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Dissociative Identity Disorder (DID) is a trauma-related mental disorder that is most often misinterpreted. This part presents a fact-based account of the primary features of DID, including symptoms an individual with this disease may endure, the provoking factors for dissociative states, and the process by which clinicians diagnose this disorder correctly. This will provide straightforward, easy-to-read material that can be utilized in favor of awareness, understanding, and empathy.
Symptoms of Dissociative Identity Disorder
Symptoms of Dissociative Identity Disorder
Identity disruption:
Two or more distinct personalities exist in a person, each having its style of perceiving, thinking, and acting. They may also include alteration of mood, behavior, memory, and sensations. In certain cultures, they may be referred to as possessions.
Large gaps in memory:
Recurring instances of memory loss for common daily tasks, important personal information, or past traumatic experiences—far more than mere forgetfulness.
Loss of sense of agency:
Patients with DID may experience a lack of connection to their thoughts, words, and actions, as though controlled by another individual.
Emotional instability and dissociation:
Characteristically, symptoms involve depersonalization (feeling disconnected from oneself) and derealization (perceiving the world as unreal).
Functional impairment:
Symptoms markedly interfere with work, relationships, school, or other important aspects of life, and usually result in significant distress and instability.
Not accounted for by cultural or religious practices:
DID symptoms are not integrated into culturally accepted spiritual or religious practices. In children, symptoms must be distinguished from normal fantasy play.
Not caused by substances or medical conditions:
DID symptoms are not drug, alcohol, or other medical condition induced, so proper clinical assessment is necessary.
What Sparks Dissociation? Recognizing Common Triggers
Stressful life events include relationship issues, major losses, or sudden changes.
Reminders of past trauma (trauma cues): Some sounds, smells, sights, or environments that are identical to the original trauma can involuntarily cause dissociative reactions or identity switching.
Emotional overload: Overwhelming feelings such as fear, shame, or anger might cause dissociation in an attempt to cope.
Media exposure: Gory films, TV shows, books, or even certain types of music that involve abuse, violence, or trauma content could unconsciously induce dissociation.
Unraveling the Puzzle: How Is DID Diagnosed
Diagnosing Dissociative Identity Disorder is time-consuming—it's a painstaking process in identifying persistent identity change patterns, memory loss, and distress. As symptoms overlap with other mental disorders and can be hidden or confused even in the person who experiences them, clinicians must proceed through a cautious, step-by-step process.
Dissociative Identity Disorder often takes weeks or months to diagnose. This is due to the hidden, adaptable, or co-symptomatic symptoms that resemble other disorders like PTSD, depression, and last but not least, anxiety, and thus the time-consuming observations and screenings (Dorahy et al., 2014). Experts sometimes use the following specialized tools to review dissociative symptoms and allow for correct scoring: the Structured Clinical Interview for Dissociative Disorders (SCID-D) or Dissociative Experience Scale (DES) (Steinberg, 1993). These systematic assessments specifically prove helpful in detecting patterns of dissociative episodes, memory loss, and identity fragmentation, which manifest in the disorder.
DSM-5 symptom criteria must be met before the diagnosis of DID can be concluded. Therapists are constantly observing patients for these patterns that are characterized by the preceding symptoms. In the diagnostic procedure, experts also make it a necessity to rule out any other psychiatric disorders that may consist of similarities with DID; such disorders include schizophrenia, bipolar disorder, or borderline personality disorder (American Psychiatric Association, 2013). The procedure usually includes a detailed neurological examination, medical history, and referral to other psychiatric experts.
DID has strong correlations with histories of abuse, neglect, or extreme stress in childhood, and because of this, a critical part of an assessment is a complete trauma history (American Psychiatric Association, 2013). Clinicians go over such histories to observe how dissociation may have developed as a survival mechanism. Due to the sheer number of symptoms and the tendency for patients to remain unaware or ambiguous regarding their dissociative symptoms, a diagnosis may take anywhere from several months up to over one year, depending on presentation type and availability of uninterrupted care to the patient.
Living with DID: Personal Journeys and Clinical Insights
For those who want to learn about the reality and personal views of having Dissociative Identity Disorder, we suggest Lyn Barrett's moving interview on what it is like to live with DID (link here) and a detailed interview video with multiple individuals with DID describing their struggles and clinical experiences also within this video you get a glimpse of alter switching (link here). To better comprehend the clinical presentation, etiology, and treatment plan of Dissociative Identity Disorder, you may refer to this educational video guided by an expert, which breaks down the complexity of the disorder step by step (link here).
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