Dissociative Identity Disorder is the most complex dissociative disorder it is also referred to as multiple personality disorder. This has lead to many seeing the disorder as one to do with personality and thus a personality disorder. However, this disorder is categorised within the ‘dissociative’ disorders of the DSM. The defining feature of this disorder is a severe change in identity.
When a person experiences DID they may experience the shifts in identity as separate personalities. Each identity may be in control of the persons behaviour and thoughts at differing times yet, each has a distinctive pattern of thinking and relating to the world around them. If a person also suffers from amnesia they may not have any memories of what has happened during the shifts in identity. A person whom suffers from DID must have two distinct personality states known as alters to be diagnosed with Dissociative Identity Disorder.
Diagnostic Features
A. A disruption to ones identity characterised by two or more distinct personalities (in
some cultures this may be known as an experience of possession). The disruption in identity involves marked discontinuity in sense of self and sense of agency accompanied by related alterations in affect, behaviour, consciousness, memory, perception, cognition and/or sensory-motor functioning. This signs and symptoms may be observed by others or reported by the individual.
B. Recurrent gaps in recalling everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.
C. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
D. The disturbance is not a normal part of a broadly accepted cultural or religious practice.
E. The symptoms are not attributable to the physiological effects of a substance (e.g.,
blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).
Typical Signs and Symptoms
Dissociative identity disorder is characterized by the presence of two or more distinct or split identities or personality states that continually have power over the person’s behavior. With dissociative identity disorder, there’s also an inability to recall key personal information that is too far-reaching to be explained as mere forgetfulness. With dissociative identity disorder, there are also highly distinct memory variations, which fluctuate with the person’s split personality.
The “alters” or different identities have their own age, sex, or race. Each has his or her own postures, gestures, and distinct way of talking. Sometimes the alters are imaginary people; sometimes they are animals. As each personality reveals itself and controls the individuals’ behavior and thoughts, it’s called “switching.” Switching can take seconds to minutes to days. When under hypnosis, the person’s different “alters” or identities may be very responsive to the therapist’s requests.
Typical symptoms are:
- feeling like a stranger to yourself
- being confused about your sexuality or gender
- feeling like there are different people within you
- referring to yourself as ‘we’
- behaving out of character
- writing in different handwriting
Causes
While the causes of dissociative identity disorder are still vague, research indicates that it is likely a psychological response to interpersonal and environmental stresses, particularly during early childhood years when emotional neglect or abuse may interfere with personality development. As many as 99% of individuals who develop dissociative disorders have recognized personal histories of recurring, overpowering, and often life-threatening disturbances at a sensitive developmental stage of childhood (usually before age 9).
Prevalence, Risk and Prognostic Factors
The ISSTD in their updated Treatment Guidelines (2011) place the prevalence of dissociative identity disorder at about 1-3% of the general population. Females with dissociative identity disorder dominate in adult clinical settings. Adult males with dissociative identity disorder may deny their symptoms and trauma histories, and this can lead to elevated rates of false negative diagnosis.
Females with dissociative identity disorder present more frequently with acute
dissociative states (e.g., flashbacks, amnesia, fugue, hallucinations, self-mutilation). Males commonly exhibit more criminal or violent behavior than females; among males, common triggers of acute dissociative states include combat, prison conditions, and physical or sexual assaults.
Due to the nature of DID environment plays a large role with regards to the onset of the disorder; trauma and abusive acts increase the risk of Dissociative Identity Disorders.
The 'Grey' Area 