While awareness for this condition has grown, many still know it as “multiple personality disorder” and have negative connotations for it considering the way it has historically been represented in media. DID is a trauma based disorder, most likely to initially form due to repeated inescapable trauma experienced in childhood. Often, the person with DID doesn’t recognize that they are a system of alters until later in life, if ever.
DSM 5 Criteria for DIssociative identity disorder
- 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.
- Amnesia must occur, defined as gaps in the recall of everyday events, important personal information and/or traumatic events. It’s important to note that the amnesia does not only occur in traumatic situations.
- The person must be distressed by the disorder or have trouble functioning in one or more major life areas because of the disorder.
- The disturbance is not part of normal cultural or religious practices. For example, a child’s imaginary friend or spiritual beliefs around multiplicity likely doesn’t indicate the presence of DID.
- The symptoms are not due to the direct physiological effects of a substance (such as blackouts or chaotic behavior when drinking or high) or a general medical condition (such as complex partial seizures).
In real life, this might look like not remembering conversations that others report you had, large gaps in memory not explained by a substance, and suddenly finding yourself somewhere without knowing why/how you got there. Others might observe unusual shifts in personality, behavior, interests, and taste. It can be very subtle to start, and difficult to differentiate from other potential explanations.
Other specified dissociative disorders (OSDD) is another diagnosis to consider. There are 4 types.
OSDD1
“Identity disturbance associated with less-than-marked discontinuities in sense of self and agency, or alterations of identity or episodes of possession in an individual who reports no dissociative amnesia.” The alters you have are less distinct, might never front, and might only be accessed in your mind. The alters might more so be different versions of the host, as opposed to completely different personalities. Emotional amnesia and grey-outs in memory occur, rather than full blackouts.
OSDD2
“Identity disturbance due to prolonged and intense coercive persuasion.” For example, prisoners of war and victims of brainwashing or torture might experience this. Being in a prolonged, abusive relationship might also bring up symptoms. This is less likely to result in fully formed alters.
OSDD3
An acute reaction to stressful events, with symptoms of depersonalization and derealization. This is also less likely to result in fully formed alters, and is more accurately described dissociative trauma response.
OSDD4
A dissociative trance “an acute narrowing or complete loss of awareness of immediate surroundings that manifests as profound unresponsiveness or insensitivity to environmental stimuli.” This is also unlikely to result in alters, and is more accurately described as a dissociative trauma response.
Other diagnoses to consider and potentially rule out (or understand how the symptoms interact with each other!) include autism, ADHD, and C-PTSD. All of these can impact your memory and sense of self in a way that doesn’t necessarily mean you have DID. Talking with a therapist, friends, and family can be a way to get more information to understand yourself. At the end of the day, the diagnosis itself likely isn’t as relevant as the way you go about treating it. It can be an important part of understanding yourself and validating your experiences, but I encourage anyone reading this to focus on the trauma work first. The other answers will come with time, and you’re most likely to get the best results for yourself if you enter with an open mind. Find a therapist with an open mind as well who is willing to consider everything that you want to explore, and is knowledgeable about complex trauma.
Kit Shulman, LCAT is licensed in New York State as a creative arts therapist. He has an MS in creative arts therapy from Nazareth College and has been practicing art-based psychotherapy since 2020. He currently see clients at Spotted Rabbit’s Brighton, NY studio and serves as intern coordinator.
Kit has a special interest in, and experience treating dissociative disorders. He believes in developing communication between alters first, rather than forcing integration. IFS and other trauma-focused approaches are utilized.