Dissociative Identity Disorder: General Characteristics

According to the DSM-5, “Dissociative disorders are characterized by a disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior.” (American Psychiatric Association, 2013). The criteria for being diagnosed is difficult to meet considering the factors are almost exclusive to this disorder. Except maybe a few. For this reason there are not many cases of dissociative identity disorder. It is quite rare for the average psychologist to come across a genuine case. Being as there are many symptoms to go with this disorder, it is more likely that a person is experiencing something else. But there are always exceptions.

Diagnostic Criteria A goes over the experience of having another personality takes over, through consciousness, behavior, memory, perception, and cognition. The DSM-5 goes on to explain that the personality states vary on discreteness based on stress, culture, internal conflicts and dynamics. This proves that there are different levels to this disorder based on person-to-person. People can even experience prolonged periods of disruption of identity due to severe psychological pressures. There are even different types of case; possession and non-possession type cases. Non-possession cases are not as likely to display their different personalities, at least not in an obvious way. Only a small amount of people present their case to a clinician. A reason for unobserved personalities can be because of dissociative amnesia. This can cause plenty of distress and dysfunction in a person’s life. Constantly forgetting what you did while another personality has taken over can also be very dangerous. It is more beneficial and likely that a close family member or clinician would point out the disorder, since the individual experiencing amnesia cannot. They are also likely to have amnesia not only with everyday events, but also with traumatic events; which is very unfortunate because this is usually the answer for the disorder. The disorder closely resembles dementia, Alzheimer’s disease, or bipolar disorder. This can cause confusion when it comes to diagnosing. An individual is more likely to be diagnosed with a disease than with a disorder, which could cause even more dysfunction; especially if the person is taking medication or going to therapy for the wrong diagnosis. Many psychologists even report that likelihood of diagnosing DID is very rare. According to a PsychologyToday discussion, “Still, before placing the label MPD or DID on someone, other more rational explanations for the behavior must be ruled out, such as serious medical or severe neurological conditions, drug intoxication, or perhaps more credible psychological disturbances such as Post-Traumatic Stress Disorder, Factitious Disorder, Malingering, or extreme Personality Disorders.” (Lazarus, 2011). This psychologist questions how genuine the disorder even is. Diagnosing someone with DID is something very serious and should be avoided at all costs; it’s better to look at all possible choices than to jump the gun.

Individuals also report “voices” in their head. These voices can vary: there is uncontrolled speech, which is observing speech happening, but not having any control over it; different perceptions of voice; and multiple, independent though streams. The addition of not knowing what is controlling your body can induce “random” urges that can cause dysfunction, and maybe even danger. People with this disorder experience fear to an extent that is unimaginable. They have distress from knowing they can “blackout” at any moment, and do things that they do not want to do. They have to accept that this disorder can cause a significant amount of dysfunction in their everyday life and social life. There is also the possibility of danger, simply from saying something they’re not supposed to, and from urges they cannot control. Based on their culture and religious background, the dissociation can be explained by possessions. This, in almost any culture, can definitely be seen as deviance (Criterion C). Not to mention, there are usually more symptoms present with this disorder, like depression, anxiety, substance abuse, self-injury, and more.

Dissociative Identity Disorder also has specific disorders that resemble the symptoms. For example, dissociative amnesia, which is a criteria for DID, doesn’t necessarily mean someone has it, but instead just amnesia, not multiple personalities. In fact dissociative amnesia has its own criteria to meet. Although, the criteria is very similar to DID itself: inability to recall events, can cause distress or social impairment, and is not caused by a substance or medical condition. The only difference is that dissociative amnesia is not associated with personalities, instead this type of amnesia is almost always psychological, not caused by drugs or neurological damage. This can be confusing when it comes to diagnosing because someone with dissociative amnesia can simply forget about their other personalities and not be diagnosed correctly. There is plenty of room for error when it comes to an individual with amnesia. They simply cannot remember periods of which are very important when trying to understand what is happening. For this reason, it is helpful to get an opinion of someone close to the individual to help understand the bigger picture. This disorder can cause distress from social impairment, danger in episodes of forgetfulness, and dysfunction from everyday life.

In contrast to dissociative amnesia, depersonalization/derealization disorder is also a similar criteria for DID, Criteria A. In depersonalization, an individual experiences a detachment from self; they become an observer in their own body. In derealization, an individual experiences detachment from surroundings; they feel unreal. Unlike DID, there is no amnesia present. People will remember feeling detached. There is also a similar criteria for this disorder: cause distress or social impairment, and it is not attributed to a substance or a medical condition. There is a clearer picture painted here, unlike with dissociative amnesia, because of the fact that the individual remembers the experience. The DSM-5 explains the thought processes of someone with this disorder and there could be room for misdiagnosis here as well. There are reported feelings of hypoemotionality, which sounds like someone with sociopathic tendencies. Not recognizing what you’re supposed to be feeling from not being present in your body or in your surroundings can cause significant distress and dysfunction.

The diagnosis of either dissociative amnesia or depersonalization/derealization seems pretty distinctive. The only trouble could come from decided if they ultimately have dissociative identity disorder. These two disorders added together truly do result in DID, so it would seem to be simple. Yet there is plenty of room for error. Not getting every aspect of a situation can result in misdiagnosing a client. It’s especially tricky because amnesia plays a part, and every symptom/criteria could mean another disorder. Ultimately diagnosing this disorder should be quite rare; there is usually another answer.

References

1. American Psychiatric Association. (2013). Dissociative Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.).
2. https://dsm.psychiatryonline.org/doi/full/10.1176/appi.books.9780890425596.dsm08
3. Clifford, Lzarus N. (2011, Dec. 29), Why DID or MPD is a Bogus Diagnosis, retrieved from: https://www.psychologytoday.com/us/blog/think-well/201112/why-did-or-mpd-is-bogus-diagnosis