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Have you ever awakened during the night and, just for a moment, been unsure about where you were or even who you were? Such temporary disruptions in our normal cognitive functioning are far from rare; many people experience them from time to time due to fatigue, illness, and alcohol.
Dissociative disorders1, however, take up a much more severe form. They involve a break – or dissociation – in consciousness, profound losses of identity or memory, intense feelings of unreality, and uncertainty about one’s sense of identity.
We all dissociate from time to time – mild dissociative symptoms occur when we daydream, lose track of what is going on around us or miss a part of the conversation we were engaged in.
In persons with dissociative disorders, this normally integrated and well-coordinated multi-channel quality of human cognition becomes much less coordinated and integrated. When that happens, we observe the pathological dissociative symptoms cardinal characteristic of dissociative disorders.
Since these mental health disorders have more to do with alterations in personality states, they are often confused with personality disorders. However, in the diagnostic and statistical manual, “Dissociative and Somatoform disorders” are given separately from personality disorders.
Below we will discuss the different types of dissociative and personality disorders but first, let us start by describing what mental illness means.
1. Difference Between Personality Disorder and Mental Illness
Mental illness or mental health disorders refers to a wide range of mental health conditions- these involve changes in emotions, thinking a person’s behaviour, or a combination of all/some.
These mental disorders cause clinically significant distress for the individual and involve impairment or emotional distress in important areas of functioning. They are so common that almost 1 in every 8 people in the general population has a mental disorder.
This is why mental health conditions are not something to be embarrassed about – they are as common as a woman having PCOD2 or people having any other medical condition. This is also why it is important to consult mental health professionals, as the treatment varies depending on the mental disorder.
There can be many mental disorders, and each affects people differently – from having severe symptoms to mild ones. Causes can also range from biological ones (genetic, mental health conditions) to traumatic events, problems with family members, and child abuse.
Personality disorders, on the other hand, are a type of mental health disorder that is accompanied by personality impairment. Within personality disorders as well, there are subtypes such as Paranoid personality disorder, Antisocial personality disorder, Schizoid personality disorder, and Borderline personality disorder, to name a few.
Dr. Parih claims that a personality disorder is characterized by a persistent trend of pathological 3behaviour that begins during puberty and persists for extended periods, as well as dysfunctional personality states.
Personality disorders may persist for a lifetime and are differentiated from mental illness because they are thought to be the extremes of normal variation rather than the result of some morbid process4.
A person with a personality disorder is also more likely to experience depression, anxiety disorders, alcoholism, drug abuse, and dependence, among other mental health conditions.
Thus, if a personality disorder is not regarded as a mental illness despite its undeniable relevance to the clinical phenomenon, the other alternative is to view personality disorders as risk factors and complicating factors for a wide spectrum of mental diseases, much like obesity is a risk factor for diabetes.
Below, we are going to talk about one such important personality disorder.
2. Borderline Personality Disorder
According to the Diagnostic and Statistical Manual (DSM) – 5, individuals with borderline personality disorder show a pattern of behaviour characterized by impulsivity and instability in interpersonal relationships, self-image, and moods.
Their life goals, career choices, and friendships may change quickly and dramatically. Close personal and romantic relationships are marked by extreme swings from idealization to demonization.
Periods of depression are not unusual, and some may engage in excessive spending, drug abuse, and self-harm (suicide attempts may be part of the manipulation used against others in a relationship).
Emotions are often inappropriate and excessive, with a pattern of self-harm, chronic loneliness, and disruptive anger in close relationships.
The frequency of borderline personality disorder is three times greater in women than in men (American Psychiatric Association, 2013).
3. Types of Dissociative Disorders
The DSM 5 recognizes several types of pathological dissociation, which are given below.
3.1. Dissociative Identity Disorder
Dissociative identity disorder, a condition previously called multiple personality disorder or split personality disorder, is one of the most severe dissociative disorders wherein a person seems to possess two or more distinct identities or personality states that alternate in taking control of behaviour (alternate identities). These coexisting but separate identities may have personality traits, self-image, and memories.
3.1.1. Reasons
- The reason for rejecting the use of the term multiple personality disorder and the adoption of “dissociative identity disorder” was the growing recognition that it had misleading connotations, suggesting multiple occupancies of space, time, and the person’s body by differing but fully organized and coherent distinct personality states.
Alternate identities are not, in any meaningful sense, personalities but rather reflect a failure to integrate various aspects of a person’s identity, consciousness, and memory. Thus, “dissociative identity disorder” better captures these changes than “multiple personality disorder.” - Another important reason is that throughout the 1980s, psychiatric patients were diagnosed with “multiple personalities” at an alarming rate – the split personality disorder had turned into a fad.
The alternate identities may differ in striking ways involving gender, age, sexual orientation, and spoken languages, E.g., Some alternate identities might be loving and carefree, whereas others might be serious and prudish.
These alternate personalities take control at different points in time, and the switches typically occur very quickly. Needs and behaviours inhibited in the core/host identity are usually liberally displayed by one or more alternate personalities.
3.2. Dissociative Amnesia
In dissociative amnesia, a person cannot remember personal information such as one’s name or specific personal events. Thus, the only memory type affected is episodic and autobiographical memory.
The DSM-5 5recognizes several types of amnesia. One is localized amnesia, where a person remembers nothing that happened during a specific period, most commonly the first few hours or days following some severe trauma.
Another is selective amnesia, in which a person forgets some but not all of what happened during a given period. The reported memory loss is usually associated with stressful or traumatic events like rape or childhood abuse.
Usually, amnesic episodes last between a few days and a few years, and although many people experience only one such episode, some people have multiple episodes in their lifetimes.
3.3. Dissociative Fugue
It is somewhat related to dissociative amnesia6 and is characterized by a sudden and extreme disturbance of memory in which identity alteration occurs. Individuals wander off and are unable to recall their past.
Such flight occurs in emotional distress and is more common in disasters or war. Days, weeks, or even years later, such people may emerge from the fugue state and find themselves in a strange place, working a new occupation with no idea how they got there.
3.4. Depersonalisation/Derealisation Disorder
Depersonalization and derealisation are symptoms of dissociative disorders. In derealisation, one’s sense of the outside world’s reality is temporarily lost. Almost all of us experience this in a mild form during stressful periods.
But when these episodes become persistent and recurrent and interfere with normal functioning, the correct diagnosis would be depersonalization disorder.
In this disorder, people experience feeling detached from their bodies. They may even feel like they are floating above their physical body – as if they are in a dream or movie.
The lifetime prevalence of depersonalization disorder is unknown. Still, such symptoms are common in various mental health disorders, such as post-traumatic stress disorder, panic disorder, and other stressor-related disorders.
4. Difference between Dissociative Identity Disorder and Schizophrenia
The general population has long been confused about the difference between dissociative identity disorder and schizophrenia. It is not uncommon for people diagnosed with schizophrenia to have “multiple personalities.”
Some people even say, “I’m a bit schizophrenic on this issue,” meaning they have more than one opinion on it! This is also due to the myths about dissociative identity disorder (which are discussed below)
However, dissociative disorders and schizophrenia are two different mental health problems. People diagnosed with schizophrenia do not have multiple distinct personalities that alternately take control of the mind and a person’s behaviour.
They may have a delusion and believe they are someone else, but they do not show changes in identity accompanied by changes in vocabulary or tone.
Furthermore, people with dissociative identity disorder do not exhibit such characteristics of schizophrenia as a disorganized mental health system, hearing voices, or incoherent loose associations.
5. Myths About Dissociative Identity Disorder
Dissociative identity disorder is stigmatized and misunderstood frequently. There are a lot of myths about dissociative identity disorder, which have been addressed below.
One of the myths about dissociative identity disorders is that people with this disorder are violent. Violence is not more likely in dissociative disorder sufferers than in the general population.
Few known instances had dissociative disorders and crime together. There is no such thing as an “evil” alter. Compared to the general population, people with dissociative identity disorder are more prone to re-traumatize themselves and endure additional physical pain, abuse, and violence.
Other myths about dissociative disorder are that it is a personality disorder. Dissociative identity disorder is frequently mistaken for a personality disorder (reason for the previous use of the term multiple personality disorder) because of the relationship with numerous or “split” personalities. However, they are two entirely different conditions.
Personality disorders, which typically begin to manifest in early adulthood, are persistent set patterns of feeling and acting across time.
Individuals with personality disorders, such as borderline personality disorder, exhibit strong emotional outbursts and behavioural patterns that make it difficult for them to maintain healthy relationships and contribute to society.
Instead of having strong emotional reactions to everything around them, people with dissociative identity disorder lose touch with their memories, sense of self, emotions, and behaviour. In contrast to personality disorders, dissociative disorders can appear at nearly any age.
As mentioned above, dissociative identity disorder is also confused with Schizophrenia, which is one of the myths about dissociative identity disorder. Those with dissociative identity disorder may experience certain psychotic symptoms, such as hearing voices, but the two are separate mental health conditions.
One of the most common myths about dissociative identity disorder is that it is assumed to be a rare condition. A dissociative disorder is more common than schizophrenia. Research Trusted Source shows dissociative identity disorder is present in about 1.1% to 1.5% of community samples. In comparison, schizophrenia is estimated to occur in about 0.25% to 0.64%
6. Causes of Dissociative Identity Disorder
6.1. Past Trauma
In contemporary literature, the original major theory of how dissociative identity disorder and other dissociative disorders develop is the past trauma model. Most patients with dissociative disorder (over 95%) report having traumatic memories of physical and sexual abuse or other traumatic events in their childhood.
In the psychodynamic view, loss of memory or disconnecting one’s awareness from psychological trauma is adaptive in that it reduces emotional pain.
According to this view, dissociative identity disorder starts with the child’s attempt to cope with an overwhelming sense of hopelessness and powerlessness in the face of repeated traumatic abuse.
Lacking other resources or routes of escape, the child may dissociate and escape into fantasy, becoming someone else.
Those who view childhood trauma as playing a critical role in the development of dissociative identity disorder are beginning to see dissociative disorders as perhaps a complex and chronic variant of physical abuse or other traumatic events.
6.2. Socio-Cognitive Theory
It claims that a dissociative disorder develops when a highly suggestible person learns to adopt and enact the role of distinct identities, mostly because the clinical population has inadvertently suggested, legitimized, and reinforced them and because these separate identities are geared to the individual’s own personal goals.
However, this does not mean that the dissociative disorder occurs consciously but spontaneously with little or no awareness.
7. Treatment of Dissociative Identity Disorder and Other Dissociative Disorders
Unfortunately, virtually no systematic, controlled research has been conducted on dissociative disorders, so very little is known about how to treat them successfully or manage symptoms.
In dissociative fugues or amnesia, the person needs to be in a safe environment, so the therapeutic relationship plays a vital role. Therapy focuses on using drugs and hypnosis to recall memories that affect a person’s behaviour so that these memories can be reframed in new ways.
For patients with dissociative identity disorder, therapy focuses on past trauma and working through it to manage symptoms of dissociative disorders. One of the primary techniques used is hypnosis.
Through the use of hypnosis, therapists are often able to make contact with separate identities and re-establish connections between distinct, seemingly alternate personalities. An important goal is to integrate the alternate personalities into one identity that can better use its coping mechanism best suited to cope with current stressors.
8. So, Is Multiple Personality Disorder Real?
Dissociative identity disorder diagnosis has been controversial and scrutinized among the general population, with many professionals doubting the validity of previous psychiatric diagnoses, some believe otherwise.
Some research suggests that dissociative identity disorder is not only a valid diagnostic category; it may also co-occur in other disorders, such as individuals with borderline personality disorder, and may possibly be characterized by specific variations in brain functioning. Several kinds of evidence offer support for its reality.
First, persons with dissociative disorders sometimes show distinct brain imaging patterns when each of their supposedly distinct personalities appears. Similarly, alters sometimes differ in ways that are hard to fake: Some are right-handed and others left-handed; some show allergic reactions to various substances while others do not.
Findings like these suggest that some cases of dissociative identity disorder may be real.
However, this evidence itself is somewhat controversial, so at present, the best approach is one of considerable caution.
This is in no way to suggest that the potentially harmful effects of early traumatic events or physical abuse should be ignored – if these are severe, many psychologists believe they may lead to some dissociation. However, accepting exaggerated claims about dissociative identity disorder seems unjustified.
Dissociative symptoms and features can also be found in other cultures. The trancelike state known as amok, in which a person suddenly shows violent behaviour, is usually associated with no memory for the period during which the trance or violent behaviour lasts.
It is usually found in places like Malaysia, Laos, the Philippines, and Puerto Rico (American Psychiatric Association, 2000). However, despite their occurrence, in most cultures, dissociative disorders are not always perceived as a source of stress or problems.
9. FAQs
Q1. What Causes Multiple Personality Disorder?
A dissociative personality disorder is associated with extreme childhood experiences, traumatic events, and/or abuse. Dissociative personality disorder was formerly called multiple personality disorder.
Q2. Can You Live a Good Life With Did?
With effective treatment from a mental health provider trained in trauma and dissociation, or someone who can consult with someone who is trained, people with DID can recover. People with DID can live full and productive lives.
Q3. Can Multiple Personalities Go Away?
There is no cure for DID. Most people will manage this disorder for the rest of their lives. However, a combination of medications can help reduce symptoms.
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Last Updated on by Sathi Chakraborty, MSc Biology
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