Have you ever thought about how you organize your sense of self? You might take it for granted that you’re one person — and your sense of self, the part of you that identifies as me or I — is singular and cohesive, right? For people living with dissociative identity disorder (DID), however, the internal system of self, or identity, is organized in a different way. While DID used to be known as multiple personality disorder (MPD), and is typically dramatized in some pretty sensational ways in films and media, it remains an often misunderstood condition.
“The key feature of DID is the presence of more than one center of consciousness — that is the ‘multiplicity’ part of the picture,” Dr. John Allison O’Neil, a psychiatrist and psychoanalyst in private practice in Montreal, Quebec, tells Bustle via email. Basically, people living with DID experience multiple selves, and the disorder is characterized by switching from one self state to another. Switching can be prompted by certain triggers or stressors in relationships or the environment, and amnesia is often present with the shift from one self to another. Meaning that when in one self state, someone with DID might experience amnesia around what happened when other self states were forward, according to Dr. O’Neil.
According to the National Alliance on Mental Health (NAMI), dissociative disorders like DID occur in about two percent of the population, and involve a disconnect between identity, memory, and consciousness. Dr. O’Neil notes that DID is caused by severe, long-term, and repeated early child abuse and neglect that often starts before age five or younger. In order to cope with overwhelming events, other self states, called alters, form in order to provide internal containers for the trauma. While certain alters hold abuse memories for instance, others might preserve functioning in other ways — like maintaining the ability to go to school, play with friends, or excel in a particular art or activity.
Psychology Today characterizes DID as more of a process of identity fragmentation, and less about the creation of fully formed multiple personalities — though distinct personality states can exist with the disorder. Dr. O’Neil also says that misconceptions about DID are common, especially since fiction and media often dramatizes the disorder in ways that aren’t always accurate, and often propel the narrative of crime dramas. While some cases of DID present in more overt and extreme ways, many others are more subtle. “The overwhelming majority of DID cases have never committed a crime, have never been arrested … The clinical presentation is also generally more complex than can be covered in a single film or series,” Dr. O’Neil says. He further notes that “a few dozen personalities or alters,” are typical for those living with the disorder.
While both the conditions that lead to DID, as well as the disorder itself, create unique and sometimes severe challenges for survivors with this diagnosis, many people with DID are highly gifted individuals with a marked capacity for resilience, according to Dr. O’Neil. Per The Recovery Ranch blog, DID exists along a continuum, and the severity of the disorder tends to depend on the both the nature of the abuse suffered, and its duration.
The Ranch also notes that recovery from DID looks different for each person, but it generally aims to increase a sense of internal cohesiveness within a person’s sense of self, while gradually relieving amnesia over time. According to a Healthy Place, some with DID aim to integrate their alters into a single sense of self, while others aim to keep the alter system in place as they work to improve internal cooperation and communication. While the road to recovery from DID can be long and difficult, with the right support, therapy, and time, healing is absolutely possible.