Written by Rose Marie Balzan, Aaliyah Ohaegbu, Georgette Mifsud, Elisa Bugeja, Anika Buttigieg
Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder, is a complex mental health condition characterized by the presence of two or more distinct personality states within an individual. This disorder profoundly affects a person’s behavior, cognition, and memory. In this essay, we will explore the ongoing debate surrounding the causes of DID, delve into its symptoms, discuss the challenges of diagnosis and treatment, and address the misconceptions that cloud public understanding of this disorder.
Defining Dissociative Identity Disorder
DID is a mental condition in which a person struggles to access their complete personality structure, resulting in the emergence of multiple distinct identities, or alters. Each alter may exhibit unique behaviors, thoughts, and even physiological traits. This disorder often develops as a coping mechanism in response to severe trauma, particularly during early childhood.
Understanding Hosts and Alters
People with DID typically experience three main identity categories: the original identity, the host, and the alters. The original identity is the self with which a person is born. The host is the dominant personality that navigates daily life, often trying to manage and conceal the presence of alters. Alters, on the other hand, arise from trauma and can vary significantly in age, gender, mannerisms, and skill sets. Some alters serve protective roles, while others may bring distress. Switching between alters is often triggered by stress or traumatic memories and can be recognized through noticeable shifts in voice, posture, and behavior. The level of co-consciousness, or awareness between alters, differs from person to person.
Symptoms of Dissociative Identity Disorder
DID manifests through a range of symptoms that disrupt an individual’s identity and cognitive functions. A person with DID may experience severe memory lapses, struggling to recall important life events. Their behavior and skill set may also fluctuate depending on which alter is in control. For example, someone who knows how to drive may suddenly struggle if a child alter takes over.
Other symptoms include dissociative amnesia, where the host lacks awareness of past events due to alters shielding them from traumatic memories. DID is often accompanied by depression, anxiety, somatoform symptoms (such as chronic pain), self-harming tendencies, and substance abuse. Many of these symptoms stem from the individual’s history of severe trauma.
The Nurture Debate: The Role of Trauma in DID
The origins of DID have sparked ongoing debate, with two primary models attempting to explain its development: the trauma model and the fantasy model. The trauma model suggests that DID is a severe form of post-traumatic stress disorder (PTSD), resulting from chronic and extreme trauma, particularly in early childhood. Research strongly supports this model, showing that children exposed to severe trauma are seven times more likely to develop a dissociative disorder. Additionally, WebMD reports that 99% of individuals with DID have a history of overwhelming, life-threatening trauma before age six (Begum, 2023).
In contrast, the fantasy model claims that DID is largely a product of suggestion and fantasy proneness, implying that it is a factitious disorder. However, follow-up studies and brain imaging research have largely discredited this theory, reinforcing the idea that DID develops as a direct response to severe trauma rather than imaginative fabrication (Reinders et al., 2012).
The Nature Perspective: Biological Factors in DID
While DID is primarily linked to environmental factors, research has explored biological influences as well. Advanced brain imaging techniques, such as SPECT, EEG, MRI, and PET scans, have revealed distinct structural and functional differences in individuals with DID. The orbitofrontal hypothesis suggests that changes in the orbitofrontal cortex occur due to early trauma. Similarly, EEG studies have detected variations in the temporal and frontal lobes when individuals switch between alters. MRI scans reveal a smaller amygdala and hippocampus, along with differences in grey and white matter. Additionally, PET scans show fluctuating brain activity that mirrors PTSD, with hypo- and hyperarousal states triggered by traumatic memories (Reinders et al., 2020). These findings further support the idea that DID is deeply rooted in both psychological and physiological responses to trauma.
Diagnosis and Misdiagnosis of DID
Diagnosing DID is challenging, as its symptoms often overlap with other psychiatric disorders, leading to frequent misdiagnoses. DID is often confused with schizophrenia, bipolar disorder, or PTSD. One key distinction is that individuals with schizophrenia hear external voices, whereas those with DID experience internal voices from their alters. While PTSD and DID share trauma-related origins, DID involves a fragmented sense of identity. In bipolar disorder, mood fluctuations may be mistaken for identity shifts, particularly in individuals with coexisting PTSD. A precise diagnosis is essential to ensure that patients receive appropriate treatment tailored to their unique experiences (Dorahy et al., 2014).
Treatment Methods for DID
Although there is no definitive cure for DID, several therapeutic approaches can help manage symptoms and improve quality of life. The Phase-Oriented Trauma Treatment Model (POTTS) provides a structured approach to processing trauma by focusing on safety and emotional regulation before delving into distressing experiences. Psychotherapy, particularly talking therapy, plays a crucial role in helping individuals process trauma, reduce distress, and improve overall well-being. Another promising method is Schema Therapy, which targets deep-seated maladaptive patterns and fosters long-term emotional stability through structured therapeutic interventions (Bachrach et al., 2023).
The Role of Media in Perpetuating Myths About DID
Public perception of DID is heavily influenced by media portrayals, many of which reinforce harmful stereotypes. A notable example is the movie Split, which depicts a man with DID as a violent kidnapper and murderer. The film exaggerates symptoms, including a supernatural alter, which contributes to the false perception that individuals with DID are dangerous. While Split correctly portrays aspects such as distinct alters with different personalities, ages, and medical conditions, it ultimately presents a misleading and fear-inducing narrative that fuels societal stigma.
To summarise, DID is a complex and often misunderstood mental health condition that primarily develops in response to severe trauma. While debates persist regarding its origins, extensive research supports the trauma model, emphasizing the role of early-life adversity in shaping brain morphology. The frequent misdiagnosis of DID highlights the need for increased awareness and more precise assessment methods.
Despite the negative portrayal of DID in media, individuals with this condition can lead fulfilling lives with the right treatment and support. March 5th marks DID Awareness Day, a reminder of the importance of educating the public and dismantling misconceptions. By fostering a more informed and compassionate society, we can create a supportive environment for those living with DID, helping them navigate their journey toward healing and self-acceptance.
References
Amazon. (n.d.). https://a.co/d/dYqAm4Z
Bachrach, N., Rijkeboer, M. M., Arntz, A., & Huntjens, R. J. C. (2023). Schema therapy for Dissociative Identity Disorder: A case report. Frontiers in Psychiatry, 14, 1151872. https://doi.org/10.3389/fpsyt.2023.1151872
Begum, J. (2023). Dissociative Identity Disorder (Multiple Personality Disorder). WebMD. https://www.webmd.com/mental-health/dissociative-identity-disorder-multiple-personality-disorder
Dorahy, M. J., Brand, B. L., Şar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas, A., Lewis‐Fernández, R., & Middleton, W. (2014). Dissociative identity disorder: An empirical overview. Australian and New Zealand Journal of Psychiatry, 48(5), 402–417. https://doi.org/10.1177/0004867414527523
Dormaier, J. (n.d.). Understanding Dissociative Identity Disorder [Free Webinar]. Retrieved November 29, 2023, from https://www.eventbrite.com/e/understanding-dissociative-identity-disorder-free-webinar-tickets-740412703327
Hales, R. E., Yudofsky, S. C., Laura Weiss Roberts, & American Psychiatric Publishing. (2014). The American Psychiatric Publishing textbook of psychiatry. American Psychiatric Publishing.
International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115–187. https://doi.org/10.1080/15299732.2011.537247
Lady Xenia Bowlby. (2014). Living with the reality of Dissociative Identity Disorder: Campaigning voices. Edited by Deborah Brigg & Xenia Bowlby. London: Karnac Books.
Maharaj, Ms., HSP3C, WordPress, & Vanier. (2017). [Dissociative Identity Disorder reference]. https://hsp3catvanier.files.wordpress.com/2017/05/picture1.png?w=300
Marmormo, & IStock. (2019). Dissociative Identity Disorder vector illustration. https://www.istockphoto.com/vector/dissociative-identity-disorder-vector-illustration-woman-with-other-faces-gm1158616190-316555386?phrase=dissociative&searchscope=image%2Cfilm
Melitas, & IStock. (2020). Metaphor bipolar disorder mind mental double face split personality concept. https://www.istockphoto.com/vector/metaphor-bipolar-
Mohsin, H. (2022, June 14). Dissociative Identity Disorder Awareness Day. National Today. https://nationaltoday.com/dissociative-identity-disorder-awareness-day/#:~
Oxford Languages. (2023). Oxford Languages. Oxford University Press. https://languages.oup.com/google-dictionary-en/
Pasquini, P., Liotti, G., Mazzotti, E., Fassone, G., & Picardi, A. (2002). Risk factors in the early family life of patients suffering from dissociative disorders. Acta Psychiatrica Scandinavica, 105(2), 110–116. https://doi.org/10.1034/j.1600-0447.2002.01062.x
Reinders, A. A. T. S., Willemsen, A. T. M., Vos, H. P. J., Boer, J. A. D., & Nijenhuis, E. R. S. (2012). Fact or factitious? A psychobiological study of authentic and simulated dissociative identity states. PLOS ONE, 7(6), e39279. https://doi.org/10.1371/journal.pone.0039279
Reinders, A. A. T. S., & Veltman, D. J. (2020). Dissociative identity disorder: Out of the shadows at last? British Journal of Psychiatry, 219(2), 413–414. https://doi.org/10.1192/bjp.2020.168
Reinders, A. A. T. S., Marquand, A. F., Schlumpf, Y. R., Chalavi, S., Vissia, E. M., Nijenhuis, E. R. S., Dazzan, P., Jäncke, L., & Veltman, D. J. (2018). Aiding the diagnosis of dissociative identity disorder: Pattern recognition study of brain biomarkers. British Journal of Psychiatry, 215(3), 536–544. https://doi.org/10.1192/bjp.2018.255
Ringrose, J. L. (2012). Understanding and treating Dissociative Identity Disorder (or Multiple Personality Disorder). Taylor & Francis Group.
Schematherapyservices.co. (n.d.). [Schema Therapy Services – Individual therapy]. https://schematherapyservices.co.uk/individual-therapy/
Shyamalan, M. (Producer & Director). (2016). Split [Film]. Universal Pictures.
Split: A review and its unexpected merit. (n.d.). https://wp.nyu.edu/steinhardt-appsych_opus/split-a-review-and-its-unexpected-merit/