What is Dissociative Identity Disorder?

Understanding Dissociative Identity Disorder

Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder, is a complex trauma-related condition characterized by the presence of two or more distinct identity states or personality states, along with recurrent amnesia for important personal information (American Psychiatric Association, 2022).

DID is often misunderstood due to sensationalized media portrayals that focus on dramatic switching between personalities rather than the daily reality of living with this condition. In reality, DID is a sophisticated survival mechanism that develops when a child’s developing mind cannot integrate overwhelming traumatic experiences (Brand et al., 2016).

The condition affects approximately 1-1.5% of the general population, making it as common as bipolar disorder or schizophrenia, yet it remains largely misunderstood and underdiagnosed. Many people with DID go years or decades without proper recognition or treatment (Dorahy et al., 2014).

DID represents the most complex form of dissociative disorder, involving not just disconnection from experiences, but the development of separate identity states that can have their own memories, preferences, skills, and ways of relating to the world. Despite this complexity, people with DID are not “broken” or “crazy”—they are survivors who developed an adaptive response to impossible childhood circumstances.

Core Features of DID

Distinct Identity States or Alters

The hallmark feature of DID is the presence of two or more distinct identity states, often called “alters” or “parts”:

Characteristics of Identity States:

• Each may have their own name, age, gender, and personality traits
• Different preferences, skills, and abilities
• Unique memories and perspectives
• Distinct ways of speaking, moving, or expressing themselves
• May have different roles or functions within the system

Types of Identity States:

• Host: The identity that’s out most often (not necessarily the “original”)
• Protectors: Alters that try to keep the system safe from harm
• Persecutors: Parts that may be self-critical or recreate trauma dynamics
• Caretakers: Alters focused on caring for others or younger parts
• Child Alters: Younger identity states that may hold traumatic memories
• Trauma Holders: Parts that contain specific traumatic experiences
• Internal Self-Helpers: Wise or spiritual parts that offer guidance

Amnesia Between Identity States

DID involves significant gaps in memory that go beyond normal forgetfulness:

Types of Amnesia:

• Switching Amnesia: Memory gaps when different alters are in control
• Emotional Amnesia: Remembering events but not the emotions
• Childhood Amnesia: Large gaps in childhood memories
• Trauma Amnesia: Blocked memories of traumatic experiences

Common Experiences:

• Finding items you don’t remember buying
• Being told about conversations or events you don’t recall
• Discovering skills or knowledge you don’t remember learning
• Others mentioning personality changes you’re unaware of
• Losing time or “coming to” in unfamiliar places

Recurrent Intrusions

Identity states may intrude into consciousness in various ways:

Passive Influence:

• Voices or commentary from other alters
• Sudden changes in mood, preferences, or abilities
• Knowledge or memories that don’t feel like your own
• Feeling controlled by other parts

Active Intrusion:

• Complete switches where different alters take control
• Co-consciousness where multiple parts are aware simultaneously
• Blending where characteristics of different alters merge
• Internal conflict between different parts

Significant Distress and Impairment

DID symptoms must cause meaningful problems in daily life:

Functional Impairment:

• Difficulty maintaining consistent relationships
• Problems with work or school performance
• Challenges with daily tasks and responsibilities
• Safety concerns due to amnesia or switches

Emotional Distress:

• Confusion about identity and memory gaps
• Fear about losing time or control
• Shame about having the condition
• Anxiety about others discovering the disorder

How DID Develops

Childhood Trauma and Attachment

DID almost always develops from severe, repeated childhood trauma occurring before age 6-9:

Types of Trauma Associated with DID:

• Physical, sexual, or emotional abuse
• Severe neglect or abandonment
• Witnessing extreme violence
• Medical trauma or invasive procedures
• Ritual or organized abuse
• Human trafficking or exploitation

Attachment Disruption:

• Occurs when caregivers are sources of both comfort and terror
• Creates impossible double-bind for developing child
• Disrupts normal identity formation and integration
• Leads to fragmented survival strategies

You can read more about What Trauma is here.

The Development Process

DID develops through a specific process during critical developmental periods:

Normal Identity Development (Disrupted):

• Children normally integrate different ego states into unified identity
• This process typically completes by age 6-9
• Requires safe, consistent caregiving environment
• Trauma disrupts this natural integration process

Structural Dissociation:

• Mind creates separate identity states to cope with different situations
• Each state may handle specific types of experiences or relationships
• Allows child to maintain attachment to caregivers despite abuse
• Provides compartmentalization of traumatic experiences

Reinforcement Over Time:

• Continued trauma strengthens dissociative barriers
• Different parts develop distinct characteristics and memories
• System becomes more complex and elaborate
• Amnesia barriers become more pronounced

Protective Functions

Each aspect of DID serves important protective functions:

Compartmentalization: Keeps traumatic experiences separate from daily life Specialized Coping: Different parts handle different types of situations Maintained Attachment: Allows connection to caregivers despite abuse Survival: Enables psychological survival of overwhelming experiences

Living with DID

Daily Life Challenges

DID creates unique challenges in everyday functioning:

Time Management:

• Losing time during switches between alters
• Different parts having different schedules or priorities
• Difficulty planning when you don’t know who will be present
• Missing appointments or commitments due to amnesia

Identity Consistency:

• Feeling like different people at different times
• Conflicting preferences, values, or goals between parts
• Difficulty maintaining consistent relationships
• Others noticing personality changes or inconsistencies

Memory and Information:

• Important information stored with different parts
• Difficulty accessing memories when needed
• Conflicting memories of the same events
• Trouble forming new memories during dissociative episodes

Decision Making:

• Different parts wanting different things
• Internal conflict about choices and directions
• Difficulty making commitments that all parts agree with
• Regret when decisions are made by other parts

Internal System Dynamics

The internal experience of DID involves complex relationships between parts:

Communication:

• May range from no contact to constant chatter
• Some systems have good internal communication, others don’t
• Can involve internal meetings, notes, or journals
• Technology sometimes used for communication between parts

Cooperation vs. Conflict:

• Some systems work together harmoniously
• Others experience significant internal conflict
• May include internal violence or self-harm
• Power struggles between different parts

Co-consciousness:

• Varies from complete amnesia to full awareness
• Some parts may watch when others are in control
• Blending occurs when multiple parts influence behavior
• Complete co-consciousness allows full internal communication

System Roles and Hierarchy:

• Different parts may have specific jobs or roles
• Some may be leaders or decision-makers
• Others may be relegated to specific situations
• Roles can change over time with healing

External Relationships

DID significantly impacts relationships with others:

Family Relationships:

• Family members may be confused by personality changes
• May trigger traumatic family dynamics
• Different parts may have different relationships with family members
• Can affect parenting abilities and consistency

Romantic Relationships:

• Partners may feel like they’re in relationships with multiple people
• Need for understanding and education about DID
• Challenges with intimacy and trust
• Different parts may have different feelings about partners

Friendships:

• Friends may be confused by inconsistent behavior
• Some parts may like certain friends while others don’t
• Difficulty maintaining long-term friendships
• May have different social circles for different parts

Professional Relationships:

• Workplace challenges due to inconsistent presentation
• Difficulty with professional identity and career planning
• May need accommodations or understanding from employers
• Risk of discrimination if condition is disclosed

Diagnosis and Assessment

Diagnostic Criteria

The DSM-5 criteria for DID include:

A. Identity Disruption:

• Two or more distinct identity states
• Marked discontinuity in sense of self and agency
• Alterations in affect, behavior, consciousness, memory, perception, cognition, or sensory-motor functioning

B. Amnesia:

• Recurrent gaps in recall of everyday events, personal information, or traumatic events
• Inconsistent with ordinary forgetting

C. Distress or Impairment:

• Symptoms cause clinically significant distress or impairment
• In social, occupational, or other important areas of functioning

D. Cultural Considerations:

• Not part of normal cultural or religious practice
• Not attributable to substance use or medical condition

Assessment Process

Proper diagnosis typically involves extensive evaluation:

Clinical Interviews:

• Detailed history of symptoms and development
• Assessment of trauma history and attachment
• Evaluation of current functioning and relationships
• Observation of switches or different presentations

Specialized Assessment Tools:

• Structured Clinical Interview for DSM-5 Dissociative Disorders (SCID-5-D)
• Dissociative Experiences Scale (DES)
• Multidimensional Inventory of Dissociation (MID)
• Clinician-Administered Dissociative States Scale (CADSS)

Challenges in Diagnosis:

• Many clinicians lack training in dissociative disorders
• Symptoms may be hidden due to shame or fear
• Often misdiagnosed as other conditions (bipolar, borderline personality disorder)
• May take years to receive accurate diagnosis
• Covert nature of many DID presentations

Differential Diagnosis

DID must be distinguished from other conditions:

Other Dissociative Disorders:

• OSDD/DDNOS may have similar but less distinct symptoms
• Dissociative amnesia involves memory loss without identity states
• Depersonalization/derealization disorder lacks identity fragmentation

Mood Disorders:

• Bipolar disorder involves mood episodes, not identity states
• Depression may include dissociative symptoms but not alters
• Rapid cycling doesn’t involve amnesia or identity changes

Personality Disorders:

• Borderline personality disorder may include identity disturbance but not separate identities
• Antisocial personality disorder doesn’t involve amnesia or switching
• Narcissistic personality disorder lacks the trauma history and amnesia

Psychotic Disorders:

• Schizophrenia involves hallucinations and delusions, not identity states
• Voices in DID are internal parts, not external hallucinations
• Reality testing is typically intact in DID

Treatment and Recovery

Phase-Oriented Treatment

Treatment for DID typically follows a three-phase model:

Phase 1: Safety and Stabilization

• Establishing safety and reducing self-harm
• Teaching coping skills and emotional regulation
• Building internal communication and cooperation
• Addressing substance abuse or other destructive behaviors
• Creating external safety and support systems

Phase 2: Trauma Processing

• Working through traumatic memories carefully
• Processing trauma held by different parts
• Integration of traumatic experiences
• Grief work for losses and developmental trauma
• May use EMDR, somatic approaches, or other trauma therapies

Phase 3: Integration and Reconnection

• Working toward greater internal cooperation or integration
• Developing healthy relationships and social connections
• Pursuing life goals and meaningful activities
• Ongoing maintenance and relapse prevention
• Post-traumatic growth and meaning-making

Therapeutic Approaches

Various therapeutic modalities can be effective for DID:

Specialized DID Therapy:

• Therapists trained specifically in dissociative disorders
• Internal Family Systems (IFS) approach
• Trauma-focused dissociative therapy
• Phase-oriented treatment protocols

Trauma-Focused Therapies:

• Eye Movement Desensitization and Reprocessing (EMDR)
• Somatic Experiencing and body-based approaches
• Cognitive Processing Therapy for trauma
• Trauma-focused CBT adapted for dissociation

Skills-Based Approaches:

• Dialectical Behavior Therapy (DBT) for emotional regulation
• Cognitive Behavioral Therapy (CBT) for symptom management
• Mindfulness and grounding techniques
• Art, music, and expressive therapies

Treatment Goals

Goals may vary depending on individual needs and preferences:

Integration:

• Working toward a unified sense of self
• Blending or merging of different identity states
• Reduction of amnesia barriers
• Single, coherent identity

Functional Multiplicity:

• Maintaining separate identity states
• Improving communication and cooperation between parts
• Reducing conflict and increasing collaboration
• Healthy coexistence of different parts

Stabilization:

• Focus on safety and symptom management
• Improving daily functioning
• Building coping skills and support systems
• May be appropriate for those not ready for intensive trauma work

Medication Considerations

No medications specifically treat DID, but some may help with associated symptoms:

Antidepressants:

• For depression, anxiety, and PTSD symptoms
• May help with mood regulation
• Different parts may respond differently
• Careful monitoring needed

Mood Stabilizers:

• For emotional dysregulation
• May help with rapid switching
• Can stabilize internal system
• Useful for some individuals

Sleep Medications:

• For insomnia and nightmares
• Can improve overall functioning
• Important since sleep problems worsen dissociation
• Natural approaches often preferred

Important Considerations:

• Medication response may vary between identity states
• Some medications may worsen dissociative symptoms
• Need for psychiatrist familiar with dissociative disorders
• Integration of medication with therapy essential

/image <Add a diagram showing the three phases of treatment and various therapeutic approaches for DID>

Myths and Misconceptions

Common Myths About DID

“People with DID are dangerous”

• No evidence that people with DID are more violent than general population
• More likely to harm themselves than others
• Often very empathetic and caring individuals
• Media portrayals are inaccurate and harmful

“DID is extremely rare”

• Actually affects 1-1.5% of general population
• As common as bipolar disorder or schizophrenia
• Underdiagnosed due to lack of awareness and training
• Many people remain undiagnosed for years

“People fake DID for attention”

• Extensive research shows genuine neurobiological differences
• Brain imaging reveals distinct patterns
• Would be extremely difficult to fake consistently
• Most people hide their symptoms due to shame

“DID is caused by suggestion or therapy”

• Symptoms typically predate any knowledge of condition
• Develops from childhood trauma, not suggestion
• Brain imaging shows objective differences
• Symptoms often improve with appropriate treatment

“Integration means all parts disappear”

• Integration can mean cooperation rather than merger
• Parts may maintain distinct characteristics while working together
• Goal is functional improvement, not necessarily single identity
• Many people live successfully with functional multiplicity

Media Representation Issues

Popular media often misrepresents DID:

• Focus on dramatic switching rather than daily struggles
• Emphasis on violence or danger
• Lack of accurate treatment portrayal
• Confusion between DID and other conditions
• Sensationalization rather than education

Support and Resources

Finding Appropriate Treatment

Locating Qualified Therapists:

• International Society for the Study of Trauma and Dissociation (ISSTD)
• Therapists with specific dissociative disorders training
• Trauma-informed care providers
• Referrals from other mental health professionals

What to Look For:

• Experience with dissociative disorders
• Trauma-informed approach
• Understanding of phase-oriented treatment
• Belief in the validity of DID
• Cultural competence and sensitivity

Support Systems

Professional Support:

• Individual therapy with DID specialist
• Group therapy with other trauma survivors
• Psychiatric care for medication management
• Case management for complex needs

Peer Support:

• Support groups for people with dissociative disorders
• Online communities and forums
• Peer mentoring programs
• Educational workshops and conferences

Family and Friends:

• Education about DID for loved ones
• Family therapy when appropriate
• Building understanding support networks
• Reducing stigma and shame

Self-Help Strategies

Internal Communication:

• Journaling between parts
• Internal meetings and negotiations
• Art, music, or creative expression
• Mindfulness and internal awareness

Grounding and Stability:

• Grounding techniques for dissociative episodes
• Creating safety plans and coping strategies
• Routine and structure to promote stability
• Self-care practices for all parts

Education and Advocacy:

• Learning about DID and trauma
• Advocating for appropriate treatment
• Reducing self-stigma through education
• Helping others understand the condition

Simplified Version for Difficult Moments:
DID is when someone has different identity states or “parts” that developed to help them survive severe childhood trauma. These parts may have different names, ages, and personalities, and there may be memory gaps between them. This is a real condition that developed as protection, not something someone chooses or fakes. With proper support and treatment, people with DID can live fulfilling lives.

Living Successfully with DID

Recovery and Hope

Many people with DID experience significant improvement and lead fulfilling lives:

Symptom Improvement:

• Reduced switching and amnesia over time
• Better internal communication and cooperation
• Decreased trauma symptoms and flashbacks
• Improved emotional regulation and stability

Functional Improvement:

• Better relationships with family and friends
• Improved work or school performance
• Greater consistency in daily functioning
• Enhanced quality of life and satisfaction

Personal Growth:

• Increased self-awareness and understanding
• Development of healthy coping strategies
• Greater empathy and connection with others
• Meaning-making from traumatic experiences

Factors That Promote Recovery

Professional Factors:

• Access to knowledgeable, trauma-informed therapists
• Consistent, long-term therapeutic relationships
• Appropriate medication management when needed
• Integration of multiple treatment approaches

Personal Factors:

• Commitment to healing and growth
• Development of internal cooperation
• Building healthy coping strategies
• Self-compassion and patience with the process

Social Factors:

• Understanding and supportive relationships
• Connection with others who have similar experiences
• Reduced stigma and increased acceptance
• Safe and stable living environment

Environmental Factors:

• Financial security and access to resources
• Safe housing and living situation
• Supportive work or educational environment
• Access to appropriate healthcare

Advocacy and Awareness

Many people with DID become advocates for:

• Increased awareness and understanding of dissociative disorders
• Better training for mental health professionals
• Reduced stigma and discrimination
• Improved access to appropriate treatment
• Support for other trauma survivors

Grounding and Acknowledgment

Take a moment to honor all parts of yourself or anyone you know who lives with DID. Place your hand on your heart and acknowledge the incredible strength it takes to survive childhood trauma and continue living. Remember that DID developed as protection, and every part deserves compassion and respect. Healing is possible, and you are not alone.

Recommended Reading

For Understanding DID:

• “The Stranger in the Mirror” by Marlene Steinberg – Comprehensive guide to dissociative disorders including DID
• “Dissociation and the Dissociative Disorders” edited by Paul Dell and John O’Neil – Clinical perspectives on DID
• “Got Parts? An Insider’s Guide to Managing Life Successfully with Dissociative Identity Disorder” by ATW – Personal perspective on living with DID

For Healing and Treatment:

• “Coping with Trauma-Related Dissociation” by Suzette Boon, Kathy Steele, and Onno van der Hart – Practical skills for DID recovery
• “No Bad Parts” by Richard Schwartz – Internal Family Systems approach to parts work
• “The Body Keeps the Score” by Bessel van der Kolk – Understanding trauma’s impact and paths to healing
• “Complex PTSD: From Surviving to Thriving” by Pete Walker – Healing from severe childhood trauma

References

1. American Psychiatric Association. (2022). Diagnostic and Statistical Manual of Mental Disorders (5th ed., text rev.).
2. Brand, B. L., Sar, V., Stavropoulos, P., Krüger, C., Korzekwa, M., Martínez-Taboas, A., & Middleton, W. (2016). Separating fact from fiction: An empirical examination of six myths about dissociative identity disorder. Harvard Review of Psychiatry, 24(4), 257-270.
3. Dorahy, M. J., Brand, B. L., Şar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas, A., … & Middleton, W. (2014). Dissociative identity disorder: An empirical overview. Australian & New Zealand Journal of Psychiatry, 48(5), 402-417.
4. 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.
5. Putnam, F. W. (1989). Diagnosis and Treatment of Multiple Personality Disorder. Guilford Press.
6. Kluft, R. P. (2009). A clinician’s understanding of dissociation: Fragments of an acquaintance. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders (pp. 599-623). Routledge.