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What is Dissociative Identity Disorder?

Many people will experience dissociation at some point in their lives. Lots of different things can cause you to dissociate. For example, you might dissociate when you are very stressed, or after something traumatic has happened to you. You might also have symptoms of dissociation as part of another mental illness like anxiety. For many people these feelings will pass over time.

If you dissociate you might feel like you are not connected to your own body. Or like you are watching things happen around you, without feeling them.

• If you dissociate you might have symptoms such as not feeling connected to your own body, or developing different identities.
• Dissociative disorders are a mental illness that affects the way you think. You may have the symptoms of dissociation, without having a dissociative disorder. You may have the symptoms of dissociation as part of another mental illness.
• There are lots of different causes of dissociative disorders.
• You may get medication and talking therapies for dissociative disorders.

General symptoms of Dissociative Identity Disorder

You might have these symptoms for as long as the event that triggered them, or for a short time afterwards. This is called an episode.
For some people these symptoms can last for much longer. If you have a dissociative disorder you might experience these symptoms for long episodes or even constantly.

Amnesia - This means memory loss. You might lose your memories of things that have happened to you.
Depersonalization - Feeling disconnected from your own body.
Derealization - Feeling disconnected from the world around you.
Identity confusion - You might not have a sense of who you are.
Identity alteration - This means your identity may have changed. You might remember your old identity or not.
Loss of feelings.
Losing control of your body movements.

Types of Dissociative Identity Disorder

There are different types of dissociative disorder. There is more information on each of these below.
It is important to remember that you could have the symptoms of dissociation without a dissociative disorder. There is also a lot of disagreement among professionals over dissociative disorders.

Dissociative amnesia

If you have dissociative amnesia you might not remember things that have happened to you. This may relate to a stressful or traumatic event, but doesn’t have to.

In severe cases you might struggle to remember

• who you are,
• what happened to you, or
• how you felt at the time of the trauma.

This is not the same as simply forgetting something. It is a memory ‘lapse’. This means you cannot access the memories at that time, but they are not permanently lost.

With dissociative amnesia you might still engage with other people, such as holding conversations. You might still remember other things, and live a normal life. But you might have flashbacks, unpleasant thoughts or nightmares about the things you struggle to remember.

You may have dissociative amnesia with dissociative fugue. This is where someone with dissociative amnesia travels or wanders somewhere else, related to the things they can’t remember. You may or may not have travelled on purpose.

Dissociative identity disorder (DID)

Dissociative identity disorder (DID) is sometimes called ‘Multiple Personality Disorder'. But we have called it DID in this section.

Common Experiences of DID

If you have DID you might seem to have 2 or more different identities, called ‘alternate identities’. These identities might take control at different times.

You might find that your behaviour changes depending on which identity has control. You might also have some difficulty remembering things that have happened as you switch between identities. Some people with DID are aware of their different identities, while others are not.

There is a lot of disagreement between researchers over the notion of DID. While we think of someone with DID as having different identities, some researchers think that these are actually different parts of one identity which are not working together properly. They suggest that DID is caused by experiencing severe trauma over a long time in childhood. By experiencing trauma in childhood, you take on different identities and behaviours to protect yourself. As you grow up these behaviours become more fully formed until it looks like you have different identities, when in fact the different parts of your identity don’t work together properly.

Other specified dissociative disorder

With this diagnosis you might regularly have the symptoms of dissociation but not fit into any of the types. A psychiatrist uses this diagnosis when they think the reason you dissociate is important.

The reasons they give include the following.

• You dissociate regularly and have done for a long time. You might dissociate in separate, regular episodes. Between these episodes you might not notice any changes.

• You have dissociation from coercion. This means someone else forced or persuaded you. For example, if you were brainwashed, or imprisoned for a long time.

• Your dissociation is acute. This means that your episode is short but severe. It might be because of one or more stressful events.

• You are in a dissociative trance. This means you have very little awareness of things happening around you. Or you might not respond to things and people around you because of trauma.

Unspecified dissociative disorder

This diagnosis is also used where you dissociate but do not fit into any specific disorder.

Diagnoses explained

Psychiatrists use this diagnosis when they choose not to give a reason that you have the symptoms. Or if they do not have enough information for a specific diagnosis. For example, after a first assessment in accident and emergency.

Depersonalization / derealization disorder (DPDR)

The feelings of depersonalization and derealization can be a symptom of any of the other conditions listed here. It has also been found among people who have paranoid delusions, and people with frontal lobe epilepsy and migraines.

Many people think that this disorder might be more common than previously thought.

This might be because of:

• there is a lack of information about it,
• some patients do not report their symptoms, and
• doctors who don’t know enough about it, meaning they under-report the condition.

With DPDR you might have symptoms of depersonalization or derealization or both.

With depersonalization you might feel ‘cut off’ from yourself and your body, or like you are living in a dream. You may feel emotionally numb to memories and the things happening around you. It may feel like you are watching yourself live.

What causes dissociation??

There are different things that can cause you to dissociate. For example:
• traumatic events,
• difficult problems that cause stress, and
• difficult relationships.
Other researchers have suggested that the use of cannabis may be a cause of depersonalization/derealization disorder (DPDR).

Treatment and Help

Dissociative disorders are managed through various therapies including:

• Psychotherapies such as cognitive behavioral therapy (CBT) and dialectical behavioral therapy (DBT)

• Eye movement desensitization and reprocessing (EMDR)

• Medications such as antidepressants can treat symptoms of related conditions

If you are needing a referral to a psychologist, psychiatrist or support group, please can you call The South African Depression and Anxiety Group (SADAG) on 011 234 4837 or 0800 20 50 26 and speak to a trained counselor who can assist you further.

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