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Multiple Personality Disorder, now known as Dissociative Identity Disorder (DID), is one of the most complex and controversial mental health conditions. Characterised by the presence of two or more distinct personality states within a single individual, DID has captured public imagination through portrayals in media and literature. However, understanding the realities of this condition requires a nuanced exploration of its symptoms, causes, diagnosis, and treatment. This article delves into the intricacies of Dissociative Identity Disorder, providing a comprehensive overview based on scientific research.

Keywords: Multiple Personality Disorder, Dissociative Identity Disorder, DID symptoms, DID causes, mental health disorders, trauma and DID, Australian psychology

Dissociative Identity Disorder (DID), previously referred to as Multiple Personality Disorder, is a severe form of dissociation—a mental process that produces a lack of connection in a person’s thoughts, memory, and sense of identity. DID is a chronic condition where a person has two or more distinct personality states, often referred to as “alters,” which may take control of the individual’s behaviour at different times.

The symptoms of DID can vary widely from person to person but generally include the following:

• Presence of Multiple Identities: Individuals with DID experience the existence of two or more distinct identities or personality states. Each alter has its own unique name, age, gender, and way of interacting with the world. These identities can have their own memories, behaviours, and even physical characteristics (APA, 2013).
• Amnesia: Individuals often experience gaps in memory for everyday events, personal information, or traumatic events that cannot be explained by ordinary forgetfulness. This amnesia is typically associated with the switching of alters (Putnam, 1997).
• Dissociation: Dissociative symptoms include feelings of detachment from oneself, a sense of observing oneself from outside the body, or a distorted sense of time and reality (Spiegel et al., 2011).
• Depersonalisation and Derealisation: Depersonalisation involves feelings of being detached from one’s own body, while derealisation is the perception that the external world is unreal or distorted (APA, 2013).

Diagnosing DID can be challenging due to the overlap of its symptoms with other mental health conditions such as borderline personality disorder, post-traumatic stress disorder (PTSD), and schizophrenia. Diagnosis typically involves:

• Clinical Interviews: Mental health professionals conduct thorough interviews to explore the individual’s history, symptoms, and experiences. Standardised diagnostic tools, such as the Dissociative Experiences Scale (DES), may be used to assess dissociative symptoms (Carlson & Putnam, 1993).
• Rule Out Other Conditions: It is essential to rule out other potential causes of the symptoms, such as neurological conditions, substance abuse, or other psychiatric disorders (Brand et al., 2016).

DID is generally understood to result from severe and chronic trauma, particularly during childhood. This trauma may include physical, emotional, or sexual abuse, neglect, or extreme stress.

The link between trauma and DID is well-documented. It is believed that DID develops as a coping mechanism in response to overwhelming trauma, where the mind dissociates to protect the individual from unbearable memories and emotions.

• Childhood Abuse: Studies have shown that a high percentage of individuals diagnosed with DID report experiencing severe abuse or neglect during childhood (Putnam, 1997). The dissociation acts as a defence mechanism, allowing the child to distance themselves from the trauma.
• Attachment Issues: Disruptions in early attachment relationships, such as inconsistent caregiving or early loss of a caregiver, can also contribute to the development of DID. The lack of a stable attachment figure may lead to difficulties in forming a cohesive sense of self (Liotti, 2006).

Research suggests that neurobiological factors may also play a role in the development of DID. These include:

• Brain Structure and Function: Studies using neuroimaging techniques have identified differences in brain structure and function among individuals with DID, particularly in areas related to memory, emotion regulation, and identity (Reinders et al., 2003).
• Genetic Factors: While the exact genetic basis of DID is not well understood, some research indicates that genetic predispositions to dissociation may exist, making certain individuals more susceptible to developing the disorder under extreme stress (Sar et al., 2006).

DID is a subject of ongoing debate within the psychological and psychiatric communities. Some controversies and misconceptions include:

Some critics argue that DID is overdiagnosed or misdiagnosed, particularly in cases where symptoms may overlap with other disorders. Others suggest that the disorder is sometimes suggested by therapists, leading to the creation or reinforcement of alters through suggestibility (Lynn et al., 2012).

• False Memories: Concerns about the potential for therapists to unintentionally implant false memories of trauma have led to debates about the validity of some DID diagnoses (Piper & Merskey, 2004).

DID has been sensationalised in films, television, and literature, often portrayed inaccurately as a dangerous or violent condition. These portrayals can perpetuate stigma and misunderstandings about the disorder.

• Impact of Media: While some portrayals, such as in the movie “Split,” bring attention to DID, they often exaggerate symptoms or depict the disorder in a negative light, contributing to public fear and misunderstanding (Kaplan, 2017).

Effective treatment of DID requires a comprehensive and integrative approach, often involving psychotherapy, medication, and support from a multidisciplinary team.

Psychotherapy is the primary treatment for DID, with the goal of integrating the separate identities into one cohesive self and helping the individual process and heal from trauma.

• Trauma-Focused Therapy: Therapies such as Eye Movement Desensitisation and Reprocessing (EMDR) and Cognitive Behavioural Therapy (CBT) are often used to help individuals with DID process traumatic memories and reduce dissociative symptoms (Brand et al., 2009).
• Integrative Therapy: The process of integration involves helping the individual develop a unified sense of self by addressing and resolving conflicts between the alters. This process can be lengthy and requires a safe and supportive therapeutic environment (Kluft, 1999).

While there are no specific medications for DID, medications may be prescribed to manage co-occurring conditions such as depression, anxiety, or PTSD.

• Antidepressants and Antianxiety Medications: These medications can help alleviate some of the symptoms associated with DID, such as mood instability, anxiety, and depression (Schmahl et al., 2014).
• Mood Stabilisers: In some cases, mood stabilisers may be used to help manage emotional dysregulation and impulsivity (Schmahl et al., 2014).

Support from family, friends, and support groups can play a crucial role in the recovery process for individuals with DID.

• Support Groups: Joining support groups where individuals can share their experiences and coping strategies can provide a sense of community and understanding (International Society for the Study of Trauma and Dissociation, 2011).
• Self-Care Practices: Encouraging self-care practices, such as mindfulness, journaling, and relaxation techniques, can help individuals manage stress and reduce dissociative episodes (Spiegel et al., 2011).

Dissociative Identity Disorder, formerly known as Multiple Personality Disorder, is a complex and often misunderstood condition. It is closely linked to severe trauma, particularly in childhood, and presents significant challenges in diagnosis and treatment. While controversies and misconceptions continue to surround DID, ongoing research and clinical practice aim to improve our understanding and treatment of this disorder. Effective management of DID requires a multidisciplinary approach, combining psychotherapy, medication, and strong support systems to help individuals achieve greater integration and quality of life.

• American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.
• Brand, B. L., Loewenstein, R. J., & Lanius, R. A. (2014). Dissociative identity disorder. In G. O. Gabbard (Ed.), Gabbard’s treatments of psychiatric disorders (5th ed., pp. 833-849). American Psychiatric Publishing.
• Carlson, E. B., & Putnam, F. W. (1993). An update on the Dissociative Experiences Scale. Dissociation: Progress in the Dissociative Disorders, 6(1), 16-27.
• International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115-187.
• Kaplan, A. (2017). Split [Film]. Universal Pictures.
• Kluft, R. P. (1999). Treating the traumatic memories of patients with dissociative identity disorder. American Journal of Psychiatry, 156(11), 1767-1769.
• Liotti, G. (2006). A model of dissociation based on attachment theory and research. Journal of Trauma & Dissociation, 7(4), 55-73.
• Lynn, S. J., Lilienfeld, S. O., Merckelbach, H., Giesbrecht, T., & van der Kloet, D. (2012). Dissociation and dissociative disorders: Challenging conventional wisdom. Current Directions in Psychological Science, 21(1), 48-53.
• Piper, A., & Merskey, H. (2004). The persistence of folly: A critical examination of dissociative identity disorder. Part II. The defence and decline of multiple personality or dissociative identity disorder. Canadian Journal of Psychiatry, 49(10), 678-683.
• Putnam, F. W. (1997). Dissociation in children and adolescents: A developmental perspective. New York: Guilford Press.
• Reinders, A. A., Willemsen, A. T., den Boer, J. A., Vos, H. P., de Jong, J. R., & Nijenhuis, E. R. (2003). Opposite brain emotion-regulation patterns in identity states of dissociative identity disorder: A PET study and neurobiological model. Psychiatry Research: Neuroimaging, 123(2), 139-152.
• Sar, V., Akyüz, G., & Doğan, O. (2006). Prevalence of dissociative disorders among women in the general population. Psychiatry Research, 149(1-3), 169-176.
• Schmahl, C., Bohus, M., & Vermetten, E. (2014). Neurobiological findings in dissociation. In V. Sinason & R. Davies (Eds.), Attachment and dissociation: Understanding and treating complex trauma (pp. 120-134). Routledge.
• Spiegel, D., Loewenstein, R. J., Lewis-Fernández, R., Sar, V., Simeon, D., Vermetten, E., … & Dell, P. F. (2011). Dissociative disorders in DSM-5. Depression and Anxiety, 28(9), 824-852.

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