Dissociative Identity Disorder: A Controversial Diagnosis
DSM-IV-TR Diagnostic Criteria-used to be multiple personality disorder
-Think schizophrenia is split personality… schizophrenia is psychotic disorder, DID is dissociative.
1. Two or more distinct identities or personality states
Each has its own relatively enduring pattern of perceiving, relating to environment, self
Alters very different from host, host is very passive, alters can be aggressive and destructive, average number of
alters is 10, range from 2-100’s.
2. Recurrently take control of person’s behavior
Some identities aren’t aware of other, some know others exist, critical with one another, can be in open conflict
with one another. Transition often caused by stress,
3. Loss of memory for personal information
Frequent gaps in memory of history, more passive identities have fewer memories, aggressive ids have more
control, more memories.
4. Not due to physiological effect of a substance or general medical condition
Complex partial seizures can look like this, children with imaginary friends not considered DID.
Often history of severe childhood abuse
Nightmares, flashbacks, heightened startled response.
High rates of comorbidity – depression, anxiety, borderline personality, suicide, substance abuse, PTSD, eating
Often meet criteria for borderline personality disorder
Self-mutilation, suicide attempts, aggression
Usually highly hypnotizable, dissociative tendencies
Suggestible, easy to hypnotize.
Tends to be chronic and recurrent
More common in women than men (3 – 9 x)
Women tend to have more identities
Avg women have 15 and men have avg 8 personalities.
Typically diagnosed at 29 – 35 years
Average of 6-7 years between first symptom presentation and diagnosis of DID
See numerous doctors before getting diagnosed, shows unreliability
Shirley Mason, said to be diagnosed through therapy.
The Host- original personality, unaware of alters
The Child- memories of trauma, cuteness, anxiety, depression, hyper sexuality
The Avenger- aggression directed towards others, revenge for abuse
The Protector- protecting against others that will give further abuse
The Trauma Repository- PTSD symptoms
The Narcissist- strong energetic acting out character, nonconformist, critical
The Helper- better adjusted, help with character. Video:
- At least 53 different personalities
- Different voices, one alter was a cousin who dies of a brain tumor
- Draw out each alter in therapy and probe for information
- Change can be subtle like a cough or blink
- No recollection of what happens when other alters come out, alters don’t tell host what they did
- Refers to himself as imposter, alters see original personality as intruding on them
History of DID
Extremely rare until 30 years ago
Only about 200 cases before 1980
1957 – “Three Faces of Eve” based on real case
1970s – “Sybil” - book, film based on real case
Drew media attention to multiple personality
1980’s – dramatic increase in cases
DSM III- MPD now legit specific disorder, treat with hypnosis, uncover personalities during hypnosis.
1986- 6,000 cases only in North America
Glamorous disorder that brought attention to therapists and patients. Over diagnosis?
Growing clinical interest
Therapy books, journal articles
Conferences, professional associations
1990s – False Memory Syndrome controversy – growing concerns – lawsuits
2000s – dramatic drop-off in numbers of cases
Trauma Theory of DID
A “Diathesis – Stress” model
Stress: Childhood - severe trauma, abuse