Global InformationDissociative identity disorder information
| Dissociative identity disorder[1][2] | |
|---|---|
| Other names | Multiple personality disorder Split personality disorder |
| Specialty | Psychiatry, clinical psychology |
| Symptoms | At least two distinct and relatively enduring personality states,[3] recurrent episodes of dissociative amnesia,[3] inexplicable intrusions into consciousness (e.g., voices, intrusive thoughts, impulses, trauma-related beliefs),[3][4] alterations in sense of self,[3] depersonalization and derealization,[3] intermittent functional neurological symptoms,[3] emotion and behavior dysregulation,[5][6] Schneiderian first-rank symptoms[7][8] |
| Complications | Trauma and shame-based beliefs,[9][10] dissociative fugue,[11] eating disorders,[5] depression,[5] anxiety,[5] sleep disturbances (eg. sleep terrors, nightmares, sleepwalking, insomnia, hypersomnia),[12] suicidality, self-harm[3] |
| Duration | Long-term[13] |
| Causes | Disputed |
| Risk factors | Suicide, Interpersonal problems, aggressive behaviors[5] |
| Differential diagnosis | Other specified dissociative disorder, psychotic disorder, schizotypal personality disorder,[14] [15][16] temporal lobe epilepsy,[17][18]traumatic brain injury,[19] seizure disorder, personality disorder[3] |
| Treatment | Patient education,[6] peer support,[6] Safety planning,[6] grounding techniques,[6] supportive care, psychotherapy[13] |
| Frequency | 1.1–1.5% lifetime prevalence in the general population[3][20] |
Dissociative identity disorder (DID), previously known as multiple personality disorder, is one of multiple dissociative disorders in the DSM-5, DSM-5-TR, ICD-10, ICD-11, and Merck Manual. It has a history of extreme controversy.[21][22][23][24][25]
Dissociative identity disorder is characterized by the presence of at least two distinct and relatively enduring personality states.[3][26](p331) The disorder is accompanied by memory gaps more severe than could be explained by ordinary forgetfulness.[3][26](p331)[27] The personality states alternately show in a person's behavior;[3][26](p331) however, presentations of the disorder vary.[27][28]
According to the DSM-5-TR, early childhood trauma, typically starting by 5-6 years of age, can place someone at risk of developing dissociative identity disorder.[26][29](p334) Across diverse geographic regions, 90% of individuals diagnosed with dissociative identity disorder report experiencing multiple forms of childhood abuse, such as rape, violence, neglect, or severe bullying.[26](p334) Other traumatic childhood experiences that have been reported include painful medical or surgical procedures,[26](p334)[30] war,[26](p334) terrorism,[26](p334) attachment disturbance,[26](p334) natural disaster, cult, and occult abuse,[31] loss of a loved one or loved ones,[30] human trafficking,[26](p334)[31] and dysfunctional family dynamics.[26](p334)[32]
There is no medication to treat DID directly. However, medications can be used for comorbid disorders or targeted symptom relief, for example antidepressants or treatments to improve sleep.[20][33] Treatment generally involves supportive care and psychotherapy.[13] The condition usually persists without treatment.[13][34]
The condition is believed to affect 1.1–1.5% of the general population (based on multiple epidemiological studies) and 3% of those admitted to hospitals with mental health issues in Europe and North America.[3][26](p334)[20] DID is diagnosed about six times more often in women than in men.[27]
The number of recorded cases increased significantly in the latter half of the 20th century, along with the number of identities reported by those affected. However, it is unclear whether increased rates of diagnosis are due to better recognition or sociocultural factors such as mass media portrayals.[27] The typical presenting symptoms in different regions of the world may also vary depending on culture, such as alter identities taking the form of possessing spirits, deities, ghosts, or mythical creatures and figures in cultures where normative possession states are common.[3][26](p335)
- ^ Nevid JS (2011). Essentials of Psychology: Concepts and Applications. Cengage Learning. p. 432. ISBN 978-1-111-30121-7.
- ^ Kellerman H (2009). Dictionary of Psychopathology. Columbia University Press. p. 57. ISBN 978-0-231-14650-0.
- ^ a b c d e f g h i j k l m n American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Arlington: American Psychiatric Publishing. pp. 291–298. ISBN 978-0-89042-555-8.
- ^ Lanius R (June 2015). "Trauma-related dissociation and altered states of consciousness: a call for clinical, treatment, and neuroscience research". Eur J Psychotraumatol. 6: 27905. doi:10.3402/ejpt.v6.27905. PMC 4439425. PMID 25994026.
- ^ a b c d e Brand BL, Lanius RA (2014). "Chronic complex dissociative disorders and borderline personality disorder: disorders of emotion dysregulation?". Borderline Personality Disorder and Emotion Dysregulation. 1 (1): 13. doi:10.1186/2051-6673-1-13. PMC 4579511. PMID 26401297.
- ^ a b c d e Mitra P, Jain A (2023). "Dissociative Identity Disorder". StatPearls. StatPearls Publishing. PMID 33760527. NBK568768.
- ^ Ross CA, Miller SD, Reagor P, Bjornson L, Fraser GA, Anderson G (1990). "Schneiderian symptoms in multiple personality disorder and schizophrenia". Comprehensive Psychiatry. 31 (2): 111–118. doi:10.1016/0010-440x(90)90014-j. PMID 2311378.
- ^ Renard S (1 January 2017). "Unique and Overlapping Symptoms in Schizophrenia Spectrum and Dissociative Disorders in Relation to Models of Psychopathology: A Systematic Review". Schizophrenia Bulletin. 43 (1): 108–121. doi:10.1093/schbul/sbw063. PMC 5216848. PMID 27209638.
- ^ Dorahy MJ, Corry M, Black R, Matheson L, Coles H, Curran D, Seager L, Middleton W, Dyer KF (April 2017). "Shame, Dissociation, and Complex PTSD Symptoms in Traumatized Psychiatric and Control Groups: Direct and Indirect Associations With Relationship Distress: Shame and Dissociation in Relationship Distress". Journal of Clinical Psychology. 73 (4): 439–448. doi:10.1002/jclp.22339. PMID 28301038. S2CID 206045401.
- ^ Temple M (23 November 2018). "Understanding, identifying and managing severe dissociative disorders in general psychiatric settings". BJPsych Advances. 25: 14–25. doi:10.1192/bja.2018.54. S2CID 81151326.
- ^ "Dissociative Fugue (Psychogenic Fugue) | Psychology Today".
- ^ Dimitrova L, Fernando V, Vissia EM, Nijenhuis ER, Draijer N, Reinders AA (2020). "Sleep, trauma, fantasy and cognition in dissociative identity disorder, post-traumatic stress disorder and healthy controls: A replication and extension study". European Journal of Psychotraumatology. 11 (1). doi:10.1080/20008198.2019.1705599. PMC 7006753. PMID 32082509.
- ^ a b c d "Dissociative identity disorder". MSD Manuals. Psychiatric disorders (Professional ed.). March 2019. Archived from the original on 28 May 2020. Retrieved 8 June 2020.
- ^ Ghorbali A, Shaeiri M, Fesharaki M (July 2021). "Relationship between Dissociative Experiences and Schizotypal Personality Traits: Mediating Role of Inferential Confusion". Iranian Journal of Psychiatry. 17 (1): 52–60. doi:10.18502/ijps.v17i1.8049. PMC 8994835. PMID 35480133.
- ^ Kaplan AM, Smith CM (20 July 2021). "Schizotypal personality disorder disguised as dissociative identity disorder". BMJ Case Reports. 14 (7): e243454. doi:10.1136/bcr-2021-243454. PMC 8292736. PMID 34285029.
- ^ Giesbrecht T, Merckelbach H, Kater M, Sluis AF (October 2007). "Why dissociation and schizotypy overlap: the joint influence of fantasy proneness, cognitive failures, and childhood trauma". The Journal of Nervous and Mental Disease. 195 (10): 812–818. doi:10.1097/NMD.0b013e3181568137. PMID 18043521. S2CID 45086235.
- ^ Schiavone FL, McKinnon MC, Lanius RA (January 2018). "Psychotic-Like Symptoms and the Temporal Lobe in Trauma-Related Disorders: Diagnosis, Treatment, and Assessment of Potential Malingering". Chronic Stress. 2: 247054701879704. doi:10.1177/2470547018797046. PMC 7219949. PMID 32440584.
- ^ Schenk L, Bear D (October 1981). "Multiple personality and related dissociative phenomena in patients with temporal lobe epilepsy". American Journal of Psychiatry. 138 (10): 1311–1316. doi:10.1176/ajp.138.10.1311. PMID 7294186.
- ^ Cantagallo A, Grassi L, Della Sala S (January 1999). "Dissociative disorder after traumatic brain injury". Brain Injury. 13 (4): 219–228. doi:10.1080/026990599121593. PMID 10230523.
- ^ a b c International Society for the Study of Trauma Dissociation (2011). "Guidelines for treating dissociative identity disorder in adults, third revision". Journal of Trauma & Dissociation. 12 (2): 188–212. doi:10.1080/15299732.2011.537248. PMID 21391104. S2CID 44952969.
- ^ Peters ME, Treisman G (2017). "Dissociative Identity Disorder". Johns Hopkins Psychiatry Guide.
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- ^ a b c d e f g h i j k l m DSM-5-TR classification. Washington, DC: American Psychiatric Association. 2022. ISBN 978-0-89042-583-1. OCLC 1268112689.
- ^ a b c d Beidel DC, Frueh BC, Hersen M (2014). Adult psychopathology and diagnosis (7th ed.). Hoboken, N.J.: Wiley. pp. 414–422. ISBN 978-1-118-65708-9.
- ^ Ghorbali A, Shaeiri MR, Gholami Fesharaki M (January 2022). "Relationship between Dissociative Experiences and Schizotypal Personality Traits: Mediating Role of Inferential Confusion". Iranian Journal of Psychiatry. 17 (1): 52–60. doi:10.18502/ijps.v17i1.8049. PMC 8994835. PMID 35480133.
- ^ "Dissociative Identity Disorder: What Is It, Symptoms & Treatment". Cleveland Clinic. Retrieved 2023-04-13.
- ^ a b "Dissociative Identity Disorder - Psychiatric Disorders".
- ^ a b Hassan S, Shah M (2019). "The anatomy of undue influence used by terrorist cults and traffickers to induce helplessness and trauma, so creating false identities". Ethics, Medicine and Public Health. 8: 97–107. doi:10.1016/j.jemep.2019.03.002. S2CID 151201448.
- ^ Şar V, Dorahy MJ, Krüger C (2017). "Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective". Psychology Research and Behavior Management. 10 (10): 137–146. doi:10.2147/PRBM.S113743. PMC 5422461. PMID 28496375.
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