Medical terminology has evolved over time to better reflect new understandings and to diminish stigma. For instance, ‘consumption’ has been replaced with ‘tuberculosis,’ ‘hypochondria’ is now referred to as ‘illness anxiety disorder,’ ‘ADD’ has been updated to ‘ADHD,’ and ‘drug addiction’ is now known as ‘substance use disorder.’

An example of this evolution is with dissociative identity disorder (DID), a condition that affects approximately 1.5% of the population and was previously termed multiple personality disorder or split personality disorder.

What does dissociative identity disorder entail?

Dissociative identity disorder (DID) is a mental health disorder in which a person possesses multiple identities, commonly known as “alters.” According to Dr. Omar Fattal, system chief of behavioral health at NYC Health, these alters emerge in different situations.

Each alter can have distinct characteristics such as a unique name, age, gender, and personality traits. Dr. Amber McGregor, clinical director at the 1st Priority Institute for Better Living in Colorado, mentions that “each alter has various behaviors, memories, perceptions, and interaction styles with the world.”

The term ‘dissociative’ implies a disconnection, which occurs when one of these identities takes over the primary identity known as the “host.” The host identity generally manages daily living and social interactions but may not be aware of the other identities, some of which may only surface infrequently or under specific triggering circumstances.

Since alters can manifest unpredictably, and because of other related challenges, “unmanaged symptoms of DID can hinder individuals from achieving personal goals and developing meaningful relationships,” explains William Buerger, clinical director for the adolescent dialectical behavior therapy program at Montefiore Medical Center in New York.

What are the causes of dissociative identity disorder?

Buerger notes that “the causes of DID have been debated among researchers for years.” Current studies examine multiple factors contributing to the disorder, including cognitive attribution errors and disturbances in sleep. A significant focus is also placed on why women are diagnosed with DID at a greater rate than men during young adulthood.

Dr. Fattal concurs that DID may stem from a variety of factors, with the most significant being that many individuals with DID have experienced “extensive and severe childhood trauma, particularly when it hampers the development of a secure and safe attachment to a caregiver.”

This trauma can lead to the fragmentation or compartmentalization of different parts of the self, as McGregor explains. “This is considered a defense mechanism by the brain to cope with unbearable situations that cannot be processed or escaped.” The emergence of these different identities allows the person to mentally ‘escape’ from overwhelming stress.

How is dissociative identity disorder addressed in treatment?

One of the main difficulties with DID is that there are limited treatment options available, according to Buerger, who states that “there are currently no treatment methods supported by robust empirical evidence specifically aimed at this disorder.” Nevertheless, various therapies are employed and reported to be effective for many diagnosed with DID.

Buerger indicates that some treatments involve medications that can assist in managing and alleviating the symptoms of DID, along with psychodynamic therapies that analyze how past experiences influence current challenges and desires.

“Psychotherapies remain the foundation of treatment for DID,” adds Dr. Fattal, particularly emphasizing trauma-focused and cognitive-behavioral therapies.

In providing these treatments, McGregor notes that it is essential for mental health professionals to adopt a comprehensive, trauma-informed approach that fosters safety and trust: “Individuals with DID typically have a history of significant trauma and may struggle with deep-seated distrust of others, including therapists.”