Updated January 2026
Welcome to class, everyone!
Here we explore mental health awareness by seeking to understand various diagnoses found within the holy bible of psychology, the DSM-V.
Today’s class topic: DID
What is DID?
Its previous term Multiple Personality Disorder was officially reconstructed in 1994 when the DSM-IV was published. For many, the outdated term came with many misconceptions. This update to renaming MPD to Dissociative Identity Disorder clarifies the understanding of the condition: it wasn’t describing multiple personalities housed within one mind; rather, that the condition centers around a fragmentation of identity.
It isn’t classified as a personality disorder, it is listed as a dissociative disorder, hence the name. Its primary purpose is to compartmentalize trauma away from the consciousness of a young child so they are blissfully unaware of anything amiss.
What is Identity?
Psychologists theorize about how identity forms at birth. Everyone starts at square one in which their identity has yet to fuse together. As they grow, they learn what is right (“I shouldn’t lie to Mom.”) and what is wrong (“Should I help my friend cheat on the math test?”). They learn from the world around them and anticipate that this is the way the world welcomes them (“Daddy and Mommy always fight, so love means you’re always fighting.” or “Nobody comforts me when I cry, so crying shows weakness.”)
These separated states of consciousness co-exist without barriers of any kind and during the years from birth up until the ages of nine or ten, these different states fuse together and become one identity with morals, values, likes, dislikes, and a consistent perspective of how the child views themselves and the world.
The Fragmentation
Dissociative Identity Disorder isn’t formed without a reason.
So, what happens that causes the condition?
The disorder is commonly associated with childhood abuse and trauma. Much of the trauma a child experiences in these cases are intense, and are difficult for anyone to process regardless of age. And imagine: for a child, they are typically unable to fight physically against the abuse to defend themselves. They are also typically unable to flee from their aggressor, abuser, or the situation they’re in. And it’s guaranteed in many cases for the abuse to happen again and again. It’s not a matter of if, but when.
So the brain develops the healthiest way it can protect itself.
It goes, “This can’t be my reality. This can’t be my life. If this is my life, I will not be able to function at all.”
In a 2023 study, it is noted from Putnam et al. that, “alternative identities result from the inability of many traumatized children to develop a unified sense of self…particularly if the traumatic exposure first occurs before the age of 5.”
The process of identity is disrupted, focusing intently on safety for the child’s present. The brain rewires itself on a subconscious level to cope with reality. A mental barrier is put into the splits of consciousness that didn’t get a chance to merge. Oftentimes, children who develop this coping mechanism cannot escape their situations. If they can’t flee, they’ll dissociate between these altered states, termed alters, routinely to stay alive.
The Presentation
Depending on the person, the presentation ranges significantly. Like many other disorders, there’s a spectrum within the presentation of its criteria.
A DID system is the collection of alters. It can be as little as two alters in one system to hundreds or more, sometimes thousands.
Yes, you read that right. It’s not an exaggeration.
Alters hold various roles within a system, ranging from simple tasks, like holding a specific feeling or memory, to complicated ones, like being a protector or living everyday life as the host. These roles are interchangeable, and one alter can take on multiple roles at once depending on the system’s need. When one needs to step back, another takes the steering wheel by switching into consciousness.
There are two ways a system may present itself. For the general public, it is associated that many systems are overt systems, where one can visibly watch the switching and behavioral differences happen between alternative states. Hollywood, for example, showcases characters with overt DID in order for the audience to understand the context of what’s happening on screen: from Sybil to The Three Faces of Eve.
A recommended example of showing how overt systems works together to build a fulfilling life, I highly recommend checking out the documentaries The Many Sides of Jane and Saturday Night Live’s All of Me.
The second way of presentation is that the system is covert, hiding in plain sight. The switches are hidden or not as easily recognizable, or the system’s method of functioning is blending in to remain undetected by others, instead having more internal influence than switching episodes.
The purpose for both remains the same: survival adaptation depending on the context and upbringing of the DID system – all of it is to ensure safety and survival.
Diagnosis and Treatment
Those with DID who seek out a diagnosis oftentimes have differential diagnoses with two to five wrongly diagnosed as the root. The most common include borderline personality disorder, histrionic personality disorder, and primary psychotic disorders. Patients report being in therapy for an average of five to twelve years before receiving a diagnosis of DID and before treatment is adjusted to include it.
In order for a diagnosis to be reached, it must be noted or reported by the individual that there is a disruption of identity characterized by two or more distinct personality states, with recurrent gaps in important memory recall that is inconsistent with ordinary forgetting. The disturbance isn’t part of a broadly accepted cultural or religious practice, and it is not caused by physiological effects of a substance or another medical condition.
According to a StatPearls scholarly article by Mitra and Jain, about 1.5 percent of the international population is diagnosed with DID. Using these numbers, 7.9 billion and 1.5 percent, results in a total of 118,500,000 confirmed DID cases. This disorder is not as uncommon as one might think – worldwide, it is 1 in every 67 people.
To date, there is no medication to treat DID – antipsychotic medications, mood stabilizers, and stimulants have been recorded in reviews, though many results of these medications taken specifically for the treatment of DID itself have proven ineffective. There are serious cautions to consider for systems choosing this path: one alter may have an allergy to a drug that others tolerate without issue. In cases like this, the difference can be as stark as uphill recovery versus an unexpected trip to the ER.
When taking the pharmaceutical route, it is always in conjunction with therapies such as trauma-focused cognitive behavioral therapy (CBT), dialectical behavioral therapy (DBT), and Eye Movement Desensitization and Reprocessing (EMDR). These psychotherapy treatments are often the most common approaches to treating DID specifically. The focus is treating the core roots of the trauma with the goal of healing the individual: whether it’s by the system working together or choosing to integrate into one cohesive identity.
Additional Tips
When therapy is not accessible in the near future, establishing inner communication with alters is key to solving a bunch of problems, obstacles, and complications.
A few helpful ways to achieve this is to journal, have internal meetings, and use color-coded notes. Sticky notes are extremely useful to have in places as reminders – stick them on the fridge, on the bathroom mirror, on the dryer or dishwasher to pass information along. Tracking switches and triggers in a system journal builds awareness of patterns and triggers, which can be useful in understanding each alter’s motivations and roles – and whether or not they would be willing to cooperate or seek therapeutic help.
Building and establishing a support network of trusted friends or family who respect system boundaries goes a long way – true friends and family would not abandon ones they love after learning of their partner’s, friend’s, or family member’s condition. Having this would ease the burden of isolation, and can help ease tension in stressful situations, especially in an emergency.
Establishing a crisis plan (even a small one) can alleviate stress with triggers or unsafe situations. If one alter is allergic to a medication, for example, it is best that the information is able to be accessed by medical professionals during an emergency.
Learn grounding techniques to stay present during dissociation – for example, the 5-4-3-2-1 senses method or deep breathing exercises. Holding a specific object, like a stone, textured item, or comfort item can help reconnect the mind with the body.
Allow alters to write or draw to express themselves and communicate. Set small, stable routines for daily life to reduce stress and provide predictability – add in a self-soothing routine to establish stability, peace, and comfort.
Remember that you are not alone.
Class dismissed.