The most severe of the dissociative disorders, characterized by the appearance of two or more longterm personality states that control the person's behavior, alongside the loss of important personal information and other memories that cannot be explained by ordinary forgetfulness. It was formerly known as multiple personality disorder or MPD.
Dissociative identity disorder (DID) is one of the most controversial diagnoses in the history of the Diagnostic and Statistical Manual of Mental Disorders (DSM). There is no consensus on either its diagnosis or its treatment, and it is rarely successful as a form of the insanity defense in courts of law.
Cases of DID were rare in the medical literature up through the nineteenth century, when they were generally diagnosed as instances of hysteria by Jean-Martin Charcot (1825–1893) and other neurologists in that period. Such fictional presentations as Robert Louis Stevenson's Strange Case of Dr. Jekyll and Mr. Hyde, along with such movies as Sybil and The Three Faces of Eve, popularized the disorder in the twentieth century. Case reports of DID began to multiply in the 1980s and following—particularly after DID was formally included as a diagnosis in the fourth edition of DSM (DSM-IV), published in 1994. In addition to the number of cases, the number of alternate personalities (alters) reported by patients also rose, from two or three to as many as 16.
DID aroused numerous disputes among psychiatrists in the 1980s and 1990s, partly because of the rapid increase in the number of cases; partly because of the lack of cases in children; partly because the great majority of cases were reported only in North America rather than being distributed worldwide; and partly because of evidence that the disorder is in some instances iatrogenic (therapist-induced). In particular, the case of “Sybil,” the pseudonym for the patient in the book of the same name, was exposed as an instance of a therapist suggesting multiple personalities to the patient, in effect implanting the patient's alters. The patient and the therapist, however, are both deceased; the therapist's case files were destroyed after her death; and the case remains unresolved.
Psychiatrists disagree on the incidence of DID in the general population, although most estimate that it occurs in about 1% of people in the community. It is more common in young adults than in older people. The sex ratio is about 5–9 F: 1 M, although some researchers think that the disproportion may be due to the likelihood of males with DID ending up in jail rather than a therapist's office.
Symptoms of dissociative identity disorder include:
DSM-5 specifies five criteria that must be met for a diagnosis of DID:
Patients diagnosed with DID have a high rate of comorbid psychiatric disorders, most often major depression, borderline personality disorder, substance abuse disorders, eating disorders, and anxiety disorders. Because of this high rate of concurrent disorders, a psychiatrist evaluating a patient who claims to have DID needs to rule out malingering and factitious disorder.
DID rarely resolves by itself without therapy, and the diagnosis is often delayed; on average, patients spend six to eight years in the mental health system before their DID is identified. While there is no universally agreed-upon protocol for treating DID, most psychiatrists begin by making sure the patient is safe (not suicidal) and medically stable; hospitalization may be required during this stage of therapy. The next step usually includes tracing the patient's alters, identifying them, and helping the patient cope more effectively with the demands and stressors of daily life. In most cases some or most of the patient's alters disappear over the course of therapy as they are reintegrated into the patient's core personality, but not all patients are successful in reintegrating all their alters. Therapy for DID typically takes years rather than weeks or months.
While there is no medication that is specific to treating dissociation as a symptom, most psychiatrists will prescribe antidepressants or anxiolytics (tranquilizers) to treat the patient's depressive symptoms or anxiety disorders.
See also Abuse; Amnesia ; Post-traumatic stress disorder (PTSD) .
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International Society for the Study of Trauma and Dissociation, 8400 Westpark Dr., 2nd Fl., McLean, VA, 22102, (703) 610-9037, Fax: (703) 610-0234, email@example.com, http://www.isst-d.org/ .
National Alliance on Mental Health (NAMI), 3803 North Fairfax Dr., Ste. 100, Arlington, VA, 22203, (703) 5247600, (800) 950-6264, Fax: (703) 524-9094, http://www.nami.org/ .