What Is Multiple Personality Disorder?

Some of the earliest known cases of multiple personality disorder were reported as demonic possessions. This could be because more than one personality appeared to exist in, and alternated taking control of, an individual. Also, the behaviors exhibited usually fell outside of accepted cultural and religious norms. The case of a French nun named Jeanne Fery in 1584 was one such example. Details of her “exorcism” were documented at the time and later became one of the first preserved records of symptoms related to multiple personality disorder. The symptoms recorded in 1584 are the same signs and symptoms currently experienced by people with the disorder. They included disordered eating, self-harm, and audible hallucinations, as well as the ability of different personalities to alternate control of Jeanne Fery’s consciousness, knowledge, skill, and changes in behavior.

By the 1900s, scientists and mental health professionals began to believe that a fractured identity caused by childhood trauma and abuse created separate identities that existed within one person. These identities were viewed by some mental health professionals as separate or alternate “people,” rather than as one identity expressed in separate personalities. Many people called these separate personalities a “split personality.”

The terms “possession” cases and “non-possession” cases continued to be used to describe the difference between how the disorder was observed.

• Possession cases, where alternate personalities were easily observed by others
• Non-Possession cases, where switching between alternate personalities did not occur for extended periods of time, or changes in mannerisms and behaviors were slight or unnoticeable

By 1994, the name multiple personality disorder was changed to dissociative identity disorder in order to better reflect a current understanding of the condition. The new understanding characterized the different personalities as fragmented or splintered from one identity—it no longer considered the personalities to have developed as separate and intact identities. Instead, one identity was thought to have either never fully integrated, remaining in several parts, or was disrupted, fragmenting into split personalities that became separate parts of the whole.

When the Diagnostic and Statistical Manual of Mental Health 4th Edition (DSM-IV) was published, multiple personality disorder was renamed as dissociative identity disorder. The two disorders are essentially the same, meaning they refer to the same condition. However, the re-characterization of the disorder left some scientists and mental health professionals discerning between the two, citing their differences. The discussion has been centered around whether one believes there are multiple, independent, and easily observable identities residing within one body, or that one core identity has been fractured into many split personalities that may or may not be easily observed by others.

Previously, multiple personality disorder described the main issue as:

• Many identities in one person that are easily observed by others
• Gaps in memory, or the switching of personalities, triggered solely by traumatic events

When the name changed to dissociative identity disorder, so did the description of the main issue. It was updated and expanded the diagnostic criteria to include the following:

• Splintering of a single identity into multiple, or split personalities
• Switching of personalities that was either self-reported or observable by others
• Gaps in memory, or switching between personalities, that could occur during everyday life events and not solely during traumatic situations

Although some place great weight on changes in the disorder’s characterization, most mental health professionals who are trained in this condition tend to find the changes less about the disorder and more about addressing how the disorder is currently understood.

Even though people have observed symptoms of multiple personality disorder over the course of history, and the disorder was formally recognized as a mental health condition by the first Diagnostic and Statistical Manual of Mental Disorders (DSM-I) in 1952, skepticism about the disorder persists.

Multiple personality disorder has been described by some as an “iatrogenically inspired diagnosis,” meaning that a mental or medical health practitioner somehow inadvertently introduced the condition to the individual seeking help, during diagnostic procedures or treatment. However, that characterization does not explain the symptoms that prompted the individual to seek treatment in the first place. Nor does it explain why, if dissociative identity disorder is not responsible, treating for other mental health conditions appears not to alleviate symptoms, but later treating for DID appears to help. While the disorder continues to be hotly debated, nearly two percent of the population is suffering from it.

Many people have experienced episodes of disassociation where they feel as though reality is “hazy” and they are “in a dream,” or feel as if they are outside of their body, observing events happen to them. However, people who suffer from multiple personality disorder/dissociative identity disorder have much more severe experiences of disassociation that occur often and interfere with their ability to carry out daily life functions. Disassociation is caused by a lack of connection between a person’s memory, thoughts, feelings, behaviors, and individual sense of self.

Many people who suffer from dissociative identity disorder have described the sensation that their bodies “feel different,” or as if their bodies are not under their own control. At these times, a person might suddenly feel as though they are small, like a child, or frail, or more muscular than what his or her body normally feels like. People have also reported sudden impulses and/or significant changes in emotions, attitudes, or personal preferences, where there is no sense of control or ownership over those feelings. During those times, people have expressed a loss of time, or a sense of watching over themselves while “someone else” has control of their body and behaviors. Some people who have DID have even described hearing the voices of others, while those others have control over the body. They have also heard the voices of various personalities attached to multiple independent streams of thought occurring simultaneously.

People with dissociative identity disorder who experience fugue states, when there is a loss of time and experience, have reported various stages of recollection and awareness. Some have no memory of what happened, where they went, or what they did, and others have some awareness of the overall amnesia and “missed” experience.

Living with dissociative identity disorder can be distressing and can often overlap with other conditions such as depression, anxiety, and personality disorders. Controversy surrounding diagnosis and the disorder itself can create added confusion for people who may already be struggling with their symptoms. It is important to seek help from a trained mental health professional, or one who has experience with trauma or dissociative disorders.

Currently, there is no cure for multiple personality disorder. But with treatment, it is possible to alleviate symptoms and reduce disruptions in the ability to function in daily life.

Treatment usually includes a combination of talk therapy and medication. Talk therapy is generally aimed at trying to unify, or re-unify, a fractured identity. The prevailing belief is that the identity is fractured during childhood, and in children who are exposed to extreme persistent trauma, abuse, and/or life-threatening experiences. These children also often lack adequate safe, nurturing resources to handle these traumatic situations, and they disassociate in order to cope. During this disassociation, the experience “feels like” it is happening to someone else rather than to the child.

Some professionals assert that since children have not yet fully integrated their identities, the disassociation prevents the identity from integrating, or causes it to split. The goal of psychotherapy is to deconstruct each split personality and reintegrate it with the core identity. Specific types of talk therapy focus on dealing with the traumas and abuses of each personality, developing coping strategies, and working toward several objectives:

• To prevent further traumas
• To stabilize emotions
• To unify and integrate personalities
• To establish relationships between personalities (when integration is not possible)

Sometimes re-unification, or re-integration, is not possible. In those situations, the goal is to create a harmonious environment where the remaining personalities work together in a way that allows for better functioning in everyday life.

Medications are generally used to treat symptoms associated with other mental health disorders, rather than to treat dissociative identity disorder. Usually, anti-anxiety medications are used to treat anxiety, antidepressants to treat depression, and antipsychotics to treat auditory or visual hallucinations.

Therapists who have advanced training or who specialize in trauma-related conditions can be helpful in treating dissociative identity disorder. Long-term, residential care can also be a very effective option.

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