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Clarification of Dissociative Identity Disorder

By Edited Nov 13, 2013 2 2

Dissociative Disorder – photo by user: 04Mukti

Dissociative Identity Disorder (DID) is found in various cultures.  It is rarely diagnosed in children and is diagnosed three to nine times more often in female adults than male adults.  Females average 15 identities; while males average about eight. 

The Difficulty of Diagnosing Dissociative Identity Disorder 

DID has similar or overlapping symptoms of other disorders making it difficult to diagnose.  Generally accepted by experts the root of DID is repressed memories of childhood trauma of abuse; it therefore, comes as no surprise that it shares symptoms with Post Traumatic S

DID Previously Called Multiple Personalities  - photo by user: Hunnnterr
tress Disorder (PTSD).     

In the early years of psychology, DID was often confused with schizophrenia.  This is most likely due to the occurrence of schizophrenics displaying evidence of hallucinations.  Though hallucinations are a distinguishing feature of schizophrenia is not a characteristic of DID.  However, when more than one dissociative personality is present; it may be mistaken for a delusion.  Furthermore, if dissociative personalities are communicating, it may be mistaken for auditory hallucinations.  

Shifts between dissociated personalities may lead to a therapist to diagnose Bipolar Disorder with Rapid Cycling.    Symptoms of DID may also mimic other personality disorders, most notably Borderline Personality Disorder. 

In order to rule out other possible diagnoses; professionals use a variety of assessment skills and tests.  Supporting factors for the diagnosis of DID include:

  • presence of clear-cut dissociative symptomatology with sudden shifts in identity states,
  • persistent and consistent identity-specific behaviors and demeanors over time,
  • reports by family or co-workers that show evidence of dissociative behavior that predates the clinical or forensic presentation,
  • reversible amnesia,
  • and high scores on dissociative measuring tests. 

Criteria for Dissociative Identity Disorder 

The main feature of DID is the presence of two or more separate identities or personalities that take control of behavior. In the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR) (APA, 2000), the criteria for a diagnosis of DID is:

  • The presence of two or more distinct identities or personality states; each having its own way of interacting with the environment and self. 
  • At least two of these identities or personality states recurrently take control of the person’s behavior.
  • Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
  • The disturbance is not due to the direct physiological effects of a substance or a general medical condition.  (In children, the symptoms are not attributable to imaginary playmates or other fantasy play.)  

The Controversy Surrounding DID 

Many experts do not believe that DID exists.  This was one factor in the decision to change the name of the disorder from Multiple Personalities to DID in the latest edition of the DSM.   Because of the difficulty in diagnosing the disorder, statistics have been largely unreliable.  Ma

Dissociative Identity Disorder – photo by user: Hunnnterr
ny experts cite this lack of empirical evidence as support for their argument. 

Other factions of the argument, contend that DID is actually a social construct of the therapist and the patient.  They argue therapists instill false memories into their patients while under hypnosis.  This argument gained support when it was revealed the woman on whom the book Sybil was based was Shirley Ardell Mason and her diagnosis was challenged by several psychiatrists.  

Some psychiatrists claimed that the primary psychiatrist and author of the book, Cormelia Wilbur, manipulated Mason into believing she had multiple personalities.  However, others claimed that in fact, these psychiatrists distorted facts of the case to support their claims.  This particular case remains in controversy today as both Mason and Wilbur are deceased and Wilbur’s psychiatric files are sealed.  

Another well-known book regarding the account of a multiple personality is When Rabbit Howls, written by the individual herself, Truddi Chase.   This is one of the few books written by a patient rather than the treating psychiatrist. Other well known cases were also depicted in Hollywood movies; most notably “The Three Faces of Eve.”  Recently, television created their version in the series “The United States of Tara.” 

Individuals diagnosed with DID are at high risk for suicide (one of the highest of all mental disorders) and substance abuse.  They also tend to exhibit violent behavior more often than many other mental disorders. No matter which side of the argument a person falls; the fact remains that this disorder, as with other severe mental disorders, can be devastating not just for the individual but for the families as well. 



American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Washington, D.C.: American Psychiatric Association, 2000. 



The copyright of the article “Clarification of Dissociative Identity Disorder” is owned by Cheryl Weldon and permission to republish in print or online must be granted by the author in writing.



Jan 21, 2013 1:50pm
I can understand why "mild" cases would be hard to recognize for those who don't believe or have little knowledge about the problem, but I'm surprised that DID in general is still so difficult to diagnose.

Maybe it's because a clinical setting makes it harder to see. When you've lived near or worked around someone for several hours every day who has this problem, it's obvious. But I can understand how someone who only sees a patient for an hour or less, once a week and especially once a month, might have difficulties figuring it out.

At the DD group home I worked at years ago, we had to keep detailed notes on one particular DID resident for the psychologist because 1) he'd never had a DID patient before; and 2) she wasn't manifesting the problem or switching in his office -- only at home, work, or in the community.
Jan 28, 2013 2:45pm
When I was working in the field, I didn't have a client with DID, but some of my colleagues worked with DID clients. Most of them saw the client more than once a week. Still, you are correct about the multiples not always manifesting during sessions--but I believe this is usually in the short-term or as you pointed out- limited contact with their therapists. Multiples would manifest at some point when clients were being seen regualarly. Initially the diagnose is difficult because as the article states--the symptoms are similar to other diagnoses and the different personalities don't come out right away. On top of that, many therapists to this day, don't believe the disorder exists so they wouldn't diagnose DID.
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