Dissociative Identity Disorder (DID) Defined

Amnesia involving an inability to recall important personal information relating to some of the identities is present. Amnesia is not uniform in all personalities; what is not known by one personality may be known by another. Some personalities may appear to know and interact with other personalities in an elaborate inner world. For example, some personalities of which personality A is unaware may be aware of personality A and know what it does, as if observing its behavior. Others may be unaware of personality A or may be aware of personality A but lack co-consciousness (the simultaneous awareness of events by more than one personality) with personality A.

Dissociative identity disorder is serious and chronic and may lead to disability and incapacity. It is associated with a high incidence of suicide attempts and is believed to be more likely to end in suicide than any other mental disorder.

Several studies show that previously undiagnosed dissociative identity disorder is present in 3 to 4% of acute psychiatric inpatients and in a sizable minority of patients in psychoactive substance abuse treatment settings. It appears to be rather common, being diagnosed more frequently in recent years because of enhanced awareness of it, improved diagnostic methods, and increased awareness of childhood mistreatment and its consequences. Although some experts believe that increased reports of this disorder reflect the influence of physicians on suggestible patients, no firm evidence substantiates this view.

Development of DID

Dissociative identity disorder is attributed to the interaction of several factors: overwhelming stress, dissociative capacity (including the ability to uncouple one's memories, perceptions, or identity from conscious awareness), the enlistment of steps in normal developmental processes as defenses, and, during childhood, the lack of sufficient nurturing and compassion in response to hurtful experiences or lack of protection against further overwhelming experiences. Children are not born with a sense of a unified identity--it develops from many sources and experiences. In overwhelmed children, its development is obstructed, and many parts of what should have blended into a relatively unified identity remain separate.

North American studies show that 97 to 98% of adults with dissociative identity disorder report abuse during childhood and that abuse can be documented for 85% of adults and for 95% of children and adolescents with dissociative identity disorder and other closely related forms of dissociative disorder. Although these data establish childhood abuse as a major cause among North American patients (in some cultures, the consequences of war and disaster play a larger role), they do not mean that all such patients were abused or that all the abuses reported by patients with dissociative identity disorder really happened. Some aspects of some reported abuse experiences may prove to be inaccurate. Also, some patients have not been abused but have experienced an important early loss (such as death of a parent), serious medical illness, or other very stressful events. For example, a patient who required many hospitalizations and operations during childhood may have been severely overwhelmed but not abused.

Human development requires that children be able to integrate complicated and different types of information and experiences successfully. As children achieve cohesive, complex appreciations of themselves and others, they go through phases in which different perceptions and emotions are kept segregated. Each developmental phase may be used to generate different selves. Not every child who experiences abuse or major loss or trauma has the capacity to develop multiple personalities. Patients with dissociative identity disorder can be easily hypnotized. This capacity, closely related to the capacity to dissociate, is thought to be a factor in the development of the disorder. However, most children who have these capacities also have normal adaptive mechanisms, and most are sufficiently protected and soothed by adults to prevent development of dissociative identity disorder.

continue: Signs and Symptoms of DID

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Reviewed: 04/2006