Dissociative identity disorder (DID) is a dissociative disorder that results in what is often referred to as “split” personalities. While often confused for borderline personality disorder, it is a very different illness; borderline personality disorder does not often present with amnesia and the symptoms are not as severe(Brand et al., 2017). Often in DID, there is a dominant personality and several inferior ones. DID is been classified as a trauma- based illness, due to the link between early childhood abuse and the disorder itself (Brand et al., 2016; Ross and Ness, 2010; Ducharme, 2017; Şar, Dorahy, Krüger, 2017). Evidence shows the disorder occurs around the world, but representations of clinical diagnosis may be skewed due to different cultural interpretations; some countries refer to DID as possession (Şar, Dorahy, Krüger, 2017). According to the DSM-V, to be diagnosed with DID you must present with at least two personalities that appear to alternate with one another and autobiographical amnesia (Nevid, Greene, Johnson, Taylor, Macnab, 2015). Psychotherapy is the most often used treatment style for DID, and a three-stage treatment approach is recommended for effective treatment of DID (Ducharme, 2017; Schimmenti 2017; Brand et al., 2017). Despite the influx of dissociative identity disorder in pop culture and awareness in the real world, more work needs to be done to fully understand the disease.
An early case study of DID based on a patient called Elena established an early basis for what DID is. While dissociative identity disorder has been documented since the 16th century, Elena’s case is well regarded in Italian psychological history, as it was published in a prominent journal in the thirties (Schimmenti, 2017; Brand et al., 2017). Through her time in treatment she exemplified two to five distinct personalities (Schimmenti, 2017). Her personalities being both Italian and French speaking children of varying ages, and adults who also spoke Italian and French (Schimmenti, 2017). According to Schimmenti (2017) her psychiatrist, Giovanni Morselli used the three-step treatment method successfully, before it became a guideline for treating DID. The treatment guidelines for DID were published in 1994 (Brand et al., 2017). Through Morselli’s time and careful treatment, as well as establishment of a strong therapeutic alliance, Morselli was able to help Elena resolve her childhood trauma and integrate her back into society until her untimely death in 1928 (Schimmenti, 2017). The presence of early childhood trauma likely increased the chance of, if not caused her DID. This link between early childhood trauma and DID has been studied extensively. Ross and Ness (2010) conducted a study on sexual abuse and DID. Participants with a history of sexual abuse presented with more severe symptoms, and an increase in incidence of both DID and other dissociative disorders (Ross and Ness, 2010). As DID is comorbid with several other mental illnesses, the chance that an individual will be diagnosed with dissociative identity disorder can be estimated from other mental health disorders the patient may have (Ross and Ness, 2010). Dissociative identity disorder is often comorbid with PTSD, substance abuse, major depressive disorder, and borderline personality disorder (Ross and Ness, 2010). Similar to other psychological disorders, the effects of each individual abusive factor compound upon one another, leading to an exponential increase in the chances that one will develop dissociative identity disorder (Ross and Ness, 2010). A study conducted by Middleton and Butler (1998) on Australian citizens who met the DSM-IV outlines for dissociative identity disorder, fully shows how detrimental DID can be. Descriptions of serious self-harm, depression, relationship problems, suicide, hallucinations and numerous somatic symptoms are mentioned within the paper (Middleton and Butler, 1998). Depersonalization (a feeling of disconnect within oneself) has a 71% incidence rate within the group of individuals suffering from DID (Middleton and Butler, 1998). Autobiographical amnesia (being unable to remember personal events) is an extremely common phenomenon in DID patients, and part of the DSM diagnostic criteria had a 90% incidence rate in the study (Middleton and Butler, 1998).
Since dissociative identity has come to the forefront of psychological research, there have been studies worldwide into what causes DID, who is affected etc. Studies have been conducted in Turkey, Australia, Canada, United States, Puerto Rico, the Netherlands, and Germany in regard to DID (Sar, Dorahy, Krüger, 2017). Instances of DID were found in all aforementioned countries with a approximately 1% prevalence rate within the general population (Sar, Dorahy, Krüger, 2017). Early childhood abuse, neglect or other severe trauma can induce presentation of DID. So, those who have undergone abuse throughout their childhood have a higher incidence rate of DID (Brand et al. 2017; Ducharme 2017; Sar, Dorahy, Krüger 2017; Ross and Ness, 2010). Dissociative identity disorder presents in both genders, but most literature focusses on females due to the higher rates of sexual abuse within that demographic (Ross and Ness, 2010).
Features of DID according to the DSM-V are the presence of two or more personalities that alternate in controlling the individual, and autobiographical amnesia (Nevid et al., 2015). It is also important to note that these symptoms are not produced from drugs or any other illness. Similar to Morselli’s approach with Elena, a three-step approach for treatment has been recommended since its introduction in 1994 (Brand et al., 2017; Schimmenti, 2017). The first step of treatment is to establish trust between the clinician and patient (a therapeutic alliance). This is to ease the patient into feeling comfortable when talking about what are often painful, repressed memories (Brand et al., 2017). The first stage also deals with elimination of symptoms (Brand et al., 2017). The second step involves the management of symptoms, and resolution of the initial trauma (Brand et al., 2017). The last treatment step is the process of having the patient graduate into society, with symptoms reduced (or gone completely), their past traumas resolved, and personalities merged (Brand et al., 2017). However; this process is not fast; most patients spend upwards of three years in the psychiatric system before being appropriately diagnosed and then even longer undergoing treatment (Brand et al 2017; Schimmenti et al., 2017)
Dissociative identity disorder has also been brought to the forefront of the general population’s attention more than once. Most recently, a movie titled “Split”. In this movie a man (played by James McAvoy) suffers from multiple personality disorder and kidnaps three girls from a parking lot. While this movie became very popular and no doubt brought attention to the disorder, McAvoy’s character suffered from 24 distinct personalities most of which were violent. This portrayal is incredibly inaccurate as violence among the population of individuals suffering from mental illnesses is very rare. In conjunction with Split, there has also been a book released by Ellen Hopkins called “Identical”. This book tells a story from two twins, however; the twins are simply personalities within one girl, suffering with the disorder. Hopkins successfully integrates both the traumatic beginnings to DID, and the later story following the young girls struggle with the disorder. Much father back in history, Kenneth Bianchi attempted (unsuccessfully) to plead not criminally responsible on account of a mental disorder. Bianchi tried to portray himself as having DID while he was on trial for murder (Nevid et al., 2015). The Bianchi trial gave many people doubts as to whether or not DID actually exists.
In conclusion, DID is a debilitating psychological disease. Patients are often reduced to years in mental institutions before an appropriate diagnosis. While some may believe that DID is no more than a myth, it is very real and very hard to live with. Treatment is often long, and the symptoms are unbearable. Surprisingly, for as long as the disease has been around, there is not much information about its origins and possible biological predispositions.