Many medical terms have evolved or changed over the years to reflect advancements in medical knowledge or to reduce stigma. For example, what was once called consumption is now known to be tuberculosis. Hypochondria is now defined as illness anxiety disorder. ADHD is no longer called ADD. And drug addiction is now known as substance use disorder.
Another medical name that's been changed is dissociative identity disorder – a condition that affects onlyabout 1.5%of people and was formerly called multiple personality disorder, or split personality disorder.
What is dissociative identity disorder?
Dissociative identity disorder (DID) is a psychiatric condition where a person has more than one identity– often referred to as "alters" – that the individual assumes under various circumstances, explains Dr. Omar Fattal, system chief of behavioral health at NYC Health + Hospitals.
Each alter can have their own name, age, gender and personality traits, says Amber McGregor, a doctor of education and the clinical director of 1st Priority Institute for Better Living in Colorado. "Each alter also has their own unique behaviors, memories, perceptions and ways of interacting with the world," she adds.
DID is defined the way it is because dissociate means to disconnect, which is what someone with DID does when one of these personalities assumes the primary identity called the "host" personality. The host personality is usually responsible for managing everyday life and social interactions, but is often unaware of the presence of the other identities – some of which may only appear rarely or under unique circumstances that trigger them.
Because alters can appear at any time, and because of other associated complications, "unmanaged DID symptoms can make it difficult to pursue personal goals and form meaningful relationships with others," says William Buerger, the clinical director of the dialectical behavior therapy for adolescents program at Montefiore Medical Center in New York.
What causes dissociative identity disorder?
While "the cause of DID has been contested by researchers for decades," Buerger says, much of today's research focuses on several variables and contributing factors that include cognitive attribution errors and even sleep disruptions. He says a lot of the research is also focused on why women are significantly more likely to be diagnosed with DID in early adulthood than men.
Fattal agrees that DID may be caused by any number of factors but says the most common one is that the majority of DID patients have experienced "severe, prolonged childhood trauma – especially when it disrupts the formation of a safe, secure attachment with a caregiver."
Such trauma is what often leads to the splitting off or compartmentalization of different aspects of the self, McGregor explains, "and is thought to be a defense mechanism created by the brain to manage unbearable experiences that the person cannot process or escape." She says the development of these various personalities, "allows the individual to 'escape' mentally from the overwhelming stress."
How is dissociative identity disorder treated?
One of the challenges associated with DID is that treatment options remain limited, Buerger says, "and there are currently no empirically-supported treatments that target this disorder." Still, several treatments are practiced and prescribed and are reported to be effective in many people diagnosed with DID.
Buerger says that some of these treatments include medications "that can play an integral part in helping people cope with and lessen DID symptoms;" and psychodynamic therapies, "that explore how our past experiences may shape our current difficulties and desires."
Psychotherapies remain "the cornerstone of treatment for DID," echoes Fattal, "particularly trauma-focused and cognitive-behavioral therapies."
In providing such treatment, McGregor says, mental health professionals need to follow a comprehensive, trauma-informed approach fueled by safety and trust: "Individuals with DID often have a history of severe trauma and may be deeply distrustful of others – including therapists."
