what is DID?

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by Sidran Foundation

The growing recognition of psychiatric conditions resulting from traumatic influences is a significant mental health issue of the 1990s. Until recently considered rare and mysterious psychiatric curiosities, Dissociative Identity Disorder (DID) (until very recently known as Multiple Personality Disorder - MPD) and other Dissociative Disorders (DD) are now understood to be fairly common effects of severe trauma in early childhood, most typically extreme, repeated physical, sexual, and/or emotional abuse.

In 1994, with the publication of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders-IV, Multiple Personality Disorder (MPD) was changed to Dissociative Identity Disorder (DID), reflecting changes in professional understanding of the disorder, which resulted largely from increased empirical research of trauma-based dissociative disorders.

Post-Traumatic Stress Disorder (PTSD), widely accepted as a major mental illness affecting 9-10% of the general population, is closely related to Dissociative Identity Disorder (MPD) and other Dissociative Disorders (DD). In fact, as many as 80-100% of people diagnosed with DID (MPD) also have a secondary diagnosis of PTSD. The personal and societal cost of trauma disorders [including DID (MPD), DD, and PTSD] is extremely high. For example, recent research suggests the risk of suicide attempts among people with trauma disorders may be even higher than among people who have major depression. In addition, there is evidence that people with trauma disorders have higher rates of alcoholism, chronic medical illnesses, and abusiveness in succeeding generations.

What Is Dissociation?

Dissociation is a mental process which produces a lack of connection in a person's thoughts, memories, feelings, actions, or sense of identity. During the period of time when a person is dissociating, certain information is not associated with other information as it normally would be. For example, during a traumatic experience, a person may dissociate the memory of the place and circumstances of the trauma from his ongoing memory, resulting in a temporary mental escape from the fear and pain of the trauma and, in some cases, a memory gap surrounding the experience. Because this process can produce changes in memory, people who frequently dissociate often find their senses of personal history and identity are affected.

Most clinicians believe that dissociation exists on a continuum of severity. This continuum reflects a wide range of experiences and/or symptoms. At one end are mild dissociative experiences common to most people, such as daydreaming, highway hypnosis, or "getting lost" in a book or movie, all of which involve "losing touch" with conscious awareness of one's immediate surroundings. At the other extreme is complex, chronic dissociation, such as in cases of Dissociative Identity Disorder (MPD) and other Dissociative Disorders, which may result in serious impairment or inability to function. Some people with DID(MPD)/DD can hold highly responsible jobs, contributing to society in a variety of professions, the arts, and public service. To co-workers, neighbors, and others with whom they interact daily, they apparently function normally.

There is a great deal of overlap of symptoms and experiences among the various Dissociative Disorders, including DID (MPD). For the sake of clarity, this brochure will refer to DID(MPD)/DD as a collective term. Individuals should seek help from qualified mental health providers to answer questions about their own particular circumstances and diagnoses.

How Does DID(MPD)/DD Develop?

When faced with overwhelmingly traumatic situations from which there is no physical escape, a child may resort to "going away" in his or her head. This ability is typically used by children as an extremely effective defense against acute physical and emotional pain, or anxious anticipation of that pain. By this dissociative process, thoughts, feelings, memories, and perceptions of the traumatic experiences can be separated off psychologically, allowing the child to function as if the trauma had not occurred.

DID(MPD)/DD is often referred to as a highly creative survival technique, because it allows individuals enduring "hopeless" circumstances to preserve some areas of healthy functioning. Over time, however, for a child who has been repeatedly physically and sexually assaulted, defensive dissociation becomes reinforced and conditioned. Because the dissociative escape is so effective, children who are very practiced at it may automatically use it whenever they feel threatened or anxious -- even if the anxiety-producing situation is not abusive.

Often, even after the traumatic circumstances are long past, the left-over pattern of defensive dissociation remains. Chronic defensive dissociation may lead to serious dysfunction in work, social, and daily activities. Repeated dissociation may result in a series of separate entities, or mental states, which may eventually take on identities of their own. These entities may become the internal "personality states," of a DID(MPD) system. Changing between these states of consciousness is described as "switching."

What Are The Symptoms Of DID(MPD)/DD?

People with DID(MPD) may experience any of the following: depression, mood swings, suicidal tendencies, sleep disorders (insomnia, night terrors, and sleep walking), panic attacks and phobias (flashbacks, reactions to stimuli or "triggers"), alcohol and drug abuse, compulsions and rituals, psychotic-like symptoms (including auditory and visual hallucinations), and eating disorders. In addition, individuals with DID(MPD)/DD can experience headaches, amnesias, time loss, trances, and "out of body experiences." Some people with DID(MPD)/DD have a tendency toward self-persecution, self-sabotage, and even violence (both self-inflicted and outwardly directed).

Who Gets DID(MPD)/DD?

The vast majority (as many as 98 to 99%) of individuals who develop DID(MPD)/DD have documented histories of repetitive, overwhelming, and often life-threatening trauma at a sensitive developmental stage of childhood (usually before the age of nine), and they may possess an inherited biological predisposition for dissociation. In our culture the most frequent precursor to DID(MPD)/DD is extreme physical, emotional, and sexual abuse in childhood, but survivors of other kinds of trauma in childhood (such as natural disasters, invasive medical procedures, war, and torture) have also reacted by developing DID(MPD)/DD.

Current research shows that DID(MPD) may affect 1% of the general population and perhaps as many as 5-20% of people in psychiatric hospitals, many of whom have received other diagnoses. The incidence rates are even higher among sexual abuse survivors and individuals with chemical dependencies. These statistics put DID(MPD)/DD in the same category as schizophrenia, depression, and anxiety, as one of the four major mental health problems today.

Most current literature shows that DID(MPD)/DD is recognized primarily among females. The latest research, however, indicates that the disorders may be equally prevalent (but less frequently diagnosed) among the male population. Men with DID(MPD)/DD are most likely to be in treatment for other mental illnesses, for drug and alcohol abuse, or incarcerated.

Why Are Dissociative Disorders Often Misdiagnosed?

DID(MPD)/DD survivors often spend years living with misdiagnoses, consequently floundering within the mental health system. They change from therapist to therapist and from medication to medication, getting treatment for symptoms but making little or no actual progress. Research has documented that on average, people with DID(MPD)/DD have spent seven years in the mental health system prior to accurate diagnosis.

This is common, because the list of symptoms that cause a person with DID(MPD)/DD to seek treatment is very similar to those of many other psychiatric diagnoses. In fact, many people who are diagnosed with DID(MPD)/DD also have secondary diagnoses of depression, anxiety, or panic disorders.

Do People Actually Have Multiple Personalities?

Yes, and no. One of the reasons for the decision by the psychiatric community to change the disorder's name from Multiple Personality Disorder to Dissociative Identity Disorder is that "multiple personalities" is somewhat of a misleading term. A person diagnosed with DID(MPD) has within her two or more entities, or personality states, each with its own independent way of relating, perceiving, thinking and remembering about herself and her life. If two or more of these entities take control of the person's behavior at a given time a diagnosis of MPD can be made. These entities previously were often called "personalities," even though the term did not accurately reflect the common definition of the word as the total aspect of our psychological makeup. Other terms often used by therapists and survivors to describe these entities are: "alternate personalities", "alters," "parts," "states of consciousness," "ego states," and "identities." It is important to keep in mind that although these alternate personality states may appear to be very different, they are all manifestations of a single person.

Can DID(MPD)/DD Be Cured?

Yes. Dissociative disorders are highly responsive to individual psychotherapy, or "talk therapy," as well as to a range of other treatment modalities, including medications, hypnotherapy, and adjunctive therapies such as art or movement therapy. In fact, among comparably severe psychiatric disorders, DID(MPD) may be the condition that carries the best prognosis, if proper treatment is undertaken and completed. The course of treatment is long-term, intensive, and invariably painful, as it generally involves remembering and reclaiming the dissociated traumatic experiences. Nevertheless, individuals with DID(MPD)/DD have been successfully treated by therapists of all professional backgrounds working in a variety of settings.

Where Can I Get More Information?

The Sidran Foundation is a publicly-supported, non-profit organization devoted to advocacy, education, and research on behalf of people with psychiatric disabilities. The foundation is particularly interested in providing support and advocating empowerment for people who have survived psychological trauma, and has developed resources in this area. The Sidran Foundation Bookshelf is a mail-order book service providing annotated catalogs and home-delivery of books, audio and video tapes, and informational materials of particular interest to DID(MPD)/DD survivors, their supportive family and friends, and their therapists. The Sidran Press is publisher of the highly acclaimed Multiple Personality Disorder From the Inside Out, a collection of writings about living with MPD by 146 survivors and their significant others, and Dissociative Disorders: A Clinical Review, a state-of-the-art survey of diagnosis, treatment, and research written by six of the nation's foremost MPD/DD specialists. In addition, Sidran has compiled lists of MPD/DD support and treatment resources and conducts educational workshops.