is having suicidal thoughts, help is available through the National Suicide Prevention Lifeline at 800-273-TALK (8255).

For a mental health crisis, call the National Hotline For Mental Health Crises And Suicide Prevention by dialing 988.

A lot has changed -- including the name of the disorder -- since 1976 when Sally Field appeared in the Emmy Award-winning TV movie “Sybil” about a woman with a split personality. Because dissociative disorders include behaviors we rarely encounter, you may not have had any personal experience with an individual who’s displaying symptoms of this type of mental illness. Just be calm, take a deep breath, and use the resources available to you. It’s all anybody can ask.

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