Home » Misc » What can cause multiple personality disorder

What can cause multiple personality disorder


Dissociative disorders - Symptoms and causes

Overview

Dissociative disorders are mental disorders that involve experiencing a disconnection and lack of continuity between thoughts, memories, surroundings, actions and identity. People with dissociative disorders escape reality in ways that are involuntary and unhealthy and cause problems with functioning in everyday life.

Dissociative disorders usually develop as a reaction to trauma and help keep difficult memories at bay. Symptoms — ranging from amnesia to alternate identities — depend in part on the type of dissociative disorder you have. Times of stress can temporarily worsen symptoms, making them more obvious.

Treatment for dissociative disorders may include talk therapy (psychotherapy) and medication. Although treating dissociative disorders can be difficult, many people learn new ways of coping and lead healthy, productive lives.

Products & Services

  • Book: Mayo Clinic Family Health Book, 5th Edition
  • Newsletter: Mayo Clinic Health Letter — Digital Edition

Symptoms

Signs and symptoms depend on the type of dissociative disorders you have, but may include:

  • Memory loss (amnesia) of certain time periods, events, people and personal information
  • A sense of being detached from yourself and your emotions
  • A perception of the people and things around you as distorted and unreal
  • A blurred sense of identity
  • Significant stress or problems in your relationships, work or other important areas of your life
  • Inability to cope well with emotional or professional stress
  • Mental health problems, such as depression, anxiety, and suicidal thoughts and behaviors

There are three major dissociative disorders defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), published by the American Psychiatric Association:

  • Dissociative amnesia. The main symptom is memory loss that's more severe than normal forgetfulness and that can't be explained by a medical condition. You can't recall information about yourself or events and people in your life, especially from a traumatic time. Dissociative amnesia can be specific to events in a certain time, such as intense combat, or more rarely, can involve complete loss of memory about yourself. It may sometimes involve travel or confused wandering away from your life (dissociative fugue). An episode of amnesia usually occurs suddenly and may last minutes, hours, or rarely, months or years.
  • Dissociative identity disorder. Formerly known as multiple personality disorder, this disorder is characterized by "switching" to alternate identities. You may feel the presence of two or more people talking or living inside your head, and you may feel as though you're possessed by other identities. Each identity may have a unique name, personal history and characteristics, including obvious differences in voice, gender, mannerisms and even such physical qualities as the need for eyeglasses. There also are differences in how familiar each identity is with the others. People with dissociative identity disorder typically also have dissociative amnesia and often have dissociative fugue.
  • Depersonalization-derealization disorder. This involves an ongoing or episodic sense of detachment or being outside yourself — observing your actions, feelings, thoughts and self from a distance as though watching a movie (depersonalization). Other people and things around you may feel detached and foggy or dreamlike, time may be slowed down or sped up, and the world may seem unreal (derealization). You may experience depersonalization, derealization or both. Symptoms, which can be profoundly distressing, may last only a few moments or come and go over many years.
When to see a doctor

Some people with dissociative disorders present in a crisis with traumatic flashbacks that are overwhelming or associated with unsafe behavior. People with these symptoms should be seen in an emergency room.

If you or a loved one has less urgent symptoms that may indicate a dissociative disorder, call your doctor.

Suicidal thoughts or behavior

If you have thoughts of hurting yourself or someone else, call 911 or your local emergency number immediately, go to an emergency room, or confide in a trusted relative or friend. Or call a suicide hotline number — in the United States, call the National Suicide Prevention Lifeline at 1-800-273-TALK (1-800-273-8255) to reach a trained counselor.

Request an Appointment at Mayo Clinic

From Mayo Clinic to your inbox

Sign up for free, and stay up to date on research advancements, health tips and current health topics, like COVID-19, plus expertise on managing health.

To provide you with the most relevant and helpful information, and understand which information is beneficial, we may combine your email and website usage information with other information we have about you. If you are a Mayo Clinic patient, this could include protected health information. If we combine this information with your protected health information, we will treat all of that information as protected health information and will only use or disclose that information as set forth in our notice of privacy practices. You may opt-out of email communications at any time by clicking on the unsubscribe link in the e-mail.

Causes

Dissociative disorders usually develop as a way to cope with trauma. The disorders most often form in children subjected to long-term physical, sexual or emotional abuse or, less often, a home environment that's frightening or highly unpredictable. The stress of war or natural disasters also can bring on dissociative disorders.

Personal identity is still forming during childhood. So a child is more able than an adult to step outside of himself or herself and observe trauma as though it's happening to a different person. A child who learns to dissociate in order to endure a traumatic experience may use this coping mechanism in response to stressful situations throughout life.

Risk factors

People who experience long-term physical, sexual or emotional abuse during childhood are at greatest risk of developing dissociative disorders.

Children and adults who experience other traumatic events, such as war, natural disasters, kidnapping, torture, or extended, traumatic, early-life medical procedures, also may develop these conditions.

Complications

People with dissociative disorders are at increased risk of complications and associated disorders, such as:

  • Self-harm or mutilation
  • Suicidal thoughts and behavior
  • Sexual dysfunction
  • Alcoholism and drug use disorders
  • Depression and anxiety disorders
  • Post-traumatic stress disorder
  • Personality disorders
  • Sleep disorders, including nightmares, insomnia and sleepwalking
  • Eating disorders
  • Physical symptoms such as lightheadedness or non-epileptic seizures
  • Major difficulties in personal relationships and at work

Prevention

Children who are physically, emotionally or sexually abused are at increased risk of developing mental health disorders, such as dissociative disorders. If stress or other personal issues are affecting the way you treat your child, seek help.

  • Talk to a trusted person such as a friend, your doctor or a leader in your faith community.
  • Ask for help locating resources such as parenting support groups and family therapists.
  • Look for churches and community education programs that offer parenting classes that also may help you learn a healthier parenting style.

If your child has been abused or has experienced another traumatic event, see a doctor immediately. Your doctor can refer you to a mental health professional who can help your child recover and adopt healthy coping skills.

By Mayo Clinic Staff

Related

Associated Procedures

Products & Services

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.

 

What is Dissociative Identity Disorder?

Dissociative Identity Disorder is a mental disorder characterized by either having two or more personalities, or a state of disconnection from the outside world, one's identity, and an inability to recall certain daily life events and important personal information. This disorder is often mistaken for depression, anxiety, or psychosis. Long before our days, this condition was called possession, and it was treated with exorcism. In the 19th century, this disorder was called hysteria, and in the 20th century it was called multiple personality disorder or multiple personality disorder.

Types of dissociative personality disorder

There are several types of dissociative disorders, which are characterized by different symptoms and manifestations. One of them is dissociative fugue, a disorder in which a person can find himself in a completely unfamiliar place and not remember how he got there. In this case, a person may forget some important information about himself and not even remember his name. At the same time, memory for some information, such as literature, science, and other things, can be preserved. In a state of fugue, a person assumes a different personality and identity with a different character, mannerisms and behavior. While in this identity, a person can lead an outwardly normal life. A dissociative fugue can last for hours or years. After that, a person may find himself in a completely unfamiliar place and at the same time not remember anything that happened to him in a state of fugue.

A person who has a dissociative disorder is actually suffering a lot from their condition.

Another type of dissociative disorder is the presence of several personalities in which a person finds himself in turn or simultaneously. At such moments, he disconnects from himself and stops feeling his own body, and also cannot see himself from the outside. Personalities within a person can have different ages, genders, nationalities, mental abilities, temperaments, and behave in completely different ways. Often these personalities can even have different physiological manifestations. For example, while in one personality, a person can see poorly and wear glasses, and in another, have excellent vision and walk without glasses or lenses (or think that he sees perfectly and does without glasses). Just as in the case of dissociative fugue, when switching, one person cannot remember what happened to the person during immersion in another.


Manifestations of dissociative identity disorder

This disease affects both children (adolescents) and adults and presents with similar symptoms. However, dissociative disorder with multiple personalities in adolescents is quite rare. In old age, dissociation practically does not develop. When a specialist suspects a person of dissociative identity disorder, he usually asks if it happened that the person suddenly found himself in some place and did not understand how he got there. Also, the patient may suddenly speak in a completely different voice, he may have a different handwriting. For example, a person who has one of his personalities as a child may suddenly begin to write in a child's handwriting. Such phenomenal manifestations can be evoked in a patient suffering from dissociative personality disorder, and in a state of hypnosis. That is why the French psychiatrist Jean-Martin Charcot at one time mistakenly believed that hypnosis is a pathological condition that causes hysteria and the manifestation of multiple personalities. However, later it turned out that hypnosis is only superficially similar to dissociative personality disorder, but does not cause it, and the disease itself develops without any connection with hypnosis.

See also

Myths about hypnosis

A person who has a dissociative disorder is, in fact, suffering greatly from his condition. He sees the negative or dismissive attitude of those around him: they look at him strangely, they reject him, no one finds a common language with him, because of him the family can collapse, and so on. At the moment of a dissociative state, a person does not have the opportunity to critically look at himself and his own behavior. That is, in a situation where one of the alternative personalities appears, he is in an inadequate state.

The main theory about the origin of this disease is based on the fact that in childhood such people experienced a traumatic situation, usually bullying or violence.

Dissociation is one of three conditions in which the patient is exempt from criminal liability, along with psychosis and mental retardation. There were cases when people in a dissociative state committed murder and rape. In such situations, even taking into account the severity of the crimes, patients are not sent to prison, but are sent to a psychiatric hospital or, in extreme cases, to a special ward of the psychiatric department of the prison.


Causes of dissociative identity disorder

Scientists have not yet found the genetic causes of dissociative identity disorder. The main theory about the origin of this disease is based on the fact that in childhood such people experienced a traumatic situation, usually bullying or violence. However, even this theory does not explain all 100% of cases of dissociative states. There are patients who, without an overt or identified traumatic situation in childhood, suffer from dissociative personality disorder. With regard to the physiological manifestations of this disorder, there is an assumption that in such patients certain areas of the brain stop working and others turn on. However, none of the theories suggesting physiological causes of dissociation currently explains all cases of the disease.


Diagnosis of dissociative identity disorder

Diagnosis of dissociative identity disorder is made through clinical interviews with several specialists. Sometimes the diagnosis requires not one, but several meetings with psychologists and psychiatrists, so that they have the opportunity to identify different aspects of the disorder, look at the patient's condition from several points of view and assemble a consultation. However, the specialist who identifies this disorder must have a great deal of experience and qualifications, since this disease can often be confused with others. In its manifestations, it can be similar to depression, anxiety or psychosis. It is also common for patients with dissociative identity disorder to be diagnosed with schizophrenia. Dissociation is a rare disorder and not every mental health professional can diagnose this condition.

Medications do not cure dissociative identity disorder, but only relieve some of the symptoms.

See also

Mental norm and pathology

A separate task for a specialist in the process of diagnosing dissociation in a child is to distinguish diseases from the presence of imaginary friends in a child, which very often appear in perfectly healthy children at a certain age. To do this, the specialist must be highly qualified in the field of developmental psychology and clearly be able to recognize dissociative disorder not only in adults but also in children.


Treatment of dissociative identity disorder

The main treatment for dissociative personality disorder is hypnosis. Sometimes specialists connect methods of psychoanalysis or cognitive-behavioral psychotherapy to treatment. Also, in some cases, medication is used to relieve symptoms. Drugs are prescribed if the disorder is accompanied by depression, panic attacks, drug or alcohol addiction. Medications do not cure dissociative identity disorder, but only relieve some of the symptoms. If a child suffers from this disease, then specialists carry out separate work with his parents, provide them with methods of proper communication with the child to improve the results of his treatment.

If you do not treat dissociative personality disorder, but let the disease take its course, then in the case of multiple personalities, a person in an inadequate state can commit some extremely negative actions in relation to others, for example, violent ones. In the case of a dissociative fugue, a person may get lost and never return home - it will simply be impossible to find him.

  • Diseases and disorders

Share:

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 the service remote consultation (online reception) , which is not inferior to a face-to-face meeting in terms of quality. Thus, you can get qualified help high-level specialists, 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.

Learn more