Dissociative Identity Disorder (DID): Symptoms, Treatment, Help

What is dissociative identity disorder (DID)?

Dissociative identity disorder (DID) involves perceiving multiple identities within yourself and switching between them. These identities, sometimes known as “alters” or dissociative parts, each seem to have their own independent traits, behaviors, thoughts, and perceptions of the world. They might even have their own names.

Formerly known as multiple personality disorder, DID is extremely distressful because you may lose control or awareness when one of the alters surfaces. You might wake up in a new location and learn that you drove there in an emotional state. Or perhaps you frequently experience a sense of detachment from yourself, watching on helplessly as some part of you acts out in childish, dramatic ways. Even if you don’t completely lose control, you might hear multiple voices in your head trying to influence your decision-making. This is sometimes called passive influence.

All of this can affect your ability to function in daily life and impair your relationships. Switching during an interaction at work can leave coworkers startled or confused. Voices in your head can distract you as you try to focus. Symptoms might worsen during times of high stress, making already difficult moments, such as a breakup or job loss, all the more challenging.

If you have DID, you might feel “broken.” You’re aware that something is “not quite right,” and intense shame or self-loathing can prevent you from talking about your condition. The desire to keep your internal issues a secret then leads to feeling alone and isolated.

It’s important to keep in mind that you don’t have multiple personalities, but rather a single, fragmented personality. Despite how much it may feel like separate entities are vying for control of your actions or arguing in your head, they are all parts of a whole: you. Even when it feels that your situation is hopeless, it’s possible to manage your symptoms through a combination of self-help steps and therapy.

Creation of dissociative parts

To understand DID, it helps to first understand dissociation. Some people describe dissociation as a sort of “emotional circuit breaker.” When the mind is overwhelmed by intense emotions, a sense of detachment kicks in as a protective coping mechanism. You become disconnected from your thoughts, feelings, memories, and sensations. For example, during incredibly traumatic events, such as sexual abuse, a child might dissociate. Later, those events and emotions are difficult to recall.

In dissociative identity disorder, all of those traumatic experiences and intense emotions get compartmentalized into other “identities.” Think of it as the mind saying, “These terrible things are happening to other people. Not me. Someone else is feeling this fear. Someone else is dealing with this rage and shame.” Feelings, thoughts, and memories all become fragmented into more manageable parts.

Although fragmentation often occurs due to traumatic childhood events, the effects can last into adulthood. The result is a disorganized narrative about your identity. Instead of a single sense of self, you have multiple dissociative “parts.” Maybe you can’t seem to recall experiences and memories unless you’re in a certain “state.” Or perhaps you feel as if certain thoughts, memories, and feelings belong to someone else.

Each dissociated part may serve a purpose, and can surface due to specific cues or triggers. For example, a frightened, hypervigilant child might emerge when something reminds you of a childhood trauma. Or a mature caretaker could emerge when you need to self-soothe.

Symptoms of dissociative identity disorder

Some studies estimate that up to 1.5 percent of the population has DID. But how can you tell if you’re actually suffering from this condition? The Diagnostic and Statistical Manual of Mental Disorders (DSM) uses the following criteria for diagnosing DID:

Multiple identities. You have at least two distinctive dissociative parts, each with its own way of thinking, perceiving, and interacting with the world. Everyone’s experience with DID differs, so the nature and characteristics of your alters won’t be the same as another person with the disorder. Early signs of these alters can also vary. You might initially hear voices, while another person might notice written evidence of an alter, such as changes in handwriting or an unfamiliar name on school assignments.

Switching. This is the symptom that is most commonly associated with DID. Two or more of the identities will repeatedly assume control of your behavior or assert some level of passive influence. You may or may not be aware of when switching occurs, and it’s often involuntary. Some people switch many times throughout the day, while others experience it less frequently.

Memory issues. You might have difficulty recalling conversations or events. Your level of forgetfulness can’t be explained by other conditions, such as age-related memory loss or brain injury.

The symptoms aren’t a side effect of drugs or other medical conditions. When it comes to children experiencing these symptoms, they’re not caused by imaginary play.

Other dissociative disorders

The DSM lists two other types of dissociative disorders aside from DID:

Dissociative amnesia involves difficulty recalling specific memories, often due to trauma. Memory gaps commonly affect certain events or periods of time. Unlike other forms of memory loss, dissociative memory loss tends to occur at a young age, doesn’t affect your other cognitive abilities, and you may not feel concerned about the gap in your memories.

Depersonalization-derealization disorder involves persistent feelings of detachment. It might seem like you’re observing your actions, thoughts, and feelings from afar or from outside of your body rather than experiencing them. You might also feel as if the people and things you interact with are unreal—a phenomenon known as derealization.

If you have DID, you likely experience the symptoms of dissociative amnesia and depersonalization disorder as well. However, people with dissociative amnesia and depersonalization disorder might not experience DID.

Causes of dissociative identity disorder

DID seems to usually be the result of severe childhood trauma, particularly long-term abuse at the hands of an attachment figure, such as a parent. DID with milder symptoms may be the result of more subtle forms of emotional neglect, which can also be traumatic.

[Read: How to Cope with Traumatic Events]

When faced with unbearable levels of stress and intense conflicting emotions, the consciousness attempts to compartmentalize those feelings and thoughts into multiple “states.” This makes it difficult for the person with DID to have a unified sense of self.

The role of attachment

Some researchers theorize that DID might be linked to a disorganized (or fearful-avoidant) attachment style, often the result of a neglectful or abusive caregiver. As a child, you may have seen your caregiver as both a source of safety and a threat, leading you to internally create multiple perceptions of yourself.

Diagnosis

DID remains a controversial diagnosis. Over the years, fabricated books and case studies have bred skepticism over the legitimacy of the disorder. Overly dramatic media depictions have also led to public misunderstanding of the condition.

Some researchers have proposed that DID is actually a “simulated” condition, the result of cultural influences (such as media portrayals) and a tendency to fantasize. This is called the “fantasy model” of DID.

However, most of the findings suggest it’s related to post-traumatic stress disorder (PTSD). For example, some brain imaging research has revealed differences in brain function and structure—such as a smaller volume of the hippocampus—between people with DID and people without the condition.

DID is a complex condition, so it’s no surprise that a diagnosis can be tricky and only comes after careful consideration by an expert.

Similar and related disorders

A DID diagnosis often comes later in life. One reason for this is that it’s commonly misdiagnosed as other conditions first, including:

Borderline personality disorder (BPD), which can also come with dissociative symptoms and memory difficulties.

Schizophrenia, since alters can be mistaken for auditory hallucinations.

Post-traumatic stress disorder (PTSD) is when you feel caught in a state of hypervigilance, anxiety, and distress long after a traumatic event. Most people with DID also have PTSD.

Living with DID tip 1: Practice awareness and acceptance

Your experience is unusual, and you may feel shame or embarrassment about it. But remember that DID starts as a coping mechanism. Your different states are part of a larger attempt to keep you safe and functioning despite intensely traumatic experiences.

The ultimate goal is to accept your parts without judgment. This can lead you to feel more comfortable seeing yourself as a single, whole personality. Acceptance is unlikely to simply occur overnight and you may need to work alongside a therapist to achieve it. But know that self-compassion and self-acceptance is possible.

Notice your parts and how they surface. You might already have some general awareness of your dissociative parts. You lose track of time, only to later discover you’ve been involved in events that you don’t remember. Perhaps you hear alters in your head, conversing. Maybe you feel as if you’re watching from a distance as you say and do things that you have no control over. Recognizing when a “switch” occurs can help you identify and prepare for common triggers.

Be curious about your parts. Your dissociative parts might make you deeply uncomfortable, or you may believe that there are parts that you need to avoid at all costs. Learning to accept, or at least acknowledge, all parts of yourself can prove beneficial and even lay the groundwork for future therapy. Some questions to explore:

• Do you feel like you can name, communicate, negotiate, or collaborate with parts of yourself? Some people with DID have a habit of using written communication or inward talking to convey messages to their alters.
• What parts are you most aware of? Do you feel like some parts exist beyond your knowledge?
• Do any parts seem to be in conflict with one another?
• How do you feel about each known part? Maybe you’re fearful of one part but feel intensely protective of another. Are there any parts that you’ve labeled as negative or shameful?
• Do you feel empathy for any of your states, and are you aware of any of their needs? Does any part of you feel like it needs more comfort or support? For example, you might have a trauma-stuck alter that feels trapped in a moment of past danger and needs constant soothing.

Tip 2: Identify your triggers

Specific triggers or cues cause you to switch, activate voices in your head, or lead to sudden bouts of amnesia. Being able to anticipate your triggers is a good first step toward managing these intrusive symptoms.

Identifying triggers may involve some note taking. After a switch is over, take note of where you were and when it happened. If you experienced a memory lapse, consider the last thing you remember doing. What sensations can you recall? Were you with another person? And if so, what can you remember from the interaction?

Consider that triggers can be:

• Time-related, such as a holiday or anniversary of an event.
• Place-related, such as a place where trauma originally occurred.
• Relational, such as arguments or criticism from a loved one—anything that evokes negative feelings like shame, rejection, or abandonment.
• Internal, including thoughts and feelings.
• Sensory, including bodily sensations that may remind you of past trauma, such as rapid heartbeat, hunger, or feeling overheated.

You might be able to simply steer clear of certain triggers, such as locations that remind you of traumatic events and frighten parts of you. However, avoiding triggers is often only a temporary solution. Instead, the eventual goal is to cope with triggers in a healthy way and be less reactive.

Be aware of unhealthy coping strategies that you turn to after experiencing a trigger or a switch. For example, you might feel compelled to self-medicate with alcohol after every stressful argument with a family member.

Tip 3: Learn to be present

Grounding yourself in the present can be an effective way to remind yourself that you’re in the here and now rather than stuck in the moment when the trauma occurred. Try these grounding exercises:

Use your eyes. Look around and let your gaze rest on an object. Notice some specific details about it, such as its shape or texture. You can even describe them aloud. “The table is long and rectangular. The surface has a chevron pattern. It is a golden-brown color.” Repeat this with two more objects.

Use your ears. Set your attention on a single sound in the area. It could be the hum of a refrigerator, a bird chirping, or music playing in the background. What do you notice about the quality of the sound? Is it gentle or sharp? Rhythmic? Inconsistent? Again, you can speak them aloud if that helps. Repeat this with two more sounds.

Use your sense of touch. Reach out and place your hand on a nearby object. It could be a chair, a tree—whatever is close and safe to touch. Consider touching personal items, like your clothing or even your own hands. What do you notice? Is the surface hard or soft? Smooth or rough? What’s the temperature? Remember that touch doesn’t need to be limited to what you feel with your hands. How does the ground feel under your feet right now?

Expand this exercise to your remaining senses: taste and smell. Chew a piece of gum or focus on the smell of hot tea. The key is to allow your interaction with the object to fill your awareness. Concentrate on how the object is present with you. This can help you avoid spacing out or feeling overwhelmed.

Tip 4: Regulate emotions with relaxation techniques

Whether you feel like you’ve identified your triggers or still feel puzzled by them, having go-to relaxation techniques can foster a sense of internal safety. When you, or parts of you, suddenly feel overwhelmed, relaxation strategies can help you regulate emotions and reduce dissociative symptoms.

Progressive muscle relaxation involves gradually relaxing each body part, focusing on one area at a time.

Visualization exercises rely on the power of your imagination to set a soothing scene. When it comes to DID, you might find it helpful to include your alters as part of the exercise. For example, you can imagine a quiet, calm forest in which each part of you rests together beneath a tree. Visualize in as much detail as you can, whether it’s what the bark of the tree looks and feels like, or how leaves rustle and play with the sunlight to create shadows.

[Listen: Guided Imagery Meditation]

Breathing exercises focus on the speed of your breath. Slow it down, aiming to make your exhale longer than your inhale. This eases your sympathetic nervous system (or the “fight or flight” response). Inhale for four counts, exhale for eight counts—or whatever is comfortable for you. It might help to imagine all parts of you breathing together in unison.

Tip 5: Develop a consistent daily structure

Maintaining a routine can help you stay on task and cut back on confusion, even when memory gaps occur. Here are some tips on creating more structure in your life:

Be predictable. For example, wake up, shower, and eat breakfast around the same time each day. When possible, be consistent with exercise, screen time, and your work schedule.

Use a calendar or planner. Include important events, such as doctor appointments or social meetups with friends. If you experience a memory lapse, one glance at your planner can help you determine what you’ve completed and what comes next in your day.

Wear a watch. For some people with DID, time may seem to move fast or slow. Gaps in time can be especially disruptive. A watch allows you to easily keep track of the time.

Don’t be too rigid with your schedule. Some people use a full schedule as a way to avoid feeling their emotions. However, this can lead to mental, physical, and emotional exhaustion. Set aside time to relax.

Include time for daily exercise. Exercise can be a useful way to relieve stress and anxiety. Over time, it can also improve your self-esteem and confidence. Find an activity that you enjoy enough to stick with.

Tip 6: Adopt healthy sleep habits

Sleep disruptions are common in people with dissociative disorders, which can create a downward spiral. Lack of sleep increases stress and makes it difficult to think clearly and manage your emotions. This can worsen your DID symptoms, which, in turn, worsen your sleep.

Determine a bedtime routine that calms you down. Take a warm bath, read a book, meditate, or cuddle your pet. Stick to an activity that seems to consistently put you in a relaxed state.

Write down your worries. Some parts of you may seem chatty as you’re trying to wind down. If you can’t seem to quiet your thoughts, journal those concerns and promise to address them the next day.

Perform a repetitive mental task. It might sound cliché, but counting sheep can keep you focused on a simple task, which prevents your mind from spinning on thoughts that lead to insomnia.

Be mindful of what you consume during the day. Caffeine, alcohol, tobacco, and other substances can have a negative impact on your sleep cycle. Cut back and see if you notice an improvement in your sleep.

Tip 7: Modify your diet

Healthy eating habits can help energize your mind and body when you’re experiencing high stress. However, many people with dissociative disorders also experience difficulty eating. Maybe your dissociative parts have varying food preferences or eating patterns. Or perhaps you forget when or what you’ve eaten throughout the day. Some foods might even be an emotional trigger.

To improve your diet:

Create a list of foods that you consistently enjoy. Consider whether certain parts of you feel particularly averse to certain foods and take this into account when planning out meals.

Have a regular eating routine. Aim to eat three times a day and set an alarm if you have issues remembering to eat. At times when you just can’t seem to generate an appetite, try using a nutritional supplement to ensure your body gets everything it needs.

Seek treatment for any possible eating disorders. A connection seems to exist between DID and eating disorders. For example, it’s possible that parts of you feel the desire to binge eat or purge after meals.

[Read: Eating Disorder Treatment and Recovery]

Tip 8: Build a strong support system

You likely feel as if the people around you can’t comprehend what you’re going through, even if they’re supportive. Or you may feel such shame about your condition that you haven’t talked to your loved ones about it. Know that you don’t have to endure all this alone. In fact, a strong support system can be crucial.

Plan regular social interactions. Schedule time to get coffee with friends, enjoy shared hobbies with others, or have dinner with family. Face-to-face interactions can calm your nervous system, boost your self-esteem, and allow you to feel emotionally connected with others. If you feel overwhelmed on a particular day, don’t be afraid to reschedule.

Look for shared experiences. Consider looking for books or podcasts by people who face the same struggles with DID. Seeing the situation from an outside perspective can be helpful.

Join a support group. You might be able to find a local or online support group for people dealing with DID. These groups can provide an opportunity to share your experiences, feel understood, and maybe even pick up tips on managing symptoms. If you can’t find a group that focuses specifically on DID, look for support groups focused on dissociative disorders in general. You can even broaden your search to include PTSD support groups. See “Helpful links” below.

Be prepared for times when you’re alone. When you anticipate being by yourself for a day, it can help to have a plan in place. Create a list of healthy activities to engage in that give you a sense of meaning, such as gardening, writing, or learning a new language. In times of loneliness, it can also help to make future plans to get together with loved ones, so you have social activities to look forward to.

Professional treatment

Psychotherapy is the most common professional treatment option for DID. The right therapist can help you to:

• Create a sense of safety and learn skills to manage symptoms. This can help reduce the risk of self-harm and suicidal ideation that can come with DID.
• Process past trauma. This could involve working through memories with different alters and encouraging them to share those memories with the other identities.
• Work on identity integration. Integration involves organizing the various aspects of your personality into a whole. This results in a more stable sense of self.

Eye movement desensitization and reprocessing (EMDR) can be used as part of a DID treatment program. This approach to trauma therapy involves using bilateral eye movements while recalling and reprocessing negative past experiences. EMDR may help you manage symptoms, strengthen your sense of self, and work with your alters.

Hypnosis. Some research seems to indicate that some people with DID may respond to hypnosis treatment. Hypnosis may be useful in accessing alters so they can work through therapy sessions.

Medication. While there’s no medication available to manage DID itself, a doctor may prescribe medication to help you manage related conditions or symptoms. For example, antipsychotics, stimulants, and mood stabilizers may be used for the management of mood disorders and PTSD. One major concern with prescribed medication is that some alters may refuse to take it. There’s also the risk that memory gaps will lead to overuse of prescribed drugs.

Last updated or reviewed on March 28, 2024