What is dissociative identity disorder (split personality) really?

By Laurie Scarborough

It seems that many people are confused about what Dissociative Identity Disorder (DID) is. This disorder previously known as Split Personality Disorder, has received media attention over the years, with the book Sybil and the accompanying TV movie, as well as the television series, United States of Tara. But what is the disorder really?

In essence, a diagnosis is made when someone has more than one distinct personality. Some cultures might understand this split as possession. The different personalities are split such that only one personality shows at a time. The distinct personalities are not simply someone having a mood swing, but are contrastingly different states of being.

The personalities will differ in terms of mood, behaviour, thoughts, memory, perception, or even things like posture, personal taste, vocal patterns and accents, or physical appearance. Physical changes may be only noted by the person who experiences the dissociations, for example they might think that they have blonde hair during a dissociation even though they are brunette in reality.

The dissociations are usually associated with a gaps in memory in which the core personality will not remember what the other personality did while they were active.

DID is a normally thought to be quite a profound dissociative reaction to severe trauma, usually occurring during childhood. A dissociation is usually an adaption mechanism for avoiding the trauma, such that the core personality doesn’t have to experience the pain of confronting or living with the memory of the trauma. There will be certain triggers that bring about a flip between the personalities that has to do with the trauma. When something becomes too overwhelming, the switch will then occur.

A common misconception of DID is that someone with the disorder will have many personalities.  The examples I gave earlier, like Sybil (a true story about the first documented case of DID) and the United States of Tara (a fictional depiction of the disorder) are more exceptions to the rule. Sybil was diagnosed with 16 alternate personalities and Tara with seven, but in reality  it is very rare for someone with the disorder to develop more than one or two alternative identities.

DID is a very rare disorder that only affects about 0.1-0.5% of the population. The DSM-5 (a diagnostic manual for mental health professionals) has estimated the prevalence much higher but this was using a very small sample in the US, and it is likely much less than that.

In terms of treatment, DID does not have a special “DID drug”, unlike schizophrenia which uses anti-psychotics, bipolar using mood stabilizers, or depression and anti-depressants, but often people with DID will experience comorbid anxiety, depression, seizures and even substance abuse. These would be treated with the appropriate pharmacotherapeutic measures.

DID requires input from a team of healthcare professions. A GP or physician for general well-being, a psychologist administering talking therapy, and a psychiatrist for psychopharmaceuticals would normally work together to give the best therapy possible. Despite on-going therapy, the disorder can be very difficult to treat.

And that is a very short explanation of Dissociative Identity Disorder.

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