If someone who is not a professional psychologist is asked to list the psychological disorders that they know, one of the disorders on their list would probably be Dissociative Identity Disorder, or DID, formerly known as multiple personality disorder. According to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5), symptoms of DID include a disruption to the identity by two or more personality states, gaps in memory that are inconsistent with normal forgetfulness, and significant distress. The symptoms must not be attributable to broadly accepted cultural and religious practices, and substance abuse and other medical conditions must be ruled out as causing the symptoms. Switching personalities, or “alters,” in a DID patient can result in “related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning” (Trauma Dissociation). While there are many possible explanations for the causes of DID, it is generally accepted that childhood trauma is linked to the disorder, preventing the child from forming a unified sense of self.
The novel and film Sybil is often used as a media example of DID. In this film, the young girl has DID and has 16 different alters, and loses time when her main personality is not in control. According to the DSM-5, total amnesia for the actions of the alter are not necessary to the diagnosis. It is possible for the person to be completely aware while the alter is in control, and this is known as co-consciousness. Some people can even have internal conversations with their alters. For those who do experience amnesia, it is common to have gaps in past memory of personal life events, lapses in dependable memory (depending on the alter’s memory), and “coming to” in the middle of the day with no recollection of earlier events. To hear from someone with DID, here is a woman with 12 alters who talks about her struggles with DID and how the disorder is different from what most people perceive (Youtube). She constantly communicates with the alters in her head and has to fight for control. Overall, there are a lot of different presentations of DID and symptoms can look very different in each patient.
Common treatments for dissociative identity disorder involve psychotherapy. The goal of treatment is to engage the alters and to reduce the level and length of amnesia. Depending on the patient, sometimes treatments will focus on the integration of all alters, and sometimes treatment will focus on achieving harmony between the alters so the patient can live a functional life. Most DID patients do take some form of medication. Typically these medications target the comorbid disorders the patient is suffering from. There are professionals who dedicate their entire careers to treating DID.
However, there is some disagreement within the psychology community as to whether DID truly exists. Some psychologists believe that most cases of DID are actually misdiagnosed. Multiple personality disorder was reclassified as DID in the DSM, which indicates that the disorder is hard to classify, open to debate, and the classification needed to be updated. The famous case of Sybil was actually proven to be a fraud, and the woman who the novel was about created her alters for attention from her psychiatrist (NPR). Therapists who simply accept the diagnosis without question may find and manufacture the symptoms within their patients in order to fit their theory. “It is a capital mistake to theorize before one has data. Insensibly one begins to twist facts to suit theories, instead of theories to suit facts” (Arthur Conan Doyle).
Clinicians who do not believe in the validity of DID, such as Clifford N. Lazarus, Ph.D., would argue that it is a problem when “clinicians actually encourage behaviors that seem consistent with the label, which increases the likelihood that the client will act more like the label and begin to “fit” into this diagnostic category” (Psychology Today). This view aligns with the beliefs of behavioral psychologists, specifically that the behavior (DID symptoms) follows the consequences (more positive attention from the clinicians). This is just one concern regarding the validity of DID. Other concerns are that therapists who misdiagnose a patient will fail to treat the real disorder, or the treatment may be harmful to the patient when they are forced to recount traumatic memories in great detail. Overall, clinicians who do not agree with the inclusion of DID as a diagnosis would not deny that something is wrong with patients who suffer from this disorder, and it is possible to have a fracturing of the personality. However, they would attribute the symptoms of DID to some other psychological disorder.
Today, DID is diagnosed in about 1.5% of the global population (NIH). It is in the DSM-5, which means it is accepted as a psychological disorder by the scientific community. Those who oppose its inclusion in the DSM believe that the disorder is not valid, or that it does not measure what it is supposed to, and at the very least the diagnosis needs to be updated. Those who support its inclusion believe that there are severe disruptions in patient’s personalities, and this can be presented in multiple ways. For now, the debate over DID will continue.
If you believe that you have a psychological disorder, talk to a licensed professional.