Dissociative identity disorder (DID): traits, causes, treatment

Have you ever lost track of time or had highway hypnosis where you don’t remember driving somewhere? That disconnection from yourself is called dissociation.

While having experiences like this from time to time can be expected, some people frequently experience dissociation, interfering with their daily activities and causing them great distress. In some cases, people experience so much dissociation that they are diagnosed with a condition called dissociative identity disorder (DID). 

If you think you have those symptoms or love someone who often disconnects, keep reading to learn about DID.

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Dissociation is when you disconnect from yourself. Most people experience mild dissociation when daydreaming or know what it’s like to be in a “flow” state where they lose touch with themselves and their surroundings. Dissociation is also one of your body’s defense mechanisms to help you cope during a traumatic event. For example, people who have gone through an accident, natural disaster, terrorism, or sexual abuse may dissociate from the circumstances of the event to mentally escape the trauma (APA, 2018). 

So, dissociation is a normal emotional response. However, it can become a dissociative disorder when your brain and body continue this process even when the traumatic events are long over.

The American Psychiatric Association defines dissociative disorders as a mental health condition that affects a person’s sense of self, identity, emotions, memories, feelings, and behavior (APA, 2018).

The National Alliance on Mental Illness (NAMI) says that up to 75%of people have an episode of dissociation in their lifetime. Of that percentage, only 2% have repeated or chronic episodes. Women are diagnosed more often with dissociative disorders (NAMI, 2021).

The Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5), defines three main types of dissociative disorders (NAMI, 2021).

Dissociative amnesia

Dissociative amnesia (DA) is where a person forgets essential information about themselves. Sometimes this amnesia or memory loss is about a specific traumatic event like childhood abuse or an attack. Some people may forget their life history or even who they are; this happens very rarely (NAMI, 2021).

Episodes of amnesia happen suddenly and can last from minutes to days long. Some people may experience amnesia for more extended periods, but this occurs very infrequently. Amnesic episodes can happen to anyone at any age, and a person can have these episodes throughout their life (NAMI, 2021).

Before the new classification of dissociative amnesia in the DSM-5, there was another category for a form of amnesia called dissociative fugue. Fugue is where a person forgets who they are for a brief time. This type of amnesia can happen to people who have seizure disorders. Fugue is now categorized as dissociative amnesia (Loewenstein, 2018).

Depersonalization disorder

Depersonalization disorder is when a person feels detached from their thoughts, feelings, and behaviors. This can feel like an out-of-body experience where they are watching themselves like in a movie. People with depersonalization disorder can also feel like nothing around them—people, objects, and actions—is real. This is called derealization. These feelings don’t last long, but they can be recurring.

Depersonalization symptoms can start in early childhood though many people start feeling these symptoms in their middle teens (NAMI, 2021).

Dissociative identity disorder

The third type of dissociative disorder is dissociative identity disorder. Dissociative identity disorder (DID) is a personality disorder where you experience extreme changes in your identity. Dissociative identity disorder used to be called “multiple personality disorder” until 1994. This name change was reflected in the DSM-4 to help explain the condition better (Loewenstein, 2018).

If you have dissociative identity disorder, you have at least two different parts (states) of yourself that are in control of your thoughts and behavior at different times. You may have one primary identity that reflects the “real” you. Each one of your identity states can have different ways of thinking, remembering, and behaving.

For example, your identity states may be another age or gender. These are called alternate identities or alternate personalities. Some people with DID don’t control when they slip into another identity. Others don’t remember what happens when they are in another identity (Mitra, 2021). 

Dissociative identity disorder fascinates some people. There have been movies and TV series about people with multiple personalities, like The Three Faces of Eve and Sybil, based on real-life people. Some mental health and healthcare professionals believe that dissociative identity disorder is affected by a person’s culture rather than a mental health condition. Others say that DID is a mental health disorder deserving of compassionate and professional mental health care (Loewenstein, 2018). 

Many studies have looked at the prevalence of dissociative identity disorder. Most experts agree that about 1% of people experience symptoms of DID. However, rates can be higher in populations that have experienced continual and significant trauma (Brand, 2016). 

There is no single cause for developing dissociative identity disorder. Dissociation disorders and DID, in particular, are thought to be caused by ongoing, severe childhood trauma like serious neglect or continual and harsh physical, sexual, or emotional abuse before age six (Mitra, 2021).

Not everyone who has traumatic experiences will have a dissociative identity disorder or be diagnosed. However, it is normal to respond to traumatic events by dissociating from more painful and traumatic memories. A portion of people who do this may develop a dissociation disorder (Mitra, 2021).

Does trauma cause dissociation?

Trauma can cause dissociation. Adult bodies instinctively respond to trauma and threats with a “fight or flight” response. This response starts a cascade of hormones and chemicals to allow us to react to this threat by either running away really fast or pumping us up to fight. 

Infants and young children may not react with fight or flight. Instead, they may respond by being unable to move and protest. Scientists call these reactions collapsed immobility (freezing) and quiescent immobility (flopping) (Kozlowska, 2015):

• Freezing is where their bodies release chemicals and hormones that numb them, and they become immobile.

• Flopping is where the brain switches off the thinking and judgment parts (located in the front of the brain) and turns on the automatic part (back of the brain). The automatic or instinctive part of the brain directs the muscles to become floppy. As a result, the children experiencing trauma may follow directions without fighting or protesting.

If you’ve gone through traumatic events and have DID, you may divide memories or feelings of these events as if they happened to different people (identity states) rather than to yourself. While this may have helped you as a child, it can prevent you from having a defined identity as an adult (Mitra, 2021).

People with dissociative identity disorder have significant problems with their memory. If you have symptoms of DID, you may (NAMI, 2021)

• Forget significant events in your life like your birthday, wedding, or your child’s birth 

• Be accused of lying because you do not remember saying or doing something

• Experience blackouts 

• Find things in your purse, car, or home with no memory of how they got there

• Feel disconnected from yourself in an out-of-body experience (depersonalization)

• Feel like you’re not real (derealization)

There isn’t a single test to determine that a person has a dissociative identity disorder. This can make it challenging to determine what is causing your symptoms. If you think you have DID, you may want to speak to your healthcare practitioner first to be referred to a mental health professional. 

Your healthcare practitioner will do a complete physical exam. Sometimes, dissociative identity disorder symptoms can be caused by underlying medical conditions, drug use, or cultural or religious practices, so your provider will ask questions and perform exam techniques that can help identify any of these causes (APA, 2018).

Your mental health clinician will ask you about your dissociative symptoms and how they impact your life. They will ask you about your early childhood and family history. They may use different survey tools designed for dissociative disorders to see if your symptoms are caused by DID or another mental illness (Mitra, 2021). 

Other mental health conditions that can cause dissociative symptoms include anxiety, bipolar disorder, borderline personality disorder (BPD), depressive disorders, post-traumatic stress disorder (PTSD), and substance use disorder (NAMI, 2021).

For a dissociative identity disorder diagnosis, you have to have these symptoms as determined by the DSM-5 (APA, 2018)

• You have at least two different and distinct identities (states) or distinct personalities. 

• Of these personality states, at least two of them regularly take control of your behavior.

• You can’t remember important personal information, and this isn’t caused by normal forgetfulness.

• Your symptoms interfere with your life and cause you great distress.

• These symptoms are not caused by seizures, alcohol abuse, prescribed medications, or recreational drugs.

All dissociation disorders, including dissociative identity disorder, can be treated with psychotherapy and medications. 

Psychotherapy

Talk therapy like cognitive-behavioral therapy (CBT) and dialectical behavioral therapy (DBT) help you identify traumatic events that happened to you and why you are dissociating. In addition, they give you the tools to manage your feelings and develop coping skills to help you in all aspects of your life (Mitra, 2021).  

Another type of therapy that is useful for trauma-based disorders is EMDR. EMDR means eye movement desensitization and reprocessing. It was created to help people manage their traumatic memories (Mitra, 2021).

Some people find that hypnosis helps them deal with their symptoms of dissociative identity disorder (Mitra, 2021).

If you have been diagnosed with dissociative identity disorder, choose a therapist (or hypnotist)  trained to treat DID. The overall goal of the therapy is to help you reduce your dissociative states and peacefully integrate the distinct personalities and identities into a harmonious coexistence. However, if the pace is too fast, it may cause flashbacks of traumatic events, causing emotional harm. That’s why it’s especially important to work with someone who has extensive experience with DID (Brand, 2016). 

Medications

There are no medications specifically used to treat dissociative disorders. Instead, medications may be prescribed to treat the symptoms that may occur with a dissociative identity disorder and other mental health problems. These medications can include antidepressants, antipsychotics, or mood stabilizers (Mitra, 2021). 

Electroconvulsive therapy

If you experience severe depression related to your symptoms of dissociative identity disorder, and psychotherapy and medication have not relieved your symptoms, you may be a candidate for electroconvulsive therapy (Webster, 2018).

People who live with the symptoms of dissociative identity disorder and do not seek treatment are at greater risk of abusing alcohol and other substances. People with DID are also more vulnerable to self-harm from violence and acting out violently, and are also at risk for attempting suicide. Like other untreated mental health conditions, living with untreated DID can harm your ability to find and keep a job and have good relationships with family and friends (APA, 2020).

If you have suicidal thoughts, reach out to your healthcare provider, family, or friend or call the National Suicide Prevention Hotline at 800-273-8255.

You or your loved one can recover from a dissociative disorder with the proper diagnosis and treatment based on your symptoms. Recovery means that you may not completely stop experiencing your DID symptoms, but you can feel more in control of your identity. In addition, you can help your loved one by learning more about DID, attending support groups, and staying calm if you experience behavioral changes. If you need more information about this disorder, contact your healthcare provider or mental health professional.

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Current version

June 30, 2021

Written by

Tobi Ash, MBA, RN, BSN

Fact checked by

Steve Silvestro, MD

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About the medical reviewer

Steve Silvestro, MD, Ro

Dr. Steve Silvestro is a board-certified pediatrician and Associate Director, Clinical Content & Education at Ro.