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Dissociative identity disorder

"DID" and "Split personality" redirect here. For other uses, see DID (disambiguation) and Split personality (disambiguation). For the psychological experience, see Dissociation (psychology).
Dissociative identity disorder[1][2]
Other namesMultiple personality disorder
Split personality disorder
SpecialtyPsychiatry, clinical psychology
SymptomsAt least two distinct and relatively enduring personality states,[3] recurrent episodes of dissociative amnesia,[3] inexplicable intrusions into consciousness (e.g., voices, intrusive thoughts, impulses, trauma-related beliefs),[3][4] alterations in sense of self,[3] depersonalization and derealization,[3] intermittent functional neurological symptoms.[3]
ComplicationsTrauma and shame-based beliefs,[5][6] dissociative fugue,[7] eating disorders,[8] depression,[8] anxiety,[8] sleep disturbances (eg. sleep terrors, nightmares, sleepwalking, insomnia, hypersomnia),[9] suicidality, self-harm[3]
DurationLong-term[10]
CausesDisputed
TreatmentPatient education,[11] peer support,[11] Safety planning,[11] grounding techniques,[11] supportive care, psychotherapy[10]
Frequency1.1–1.5% lifetime prevalence in the general population[3][12]

Dissociative identity disorder (DID), previously known as multiple personality disorder (MPD), is one of multiple dissociative disorders in the DSM-5, ICD-11, and Merck Manual. It has a history of extreme controversy.[13][14][15][16]

Dissociative identity disorder is characterized by the presence of at least two distinct and relatively enduring personality states.[3][17](p331) The disorder is accompanied by memory gaps more severe than could be explained by ordinary forgetfulness.[3][17](p331)[18]

According to the DSM-5-TR, early childhood trauma, typically starting before 5–6 years of age, places someone at risk of developing dissociative identity disorder.[17][19](p334) Across diverse geographic regions, 90% of individuals diagnosed with dissociative identity disorder report experiencing multiple forms of childhood abuse, such as rape, violence, neglect, or severe bullying.[17](p334) Other traumatic childhood experiences that have been reported include painful medical and surgical procedures,[17](p334)[20] war,[17](p334) terrorism,[17](p334) attachment disturbance,[17](p334) natural disaster, cult and occult abuse,[21] loss of a loved one or loved ones,[20] human trafficking,[17](p334)[21] and dysfunctional family dynamics.[17](p334)[22]

There is no medication to treat DID directly. However, medications can be used for comorbid disorders or targeted symptom relief; for example, antidepressants for anxiety and depression, or sedative-hypnotics to improve sleep.[12][23] Treatment generally involves supportive care and psychotherapy.[10] The condition generally does not remit without treatment, and many patients have a lifelong course.[10][24]

Lifetime prevalence was found to be 1.1–1.5% of the general population (based on multiple epidemiological studies) and 3.9% of those admitted to psychiatric hospitals in Europe and North America.[3][17](p334)[12] DID is diagnosed 6–9 times more often in women than in men, particularly in adult clinical settings; pediatric settings have nearly 1:1 ratio of girls to boys.[18]

The number of recorded cases increased significantly in the latter half of the 20th century, along with the number of identities reported by those affected. However, it is unclear whether increased rates of diagnosis are due to better recognition or sociocultural factors such as mass media portrayals.[18] The typical presenting symptoms in different regions of the world may also vary depending on culture, such as alter identities taking the form of possessing spirits, deities, ghosts, or mythical creatures in cultures where possession states are normative.[3][17](p335)

  1. ^ Nevid JS (2011). Essentials of Psychology: Concepts and Applications. Cengage Learning. p. 432. ISBN 978-1-111-30121-7.
  2. ^ Kellerman H (2009). Dictionary of Psychopathology. Columbia University Press. p. 57. ISBN 978-0-231-14650-0.
  3. ^ a b c d e f g h i j k l American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing. pp. 291–298. ISBN 978-0-89042-555-8.
  4. ^ Lanius R (June 2015). "Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research". Eur J Psychotraumatol. 6: 27905. doi:10.3402/ejpt.v6.27905. PMC 4439425. PMID 25994026.
  5. ^ Dorahy MJ, Corry M, Black R, Matheson L, Coles H, Curran D, Seager L, Middleton W, Dyer KF (April 2017). "Shame, Dissociation, and Complex PTSD Symptoms in Traumatized Psychiatric and Control Groups: Direct and Indirect Associations With Relationship Distress: Shame and Dissociation in Relationship Distress". Journal of Clinical Psychology. 73 (4): 439–448. doi:10.1002/jclp.22339. PMID 28301038. S2CID 206045401.
  6. ^ Temple M (23 November 2018). "Understanding, identifying and managing severe dissociative disorders in general psychiatric settings". BJPsych Advances. 25: 14–25. doi:10.1192/bja.2018.54. S2CID 81151326.
  7. ^ "Dissociative Fugue (Psychogenic Fugue) | Psychology Today".
  8. ^ a b c Brand BL, Lanius RA (2014). "Chronic complex dissociative disorders and borderline personality disorder: disorders of emotion dysregulation?". Borderline Personality Disorder and Emotion Dysregulation. 1 (1): 13. doi:10.1186/2051-6673-1-13. PMC 4579511. PMID 26401297.
  9. ^ Dimitrova L, Fernando V, Vissia EM, Nijenhuis ER, Draijer N, Reinders AA (2020). "Sleep, trauma, fantasy and cognition in dissociative identity disorder, post-traumatic stress disorder and healthy controls: A replication and extension study". European Journal of Psychotraumatology. 11 (1). doi:10.1080/20008198.2019.1705599. PMC 7006753. PMID 32082509.
  10. ^ a b c d "Dissociative identity disorder". MSD Manuals. Psychiatric disorders (Professional ed.). March 2019. Archived from the original on 28 May 2020. Retrieved 8 June 2020.
  11. ^ a b c d Mitra P, Jain A (2023). "Dissociative Identity Disorder". StatPearls. StatPearls Publishing. PMID 33760527. NBK568768.
  12. ^ a b c International Society for the Study of Trauma Dissociation (2011). "Guidelines for treating dissociative identity disorder in adults, third revision". Journal of Trauma & Dissociation. 12 (2): 188–212. doi:10.1080/15299732.2011.537248. PMID 21391104. S2CID 44952969.
  13. ^ Peters ME, Treisman G (2017). "Dissociative Identity Disorder". Johns Hopkins Psychiatry Guide.
  14. ^ Cite error: The named reference Shadows was invoked but never defined (see the help page).
  15. ^ Cite error: The named reference Stern was invoked but never defined (see the help page).
  16. ^ Cite error: The named reference Hersen2012 was invoked but never defined (see the help page).
  17. ^ a b c d e f g h i j k l DSM-5-TR classification. Washington, DC: American Psychiatric Association. 2022. ISBN 978-0-89042-583-1. OCLC 1268112689.
  18. ^ a b c Beidel DC, Frueh BC, Hersen M (2014). Adult psychopathology and diagnosis (7th ed.). Hoboken, N.J.: Wiley. pp. 414–422. ISBN 978-1-118-65708-9.
  19. ^ "Dissociative Identity Disorder: What Is It, Symptoms & Treatment". Cleveland Clinic. Retrieved 2023-04-13.
  20. ^ a b "Dissociative Identity Disorder - Psychiatric Disorders".
  21. ^ a b Hassan S, Shah M (2019). "The anatomy of undue influence used by terrorist cults and traffickers to induce helplessness and trauma, so creating false identities". Ethics, Medicine and Public Health. 8: 97–107. doi:10.1016/j.jemep.2019.03.002. S2CID 151201448.
  22. ^ Şar V, Dorahy MJ, Krüger C (2017). "Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective". Psychology Research and Behavior Management. 10 (10): 137–146. doi:10.2147/PRBM.S113743. PMC 5422461. PMID 28496375.
  23. ^ Cite error: The named reference MacDonald was invoked but never defined (see the help page).
  24. ^ Brand B, Loewenstein R, Spiegel D (2014). "Dispelling myths about dissociative identity disorder treatment: An empirically based approach". Psychiatry. 77 (2): 169–189. doi:10.1521/psyc.2014.77.2.169. PMID 24865199. S2CID 44570651.

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