Beyond Multiple Personalities: Exploring the Depths of Dissociative Identity Disorder
- Publicity PSYSOC
- Dec 31, 2023
- 6 min read
Written by: Zane Lim and Belle Ang
Until 1994, Dissociative Identity Disorder (DID) was commonly known as ‘Multiple Personality
Disorder’. DID is a rare psychiatric condition where people have two or three separate identities.
These identities surface at different times and when one surfaces, that specific identity takes
control over the person’s behaviors and thoughts (Cleveland Clinic, n.d.). The International
Society for the Study of Trauma and Dissociation describes these alternate identities as
independent entities with a set of individualized behaviors, memories, thought processes,
language and expression (Mitra & Jain, 2023). Although these identities could appear drastically
different, they are all manifestations of a single individual (American Psychiatric Association
[APA], n.d.). Over time, more identities may evolve and serve different roles to help the individual
cope with various life dilemmas with specific identities appearing after being triggered by certain
environmental factors or life events (WebMD, 2022). Some signs that indicate a switch to an
altered state include eye-blinking, trance-like behavior, and changes in posture (Mitra & Jain,
2023). In addition, this disorder is generally linked to severe trauma and abuse that occurred in
childhood and individuals who have experienced physical or sexual abuse as children are at an
increased risk of developing DID (APA, n.d.).
Dissociation can be construed as an “emergency defense” or a “shut-off mechanism” for
individuals as they attempt to avoid the overwhelming sense of consciousness during the
traumatic experience. It is said that individuals dissociate as a form of self-protection when they
are unable to control a situation yet subconsciously, could not bear being emotionally present at
the time of trauma. Dissociation allows them to endure, escape, survive, and adapt to the
intolerable trauma. However, when individuals become habituated to dissociation, they may
subsequently transfer and arbitrarily adopt this dissociative response to a wide variety of
circumstances. Eventually, this undermines the initial adaptation and becomes pathological (Allen
& Smith, 2009, as cited in Gentile et al., 2013). For individuals to be diagnosed with DID, the
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) requires the
presence of the following behaviors in an individual (WebMD, 2022):
1. Two or more distinct identities or personalities present, each with its own pattern of
perception in relation to thinking about one’s self and the environment
2. Amnesia, defined as distinctive memory gaps in the form of important personal
information, everyday experiences, and/or traumatic events
3. Dysfunction in more than one major life area or in a state of distress due to this disorder
4. Disturbances not associated with any cultural or religious practices
5. Symptoms must not be induced by direct physiological effects resulting from substance or
a general medical condition
Since this disorder is incredibly rare with only 1.5% of the global population diagnosed,
misdiagnosis is common and multiple assessments are required to ensure an accurate diagnosis
(Mitra & Jain, 2023).
Treatment for DID involves a multidisciplinary treatment plan with the inclusion of psychotherapy
as a crucial interventional strategy (Gentile et al., 2013). According to Mitra and Jain (2023),
patients with DID are managed and treated using a three-step approach which comprises: 1)
Establishing safety, stabilization, and symptom reduction, 2) Confronting, working through, and
integrating traumatic memories, and 3) Identifying integration and rehabilitation. The first step
focuses on the prevention of suicide ideation and self-harm behaviors to ensure the safety of
patients (Foote et al., 2008, as cited in Mitra & Jain, 2023), while the second step focuses on
guiding patients on how they can tolerate, process, and integrate past trauma by re-accessing
traumatic memories of different alternate identities. Lastly, the final step of the approach focuses
on the patient’s relationship with the self and the outside world (Mitra & Jain, 2023). Currently, no
evidence has shown that pharmacological treatments reduce dissociation (Stern et al., 2008, as
cited in Gentile et al., 2013).
A particularly interesting case study on DID was a 20-year-old Korean male, who was serving his
military service (Kim, Kim, & Jung, 2016). He was transferred from the military hospital and
admitted to a psychiatric ward due to his violent behavior and changes in personality. The patient
studied for six years abroad before returning back to Korea for his mandatory military service. His
parents described him as a shy and timid guy. However, the patient behaved very differently from
his usual self, being more confident and outgoing. He was also very forgetful and would lose his
way around places or his belongings. During the hospitalization procedure, they observed seven
different alters from him. His other alters consist of an arrogant and uncooperative personality
who only speaks English, a violent alter who broke a window with his fist and tried to hit the
psychiatrist as well as an alter who spoke both English and Korean, while mentioning that he
knew the host and other alters well. There were an additional three alters which included a five-
year-old boy, a mother-like personality and a metrosexual alter. Laboratory tests and a structured
clinical interview for DSM(IV) dissociative disorder [SCID-D] were conducted on the male to
confirm the diagnosis of DID (Kim, Kim, & Jung, 2016). Through the procedures, the patient was
found to have repeated childhood trauma resulting from neglect, physical and emotional abuse
by his parents. Each time these memories were faced, his violent alter would take over to help
him cope with the trauma.
For individuals who may be interested in knowing more about DID, here are some
recommendations for books and shows featuring DID. Firstly, a book about Sybil: The Classic True
Story of a Woman Possessed by Sixteen Separate Personalities written by Flora Rheta Schreiber.
The book of Sybil narrates the life of Sybil Dorsett, a victim of sexual abuse in childhood, and her
experience of dissociative identity disorder where she developed a total of sixteen different alters
(Goodreads, n.d.). After being published in the 1970s, this book gained widespread popularity
and captured the attention of both the general public and the medical community. This heightened
interest eventually contributed to the inclusion of multiple personality disorder in the DSM (CBC
Books, 2022). Secondly, a Netflix documentary titled ‘Monster Inside: The 24 Faces of Billy
Milligan’. The documentary featured Billy Milligan, who was indicted for kidnapping, robbing, and
raping three women near the campus of Ohio State University (Tonguette, 2021). His case was
so compelling because he was the first ever defendant found not guilty due to insanity (Ponti,
2021), after undergoing multiple evaluations by professionals together with his defense team who
posited that the crimes were committed by two of his other alters and not his default identity
(Tonguette, 2021). These two stories dive deep into the history of the disorder and convey various
insights about DID. Most importantly, it brings a refreshing aspect as the stories were depicted
from the patients’ perspective.
To conclude, different personality alters are formed in order to serve as a form of protection and
coping mechanism for the individual to overcome a traumatic experience. Often, these
personalities appear during certain trigger factors such as, when the host is reminded of an
unfavorable memory of childhood abuse (Rehan, et al., 2018). Depending on the case and
severity, the individual may evolve more personalities and unpredicted fragmentations of multiple
alters. It can be said that avoiding triggers of stress or environmental stimuli may help to prevent
the fragmentations of multiple personalities. DID is mostly identified by observers about the
differences in an individual’s personality state shift (Rehan, et al., 2018). Lastly, the prevalence is
found to be lower in Asian countries and rarely reported compared to Euro-American countries
(Kim, Kim, & Jung, 2016). Therefore, this makes the condition tricky as mental health
professionals from Asian regions who have rarely encountered patients with DID require
specialized training to diagnose and manage the condition.
References
American Psychiatric Association. (2022, October). What are Dissociative Disorders?
disorders#section_0
CBC Books. (2022, November 2). Who was Sybil? The true story behind her multiple
multiple-personalities-1.4268459
Cleveland Clinic. (n.d.). Dissociative Identity Disorder (Multiple Personality Disorder).
multiple-personality-disorder
Gentile, J. P., Dillon, K. S., & Gillig, P. M. (2013). Psychotherapy and pharmacotherapy for
patients with dissociative identity disorder. Innovations in Clinical Neuroscience, 10(2), 22-
29.
Goodreads. (n.d.). Sybil: The Classic True Story of a Woman Possessed by Sixteen Personalities.
Retrieved from Goodreads: https://www.goodreads.com/en/book/show/67920
Kim, I., Kim, D., & Jung, H.-J. (2016). Dissociative Identity Disorders in Korea: Two Recent Cases.
Psychiatry Investigation, 250-252. doi: 10.4306/pi.2016.13.2.250
Mitra, P., & Jain, A. (2023). Dissociative Identity Disorder. StatPearls. Retrieved August 11,
Ponti, C. (2021, October 26). Billy Milligan: Can Someone With Dissociative Identity Disorder Be
Accountable For Violent Crimes? A&E TV. https://www.aetv.com/real-crime/billy-
milligan-diagnosis
Rehan, M. A., Kuppa, A., Ahuja, A., Khalid, S., Patel, N., Cardi, F. S. B., Joshi, V. V., Khalid, A.,
& Tohid, H. (2018). A Strange Case of Dissociative Identity Disorder: Are There Any
Triggers? Cureus. doi: 10.7759/cureus.2957
Tonguette, P. (2021, September 27). Movie review: Billy Milligan documentary offers even-
handed look at complicated case. The Columbus Dispatch.
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WebMD. (2022, January 22). Dissociative Identity Disorder (Multiple Personality Disorder).
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