As you spend more time discussing goals and challenges with your Talkspace therapist, you may have questions or are interested in learning more about specific mental health topics and conditions. The Talkspace Bookshelf offers up-to-date mental health information directly from our behavioral health team to provide a better understanding of condition origins, diagnoses, various forms a condition may take, and different treatment options. Feel free to use this resource as a starting point to open up a dialogue and pose questions for your Talkspace therapist.

There is a lot confusion and misinformation related to Dissociative Identity Disorder, which is not surprising as it is generally a rare condition. In fact, all combined dissociative disorders affect just about 2% of the US population.

Dissociative Identity Disorder, or DID as it is often referred to, is a condition in which an individual experiences two or more distinct personality states. This is most often experienced by the individuals with the condition as a complete absence of awareness of the other personality states or “parts.” The term dissociative refers to the description of being disconnected or split from a sense of awareness of the other personalities or personality states. This may be expressed as complete amnesia when experiencing life through the eyes of other “parts,” but also may be experienced with some recollection.

The symptoms of Dissociative Identity Disorder are as follows:

  • A disruption of self as evidenced by two or more distinct personality states. This change or split often manifests in a presentation that differs greatly from the individual's primary way of relating to the world. This change in personality state will be exemplified by changes in behavior, memory, persecution, thoughts, feelings, and sensory-motor functioning (as evidenced by body movements, etc.)
  • This change in personality state is accompanied by periods of dissociation (lack of consciousness of the change) which often manifests in gaps of time in everyday events, memory loss, and other traumatic events
  • The experience causes significant distress or disruption in the individual’s life such as in employment, educational, social, or other important life areas
  • The condition or expression of multiple personality states is not generally or broadly accepted as a normal part of a cultural or religious practice from which the person originates
  • The experience must also not be attributed to any other psychological or medical condition or physiological effects of a substance


Popular Misconceptions

In large part, Dissociative Identity Disorders is represented in the mainstream media as a condition in which people often engage in violent, or otherwise sadistic acts. In reality, this is a gross misrepresentation of Dissociative Identity Disorder. In fact, across all major mental health conditions, those who live with diagnosable conditions are more likely than those in the general population to be victims of violent crimes, rather than perpetrators.

In the specific case of Dissociative Identity Disorder, the condition is often thought of as one response to early traumatic experiences. Abuse, in its various forms, is a risk factor for the development of Dissociative Identity Disorder and in North America and Europe rates of abuse in those living with DID is about 90%. Additionally, those living with DID may have also experienced other forms of trauma such as medical and surgical procedures, terrorism, war, or childhood prostitution.


Treatment

Dissociative disorders can be difficult to diagnose, especially as dissociative episodes may have psychological or physical causes (brain damage or other brain structural issues), therefore a medical evaluation or neurological exam and scans are often indicated in the early stages of treatment. A therapist may recommend that you seek out these services as you begin to engage in treatment.

Medication

There is no specific medication to help treat the symptoms of Dissociative Identity Disorder. However, antidepressants and anxiolytics (anti-anxiety medications) are commonly prescribed to help a client cope with symptoms of anxiety and depression that may also be due to other psychological conditions.

Psychotherapy

Individual psychotherapy, or talk therapy, is a prominent course of treatment for those living with Dissociative Identity Disorder. Due to the complicated nature of the condition, on average, those living with DID spend years in therapy. The primary goal is often to help clients re-integrate all the personality parts (also known as “alters”) into one whole personality. This may be done utilizing different models of therapy, most notably Psychodynamic Therapy.

In individual therapy, your therapist may rely on a range of interventions and suggestions to help you cope with the symptoms of DID and integrate the parts effectively. This may be done by using crisis intervention strategies at some point in treatment to deal with anxiety and depressive symptoms that emerge, as well as using therapies such as mindfulness and cognitive behavioral strategies to help cope with the effects and experiences of DID.

Your therapist may try to work with you on re-processing past traumatic experiences. This may require you to recall troubling memories and experiences (to varying degrees of detail) and work through them over time with your therapist. As such, it is very important to find a therapist that you feel most comfortable with and can relate to. The therapeutic relationship will create the foundation from which you engage in very challenging therapeutic work.

Many living with Dissociative Identity Disorder may experience suicidal thoughts. In as much of 70% of those living with DID in outpatient treatment have attempted suicide. Given this, DBT can be especially helpful in helping those living with DID tolerate distress. However, in all forms of therapy, your therapist may speak with you about suicidal risk and harm, including making crisis plans, to reduce your risk of harm and increase client safety.

EMDR

Eye Movement Desensitization and Reprocessing (EMDR) is a highly effective treatment for those attempting to heal and recover from trauma. As such, there is some belief that EMDR can be helpful in the treatment of Dissociative Identity Disorder. However, there has been little research to demonstrate the efficacy of EMDR specifically on those living with DID. While it is thought of as a helpful adjunct to therapy for those with DID, many professionals caution its use unless a therapist in highly experienced in EMDR.


Therapeutic Note

Remember your therapist is here to help you figure out the best way to address your concerns. Therapy works best when it is a collaboration between you and your therapist. It is important to be open, honest, and an active participant in this process. Talk to your therapist about your goals for therapy so that together you can come up with the best plan to achieve your goals.

Questions for my therapist:

  • It’s scary to think that I may be having moments existing as someone else. Can you help?
  • It seems like it’s hard to tell or remember if there are other parts, how will I know if I have DID?
  • I often feel depressed, are there treatments that can help that in addition to my DID?
  • Sometimes I feel disconnected from my body, but don’t recall feeling completely unaware of myself, could that be DID or something else?
  • I often have thoughts of suicide or self-harm, how can I control that?


Sources:

American Psychiatric Association. Dissociative Disorders. Desk Reference to the Diagnostic Criteria From DSM-5®. Washington: American Psychiatric Publishing, 2014. 292-298.

American Psychiatric Association. (2013). Dissociative Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Dissociative Disorders. (n.d.). Retrieved July 19, 2017, from https://www.nami.org/Learn-More/Mental-Health-Conditions/Dissociative-Disorders

Dissociative Identity Disorder (Multiple Personality Disorder). (2017, February 24). Retrieved July 19, 2017, from https://www.psychologytoday.com/conditions/dissociative-identity-disorder-multiple-personality-disorder

Garner, H. (n.d.). EMDR in the Treatment of Dissociative Disorders. Retrieved July 19, 2017, from http://www.pods-online.org.uk/index.php/information/articles/article-categories/treating-dissociation-menu/141-emdr-in-the-treatment-of-dissociative-disorders

Pais, S., PhD. (n.d.). Dissociative Identity Disorder . Retrieved July 19, 2017, from https://www.aamft.org/iMIS15/AAMFT/Content/consumer_updates/Dissociative_identity_disorder.aspx

Stuart, H. (2003). Violence and mental illness: an overview. World Psychiatry, 2(2), 121–124.