Dissociative Identity Disorder

What Causes Dissociative Identity Disorder?

DID most commonly emerges in people who have had a history of prolonged abuse (physical, sexual, or emotional) in childhood. However, it may also occur in people who have experienced traumatic situations later in life, such as:

• Combat
• Torture
• Abduction
• Natural disasters

DID functions as a way for people to cope with trauma by distancing themselves from the identity that has experienced the trauma and viewing the situation from an outsider’s perspective.

Is Dissociative Identity Disorder Hereditary?

DID is not an inherited disorder. However, scientists believe that the condition results from an interplay between multiple factors, and genetics may be one of them. Some studies have found possible connections between dissociative symptoms in general and specific genes, and these genetic connections may make certain people more susceptible than others to DID. However, research into the possible genetic links is ongoing, and no definitive connection has yet been found.

How Is Dissociative Identity Disorder Detected?

DID often emerges in childhood in proximity to the traumatic experiences that trigger the disorder. However, the condition’s early symptoms are sometimes subtle and are commonly mistaken for other mental health conditions or behavioral problems. As a result, it is common for DID to go undiagnosed until adulthood, when the dissociative identity symptoms become more apparent.

DID in childhood may be confused with problems that include:

• Learning disabilities
• Behavioral issues
• Attention-deficit/hyperactivity disorder (ADHA)
• Personality disorders

How Is Dissociative Identity Disorder Diagnosed?

There are no tests or exams that can definitively identify DID. Instead, to diagnose the disorder, medical doctors and mental health professionals will work together on several diagnostic steps to rule out other possible causes for the symptoms and confirm a DID diagnosis. The diagnostic process usually includes:

• Physical exams and medical histories to look for underlying neurological or physical problems that may be triggering the symptoms
• Psychiatric exams to compare the patient’s symptoms to the diagnostic criteria for DID

The disorder’s diagnostic criteria include:

• Presence of two or more distinct personalities or identities
• Recurrent, abnormal memory lapses
• No cultural or religious explanation for the symptoms
• Symptoms can’t be explained by substance use, medical issues, or normal imaginative play in children
• Symptoms have a significant negative impact on everyday functioning

PLEASE CONSULT A PHYSICIAN FOR MORE INFORMATION.

How Is Dissociative Identity Disorder Treated?

Treatment for DID often includes a combination of psychotherapy and medications to treat specific symptoms. Common treatment approaches include:

• Psychotherapy (talk therapy) that focuses on teaching the patient to recognize their pattern of dealing with stress or anxiety-producing situations and learning new ways to deal with these situations. Therapy may progress to confronting the underlying traumatic triggers and merging the multiple identities into one stable identity.
• Hypnosis to recover suppressed memories that may be associated with the emergence of DID
• Medications to treat specific symptoms such as depression or anxiety

How Does Dissociative Identity Disorder Progress?

When it is left untreated, DID can lead to a variety of severe, long-term psychiatric, social, and medical complications. Long-term impacts of the disorder can include:

• Substance abuse
• Sleep disruptions
• Eating disorders
• Work, school, or relationship problems
• Depression and/or anxiety
• Post-traumatic stress disorder (PTSD)
• Personality disorders
• Self-harm or suicide

How Is Dissociative Identity Disorder Prevented?

Early intervention after a child has experienced trauma may be effective at preventing the onset of DID. Parents, teachers, and other people close to the child should watch for the early behavioral signs of DID, especially when the child is known to have been subjected to abuse.

Therapy may sometimes uncover specific triggers, such as substance abuse or stress, that cause the disorder’s identity shifts. Avoiding these triggers may help to eliminate or lessen dissociative episodes.

Dissociative Identity Disorder Caregiver Tips

Caregivers for children or adults who are experiencing symptoms of DID should keep these tips in mind:

• Learn about DID and its potential impacts.
• Encourage your loved one to seek help and be an active participant in treatment when it’s appropriate. For example, joining your loved one in family therapy or support group sessions can be beneficial.
• React calmly and provide a safe, comfortable environment when your loved one experiences dissociative episodes.

Dissociative Identity Disorder Brain Science

Scientists don’t precisely understand what is happening in the brains of people who experience dissociation, a feeling of being disconnected from a sense of self. Dissociation is at the heart of DID and other dissociative disorders, and it plays a role in some other neurological conditions such as epilepsy. Researchers hope that identifying a neurological mechanism underlying the experience of dissociation may lead to more effective treatment of all these disorders.

A recent study at Stanford University attempted to look for patterns of brain activity that may be associated with dissociative episodes. Experiments on mice and an epileptic patient who experienced dissociative episodes appeared to identify a pattern of electrical brain activity associated with the episodes. The researchers also identified a particular protein that seemed to generate the triggering brain activity. The scientists suggest that this protein might be a focus for further research into potential treatments.

Dissociative Identity Disorder Research

Title: Evaluating the Neurobiological Basis of Traumatic Dissociation in Women With Histories of Abuse and Neglect

Stage: Enrolling by invitation

Principal investigator: Kyle Williams, MD PhD  

Massachusetts General Hospital

Boston, MA

This study aims to evaluate the neurobiological basis of traumatic dissociation in a cross-diagnostic sample of women who have histories of childhood abuse and neglect.

Dissociative symptoms are commonly associated with exposure to traumatic stress. Preliminary evidence from functional magnetic resonance imaging-based analysis (fMRI) of neural activation during dissociative symptom provocation in patients with PTSD or DID has implicated specific key structures involved in the generation of dissociative symptoms. Given the presumed region-to-region neural interplay implicit within this model, the investigators believe the use of intrinsic functional connectivity MRI (fcMRI) represents a valuable next line of investigation into the neurobiology of traumatic dissociation. The investigators also believe that a genetic approach holds promise as another converging line of inquiry into our understanding of traumatic dissociation.

To evaluate the neurobiological basis of traumatic dissociation, this study will recruit patients with PTSD or DID and recruit matched controls to identify neurobiological correlates of traumatic dissociation. In addition, the study will compare the phenomenology of traumatic dissociation in patients with different PTSD subtypes and DID using standardized measures to look at the neurological and genetic correlates.

This study will also include a follow-up visit that includes neuroimaging and genetic assessments.

Title: Mechanistic Interventions and Neuroscience of Dissociation (MIND)

Stage: Not yet recruiting

Principal investigator: Negar Fani, PhD   

Grady Hospital

Atlanta, GA

The purpose of this study is to test the neurophysiological mechanisms of an intervention to reduce symptoms of dissociation in traumatized people. The intervention will be tested in dissociative traumatized people at Emory University and the University of Pittsburgh. The researchers are interested in whether neural networks associated with attentional control and interoceptive awareness can be enhanced in this population. The researchers propose to evaluate whether different body-focused and non-body-focused interventions can change these mechanisms.

People exposed to chronic trauma face devastating effects on the brain and body. Chronically traumatized people become highly distressed when attending to emotional stimuli, leading to feelings of detachment from their bodies and environment. It is challenging to engage highly dissociative traumatized patients in trauma-focused treatment; however, these patients benefit from acquiring basic emotion regulation skills, including present-centeredness and body awareness. Various practices that involve present-centeredness and body awareness (including mindfulness-based interventions) have been shown to demonstrate short-term and long-term improvement in cognition, emotion regulation, and clinical symptoms in dissociative people with trauma exposure.

To address this issue, the researchers will evaluate the effectiveness of interventions that engage present-centered awareness and/or body focus.