Copyright 2010 Sidran Traumatic Stress Institute
Introduction
Dissociative Identity Disorder (DID) (known in the past as Multiple
Personality Disorder-MPD) and other Dissociative Disorders are now
understood to be fairly common effects of severe trauma in early
childhood. The most common cause is extreme, repeated physical, sexual,
and/or emotional abuse.
There is a great deal of overlap of symptoms and experiences among
the several Dissociative Disorders, including DID. Some people who may
not qualify for a specific diagnosis may, nevertheless, have problems
with dissociation. For ease of reading, we use “Dissociative Disorders”
as a general term for all of the diagnoses. Individuals should seek help
from qualified mental health providers to answer questions about their
own particular circumstances and diagnoses.
Q: Is DID the same as MPD?
n 1994, the American Psychiatric Association’s manual that classifies
and describes all psychiatric diagnoses changed the name from Multiple
Personality Disorder (MPD) to Dissociative Identity Disorder (DID). They
felt this better reflected the current professional understanding of
the disorder, based on significant recent research.
Q: What Does Trauma Have to Do with DID?
Posttraumatic Stress Disorder (PTSD) is a trauma-related mental illness
affecting 8% of Americans. PTSD is closely related to Dissociative
Disorders. In fact, most people with a Dissociative Disorder also have
PTSD. The cost of trauma disorders is extremely high to individuals,
families, and society. Recent research suggests that people with trauma
disorders may attempt suicide more often than people who have major
depression. Research also shows that people with trauma disorders have
more serious medical illnesses, substance use, and self-harming
behaviors.
Q: What Is Dissociation?
Dissociation is a disconnection between a person’s thoughts, memories,
feelings, actions, or sense of who he or she is. This is a normal
process that everyone has experienced. Examples of mild, common
dissociation include daydreaming, highway hypnosis, or “getting lost” in
a book or movie, all of which involve “losing touch” with awareness of
one’s immediate surroundings.
Q: When Is Dissociation Helpful?
During a traumatic experience such as an accident, disaster, or crime
victimization, dissociation can help a person tolerate what might
otherwise be too difficult to bear. In situations like these, a person
may dissociate the memory of the place, circumstances, or feelings about
of the overwhelming event, mentally escaping from the fear, pain, and
horror. This may make it difficult to later remember the details of the
experience, as reported by many disaster and accident survivors.
Q: What is a Dissociative Disorder?
Tragically, ongoing traumatic conditions such as abuse, community
violence, war, or painful medical procedures are not one-time events.
For people repeatedly exposed to these experiences, especially in
childhood, dissociation is an extremely effective coping “skill.”
However, it can become a double-edged sword. It can protect them from
awareness of the pain in the short-run, but a person who dissociates
often may find in the long-run his or her sense of personal history and
identity is affected. For some people, dissociation is so frequent it
results in serious pathology, relationship difficulties, and inability
to function, especially when under stress.
Q: Who Gets Dissociative Disorders?
As many as 99% of people who develop Dissociative Disorders have
documented histories of repetitive, overwhelming, and often
life-threatening trauma at a sensitive developmental stage of childhood
(usually before the age of nine). They may also have inherited a
biological predisposition for dissociation. In our culture, the most
frequent cause of Dissociative Disorders is extreme physical, emotional,
and sexual abuse in childhood. Survivors of other kinds of childhood
trauma (such as natural disasters, invasive medical procedures, war,
kidnapping, and torture) have also reacted by developing Dissociative
Disorders.
Q: Is DID a Major Mental Health Problem?
Current research shows that DID may affect 1% of the general population
and as many as 5-20% of people in psychiatric hospitals. The rates are
even higher among sexual-abuse survivors and addicts. These statistics
put Dissociative Disorders in the same category as schizophrenia,
depression, and anxiety, as one of the four major mental health problems
today.
Q: Does DID Affect Both Women and Men?
Most current literature shows that Dissociative Disorders are recognized
primarily among women. The latest research, however, indicates that the
disorders may be equally prevalent (but less frequently diagnosed)
among men. Men with Dissociative Disorders are most likely to be in
treatment for other mental illnesses or drug and alcohol abuse, or they
may be incarcerated.
Q: How Does a Dissociative Disorder Develop?
When faced with an overwhelming situation from which there is no
physical escape, a child may learn to “go away” in his or her head.
Children typically use this ability as a defense against physical and
emotional pain, or fear of that pain. By dissociating, thoughts,
feelings, memories, and perceptions of the trauma can be separated off
in the mind. This allows the child to function normally. This often
happens when no parent or trusted adult is available to stop the hurt,
soothe, and care for the child at the time of traumatic crisis. The
parent/caregiver may be the source of the trauma, may neglect the
child’s needs, may be a co-victim, or may be unaware of the situation.
Q: How Do Dissociative Disorders Help People Survive?
Dissociative Disorders are often called a self-protection or survival
technique because they allow individuals to endure “hopeless”
circumstances and preserve some healthy functioning. For a child who has
been repeatedly physically and sexually assaulted, however,
dissociation becomes a reinforced and conditioned defense.
Q: If It’s a Survival Technique, What’s the Down Side?
Because it is so effective, children who are very practiced at
dissociating may automatically use it whenever they feel threatened–even
if the anxiety-producing situation is not extreme or abusive. Even
after the traumatic circumstances are long past, the left-over pattern
of defensive dissociation sometimes remains into adulthood. Habitual
defensive dissociation may lead to serious dysfunction in school, work,
social, and daily activities.
Q: How Do the Identities of DID Develop?
Until about the age of eight or nine years, children are developmentally
primed for fantasy play, such as when they create and interact with
imaginary “friends.” When under extreme stress, young children may call
on this special ability to develop a “character” or “role” into which
they can escape when feeling threatened. One therapist described this as
nothing more than a little girl imagining herself on a swing in the
sunshine instead of at the hands of her abuser. Repeated dissociation
can result in a series of separate entities, or mental states, which may
eventually take on identities of their own. These entities can become
the internal “personality states” of DID. Changing between these states
of consciousness is often described as “switching.”
Q: Do People Actually Have “Multiple Personalities”?
Yes, and no. One of the reasons for the decision to change the
disorder’s name from MPD to DID is that “multiple personalities” is a
misleading term. A person with DID feels as if she has within her two or
more entities, each with its own way of thinking and remembering about
herself and her life. These entities previously were often called
“personalities,” even though the term did not accurately reflect the
common definition of the word. 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 states may feel or appear to be very different, they are all
manifestations of a single, whole person.
Q: Is it Obvious when a Person Switches Personalities?
Unlike popular portrayals of dissociation in books and movies, most
people with Dissociative Disorders work hard to hide their dissociation.
They can often function so well, especially under controlled
circumstances, that family members, coworkers, neighbors, and others
with whom they interact daily may not know that they are chronically
dissociative. People with Dissociative Disorders can hold highly
responsible jobs, contributing to society in a variety of professions,
the arts, and public service.
Q: What Are the Symptoms of a Dissociative Disorder?
People with Dissociative Disorders may experience any of the following:
depression, mood swings, suicidal thoughts or attempts, sleep disorders
(insomnia, night terrors, and sleep walking), panic attacks and phobias
(flashbacks, reactions to reminders of the trauma), alcohol and drug
abuse, compulsions and rituals, psychotic-like symptoms, and eating
disorders. In addition, individuals can experience headaches, amnesias,
time loss, trances, and “out-of-body experiences.” Some people with
Dissociative Disorders have a tendency toward self-persecution,
self-sabotage, and even violence (both self-inflicted and outwardly
directed).
Q: Why Are Dissociative Disorders Often Misdiagnosed?
Dissociative Disorders survivors often spend years living with the wrong
diagnosis. They change from therapist to therapist and from medication
to medication, getting treatment for symptoms but making little or no
actual progress. Research shows that people with Dissociative Disorders
spend an average of seven years in the mental health system before
getting the correct diagnosis. This is common because the symptoms that
drive a person with a Dissociative Disorder to treatment are very
similar to those of many other psychiatric diagnoses.
Q: What Are Some Common Misdiagnoses?
Common misdiagnoses include attention deficit disorder (especially among
children), because of difficulties in concentration and memory; bipolar
disorder, because “switching” can look like rapid-cycling mood swings;
schizophrenia or psychoses, because flashbacks can cause auditory and
visual hallucinations; and addictions, because alcohol and drugs are
frequently used to self medicate or to numb the psychic pain.
Q: What Other Mental Health Problems Are People with DID Likely to Have?
In addition, people with Dissociative Disorders can have other
diagnosable mental health problems at the same time. Typically these
include depression, post traumatic stress disorder, panic attacks,
obsessive compulsive symptoms, phobias, and self-harming behavior such
as cutting, eating disorders, and high-risk sexual behaviors. Although
they may get expert treatment for the more common secondary issue, if
the dissociative disorder is not addressed, recovery is generally short
lived.
Q: Where Can I Get More Information?
Sidran Institute. At Sidran, we help people understand, recover from,
and treat dissociative and traumatic stress conditions. We are a
national nonprofit organization and one of the nation’s leading
providers of traumatic stress education, publications, and resources.
Sidran is dedicated to helping people with traumatic stress conditions,
providing education and training on treating and managing traumatic
stress, and informing the public on issues related to traumatic stress.
Sidran Institute Press, our publishing division, is a leading publisher
of books about trauma and dissociation.