Dissociative identity disorder
Dissociative identity disorder (DID), previously known as multiple personality disorder (MPD), is characterized by the presence of at least two personality states or “alters”. The diagnosis is controversial and remains disputed. Proponents of DID support the trauma model, viewing the disorder as an organic response to severe childhood trauma. Critics of the trauma model support the sociogenic (fantasy) model of DID as a societal construct and learned behavior used to express distress; developed through iatrogenesis in therapy, cultural beliefs, and exposure to the behavior in media or online.
Public perceptions of the disorder were popularized by alleged true stories in the 20th century; Sybil influenced many elements of the diagnosis, but was later found to be fraudulent. After multiple personality disorder (MPD) was recognized as a diagnosis in DSM-III in 1975, an epidemic of the disorder spread across North America, closely tied to the satanic panic. Therapists began using hypnosis on patients, believing they were discovering alters and recovering forgotten memories of satanic ritual abuse. Psychologists familiar with the malleability of memory argued they were constructing false memories. Diagnoses reached 50,000 by the 1990s, but the FBI failed to validate allegations made against caregivers. Skepticism increased when MPD patients recovered from the behavior, retracted their false memories, and brought successful lawsuits against therapists. A sharp decline in cases followed, and the disorder was reclassified as “dissociative identity disorder” (DID) in DSM-IV. In the 2020s, an uptick in DID cases followed the spread of viral videos about the disorder on TikTok and YouTube.
According to the DSM, the disorder is accompanied by memory gaps more severe than could be explained by ordinary forgetfulness, including gaps in consciousness, basic bodily functions, and perception. Research has challenged this premise; McNally found that although patients reported amnesia between alters, objective tests found their memory function was intact. Some clinicians view it as a form of hysteria. After a sharp decline in publications in the early 2000s from the peak in the 90s, Pope et al. (2006) described the disorder as an academic fad. Boysen et al. (2012) described research as steady, but lacking in convincing evidence.
According to the DSM-5-TR, early childhood trauma, typically starting before 5–6 years of age, places someone at risk of developing dissociative identity disorder. Across diverse geographic regions, 90% of people diagnosed with dissociative identity disorder report experiencing multiple forms of childhood abuse, such as rape, violence, neglect, or severe bullying. Other traumatic childhood experiences that have been reported include painful medical and surgical procedures, war, terrorism, attachment disturbance, natural disaster, cult and occult abuse, loss of a loved one or loved ones, human trafficking, and dysfunctional family dynamics.
Treatment generally involves supportive care and psychotherapy. Medications can be used for comorbid disorders or targeted symptom relief. Lifetime prevalence, according to two epidemiological studies in the US and Turkey, is between 1.1–1.5% of the general population and 3.9% of those admitted to psychiatric hospitals in Europe and North America, though these figures have been argued to be both overestimates and underestimates. Comorbidity with other psychiatric conditions is high. DID is diagnosed 6–9 times more often in women than in men.
The number of recorded cases increased significantly in the latter half of the 20th century, along with the number of identities reported by those affected, but it is unclear whether increased rates of diagnosis are due to better recognition or to sociocultural factors such as mass media portrayals. The typical presenting symptoms in different regions of the world may also vary depending on culture, such as alter identities taking the form of possessing spirits, deities, ghosts, or mythical creatures in cultures where possession states are normative.
