Dissociative Identity Disorder (DID) | Knowledge Center (2023)

Dissociative Identity Disorder (DID) – formerly known as Multiple Personality Disorder – is a relatively common psychiatric disorder that may affect 1-3% of the general population. DID is characterized by a significant disruption of a unified sense of self and continuity of experience, exemplified by two or more personality/identity/self states. In some cultures, this disruption of a unified sense of self may be understood as an experience of possession that is not considered congruent with that culture’s spiritual/religious practices.

In addition, individuals with DID experience Dissociative Amnesia (DA): a disruption in memory for important personal information, as well as for current and past personal experience, that is inconsistent with ordinary memory problems.

This significant disruption in a unified sense of self and memory can occur in a number of ways that include hard to explain disturbances and/or variability in:

  • Behavior
  • Thoughts
  • Emotions
  • Memory
  • Perceptions
  • Consciousness
  • Bodily sensations or functioning

These disruptions and alterations cannot be better explained by the effects of alcohol or drugs, or a medical or brain disorder, such as epileptic seizures. These symptoms must cause significant problems with functioning.

Unlike portrayals in the media, the “fascinating”, stereotyped external characteristics of DID self states, such as different names, voice tone, accents, wardrobe, hair-styles, handwriting, and more, are not essential for diagnosis and are secondary factors to the core phenomena of DID.

The diagnostic criteria for DID mean that there are two or more relatively separate centers of information processing in the mind. Each information processing center in the mind is characterized by:

  • A sense of personal identity
  • A self-image
  • A set of (state dependent) autobiographical memories
  • A sense of ownership of personal experience
  • Capacity to control/enact behavior

These self states may shift, switch, or overlap in a number of ways that lead to the disruption in self and continuity of experience in DID.

The individual’s personality/identity/self states are NOT separate people. These are subjective states of the individual’s mind. All of the DID states together make up the whole person and that person’s total personality.

(Video) Dissociative Identity Disorder

Because of this, and unlike descriptions in the popular media, the individual with DID as a whole person is held responsible for behavior, even if experienced with amnesia or a sense of lack of control over one’s actions.

The Development of Dissociative Identity Disorder

Individuals with DID report the highest rates of childhood trauma, particularly physical, sexual, and emotional abuse – generally beginning before the age of six – of patients with any psychiatric disorder. Because of this, DID can be conceptualized as a childhood onset, posttraumatic developmental disorder in which the traumatized child is unable to complete the normal developmental processes involved in consolidating a core sense of self. Together with disturbed caretaker-child attachment and parenting, repeated early trauma disrupts the development of normal processes involved in the elaboration and consolidation of a unified sense of self. Therefore, the child fails to integrate the different experiences of self that normally occur across different states and contexts.

DID has been found in children, adolescents, and adults. Unfortunately, early trauma may be a risk factor for later trauma. DID individuals report very high rates of adult rape, intimate partner violence, and other forms of exploitation, such as being a victim of trafficking.

DID is both a disorder and a form of resilience. Psychological compartmentalization of traumatic/overwhelming experiences allows for more normal development of the capacity for clear thinking, intellectual and creative abilities, the ability to understand reality, development of a sense of humor, the capability for attachment to others, and a capacity for insight – all important in the psychotherapy treatment of DID.

Symptoms of Dissociative Identity Disorder (DID)

The posttraumatic origins of DID mean that anywhere between 80 and 100% of individuals with DID who receive treatment also have symptoms of posttraumatic stress disorder (PTSD - see section on PTSD). Other disorders commonly associated with DID are depression or very rapid “mood swings” that frequently do not (or only very partially) respond to medications; substance abuse; and unexplained medical symptoms with repeated “negative” work ups, typically for apparent seizures or other neurological disorders.

One of the most common symptoms of DID is hearing voices, most often within the mind. Because of this, many individuals with DID are unsuccessfully treated with medications for schizophrenia or other psychotic disorders (see section on psychotic disorders).

Individuals with DID have very high rates of self-destructive and suicidal behavior and often have multiple, usually unproductive, hospitalizations for mood disorders, personality disorders, and/or psychotic diagnoses. The average individual with DID spends five to 12.5 years in mental health treatment until a correct diagnosis is made.

Having suicidal or self-destructive thoughts, impulses, urges, plans or behavior require emergency treatment, including calling 911 or going to the nearest Emergency Department or Mental Health Urgent Care Clinic.

(Video) What is Dissociative Identity Disorder?

A diagnosis of dissociative identity disorder should be suspected if you or your loved one:

  • Receives numerous different psychiatric diagnoses, yet does not respond to many different types of treatments including multiple medications, types of psychotherapy, or neurostimulation treatments like electroconvulsive therapy (ECT) and transcranial magnetic stimulation (TMS).

Unlike the stereotype of DID, symptoms of DID are usually subtle and hidden, and individuals with DID do not readily reveal their symptoms without careful examination by a mental health professional.

You or your loved ones may notice the person is:

  • Repeatedly very “moody”
  • Highly changeable from time to time, and
  • Has difficulty recalling important personal experiences.
  • This can include a variety of current behaviors and parts of the life history, that are not related to use of substances or medications, or to brain injuries or diseases.

These difficulties recalling important personal experiences can include:

  • Significant gaps in memory for life history
  • Experiencing “black outs” or “time loss”: gaps in remembering current life history
  • Lack of recall of complex, witnessed behaviors – even positive behaviors, such as doing well in a presentation at work
  • Not remembering or difficulty remembering important events, such as graduations, birthdays, weddings, and vacations, that other family members recall well
  • Recurring puzzling lack of memory for things that the person has purchased or created
  • Inexplicable alterations in abilities and habits, such as forgetting that one can play a musical instrument, or changing suddenly from a smoker to a non-smoker, then back again
  • Repeated unexplained travel or “getting lost” in familiar places
  • Repeated rationalizations for being “forgetful” or “preoccupied”

Other common symptoms of DID include:

  • Hearing voices, particularly inside one’s mind; these are often experienced as having their own sense of self, such as a child’s voice, an angry voice, a caring and supportive voice, among others
  • Seeing things that others do not see, such as people, faces, or visions, including seeing the “people” that one is hearing talking
  • Out of body experiences, as if watching oneself from a distance outside, or even inside oneself, frequently accompanied by the feeling that one can observe, but not control what one is doing
  • Feeling like you are disconnected from the world around you as if seeing through a fog; things seem unreal
  • Experiencing repeated inexplicable, sudden intrusions of thoughts, feelings, urges, or actions that one does not control
  • Experiencing repeated inexplicable, sudden deletion of thoughts, feelings, behavior that one does not control
  • Feeling divided with different senses of self that seem relatively independent of one another, and often are in a conflict or a struggle
  • Inexplicably feeling very different at different times with varying opinions, abilities, habits, and access to memory and learned information

Treatment of Dissociative Identity Disorder

DID is a treatable disorder once it is properly diagnosed. Clinicians who understand DID symptoms can diagnose DID in the clinical interview. There are also paper and pencil tests that can help clinicians diagnose DID and other dissociative disorders.

Studies show that DID symptoms improve over time when treated using Phasic Trauma Treatment.

Phasic Trauma Treatment

Phasic trauma treatment is a psychotherapeutic treatment that has three phases:

(Video) Reducing the Impact of Dissociative Identity Disorder

  1. Safety and stability
  2. Work on traumatic memories
  3. Re-integration into life

In DID treatment, working directly with the DID identities is crucial to diminish symptoms and to maximize the resilience found in most people with DID. The first phase, safety and stability, is the most important. During this phase, individuals learn how to stabilize symptoms of DID and PTSD, using a variety of psychotherapeutic techniques and sometimes adjunctive/add-on medications.

It is critical for the individual with DID to develop safety from suicidal and self-destructive behaviors, substance abuse, eating disorders, high risk behaviors, unsafe people, and other dangerous behaviors and situations. This is because DID develops in a childhood environment of repeated lack of safety and unpredictable danger.

Without development of safety, DID treatment will not progress.

Not all individuals with DID wish to address his/her traumatic experiences in depth. However, if the individual with DID agrees, and has achieved safety and stability, Phase 2 is focused more on carefully and slowly recalling the life history – which is often experienced as PTSD flashbacks. Therefore, this phase also involves ongoing work on safety and additional stabilization of DID and PTSD symptoms.

In Phase 3, the individual’s DID and PTSD symptoms have usually substantially moderated, and the individual with DID may even experience subjective fusion of some or all self states, with complete merging of the characteristics of these subjective identities. This frees up energy for a focus on living better in the present.

Adjunctive/Add-On Treatments for Dissociative Identity Disorder

Hypnotherapy: Hypnotherapy can be helpful in stabilizing DID and PTSD symptoms. However, hypnotherapy can only be used if the therapist has received certification in using hypnosis and has specialized training in its use in DID and other posttraumatic disorders. Make sure to ask your provider about his/her credentials in using hypnosis.

Medications: Medications are adjunctive (add-on) treatments in DID treatment and do not directly affect the basic symptoms of DID. In DID treatment, medications do not have a major direct effect on symptoms unless there are other specific disorders present. For example, there are medications that can substantially improve symptoms of PTSD, although some people cannot take these due to side effects.

Medications for depression and mood symptoms usually have limited effects, but may provide some symptom relief as long as the patient and practitioner have carefully identified which symptoms will and will not be helped by medications. Medications for anxiety symptoms can be moderately helpful but must be monitored carefully, especially in individuals with a history of substance abuse.

(Video) What It's Like to Live with Depression & Dissociative Identity Disorder (DID)

Individuals with DID often have a complex, chronic sleep disturbance with difficulty falling asleep, staying asleep, nightmares, and even complex behaviors that appear to emerge out of sleep. There are medications that can help PTSD nightmares and this may improve sleep, if the patient does not have problematic side effects. Sedating medications often are only partially helpful. Specific DID psychotherapy is often required to assist with fears and flashbacks related to bed, night, and sleep, and nighttime dissociative symptoms.

Other Types of Psychotherapy that can Assist with DID Treatment

Other forms of psychotherapy such as dialectical behavioral therapy (DBT) and cognitive behavioral therapy (CBT) that is focused on trauma-related cognitive distortions can be helpful as adjunctive/add-on to the phasic psychotherapy for DID.

Eye-Movement Desensitization and Reprocessing Therapy (EMDR): Eye-movement Desensitization and Reprocessing Therapy (EMDR) is a treatment that has been found to improve PTSD symptoms, typically in people who have experienced specific adult traumas.

EMDR can significantly worsen the symptoms of DID, especially if used before the DID patient is stabilized in treatment. EMDR can be an adjunctive/add-on treatment if the therapist has full training in EMDR and has specialized training in its use in DID and other complex posttraumatic disorders.

Group Therapy: Group therapy can be helpful for the stabilization of individuals with DID if they are in a group dedicated to patients with this diagnosis, and the group is facilitated by practitioners that are knowledgeable about DID treatment. Individuals with DID usually do not do well in general therapy groups, even those that focus on PTSD and trauma, but are not designed for severely dissociative patients.

In general, DID experts do NOT recommend the use of non-professionally facilitated support groups in the treatment of DID, including online support groups. Both in-person and online “support” groups ultimately may have a severely negative impact on the individual with DID and his/her treatment.

Family Involvement: Family treatment, usually with the patient’s spouse, or significant other can be helpful, for education and to help support both the patient and the family during an often long and difficult treatment. In particular, family members are educated to not directly interact with the patient’s varying self states, but should regard their partner as a “whole human being,” and not a group of separate “people.” Specialized couple’s therapy may be helpful if the therapist is knowledgeable about treatment of childhood trauma and its impact on adult relationships.

Rehabilitation Therapies: Adjunctive/add-on rehabilitation therapies like art therapy and occupational therapy can be helpful if the therapist has training in the use of these modalities in the treatment of complex posttraumatic disorders like DID.

(Video) Encina Is Back: Dissociative Identity Disorder (DID) Updates [New Series]

To learn more about dissociative identity disorder, visit The Trauma Disorders Program's section of our website and the International Society for the Study of Trauma and Dissociation's website.


Is OSDD part of DID? ›

Chronic complex DD include dissociative identity disorder (DID) and the most common form of dissociative disorder not otherwise specified (DDNOS, type 1), now known as Other Specified Dissociative Disorders (OSDD, type 1).

Does a person with DID know they have it? ›

Most people with DID rarely show noticeable signs of the condition. Friends and family of people with DID may not even notice the switching—the sudden shifting in behavior and affect—that can occur in the condition.

How do you accept having DID? ›

My coping strategies for living with DID
  1. End the blame and the shame. It's important to tell yourself that this illness is not your fault. ...
  2. Build your knowledge. ...
  3. Find calm and relaxation. ...
  4. Start planning and organising. ...
  5. Develop emergency strategies. ...
  6. Form a support network. ...
  7. Communicate.
Jun 8, 2018

Where do alters come from DID? ›

In DID, alters are created unconsciously as a way for the brain to cope with trauma. Typically, it has characteristics deemed desirable to keep one safe. Each alter holds a different memory, role and meaning within the system. These alters can have different ages, gender, names and perceived appearance.

Is DID worse than OSDD? ›

In terms of other differences, it seems that as a general rule the degree of the trauma or attachment difficulties leading to OSDD will be less severe than people who are diagnosed with dissociative identity disorder, especially polyfragmented dissociative identity disorder.

How can you tell the difference between DID and OSDD? ›

Differentiating Between Dissociative Identity Disorder and Other Specified Dissociative Disorder. Some people with OSDD have two or more distinct personality states, or alters, but don't experience any gaps in memory or amnesia, a necessary symptom for a DID diagnosis.

What does switching feel like DID? ›

Some indicators that a switch may be about to occur include the following: feeling "spacey", depersonalized, or derealized; blurred vision; feeling distanced or slowed down; feeling an alter's presence; or feeling like time is beginning to jump (indicating minor episodes of time loss).

Do people with DID remember what they do? ›

People with DID cannot remember important or everyday events if they occurred while a different identity was present. They can forget meetings, lose possessions or even not recognize their own children because they cannot remember their birth at that moment.

Do people with DID know they have trauma? ›

✘ Myth: If you have DID, you can't know you have it. You don't know about your alters or what happened to you. While it is a common trait for host parts of a DID system to initially have no awareness of their trauma, or the inside chatterings of their mind, self-awareness is possible at any age.

Can you ever stop having DID? ›

There is no cure for DID. Most people will manage the disorder for the rest of their lives. But a combination of treatments can help reduce symptoms. You can learn to have more control over your behavior.

What do people with DID feel like? ›

Someone diagnosed with DID may feel uncertain about their identity and who they are. They may feel the presence of other identities, each with their own names, voices, personal histories and mannerisms. The main symptoms of DID are: memory gaps about everyday events and personal information.

What is it like living with someone with DID? ›

Living with and loving someone with multiple identities that can appear at any time is stressful and sometimes frightening. It can stir up difficult emotions, like sadness, hopelessness, anxiety, and even anger and resentment. You need care, too, for dealing with this challenging illness.

What is a gatekeeper DID? ›

Gatekeeper: A gatekeeper is an alter that controls switching or access to front, access to an internal world or certain areas within it, or access to certain alters or memories.

How do you bring out an alter? ›

A positive trigger is something non-trauma related and is pleasant enough to cause an alter to come forward and experience happy emotions, such as a special toy, cute puppies, or a favorite ice cream flavor. A positive trigger, in some instances, can be used to bring forth an alter.

Can an alter split into two? ›

Alters that take from one or more source alters as they split may have more substance or be able to quickly gain substance, but many new splits at first feel disoriented, depersonalized, hollow, flat, or incomplete. These alters, which may hold only a single primary function or emotion, can be referred to as fragments.

Is splitting the same as DID? ›

A split personality is a popular term for DID. In the past, DID was known as multiple personality disorder. People with DID have two or more distinct personalities. They do not present as simple changes in traits or moods.

Can you have DID without memory loss? ›

In DPDR you might not question your identity or have different identities at all. You may still be able to tell the difference between things around you. And there may be no symptoms of amnesia. Instead, with DPDR you might feel emotionally numb and questions what it feels like to live.

Can DID be misdiagnosed? ›

Are people with dissociative identity disorder often misdiagnosed? Yes. They are sometimes misdiagnosed as having schizophrenia, because their belief that they have different identities could be interpreted as a delusion. They sometimes experience dissociated identities as auditory hallucinations (hearing voices).

How do you tell if you're a DID system? ›

To qualify for the diagnosis, the person must have a disruption of identity characterized by two distinct personality states, which include alterations in behavior, memory, consciousness, cognition, and sense of self.

What are common alters of DID? ›

Several authors have described alter personality types: Child, persecutor, helper, opposite gender, memory trace, and suicidal alter personalities are among them [6].

How many personalities can you have with DID? ›

A person living with DID may have as few as two alters or as many as 100. The average number is about 10. Often alters are stable over time, continuing to play specific roles in the person's life for years.

How do you trigger a DID switch? ›

There are a variety of triggers that can cause switching between alters, or identities, in people with dissociative identity disorder. These can include stress, memories, strong emotions, senses, alcohol and substance use, special events, or specific situations.

Does switching Hurt DID? ›

People with DID have varying levels of awareness about their switching. Often people will experience some kind of physical symptom, like headaches, just before or after switching occurs. Loosing track of time could be another indicator that a person switched.

What kind of trauma causes DID? ›

The main cause of DID is believed to be severe and prolonged trauma experienced during childhood, including emotional, physical or sexual abuse.

Can someone with DID be aware of other personalities? ›

The person with DID may or may not be aware of the other personality states. Usually stress, or even a reminder of a trauma, can trigger a switch of alters. This can sometimes be abrupt and unexpected. In some cases, the person with DID may benefit from a particular alter.

Do people with DID have different brain activity? ›

When compared to the brains of normal controls, DID patients show smaller cortical and subcortical volumes in the hippocampus, amygdala, parietal structures involved in perception and personal awareness, and frontal structures involved in movement execution and fear learning.

Does everyone with DID have memory gaps? ›

People with DID will experience gaps in memory of every day events, personal information and trauma. Women are more likely to be diagnosed, as they more frequently present with acute dissociative symptoms.

Do people with DID have a primary personality? ›

With DID, there are two or more personalities (or identities) in one person. The main personality is known as the "host." The personalities can take over at different times. They may make you act very differently. That can make it hard for you to remember things that happen when another personality was in charge.

How many people are misdiagnosed with DID? ›

Dissociative identity disorder statistics vary but show that the condition occurs in anywhere from one-half percent to two percent of the population. Other dissociative identity disorder facts suggest that about seven percent of the general population may have the disorder, but remain undiagnosed.

Are people with DID psychotic? ›

Psychotic symptoms may occur in dissociative identity disorder (DID), in its partial presentations, and in acute dissociative conditions.

Can you willingly develop DID? ›

Well, the answer to whether you can voluntarily give yourself DID is unequivocal. No, you cannot give yourself DID.

What happens if dissociative identity disorder is left untreated? ›

Consequences of Untreated Dissociative Identity Disorder

People with untreated DID typically have significant problems in everyday life, including at work, at school, and in relationships. Suicidal behavior and other types of self-harm are especially common in people who suffer from this disorder.

Is having DID a disability? ›

Those living with dissociative identity disorder may not be viewed as having a disability. However, it is a disability that can greatly impair an individual, making them qualified for Social Security disability benefits for mental conditions if they meet the necessary criteria.

Can you merge personalities with DID? ›

It does happen! People are able to integrate their dissociated personalities that have been separate for a very long time behind an amnestic curtain. And true, it takes many years in psychotherapy with a skilled clinician for this process to complete itself thoroughly.

Is it hard to date someone with DID? ›

People with DID generally have trust issues that nearly incapacitate them in relationships. It's not unusual for protective alters to attempt to sabotage intimate relationships. That's not about you. Learn as much as you can, but remember all systems are different.

Can you live alone with DID? ›

A diagnosis of dementia does not automatically mean a person cannot safely live independently. Some people may be able to live on their own for some time after the initial diagnosis. Others may be at too much risk to continue living alone.

Is it possible to love someone with DID? ›

People with dissociative identity disorder can still have successful relationships. Consistent therapy is the only treatment, and can help them and their partners manage the anxiety, depression, and confusion that tend to come with the condition.

What is splitting DID OSDD? ›

Splitting is the act of creating a new alter in dissociative identity disorder (DID) or other specified dissociative disorder (OSDD-1). There are conflicting theories as to how this occurs, neither of which alone adequately describes all types of splitting but the combination of which does.

Does OSDD 1b have alters? ›

Most commonly, this describes individuals who have dissociative parts that are not sufficiently differentiated to qualify as alters (sometimes known as OSDD-1a) or individuals who do not have amnesia between alters (sometimes known as OSDD-1b).

Are there multiple types of DID? ›

The 3 main types are: depersonalisation-derealisation disorder. dissociative amnesia. dissociative identity disorder.

Does OSDD 1A have alters? ›

OSDD-1A usually has less distinction between parts. There will still be multiple alters in one body and amnesia still occurs, but the alters will all act like the "same person." Sometimes the alters in an OSDD-1A System will become distinct enough to want their own names, but may still act similarly to each other.

When are alters fully formed? ›

Alters are considered littles until they present at around 8 years old. After that, many consider them to be middles until they present at around 12 or 13 years old. Teenage alters are considered to be those between 13 and either 18 or 21 years of age. Adult alters, or bigs, are those older than the internal teens.

What does having OSDD feel like? ›

Conversion and somatoform types of dissociation may also occur in people with DID or DDNOS/OSDD. Thus, they may experience physical symptoms affecting their sensory or motor functions for which no physical cause in the present can be identified – e.g. blindness, deafness, mutism, paralysis, pain, seizures.

How can you tell if someone is fronting? ›

Fronting is the term used when sounds that should be made at the back of the mouth, such as /g/ are made at the front, /d/. In practical terms, this means that a child might say 'tea' instead of 'key' or say 'tar' instead of 'car. ' There are two types of fronting: velar fronting and palatal fronting.

How do you know if an alter is fronting? ›

One of the basic concepts within plurality is the idea of “fronting.” When an alter is fronting, they are controlling the body, and their emotions and thoughts are the strongest in the forefront of the mind's awareness. Some alters front frequently, while other alters never front at all.

Is split personality the same as DID? ›

A split personality is a popular term for DID. In the past, DID was known as multiple personality disorder. People with DID have two or more distinct personalities. They do not present as simple changes in traits or moods.

What is the difference between OSDD 1A and OSDD 1B? ›

Where the terminology OSDD-1A and OSDD-1B came from. Prior to today, within the (online) DID/OSDD community, OSDD-1A was described as having amnesia but no parts while OSDD-1B is described as having parts but without amnesia.

Does OSDD have amnesia? ›

OSDD type 1

The DSM states that "This category includes identity disturbance associated with less-than-marked discontinuities in sense of self and agency, or alterations of identity or episodes of possession in an individual who reports no dissociative amnesia".


1. Is Dissociative Identity Disorder Real?
(Dr. Todd Grande)
2. How I Found Out I Have Dissociative Identity Disorder | MedCircle x Encina Severa
3. Dissociative Identity Disorder
(MI Healthy Mind)
4. Developing communication in DID or OSDD through understanding alters / parts
(The CTAD Clinic)
5. Dissociative Identity Disorder The Hidden Condition
(Phoenix Publishing House)
6. Signposting: self-help for Dissociative Disorders such as OSDD and Dissociative Identity Disorder
(The CTAD Clinic)
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