What are the signs and symptoms of Dissociative Identity Disorder (DID)?

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Patients often have a remarkable array of symptoms that can resemble other neurologic and psychiatric disorders, such as anxiety disorders, personality disorders, schizophrenic and mood psychoses, and seizure disorders. Most have symptoms of depression, manifestations of anxiety (sweating, rapid pulse, palpitations), phobias, panic attacks, physical symptoms, sexual dysfunction, eating disorders, and posttraumatic stress. Suicidal preoccupations and attempts are common, as are episodes of self-mutilation. Many have abused psychoactive substances at some time.

The switching of personalities and the amnesic barriers between them frequently result in chaotic lives. Because the personalities often interact with each other, patients with dissociative identity disorder often report hearing inner conversations and the voices of other personalities, which often comment on or address the patient. The voices are experienced as hallucinations.

Several symptoms are characteristic of dissociative identity disorder: fluctuating symptom pictures; fluctuating levels of function, from highly effective to disabled; severe headaches or other bodily pain; time distortions, time lapse, and amnesia; and depersonalization and derealization. Depersonalization refers to feeling unreal, removed from one's self, and detached from one's physical and mental processes. The patient feels like an observer of his life and may actually see himself as if he were watching a movie. Derealization refers to experiencing familiar persons and surroundings as if they were unfamiliar and strange or unreal.

Persons with dissociative identity disorder are often told of things they have done but do not remember and of notable changes in their behavior. They may discover objects, productions, or handwriting that they cannot account for or recognize; they may refer to themselves in the first person plural (we) or in the third person (he, she, they); and they may have amnesia for events that occurred between ages 6 and 11. Amnesia for earlier events is normal and widespread.

Because dissociative identity disorder tends to resemble other psychiatric disorders, patients typically give histories of having had three or more different psychiatric diagnoses and of prior treatment failure. As a group, they are very concerned with issues of control, both self-control and control of others.

Diagnosis of Dissociative Identity Disorder

The diagnosis requires medical and psychiatric evaluation, including specific questions about dissociative phenomena. Under some circumstances, the psychiatrist may use prolonged interviews, hypnosis, or drug-facilitated interviews and may ask the patient to keep a journal between visits. All of these measures encourage a shift of personality states during the evaluation. Specially designed questionnaires can help identify patients with dissociative identity disorder.

The psychiatrist may attempt to contact and elicit other personalities by asking to speak to the part of the mind involved in behaviors for which the patient had amnesia or that were experienced in a depersonalized or derealized fashion.

continue: Prognosis and Treatment of DID

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Reviewed: 04/2006