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Dissociative Identity Disorder is a mental health condition that affects your personality. Your personality is what forms your character and influences your behaviour, thoughts and feelings; which are all controlled by the mind.
During puberty, you explore your identity more than any other time in your life. By the time we reach adulthood, most people’s identities are fully developed and rarely change for the rest of our lives, as we have learned how to interact with other people respectfully. So, dissociative identity disorder can affect how a person interacts with others, behaves, thinks and feels.
It causes a person to have different characters that present themselves as different personalities. For a diagnosis of dissociative identity disorder, a person must have at least two states of personality that influences them at different periods of time. The person switches between these personalities knowingly or unknowingly which can both be extremely distressing experiences.
A dissociative disorder means that a person is detached from reality (which can be described as like an out of body experience). There are many other mental health conditions that have symptoms that present as dissociative identity disorder, which can at times make diagnosis difficult.
Some of these conditions include:
- Personality Disorder.
- Post-Traumatic Stress Disorder (PTSD).
- Obsessive Compulsive Disorder (OCD).
- Eating Disorders.
- Sleep Disorders.
- Substance Misuse Disorders.
Due to the different types of personality a person experiences with the condition, it can be also referred to as “Multiple Personality Disorder” or “Split Personality Disorder”. It can be common for people with the illness to have severe gaps in memory or hallucinations (which is due to the disassociation with reality). Other types of dissociative disorders have slightly different symptoms and impacts on your life.
- Dissociative amnesia – Which has a main symptom of memory loss. A person suffering from this condition may forget basic information about their life such as who they are, significant events, and their own life history.
- Depersonalisation disorder – The main symptom of this condition is a detachment from yourself, your actions and your relationships.
How common is dissociate identity disorder?
Many people have limited information about dissociate identity disorder because it is generally regarded as a rare condition. In the UK, there are approximately 2% of the population that suffer from it.
Even among mental health professionals, there has been little training about the disorder, and it can often get misdiagnosed as Schizophrenia or Personality Disorder. It is common for people with the condition to have had frequent contact with mental health services for a number of years before obtaining a separate diagnosis. This is because its symptoms can be similar to that of other mental health conditions.
A diagnosis can also take a long time because of dissociation being a common way for people to deal with short-term stressful or traumatic situations. However, this response to stress is usually short lived before people return to their usual state of thinking. If it were to be diagnosed as soon as somebody first experiences it, there could be many false diagnoses, causing many people to fall under the mental health services unnecessarily.
It is only when dissociation is experienced for longer periods of time (weeks or months), instead of hours or days, that professionals will consider that a mental health disorder has developed.
Mental health professionals (such as psychiatrists or psychologists) use tools that consist of questions about dissociative identity disorder to screen patients for the condition. Some of the most common diagnostic tools is the Somatoform Dissociation Questionnaire (SDQ-20), or the Structured Clinical Interview for DSM-IV Disorders (SCID-D).
The DSM-5 is the manual that guides all mental health professionals to diagnose mental health disorders. It states that cultural influences can influence a person developing dissociative identity disorder, such as norms of fragmented identities like mythological creatures or spirits.
This can be particularly common in developing countries due to their alternative beliefs about health and lack of information about mental health. Developing countries can hold different perspectives about mental health, such as your body being controlled by an outside power. This can create barriers in some people from different cultures working with mental health services.
What causes dissociative identity disorder?
Dissociative identity disorder is related to trauma. A trauma can be any horrific event such as being the subject of abuse or neglect, involvement in a serious accident, being at war, or a natural disaster. These events cause us to feel frightened, stressed, and distressed, resulting in psychological harm.
Each person responds to a traumatic event differently and has a different scale for how traumatic an event is. This means that everybody’s experience is unique to them, and their reaction to a particular trauma cannot always be predicted. Some people may have immediate and long-term reactions to the event, whereas others may have a dormant response; only developing a reaction later on in life.
The reaction to a traumatic event can cause you to develop a range of mental health problems that may include trouble sleeping, panic attacks, flashbacks, low self-esteem or dissociation.
Having dissociation after trauma is a way that the mind tries to cope with what has happened (to deal with ongoing stress that it feels from the situation). Using this as a coping mechanism is a natural response to stress, but once the environment is no longer stressful, your dissociation should reduce.
It is when you continue using dissociation, or use increasing dissociations, to act as a layer of protection that it becomes a mental health issue. This is because the trauma hasn’t been processed properly so the mind continues to stay on alert for danger. Having ongoing dissociation can be a signal of your brain trying to protect you from further harm; even when harm isn’t approaching.
Childhood trauma can be a common cause of dissociation identity disorder because trauma can affect brain development in children. Once the child becomes an adult, they may have no other methods of coping with any form of stress and have difficulty with their own adult identity.
Dissociative behaviours are strongly linked as a symptom of many other mental health conditions. Other causes of the condition include weaning off medication or alcohol or choosing to dissociate from a situation (which isn’t usually an alarming sign of ill health) such as to focus on a task.
Dissociation from an event makes a person feel detached from it, to trick the mind into thinking that the situation didn’t happen to them. In doing so it can cause a person to display many behaviours.
What are the signs and symptoms?
If a person has dissociative identity disorder, they may display a range of physical and mental symptoms on top of their altering states of personality. As we mentioned at the start of this article, a person must have at least two distinct personalities that they alternate between for a diagnosis of dissociative identity disorder. Research group Lynn et al (2012) found that almost half of people with the condition had less than 10 personalities.
The personalities that people display with the condition seem to be completely different personas, with different aspects to their personalities including:
- Different thinking patterns.
- Different ways of relating to the world.
- Different ages.
- Different genders.
- Different memories.
When a sufferer switches from one personality to another, they may or may not have any control over when this happens. Instead of personalities, some people refer to the switch as “alters” or “parts” of your main personality; with your main personality referred to as your host identity.
As well as the altering personalities, other dissociative identity disorder symptoms include:
- Gaps in memory – This can include forgetting how you got to a particular place, forgetting a familiar skill, or not remembering your possessions.
- Out of body experiences – This is where a person perceives the world outside of their physical body.
- Distorted body image – This is when a person has a negative body image or unrealistic view of their physical appearance.
- Emotional detachment – This can cause someone to be unable or unwilling to connect with other people emotionally. They may appear emotionless.
- Feeling that those familiar to you are strangers – This can be a strong experience of a person when they switch between their alters.
- Referring to yourself as “we” – A person can refer to all of their personalities as “we” which signals their multiple personalities.
Can it be prevented?
Unfortunately, dissociative identity disorder cannot be prevented. Instead, ensuring children and adults are safeguarded to minimise the risk of exposure to traumatic events is the main way to prevent problems from developing. Dissociative identity disorder is mainly caused by past experiences of abuse (particularly during childhood), due to the overwhelming stress and psychological harm it causes.
Children are continually learning life skills during their development stages, and a trauma can affect attachment, emotional management and behaviour. As a way to deal with the disruption in child development, children can have an increased tendency of using dissociation to detach from reality (as children ordinarily have an increased use of imagination during their development).
The biggest protective factor to prevent dissociative identity disorder is to protect them from physical, emotional and sexual abuse (which has been found to be the most common cause of dissociative identity disorder) and other traumas.
As an adult, if you have not experienced a childhood trauma, you can ensure that you manage and reduce stress well during your life to help prevent you developing the condition. This will help you to maintain a healthy lifestyle and reduce episodes that could potentially lead to mental health problems developing.
Sadly, not every child or adult is free from abuse or trauma. If you, or a loved one, are exposed to a traumatic event, you can minimise the risk of developing the condition by seeking professional support soon after your experience.
This can help you to find healthy coping mechanisms and process your feelings; reducing the desire or need to use dissociative behaviours. Treatment of other mental health conditions can also help to minimise the symptoms of dissociative symptoms from developing.
What is the treatment for dissociative identity disorder?
Although there is no cure for dissociative identity disorder, there are many treatment options available that can alleviate symptoms or help a person with the condition to manage it better. The NHS advise that talking therapies are the best treatment for the condition as they explore the cause as well as teach techniques to manage the condition.
Some common treatment options include:
This is the most effective form of therapy treatment for dissociative identity disorder. This is because it is a therapy that is built around the experience of past trauma and how this has created challenges in your life. You can explore the feelings you have about the trauma to help you heal from the experience.
Cognitive behavioural therapy is focussed on your thoughts, feeling and actions. It explores negative thinking patterns to offer more positive thinking techniques. This recognises that your thoughts influence your feelings and actions, so thinking more positively will result in more positive feelings and actions.
Dialectic Behavioural Therapy (DBT)
Similar to cognitive behavioural therapy, dialectic behavioural therapy helps patients to understand and manage feelings. However, DBT is particularly suited to those whose feelings are really intense. It supports people to accept who they are and make positive change in their life.
There is not one specific medication that has been specially created to treat dissociation identity disorder. However, depending on the person’s experience of the condition and any other associated mental health conditions, patients may be prescribed with antidepressants. This will help with the disassociation associated with depression, anxiety and panic attacks. You may alternatively be offered anti-psychotics or mood stabilisers to help with manic or depressive personas, or psychosis.
Self-care can take different forms depending on different people’s preferences. This means that one form of self-care may not work as well for another person. Due to this, we have included a range of self-care treatments that patients can try to help manage symptoms of multiple identities. These include: keeping a journal, visualisation, maintaining your physical health, creating a crisis plan, and talking to others who have similar experiences.
The treatments above should aim to reduce the separation between the different personalities, and interlink thoughts, feelings, behaviours and actions to encourage a single persona.
This can help patients feel in control of themselves and achieve a sense of empowerment and higher self-esteem. Doing this has a positive impact on mental health which, in turn, will reduce the symptoms of dissociation and other mental health conditions.
When to call a doctor
Sometimes, despite the treatments explained above, there are times where symptoms may reach crisis point. The person may feel completely out of control which can lead to feelings of desperation, low mood and suicidal thoughts. If you feel like this or know somebody who you are concerned about, it is extremely important to contact a doctor right away.
There are always people and services that can help in any circumstance, so you are never alone to deal with how you are feeling. You can reach out to services such as Samaritans, or hospital A&E departments, or even turn to a loved one in your life who you can trust to seek help and guidance to work through difficult times.