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Multiple personalities disorder definition


Dissociative Identity Disorder (Multiple Personality Disorder): Signs, Symptoms, Treatment

Written by WebMD Editorial Contributors

In this Article

  • What Is Dissociative Identity Disorder?
  • Who Is At Risk for DID?
  • How to Recognize Dissociative Identity Disorder and Its Associated Mental Disorders
  • How Is Dissociative Identity Disorder Diagnosed?
  • What Other Psychiatric Illnesses Might Occur With DID?
  • Are There Famous People With Dissociative Identity Disorder?
  • What's the Treatment Plan for Dissociative Identity Disorder?

Dissociative identity disorder (previously known as multiple personality disorder) is thought to be a complex psychological condition that is likely caused by many factors, including severe trauma during early childhood (usually extreme, repetitive physical, sexual, or emotional abuse).

What Is Dissociative Identity Disorder?

Dissociative identity disorder is a severe form of dissociation, a mental process which produces a lack of connection in a person's thoughts, memories, feelings, actions, or sense of identity. Dissociative identity disorder is thought to stem from a combination of factors that may include trauma experienced by the person with the disorder. The dissociative aspect is thought to be a coping mechanism -- the person literally shuts off or dissociates themselves from a situation or experience that's too violent, traumatic, or painful to assimilate with their conscious self.

Who Is At Risk for DID?

Research indicates that the cause of DID 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 or traumas at a sensitive developmental stage of childhood (usually before age 6).

Dissociation may also happen when there has been persistent neglect or emotional abuse, even when there has been no overt physical or sexual abuse. Findings show that in families where parents are frightening and unpredictable, the children may become dissociative. Studies indicate DID affects about 1% of the population.

How to Recognize Dissociative Identity Disorder and Its Associated Mental Disorders

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 may fluctuate.

Although not everyone experiences DID the same way, for some the "alters" or different identities have their own age, sex, or race. Each has their 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. Some seek treatment with hypnosis where the person's different "alters" or identities may be very responsive to the therapist's requests.

Other symptoms of dissociative identity disorder may include headache, amnesia, 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). As an example, someone with dissociative identity disorder may find themselves doing things they wouldn't normally do, such as speeding, reckless driving, or stealing money from their employer or friend, yet they feel they are being compelled to do it. Some describe this feeling as being a passenger in their body rather than the driver. In other words, they truly believe they have no choice.

There are several main ways in which the psychological processes of dissociative identity disorder change the way a person experiences living, including the following:

  • Depersonalization.  This is a sense of being detached from one's body and is often referred to as an "out-of-body" experience.
  • Derealization. This is the feeling that the world is not real or looking foggy or far away.
  • Amnesia. This is the failure to recall significant personal information that is so extensive it cannot be blamed on ordinary forgetfulness. There can also be micro-amnesias where the discussion engaged in is not remembered, or the content of a meaningful conversation is forgotten from one second to the next.
  • Identity confusion or identity alteration. Both of these involve a sense of confusion about who a person is. An example of identity confusion is when a person has trouble defining the things that interest them in life, or their political or religious or social viewpoints, or their sexual orientation, or their professional ambitions. In addition to these apparent alterations, the person may experience distortions in time, place, and situation.

It is now acknowledged that these dissociated states are not fully mature personalities, but rather they represent a disjointed sense of identity. With the amnesia typically associated with dissociative identity disorder, different identity states remember different aspects of autobiographical information. There is usually a "host" personality within the individual, who identifies with the person's real name. Ironically, the host personality is usually unaware of the presence of other personalities.

How Is Dissociative Identity Disorder Diagnosed?

Making the diagnosis of dissociative identity disorder takes time. It's estimated that individuals with dissociative disorders 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 a dissociative disorder to seek treatment is very similar to those of many other psychiatric diagnoses. In fact, many people who have dissociative disorders also have coexisting diagnoses of borderline or other personality disorders, depression, and anxiety.

The DSM-5 provides the following criteria to diagnose dissociative identity disorder:

  1. Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.
  2. Amnesia must occur, defined as gaps in the recall of everyday events, important personal information, and/or traumatic events.
  3. The person must be distressed by the disorder or have trouble functioning in one or more major life areas because of the disorder.
  4. The disturbance is not part of normal cultural or religious practices.
  5. The symptoms cannot be due to the direct physiological effects of a substance (such as blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (such as complex partial seizures).

The distinct personalities may serve diverse roles in helping the individual cope with life's dilemmas. For instance, there's an average of two to four personalities present when the patient is initially diagnosed. Then there's an average of 13 to 15 personalities that can become known over the course of treatment. Environmental triggers or life events cause a sudden shift from one alter or personality to another.

What Other Psychiatric Illnesses Might Occur With DID?

Along with the dissociation and multiple or split personalities, people with dissociative disorders may experience a number of other psychiatric problems, including symptoms:

  • Depression
  • Mood swings
  • Suicidal tendencies
  • Sleep disorders (insomnia, night terrors, and sleep walking)
  • Anxiety, 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)
  • Eating disorders

Are There Famous People With Dissociative Identity Disorder?

Famous people with dissociative identity disorder include comedienne Roseanne Barr, Adam Duritz, and retired NFL star Herschel Walker.

Walker wrote a book about his struggles with DID, along with his suicide attempts, explaining he had a feeling of disconnect from childhood to the professional leagues. To cope, he developed a tough personality that didn't feel loneliness, one that was fearless and wanted to act out the anger he always suppressed. These "alters" could withstand the abuse he felt; other alters came to help him rise to national fame. Treatment helped Walker realize that these alternate personalities are part of dissociative identity disorder, which he was diagnosed with in adulthood.

What's the Treatment Plan for Dissociative Identity Disorder?

There are currently no formal, evidence-based guldelines to treat DID. Many treatments are based on case reports or are even controversial.  

While there's also no "cure" for dissociative identity disorder, long-term treatment can be helpful, if the patient stays committed. Effective treatment includes:

  • Psychotherapy: Also called talk therapy, the therapy is designed to work through whatever triggered and triggers the DID. The goal is to help “fuse” the separate personality traits into one consolidated personality that can control the triggers. This therapy often includes family members in the therapy.
  • Hypnotherapy. Used in conjunction with psychotherapy, clinical hypnosis can be used to help access repressed memories, control some of the problematic behaviors which accompany DID as well as help integrate the personalities into one.
  • Adjunctive therapy. Therapies such as art or movement therapy have been shown to help people connect with parts of their mind that they have shut off to cope with trauma.

There are no established medication treatments for dissociative identity disorder, making psychologically-based approaches the mainstay of therapy. Treatment of co-occurring disorders, such as depression or substance use disorders, is fundamental to overall improvement. Because the symptoms of dissociative disorders often occur with other disorders, such as anxiety and depression, medicines to treat those co-occurring problems, if present, are sometimes used in addition to psychotherapy.

 

Dissociative Disorders | NAMI: National Alliance on Mental Illness

Dissociative disorders are characterized by an involuntary escape from reality characterized by a disconnection between thoughts, identity, consciousness and memory. People from all age groups and racial, ethnic and socioeconomic backgrounds can experience a dissociative disorder.

Up to 75% of people experience at least one depersonalization/derealization episode in their lives, with only 2% meeting the full criteria for chronic episodes. Women are more likely than men to be diagnosed with a dissociative disorder. 

The symptoms of a dissociative disorder usually first develop as a response to a traumatic event, such as abuse or military combat, to keep those memories under control. Stressful situations can worsen symptoms and cause problems with functioning in everyday activities. However, the symptoms a person experiences will depend on the type of dissociative disorder that a person has.

Treatment for dissociative disorders often involves psychotherapy and medication. Though finding an effective treatment plan can be difficult, many people are able to live healthy and productive lives.

Symptoms

Symptoms and signs of dissociative disorders include:

  • Significant memory loss of specific times, people and events
  • Out-of-body experiences, such as feeling as though you are watching a movie of yourself
  • Mental health problems such as depression, anxiety and thoughts of suicide
  • A sense of detachment from your emotions, or emotional numbness
  • A lack of a sense of self-identity

The symptoms of dissociative disorders depend on the type of disorder that has been diagnosed. There are three types of dissociative disorders defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM):

  • Dissociative Amnesia. The main symptom is difficulty remembering important information about one’s self. Dissociative amnesia may surround a particular event, such as combat or abuse, or more rarely, information about identity and life history. The onset for an amnesic episode is usually sudden, and an episode can last minutes, hours, days, or, rarely, months or years. There is no average for age onset or percentage, and a person may experience multiple episodes throughout her life.
  • Depersonalization disorder. This disorder involves ongoing feelings of detachment from actions, feelings, thoughts and sensations as if they are watching a movie (depersonalization). Sometimes other people and things may feel like people and things in the world around them are unreal (derealization). A person may experience depersonalization, derealization or both. Symptoms can last just a matter of moments or return at times over the years. The average onset age is 16, although depersonalization episodes can start anywhere from early to mid childhood. Less than 20% of people with this disorder start experiencing episodes after the age of 20.
  • Dissociative identity disorder. Formerly known as multiple personality disorder, this disorder is characterized by alternating between multiple identities. A person may feel like one or more voices are trying to take control in their head. Often these identities may have unique names, characteristics, mannerisms and voices. People with DID will experience gaps in memory of every day events, personal information and trauma. Women are more likely to be diagnosed, as they more frequently present with acute dissociative symptoms. Men are more likely to deny symptoms and trauma histories, and commonly exhibit more violent behavior, rather than amnesia or fugue states. This can lead to elevated false negative diagnosis.

Causes

Dissociative disorders usually develop as a way of dealing with trauma. Dissociative disorders most often form in children exposed to long-term physical, sexual or emotional abuse. Natural disasters and combat can also cause dissociative disorders.

Diagnosis

Doctors diagnose dissociative disorders based on a review of symptoms and personal history. A doctor may perform tests to rule out physical conditions that can cause symptoms such as memory loss and a sense of unreality (for example, head injury, brain lesions or tumors, sleep deprivation or intoxication). If physical causes are ruled out, a mental health specialist is often consulted to make an evaluation.

Many features of dissociative disorders can be influenced by a person’s cultural background. In the case of dissociative identity disorder and dissociative amnesia, patients may present with unexplained, non-epileptic seizures, paralyses or sensory loss. In settings where possession is part of cultural beliefs, the fragmented identities of a person who has DID may take the form of spirits, deities, demons or animals. Intercultural contact may also influence the characteristics of other identities. For example, a person in India exposed to Western culture may present with an “alter” who only speaks English. In cultures with highly restrictive social conditions, amnesia is frequently triggered by severe psychological stress such as conflict caused by oppression. Finally, voluntarily induced states of depersonalization can be a part of meditative practices prevalent in many religions and cultures, and should not be diagnosed as a disorder.

Treatment

Dissociative disorders are managed through various therapies including:

  • Psychotherapies such as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT)
  • Eye movement desensitization and reprocessing (EMDR)
  • ​Medications such as antidepressants can treat symptoms of related conditions

Related Conditions

Because dissociative disorders appear on the trauma spectrum, many patients may have conditions associated with trauma, as well as additional trauma-based conditions.

  • Posttraumatic stress disorder (PTSD)
  • Borderline personality disorder (BPD)
  • Substance use disorders / Dual Diagnosis
  • Depression
  • Anxiety

Dissociative identity disorder - treatment, consultations, help.

Empathy

As a result of the change from one personality to another, the currently active personality cannot remember what the personality that was active before the "switch" was doing.

Dissociation, being a psychological defense mechanism, often occurs as a response to serious psychological trauma that occurred in childhood, to physical, sexual and emotional abuse. The disorder in question is an extreme manifestation of dissociation, as a result of which a person is protected from excessive emotions, since he perceives what happened as if it happened not to himself, but to someone else.

Symptoms

It is worth noting that dissociative disorder has nothing to do with schizophrenia, but is often aggravated by factors such as depression, panic attacks, phobias, anxiety, suicide attempts, eating and sleep disorders.

To make a diagnosis according to ICD-10 (the classification of diseases adopted in the Russian Federation), the patient must have the following symptoms:

  1. Simultaneous manifestation of one personality at a particular moment in the existential presence of two or more different personalities of the patient.
  2. Each personality has its own memory block, its priority values ​​and behavioral patterns, as well as the ability to completely control the patient's actions from time to time.
  3. A person sometimes cannot remember important events or information for her, which goes beyond the usual forgetfulness or absent-mindedness.
  4. Signs are not due to the use of psychotropic substances or disorders of a mental (eg, epileptic) nature.

According to the DSM-IV-TR criteria (used in the United States and other English-speaking countries, a manual of mental disorders), a diagnosis of dissociative identity disorder is made when four features are present:

  1. 1. Having two or more distinct identities or personal states, each with its own perception of reality and its own mentality.
  2. 2. At least two identities alternately control the patient's life.
  3. 3. The inability of the patient to remember and evoke important memories of himself, and much more serious and deeper than with ordinary forgetfulness.
  4. 4. Such manifestations are not the result of alcohol or drug abuse, and also cannot be somatic manifestations. In childhood, such signs should not be elements of the game with an imaginary friend or other fantasy games.

In addition to the main symptoms of dissociative identity disorder mentioned above, patients may experience anxiety and depression. Depression can lead to suicide attempts, cause physiological disturbances, sleep problems. With dissociation, a person cannot completely abstract from reality, a person continues to be himself, while the number of other personalities can multiply over time. In an unconscious attempt to protect themselves and isolate themselves from stressors, each time new, the patient forms new entities, completely different, with different names, intonation, mannerisms and, most importantly, life values, which, as a rule, are unaware of the existence of each other. Over the years, the situation can only get worse: there are feelings of the impossibility of controlling one's own actions, the real vision of the world is distorted.

Treatment of dissociative identity disorder


To weaken the negative impact of the disorder, to a certain extent, to secure the patient's life and promote social adaptation, treatment can be started on time.

Antidepressants are used to alleviate the pronounced manifestations of depression and anxiety in dissociative disorder. Also, as the main method of treatment, psychotherapy and its fundamental methods are widely used - such as the cognitive-behavioral method, hypnosis, the practice of family therapy, the insight method (defining conflict and overcoming the traumatic syndrome). Any chosen method of psychotherapy works to determine the causal relationship of the defense mechanism and the need to recreate multiple identities, and the main task of treating dissociative identity disorder is to combine several identities into one whole personality and its subsequent life integration.

How can we help?

If you have found some of the described symptoms in yourself or your loved ones, this may indicate the development of a mental disorder. In this case, it is worth contacting a psychiatrist for diagnosis and initiation of timely treatment. In addition to face-to-face communication , we offer remote consultation service (online reception) , which is not inferior to a face-to-face meeting in terms of quality. Thus, you can get qualified help high-level specialist, no matter where you are located.

In our center for mental health and psychological assistance, within walking distance from the Elektrozavodskaya metro station (Moscow) and the Novokosino metro station (Reutov), ​​specialists who have extensive experience in treating mental disorders work. We use the most modern and advanced techniques, guided by the principles of evidence-based medicine. Effective assistance and confidentiality of information constituting a medical secret are guaranteed.

How multiple personalities restored sight to a blind woman

The personality of a teenage boy "living" in the body of a blind woman restored her sight. The science department of Gazeta.Ru tells how, following the teenager, seven more “additional” personalities saw the light.

Dissociative personality disorder (formerly known as multiple personality disorder) is a mental illness characterized by a "split" personality. At the same time, at certain moments there is a “switching” of personalities, one of which replaces the other. Individuals can react differently to ongoing events, have different temperaments, characters, genders, ages, and even nationalities.

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At the same time, individuals perceive the surrounding world independently of each other: after the next “switching”, one personality does not remember and does not know what the other was doing.

One of the most famous cases of dissociative identity disorder is the case of William Stanley Milligan, which was also described by the writer Daniel Keyes in his work "The Multiple Minds of Billy Milligan".

William (Billy) Stanley Milligan combined 24 full-fledged personalities, ten of which were basic.

In addition to Bill himself, among them were the educated Englishman Arthur (22 years old), who was fond of medicine, the physically strong Yugoslav color-blind Reigen (23 years old), the eighteen-year-old fraudster Allen, who painted portraits (he was the only right-handed and smoker who "lived" in the body of Milligan ), a three-year-old Englishwoman Christine, her older brother Christopher, a lesbian Atalana at the age of 19years and others.

Milligan had 14 more "undesirable" personalities, among which were the deaf boy Sean, the religious Jew Samuel, the Australian hunter Walter, the girl April, who was obsessed with the idea of ​​killing Milligan's stepfather, the drug dealer Phil. Milligan's personalities communicated with each other and even came into conflict: for example, the "undesirable" personality Steve irritated the Yugoslav Reigen, parodying his accent, and Arthur, speaking Cockney. And Samuel was deemed "undesirable" because he sold a painting drawn by Allen and Tommy (one of the ten "core" personalities). By the way, it was not William Stanley Milligan himself who recognized the “undesirable” personalities, but Arthur and Reigen.

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Specialists who studied the case of William Milligan note that

some of the patient's personalities were very gifted artists and musicians (each one specialized in one musical instrument or direction in painting). Those individuals who agreed to "go out" to take IQ tests showed different levels of mental development.

Billy Milligan came to public attention after committing several robberies and rapes. He became the first person to be acquitted because of the diagnosis of "multiple personality" - the original personality of William Stanley knew nothing about the crimes committed.

Milligan's case is unique in its way, primarily due to the wide range of personalities "living" in the body of William Stanley and the publicity that his story received. Experts, however, argue that dissociative identity disorder is not at all such a rare diagnosis as it might seem at first glance: for example, Bethany Brand (Professor of Psychology at Towson University) states that the disease affects 1 to 3% of the world's population - about the same as schizophrenia or bipolar disorder.

German scientists Hans Strasburger and Bruno Waldfogel reported another case of dissociative identity disorder. True, in this situation

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90,002 dozen personalities "living" in the body of a 37-year-old German woman did not bring her to the dock, but helped her regain her sight.

The corresponding article was published in PsyCh Journal .

At the age of 20, a German woman, whom doctors call BT, was in a car accident, as a result of which she lost her sight. Doctors diagnosed her with cortical blindness, a loss of vision caused by damage to the visual centers in the cerebral cortex. A few years later, the woman turned to psychiatrists for help: she developed a dissociative identity disorder.

The cause of the formation of this disease is usually very severe psychological trauma, repeated cases of physical or emotional abuse in childhood: for example, William Stanley Milligan was abused by his stepfather at the age of eight. In this case, the body, trying to protect itself and "close" itself from the threat, includes a psychological defense mechanism - dissociation. A person begins to perceive the events happening to him as if they happen to an outsider, and then there is a gradual formation of other personalities. In the case described, the impetus for the onset of the disorder could be a car accident.

In the body of B. T. more than ten personalities of different sex, age, character and temperament arose. The behavior, facial expressions, gestures and timbre of the woman's voice changed depending on which person took control of the body into their own hands. Interestingly, some individuals spoke the patient's native language, German, and some preferred English, which the patient spoke during several years of living in another country.

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In the fourth year of treatment with a psychotherapist during one of the sessions

B.T. suddenly she could see a few words printed on the cover of a magazine lying on the table. At that moment, mind control belonged to the teenage boy's personality.

The authors of the study note that the woman was not able to see the magazine itself, the table or the letters from which the word was composed, she only saw the whole word.

Gradually, the teenage boy's vision improved. Despite the fact that his vision was never fully restored, with the help of hypnosis, doctors managed to “spread” the ability to see to other personalities of B.T., though not to all. The patient is now 37 years old and her vision has returned to eight of her personalities.

The ability to see appears and disappears at the same moment when the change of personalities occurs, that is, within a few seconds. This means that the initial diagnosis - "cortical blindness" - was incorrect, and the woman actually suffered from psychogenic blindness, which is most likely associated with damage to the thalamus. “In situations of strong emotional overstrain, a person may feel a desire not to see anything, thus, as if getting rid of this need,” Professor Strasburger comments. According to the authors of the study, this type of blindness is explained by the fact that different personalities have access to different human experiences and the most psychologically traumatized individuals are simply “afraid” to regain their sight.

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