Dissociative Identity Disorder, previously known as multiple personality disorder, is one of a group of conditions called dissociative disorders. Dissociative disorders are mental illnesses that involve disruptions or breakdowns of memory, awareness, identity and perception. When one or more of these functions is disrupted, symptoms can result. These symptoms can interfere with a person’s general functioning, including social activities, work functions, and relationships. People with dissociative identity disorder often have problems with their identities and senses of personal history.

Dissociation is a key feature of dissociative disorders. Dissociation is a coping mechanism that a person uses to disconnect from a stressful or traumatic situation or to separate traumatic memories from normal awareness. It is a way for a person to break the connection between the self and the outside world, as well as to distance oneself from the awareness of what is occurring. Dissociation can serve as a defence mechanism against the physical and emotional pain of a traumatic or stressful experience. By dissociating painful memories from everyday thought processes, a person can use dissociation to maintain a relatively healthy level of functioning, as though the trauma had not occurred.

What are the factors behind multiple personality disorder?

It is normally accepted that multiple personality disorder results from extreme and repeated trauma that occurs during important periods of development during childhood. The trauma often involves severe emotional, physical or sexual abuse, but also might be linked to a natural disaster or war. An important early loss, such as the loss of a parent, also might be a factor in the development of dissociative identity disorder. In order to survive extreme stress, the person separates the thoughts, feelings and memories associated with traumatic experiences from their usual level of conscious awareness.

The fact that dissociative identity disorder seems to run in families also suggests that there might be an inherited tendency to dissociate. Multiple personality disorder appears to be more common in women than in men. This might be due to the higher rate of sexual abuse in females.

What are the warning signs of multiple personality disorder?

Warning signs of dissociative identity disorder are similar to those of several other physical and mental disorders, including substance abuse, seizure disorder and post-traumatic stress disorder. Symptoms of dissociative identity disorder may include:

• Changing levels of functioning, from highly effective to nearly disabled
• Severe headaches or pain in other parts of the body
• Depersonalization (episodes of feeling disconnected or detached from one’s body and thoughts)
• Derealisation (perceiving the external environment as unreal)
• Depression or mood swings
• Unexplained changes in eating and sleeping patterns
• Anxiety, nervousness, or panic attacks
• Problems functioning sexually
• Suicide attempts or self-injury
• Substance abuse
• Amnesia (memory loss) or a sense of "lost time"
• Hallucinations (sensory experiences that are not real, such as hearing voices)

How multiple personality disorder is diagnosed?

If symptoms are present, the doctor will begin an evaluation by performing a complete medical history and physical examination. While there are no laboratory tests to specifically diagnose dissociative disorders, the doctor might use various diagnostic tests such as X-rays and blood tests to rule out physical illness or medication side effects as the cause of the symptoms. Certain conditions including brain diseases, head injuries, drug and alcohol intoxication, and sleep deprivation can lead to symptoms similar to those of dissociative disorders, including amnesia. In fact, it is amnesia or a sense of lost time that most often prompts a person with dissociative identity disorder to seek treatment. He or she might otherwise be totally unaware of the disorder.

If no physical illness is found, the person might be referred to a psychiatrist or psychologist, health care professionals who are specially trained to diagnose and treat mental illnesses. Psychiatrists and psychologists use specially designed interview and personality assessment tools to evaluate a person for a dissociative disorder.

How multiple personality disorder is treated?

The goals of treatment for dissociative identity disorder are to relieve symptoms, to ensure the safety of the individual, and to "reconnect" the different identities into one well-functioning identity. Treatment also aims to help the person safely express and process painful memories, develop new coping and life skills, restore functioning, and improve relationships. The best treatment approach depends on the individual and the severity of his or her symptoms. Treatment is likely to include some combination of the following methods:

• Psychotherapy: This kind of therapy for mental and emotional disorders uses psychological techniques designed to encourage communication of conflicts and insight into problems.
• Cognitive therapy: This type of therapy focuses on changing dysfunctional thinking patterns.
• Medication: There is no medication to treat the dissociative disorders themselves. However, a person with a dissociative disorder who also suffers from depression or anxiety might benefit from treatment with a medication such as an antidepressant or anti-anxiety medicine.
• Family therapy: This kind of therapy helps to educate the family about the disorder and its causes, as well as to help family members recognise symptoms of a recurrence.
• Clinical hypnosis: This is a treatment technique that uses intense relaxation, concentration and focused attention to achieve an altered state of consciousness or awareness, allowing people to explore thoughts, feelings and memories they might have hidden from their conscious minds.

Prognosis for people with multiple personality disorder

People with dissociative identity disorder generally respond well to treatment however, treatment can be a long and painstaking process. Some people with dissociative identity disorder are reluctant to reconnect their separate identities because these different identities help them to cope. To improve a person’s outlook, it is important to treat any other problems or complications, such as depression, anxiety or substance abuse.