Dissociative Identity Disorder

What is Dissociative identity disorder (DID)?

It is a disturbance in the normal integrative function of memory, identity and self and it is the only mental disorder with two or more distinct personality states.
(Chu, 2011)

Pierre Marie Félix Janet, a genius who died in 1947, understood trauma and it's affects on the brain and mind better than most do today. After his death, some influential researchers took another path which seems have been one that entailed mixing up dissociative identity disorder with the other complex dissociative disorder - otherwise described dissociative disorder. The road back to Janet's teachings had been a long and difficult one due to all the confusion, but it seems most researchers are indeed back on the correct path. The road of the DSM was also a bumpy one.

The term "multiple personalities" was first printed in the DSM in 1968 where it was used to describe what was called "hysterical neurosis, dissociative type." In 1980 (DSM III) multiple personality disorder became known as a stand alone diagnosis. Little changed with the 1994 printing of the DSM-IV other than the name, which is what is used today, and some subtleties which probably did not make much difference to diagnosis. Never has any mental disorder listed in the DSM as a dissociative disorder been considered to be a personality disorder. In addition, the term "personalities," although still used today, is only accepted as a term to refer to the many natural parts that make up everyone's personality.

I. Normal part of the personality

A normal personality state maintains a continuous sense of "I, and myself" over time, despite the transition from one state to another, whilst the separate states in individuals with dissociative identity disorder do not. (Gillig,2009)

II. Distinct state

A distinct personality state is seen in all the dissociative disorders, but only dissociative identity disorder has two or more distinct states. A distinct state is not a normal part of the personality. It's been altered due to trauma and they show up on an fMRI scan as a distinctly lit up area that switches as an individual with dissociative identity disorder switches from one distinct state to another. (Obsuth, Hennighausen, Brumariu, Lyons-Ruth, 2014) This state does not hold trauma memory and it does not usually act child-like. It is the part of an individual that attends to daily life activities such as raising children, having relationships, loving and feeling a normal range of emotions. For those that understand structural dissociation, this state is known as an apparently normal part (ANP).(Obsuth, Hennighausen, Brumariu, Lyons-Ruth, 2014) See our page on structural dissociation for more. (van der Hart, Nijenhuis, Kathy Steele, 2006)

Terminology of

The terms personalties, parts and states are correctly used interchangeably, (Dorahy, 2014) as well as subpersonalities, sides, subselves, internal self states, and ego states. (Noricks, 2011, p.1) These terms are all referring to the same thing, which are the multiple aspects that make up an individuals one personality.

III. Less than distinct state

Dissociated parts are found in all of the dissociative disorders, as well as in posttraumatic stress disorder (PTSD), dissociative posttraumatic stress disorder (D-PTSD), and the dissociative aspects of some forms of borderline personality disorder (D-BPD), but none of these disorders have more than one distinct state. Two or more distinct states, again are only found in dissociative identity disorder. (van der Hart, Nijenhuis, Kathy Steele, 2006) Lesser distinct states are far more common than distinct states. For those that understand structural dissociation, a less than distinct state is known as an emotional part (EP).(Obsuth, Hennighausen, Brumariu, Lyons-Ruth, 2014) It is often subject to vehement emotion since it's reacting to unprocessed trauma memories. See our page on structural dissociation for more.

IV. Amnesia between distinct states

Not all parts of the personality in individuals with dissociative disorders experience amnesia, and the less than distinct states can and often do have this experience, (Obsuth, Hennighausen, Brumariu, Lyons-Ruth, 2014) but the DSM-5 reports that for a diagnosis of dissociative identity disorder there must be amnesia between two or more distinct states, and as has already been explain, only dissociative identity disorder has two or more distinct states. (Dorahy & van der Hart, 2014)

V. Etiology

Unfortunately misconceptions, personal bias, media sources, and various forms of denial have worked together to distort the presentation, epidemiology and etiology of dissociative identity disorder, a mental illness often associated with extreme and early child abuse and neglect. (Dorahy & van der Hart 2014) This spread of misinformation has been going on for decades. Dissociative identity disorder is precipitated by prolonged exposure to overwhelming circumstances during early childhood. (ISSTD, 2011) This is most significantly noted in the formative years of development where the normal integration of parts should occur. Coping by dissociation is an innate ability all children have, but when nurturing and compassion are missing, the infant can rely heavily on dissociation to move their stressful and traumatic memories from consciousness. (Howell, 2011, p. 85-108) The age a child is when they become overwhelmed by trauma is critical to the development of dissociative identity disorder. (Brand, Loewenstein, Spiegel, D, 2014)(Schlumpf et al., 2014)

Important points of the DSM-5 criteria for Dissociative identity disorder

Disruption of identity characterized by two or more distinct states.

Amnesia between the distinct states.

The disturbance is not a normal part of broadly accepted cultural, religious practice, or part of the normal fantasy play of children.

The last two points are commonly stressed with any mental illness.

Causes clinically significant distress and impairment in social, occupational, or other important areas of functioning.

The disturbance is not due to the direct physiological effects of a substance.
(APA, DSM-5)

See our page on the Diagnostic and Statistical Manual of Mental Disorders (DSM-5)

VI. Integration

Normal integration can be described as thus. At birth, behavioral states are not linked, but do integrate naturally over the course of normal childhood. (Howell, 2011, p. 89) Parts group into sequences, until a sense of cohesiveness emerges that can fluently shift from one task-focused aspect of the personality to another. (Putnam, 1989, p. 51) The parts share and develop a sense of common identity, and retain the ability to easily transition from one state to another. (Howell, 2011, p. 89)

Lack of normal childhood integration can be due to repeated and extreme instances of neglect, abuse and mental torment or other trauma which inhibit normal linking. (Wilkinson, 2012, p. 81-93) Frank W. Putnam brought to light the idea that trauma in childhood causes a "disruption of the developmental tasks of consolidation of self across behavioral states and the acquisition of control over the modulation of states." (Putnam, 1989, p. 53)

VII. Physiological and psychophysiological measures

A variety of distinguishing physiological measures have been found in dissociated personality states including: visual acuity, medication response, allergies, plasma glucose levels in diabetic subjects, heart rate, blood pressure, galvanic skin response, muscle tension, immune function, electroencephalography, evoked potential patterns, functional magnetic resonance imaging activation, brain activation and regional blood flow. (ISSTD, 2011) These parts can also often have different psychophysiological organizations, such as different allergies, taste preferences, handedness, eyesight and prescriptions for glasses, and responses to medications. (Howell, 2011, p. 57)


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