Dissociative Identity Disorder

People with dissociative identity disorder exhibit various signs and symptoms, reflecting the complexity of the disorder. These symptoms can be broken down into several categories: dissociative symptoms, physical symptoms, and comorbid symptoms.

Dissociative symptoms

Dissociative symptoms may involve the following: 

• Presence of two or more distinct identities or personality states: In dissociative identity disorder, each alter, part, or state has its own way of perceiving, relating to, and thinking about the environment and self. This involves "switching" to other identities.
• Amnesia: Individuals with dissociative identity disorder may experience gaps in memory about life information or past traumatic events. Dissociative amnesia is not ordinary forgetfulness and can include forgetting skills or learned information.
• Depersonalization and derealization: Depersonalization and derealization are experiences of being detached from oneself, observing one’s actions from an outside perspective, or sensing that one’s environment or other people are not real. 

Physical symptoms

Symptoms of DID can manifest physically for some individuals, including:

• Non-epileptic seizures
• Movement issues
• Symptoms that do not have a clear physical cause
• Different allergies, medication responses, or vision abilities between alters 

Co-occurring symptoms

Below are some symptoms that are often associated with other mental health disorders that may occur with DID: 

• Depression: Depression can cause intense sadness, hopelessness, and lack of energy or interest in life.
• Anxiety: Anxiety often involves symptoms like excessive worry, panic attacks, fear, or a sense of impending doom.
• Self-harming behaviors and suicidal ideation: Acts of self-injury, self-harm, or recurring thoughts of suicide can occur with dissociative identity disorder and similar mental illness diagnoses.
• Post-traumatic stress disorder (PTSD)³ symptoms: Due to a traumatic history, some people with dissociative identity disorder experience flashbacks, nightmares, or intrusive thoughts about a traumatic event.

Symptoms can vary widely among individuals with dissociative identity disorder, and the severity and frequency of the symptoms may also vary. The presence and intensity of these symptoms can contribute to the complexity of the diagnosis and treatment process for dissociative identity disorder. 

DID is frequently linked to severe, prolonged trauma experienced during childhood, which makes children the most vulnerable. The specific causes and risk factors include the following: 

• Early life trauma: The development of DID is strongly associated with repeated childhood trauma, particularly when the trauma is severe. Trauma may involve physical, sexual, or emotional abuse, often from a caregiver or family member, breaching a close and trusting relationship.
• Disrupted attachment: A child’s attachment to a caregiver or close family member might be inconsistent, unpredictable, or neglectful, leading to a fragmented sense of self.

Risk factors

Below are the risk factors for the development of DID: 

• Age: Early traumatic experiences often occur during childhood, with symptoms being present between the ages of five and ten years old, which can be a critical stage while individuals form their identities.
• Individual response to trauma: Some individuals may be more likely to experience dissociation to cope with trauma, which could increase the risk of DID.
• Frequency, severity, and duration of trauma: The risk of developing DID increases with repetitive, long-lasting, and more severe traumatic experiences.

Triggers

Individuals with dissociative identity disorder may have specific triggers⁴ that can cause a switch between different identities. These triggers are often related to traumatic experiences and can include:

• Sensory stimuli: Sights, sounds, or smells reminiscent of the traumatic event may cause a “switch” between identities. 
• Stressful situations: High-stress situations or environments can provoke a change in which an alter is “fronting.”
• Reminders of trauma: Specific dates, people, or places associated with past trauma may act as triggers.

The process of how trauma can lead to dissociative identity disorder is not fully understood, and there is ongoing research to explore these mechanisms. Not everyone who experiences childhood trauma develops a dissociative disorder, indicating that other unknown factors could play a role in the development of the disorder. 

Treatment for dissociative identity disorder often involves talk therapy, which can be supplemented with medication. The main goal of treatment is to promote the integration of separate identities into one primary identity, improving the individual’s ability to function in daily life. However, some people may not relate to this approach; instead, they hope to work with each part of their identities and live a healthier life with each part intact. 

Medication

There is not currently a specific medication available to treat the core symptoms of individuals with DID and separate personality identities.  Antidepressants, anti-anxiety medications, and some antipsychotic medications may help individuals manage co-occurring conditions like depression, anxiety, and psychotic symptoms.

Some medications can also help manage symptoms like sleep disturbances, intrusive thoughts and self-harming behaviors. However, medication may be most effective when used in conjunction with therapy. Consult a medical doctor before starting, changing, or stopping a medication for any condition. 

Other treatment options

In addition to therapy and medication, other treatment options may be beneficial, such as clinical hypnosis. This treatment option aims to create a state of relaxation, focused attention, and increased suggestibility to help individuals explore thoughts, feelings, and memories associated with trauma that may not be easily reachable. However, it may be helpful to note that hypnotherapy is a controversial treatment option and should only be pursued under the guidance of a professional.

Self-care

Promoting self-care practices can be a crucial aspect of managing DID, overall mental health, and well-being. Below are some self-care practices that may be helpful: 

• Mindfulness techniques: Mindfulness practices may include yoga, meditation, and other relaxation practices to reduce stress and improve connection with the present moment.
• Healthy eating: A balanced diet can contribute to overall well-being.
• Exercise: Regular physical activity may reduce anxiety, improve mood, and improve sleep habits.
• Sleep hygiene: A regular sleep schedule can reduce fatigue symptoms and enhance overall health.
• Grounding and stress management techniques: These can help stabilize mood, reduce the length of dissociative episodes, and enhance the ability to remain present and engaged in therapy and daily activities.

Treatment for dissociative identity disorder may benefit from a comprehensive approach based on the individual’s experiences and symptoms. The treatment plan can be designed and overseen by a mental health professional experienced in dissociative disorders. 

Therapy is often crucial in managing dissociative identity disorder. Therapeutic modalities targeted to trauma support allow individuals to work through the traumatic memories that may be causing alternate personalities and causing them to dissociate. Working through the traumatic memories and learning coping mechanisms for the associated symptoms can improve overall functioning and quality of life. Online platforms like BetterHelp offer care with licensed therapists from the comfort of an individual’s home. 

Beyond therapy, various resources provide assistance and information, including:

• The National Alliance on Mental Health (NAMI): NAMI provides “advocacy, education, support, and public awareness so that all individuals and families affected by mental illness can build better lives.”
• The International Society for the Study of Trauma and Dissociation (ISSTD): ISSTD is an international, non-profit, professional association organized to “develop and promote comprehensive, clinically effective and empirically based resources and responses to trauma and dissociation and to address its relevance to other theoretical constructs.”

Some individuals may benefit from the community support found in support groups. Whether in person or online, having a place to discuss experiences and coping strategies can be helpful. These resources are meant to supplement professional help and treatment, not replace them.

For those with thoughts of suicide, contact 988 Suicide & Crisis Lifeline at 988. 

For help with substance use, contact SAMHSA’s National Helpline at 1-800-662-HELP (4357).

For those experiencing abuse, contact the Domestic Violence Hotline at 1-800-799-SAFE (7233). Support is available 24/7.

Please also see our Get Help Now page for more immediate resources.

The research field on dissociative identity disorder is continuously evolving, reflecting the complex and highly individual nature of the condition, which often requires a wide range of approaches for understanding, diagnosing, and treating this disorder. 

A study published in the American Journal of Psychiatry examined brain-based measures’ potential to assess the severity of dissociation beyond typical self-reporting. By analyzing functional MRI scans from 65 women with a history of childhood abuse and current PTSD, researchers found moderate success in estimating dissociation. These findings suggest that brain connectivity could offer objective, clinically useful biomarkers of dissociation severity.

Treating dissociative identity disorder

A common challenge in treating dissociative identity disorder is the lack of evidence-based guidelines. A recent report published by Cambridge University Press presents the case of a 33-year-old woman who did not improve with traditional psychopharmacological treatment or CBT. 

A new approach, centered on the therapist’s empathic resonance, focused on awareness of the disease, control, intensity, maintaining attention, and exploring what guides change. This model involved the patient’s commitment and exploration of microprocesses in a therapeutic setting, showing significant improvement and demonstrating the potential for alternative, personalized therapeutic approaches in treating dissociative identity disorder.

121 million people worldwide live with DID

1.5% of the world population, or 121 million people worldwide, are diagnosed with dissociative identity disorder (DID), a condition commonly diagnosed in those who have experienced childhood trauma.¹

¹National Library of Medicine

Below are more statistics on dissociative identity disorder:

• According to the American Psychiatric Association, “Among people with dissociative identity disorder in the United States, Canada, and Europe, about 90% were survivors of childhood abuse and neglect.”
• Research by the Harran University Faculty of Medicine found “dissociative symptoms in 50% of patients, depressive symptoms in 70% of patients, anxiety symptoms in 40% of patients, and self-mutilation behaviors in 30% of patients” and that “patients with DID received an average of three different diagnoses before being diagnosed with DID.”
• A study published in Psychological Trauma: Theory, Research, Practice, and Policy stated that patients who sought treatment provided by community providers “showed decreased levels of dissociation, post-traumatic stress disorder symptoms, general distress, drug use, physical pain, and depression over the course of treatment.”