Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder, is a complex psychiatric condition characterized by a significant disruption of a unified sense of self and continuity of experience. This disorder affects approximately 1-3% of the general population and is marked by the presence of two or more distinct personality states or identities that recurrently take control of the individual's behavior. Alongside these identity disturbances, individuals with DID experience Dissociative Amnesia, which involves significant gaps in memory for important personal information and experiences that cannot be explained by ordinary forgetfulness.
The connection between DID and trauma is particularly significant, as research indicates that individuals with DID report the highest rates of childhood trauma—particularly physical, sexual, and emotional abuse—beginning before the age of six among patients with any psychiatric disorder. This has led to conceptualizing DID as a childhood onset, posttraumatic developmental disorder in which the traumatized child is unable to complete normal developmental processes involved in consolidating a core sense of self.
Understanding Dissociative Identity Disorder
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 or religious practices. The disorder involves 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.
These disruptions and alterations in a unified sense of self and memory can manifest in various ways that include hard-to-explain disturbances and/or variability in:
- Behavior
- Thoughts
- Emotions
- Memory
- Perceptions
- Consciousness
- Bodily sensations or functioning
These disruptions cannot be better explained by the effects of alcohol or drugs, or a medical or brain disorder, such as epileptic seizures of substances or medications, or to brain injuries or diseases.
Symptoms and Clinical Presentation
The difficulties in recalling important personal experiences for individuals with DID 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
Diagnostic Challenges and Treatment Considerations
The average individual with DID spends five to 12.5 years in mental health treatment until a correct diagnosis is made. This diagnostic challenge occurs because 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.
A diagnosis of dissociative identity disorder should be suspected if an individual 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. Family members may notice the person is repeatedly very "moody," highly changeable from time to time, and has difficulty recalling important personal experiences.
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. Because of this, many individuals with DID are unsuccessfully treated with medications for schizophrenia or other psychotic disorders. 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.
It is important to note that because DID is characterized by different identity states, 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. These identity states are subjective states of the individual's mind, and all of the DID states together make up the whole person and that person's total personality.
Trauma and the Development of DID
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. Early trauma may also be a risk factor for later trauma.
Hypnotherapy Approaches in Trauma Resolution
Historically, hypnosis has been used in the treatment of posttraumatic conditions. It has been systematized for the hypnotic treatment of posttraumatic speeds and facilitates mourning and makes stress disorder (PTSD), including traumatic grief possible a personal reorientation to the future. Hypnosis is specifically indicated in the resolution of traumatic grief. Grief is traumatic when it follows objective and severe subjective trauma and when posttraumatic reactions inhibit mourning.
In recent years, reports of traumatic grief have been taken up again, especially within the context of advances in hypnotherapy of PTSD. However, further development has been hampered by the absence of an adequate conceptual basis for diagnosis and treatment.
Treatment of Dissociative Identity Disorder
DID is a treatable disorder once it is properly diagnosed. Treatment approaches typically involve psychotherapy aimed at addressing the underlying trauma and helping the individual integrate their different identity states into a more unified sense of self. While the provided sources do not specify particular therapeutic modalities beyond mentioning hypnosis for trauma-related conditions, the connection between DID and trauma suggests that trauma-focused approaches may be beneficial.
The sources indicate that hypnosis has been used in the treatment of PTSD and traumatic grief, which are conditions often comorbid with DID. Hypnosis may facilitate mourning and personal reorientation to the future following traumatic experiences. This suggests potential applications for individuals with DID who have experienced significant trauma, though the specific application of hypnosis in DID treatment would require further development based on adequate conceptual frameworks for diagnosis and treatment.
Conclusion
Dissociative Identity Disorder represents a complex psychiatric condition with profound connections to early life trauma. The disorder is characterized by disruptions in identity, memory, and consciousness, often leading to significant impairment in functioning. Despite the challenges in diagnosis, which can take an average of five to 12.5 years, DID is treatable once properly identified.
The relationship between DID and trauma suggests that therapeutic approaches addressing traumatic experiences may be beneficial. While the provided sources indicate that hypnosis has applications in treating PTSD and traumatic grief, further development of conceptual frameworks is needed to fully understand its potential role in DID treatment.
Given the high rates of suicidal and self-destructive behavior among individuals with DID, appropriate emergency protocols must be in place when such behaviors are present. Treatment should be approached with careful consideration of the unique aspects of DID while maintaining responsibility for behavior at the level of the whole person.