Multiple Personality Disorder: Real Or Imagined?

What was once referred to as multiple personality disorder, or MPD, is one of the most fascinating and controversial mental illnesses. Technically, MPD is no longer the correct term for the mental health condition, as it is now known as dissociative identity disorder (DID), and DID is no longer classified by the Diagnostic and Statistical Manual, now in its fifth edition, as a personality disorder.

According to the DSM-V, a personality disorder is "an enduring pattern of inner experience and behavior that deviates from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment."

Today, DID is categorized in the DSM-V as a dissociative disorder, a form of mental illness characterized by a disconnection with one’s feelings, thoughts, sense of self, motor functions, memory, or behavior. Other dissociative disorders include dissociative amnesia, depersonalization-derealization disorder, other specified dissociative disorders, and unspecified dissociative disorder. Ahead, this article will explain the different ways in which DID may manifest, its symptoms, and information meant to differentiate facts and myths relative to DID.

What causes dissociative identity disorder?

DID, unlike a personality disorder, develops in childhood because of exposure to severe trauma or abuse. The traumatic experience could start as early as infancy or later in childhood, however, the onset of DID tends to be in early childhood. No one is born with DID, and it develops over time. Childhood trauma can come in many forms, including neglect, physical abuse, sexual abuse, emotional abuse, or the loss of a primary caregiver early on in life.

DID can be challenging for mental health professionals to treat. The severity of the illness depends on what abuse the person was subjected to and the nature of their environment. Someone with DID is used to an inconsistent home life where neglect or harm is the norm. When a human being is born, it inherently knows the concept of survival. An infant cannot articulate that they need food, but they will cry to get their needs met. A person with DID is accustomed to a chaotic life and they cannot necessarily predict whether or not their needs will be met.

Many people do not know what DID is because they have never met, or known that they’ve met, someone with the illness. Some people's knowledge of DID may stem from characters in fictional works, television court cases, and movies. People with different personalities can contribute to an interesting plot twist or a shocking ending. 

An example of DID in pop culture that is portrayed fairly well, rather than in a negative light, is the TV show the United States of Tara, about a mom and wife who has DID, the challenges she and her family face, and her grapple with realizing and addressing her past trauma. To offset the serious nature of the content, there is a good amount of comedy spliced in to keep it a bit lighter from time to time, as DID is not always severe as many other movies and shows like to portray.

Media portrayals may lead people to wonder if DID is an imagined illness. Some experts argue DID should not be viewed as a separate illness, but rather as a by-product or effect of other illnesses like borderline personality disorder, while others insist it's a disorder in its own right. 

Regardless of the controversy, DID is a disorder that affects approximately 1.5% of the population across the world. It is a complicated psychological condition caused by several factors. Individuals of any race and sex can develop the disorder, however, it is more common in Americans and the number of women who live with DID is higher than men. This could be because women are ten times more likely than men to be a survivor of childhood abuse.

What are DID alters?

Dissociative identity disorder is defined as a disorder in which two or more distinct and separate personalities (known as alters) exist within an individual. Some people with DID refer to their personalities as parts, alters, others, or head mates. It depends on the individual's preferences about identity.

Many people occasionally check out or shut down emotionally to escape from pain or trauma. For someone with DID, though, dissociation may be overt, during which seemingly different personalities are easily observable, or it may be covert and less obvious to both the person with the experience and those around them. Most cases of DID are covert rather than overt in presentation.

As previously stated, one of the primary causes of DID is due to an individual's childhood abuse. They experience a serious traumatic event as a child, typically before the age of nine. It can be sexual, physical, or emotional abuse and is usually severe; for instance, being repeatedly and regularly sexually abused.

Someone who has DID develops it as a way of coping with the trauma the individual has experienced. They remove themselves from the painful situation and an alter takes over to defend them from pain or hardship. DID is the culmination of an individual's inability to integrate their memories, trauma, and consciousness within one single identity. Research shows that DID is often comorbid with post-traumatic stress disorder. Some experts believe that dissociative disorders and post-traumatic stress disorder should have the same classification.   

When someone goes through a shocking experience too difficult to manage at that moment, they repress the experience to cope. They may live in a state of denial regarding this trauma. With DID, the individuals create a separate identity or awareness to safeguard themselves from the traumatic experience. Alters, or parts, represent different aspects of the individual who lives with DID.

Alters can switch back and forth or become dominant within the patient. Alterations between these different awarenesses can be triggered by an event or circumstance, and the individual may or may not be aware of them. Amnesia is frequently reported by witnesses and the individuals themselves. They may experience gaps in memory, be unable to remember major life events, or even have gaps in memory to the extent of not knowing how or why they are in a certain place.

A transition may be triggered by both positive and negative situations. For example, being in an amusement park environment could trigger a child alter to come out to experience the joyful atmosphere. A negative experience (such as a fight or particularly stressful event) can trigger a more defensive awareness to emerge to safeguard the individual. A 'switching' episode can last anywhere from minutes to hours to even days. The switches can be gradual or extremely quick.

The symptoms of dissociative identity disorder

The Diagnostic and Statistical Manual V lists the diagnostic criteria of DID as the following:

• Disruption of identity is characterized by two or more distinct personality states, which may be described in some cultures as an experience of possession. The disruption in identity involves marked discontinuity in the sense of self and sense of agency, accompanied by related alterations in effect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.

• Recurrent gaps in the recall of everyday events, important personal details, and/or traumatic events are inconsistent with ordinary forgetting.

• The symptoms cause clinically significant distress or impairment in social, occupational, or other critical areas of functioning.

• The disturbance is not a normal part of a broadly accepted cultural or religious practice. In children, the symptoms are not better explained by imaginary playmates or other fantasy play.

• The symptoms are not attributable to the physiological effects of a substance or another medical condition.

Some notable accompanying issues are:

• Preoccupation with and thoughts of suicide

• Problems with sleeping, i.e., insomnia or night terrors

• Substance use challenges, i.e., drugs or alcohol (used as a means of self-medication)

• Anxiety

• Depression

• Panic attacks, flashbacks, or reacting to triggers

Because many of the symptoms and associated risk factors are also indicators of other mental health conditions—for example, post-traumatic stress disorder (PTSD)—a healthcare professional must perform a diagnostic evaluation. Self-diagnosis or inadequate diagnosis can lead to misdiagnosis of other conditions and result in ineffective treatment.

Life for individuals with DID is often confusing, disruptive, and may feel scary. Imagine waking up and not being able to remember that you got married, had a child, or are suddenly able to speak a different language that you do not recall learning, or simply not knowing how you got where you are. It can feel like a shocking, never-ending nightmare.

Living life in this way can feel exhausting and downright terrifying, which is why it's extremely important to seek treatment as soon as possible.

The earliest cases of multiple personality disorder

The earliest documented case of DID surfaced in 1791. A German botanist, Eberhardt Gmelin, was responsible for determining the case of multiple personality disorder (now referred to as DID). His patient was a German woman who alternated between two personalities, her German identity and a French alter. When she switched to her French personality, she was fully aware of her German alter, but as a German woman, she had no recollection or memory of being French. Gmelin's findings launched the beginning of research into DID and psychologists like William James found this new disorder intriguing.

In the 1970s, multiple personality disorder was included in psychology books and in 1980, after decades of research and study, the American Psychiatric Association finally legitimized the disorder by adding it to the DSM-III. In 1994, when DSM-IV was published, MPD was redefined and officially renamed dissociative identity disorder to better reflect the characteristics of the illness.

A famous case of DID in recent years is that of Herschel Walker, an NFL player. He lived with the disorder for years, not understanding what was going on with him and how his alters were affecting his life, his loved ones, his marriage, etc. When he was diagnosed with the disorder in his forties, things started to make more sense to him. He sought treatment and is now able to live a fulfilling life with DID.

Can someone with dissociative identity disorder be cured?

DID is tough to treat but when treated successfully, people can live a successful and happy life. Keep in mind that different personalities are integrated parts of the host. They're not a group of strangers who happen to inhabit the same body. This is an important distinction to make and understand for both the professional and the individual when undergoing treatment. The goal of DID treatment is much like putting a puzzle together; different pieces need to come together to create one whole.

A therapist achieves the goal of helping the person with DID integrate their parts by getting the alters to communicate with each other. Parts acknowledge each other and help resolve their conflicts. Over time, the individual begins to come to terms with their unresolved issues, and the personalities begin to integrate and fuse. When all the identities have come together within one unified whole, it is referred to as final fusion, and this final fusion is the ultimate goal for a person with DID as it involves ultimate realization and acceptance of their past trauma and their condition.

Before treatment begins, the person needs to have a clinician diagnose them with DID. A psychologist or psychiatrist will use screening tests and clinical evaluations. It is important to be honest in your answers to receive an accurate diagnosis – especially for an illness like DID – where a diagnosis can be a lengthy process. This is because the symptoms of DID are similar to other psychiatric disorders, which makes it challenging to diagnose.

Medication does not cure DID, but doctors may prescribe psychotropic medications to help curb the symptoms that arise, such as depression, psychosis, anxiety, and flashbacks. Psychotherapy is one of the primary treatments for DID. The techniques used follow three stages:

• Stabilization: ensure the safety of the individual, stabilize the situation, and work to reduce the symptoms.

• Trauma work: confront the trauma of the past as well as trigger memories.

• Integration: integrate the distinct parts of self into the host.

Cognitive behavioral therapy is a commonly utilized modality for individuals with DID. Through cognitive behavioral therapy, participants can process trauma, such as physical or sexual abuse, while identifying negative thoughts that contribute to their symptoms. Additionally, research suggests that cognitive behavioral therapy may be an effective treatment for individuals with comorbid dissociative identity disorder and post-traumatic stress disorder. 

Seeking professional help and receiving appropriate care are crucial in treating DID. Without appropriate mental health treatment, it is nearly impossible to manage the symptoms of DID. Left untreated, DID can have detrimental effects, leaving a person vulnerable to abuse and suicidal ideation. The lives of their families and loved ones are also negatively impacted if they do not seek treatment.

The treatment progress for DID is unpredictable. Memories of the past may be too painful to process, and the individual may have undiagnosed comorbid mental health conditions—such as post-traumatic stress disorder (PTSD), eating disorders, or acute stress disorder—that complicate treatment. Letting go of the coping skill that they have used for so long is an arduous process. While the end goal is to reach the stage of final fusion, therapy isn't over. Patients continue to work with their therapists and prescribing doctors long after the final fusion.

A DID patient, Karen Overhill, is an example of an instance where the illness was cured. (ABC News, 2007). Her doctor, Dr. Richard Baer wrote a book on Karen's case called Switching Time: A Doctor's Harrowing Story of Treating a Woman with 17 Personalities. As a child, various male individuals of the family, including her father and grandfather, sexually and physically abused Karen. She started to see Dr. Baer in her late twenties to seek treatment for depression and problems with her memory. She would experience total blackouts and could not remember things like delivering her baby or how she got from point A to point B.

Over the next two decades, through hundreds of therapy sessions, Dr. Baer uncovered seventeen different personalities in Karen. The alters were both male and female, of different ethnicities, as young as two and as old as 34. By using different treatment methods like hypnosis and visualization he was able to treat Karen and help her alleviate her dissociations. One by one, her multiple personalities were eventually integrated into one whole individual.

You too can enjoy a fulfilled, successful life with DID. It is a challenging illness to live with; however, with the right tools and support in therapy you can get better.

How BetterHelp can help

BetterHelp is a fully remote therapy service that takes place online or over the phone. Research published in the Journal of Medical Internet Research shows that people who used BetterHelp experienced a significant reduction in depression symptoms.Although online therapy is not recommended for those with DID due to its complex nature, it can be incredibly useful for the friends and families of those with DID as a means to help them cope and better understand and help their loved ones.

The online nature of BetterHelp enables people of all walks of life to have affordable and convenient therapy, as you do not have to commute to and from sessions, and therapists do not have to pay to rent out office space (meaning lower billing rates). 

Additionally, sessions can be held anytime, anywhere – including in the comfort of your own home. You will just need an internet connection to get started. Sessions can be conducted via phone call, video chat, live voice recordings sent back and forth, instant messaging/texting, or any combination thereof. 

Studies have highlighted positive outcomes that can result from an individual and their family relatives participating in therapy for dissociative identity disorder. In one case study, individual therapy helped a male participant improve his functioning, coping skills, and assertiveness, while family therapy aided in restructuring unhealthy boundaries by controlling familial power dynamics. 

Living with someone who lives with DID can come with its own set of challenges, like anxiety and depression, and online therapy has shown efficacy in mitigating these symptoms for people living with those diagnosed with a severe mental health condition.