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Expert Q&A: Dissociative Disorders

Dissociative identity disorder involves a lack of connection among a person’s sense of identity, memory and consciousness. People with this disorder do not have more than one personality but rather less than one personality. (The name was changed recently from ‘multiple personality disorder’ to ‘dissociative identity disorder.’) This disorder usually arises in response to physical and sexual abuse in childhood as a means of surviving mistreatment by people who should be nurturing and protecting.

Yes. They are sometimes misdiagnosed as having schizophrenia, because their belief that they have different identities could be interpreted as a delusion. They sometimes experience dissociated identities as auditory hallucinations (hearing voices). Their symptoms do not improve with antipsychotic medication, but the emotions they display get flatter. This can leading to the mistaken belief that they have schizophrenia and to further ineffective increases in medication. Another common misdiagnosis is borderline personality disorder. People with dissociative identity disorder frequently also have depression.

You may notice sudden changes in mood and behavior. People with dissociative identity disorder may forget or deny saying or doing things that family members witnessed. Family members can usually tell when a person “switches.” The transitions can be sudden and startling. The person may go from being fearful, dependent and excessively apologetic to being angry and domineering. He or she may report not remembering something they said or did just minutes earlier.

Be open and accepting in your responses. Do not ‘take sides’ with one or another component of their identity. Rather view them as portions of the person as a whole. We are all different in different situations, but we see this as different sides of ourselves. Try to maintain that perspective with the person with dissociative disorder. Also, help them to protect themselves from any trauma, abuse, or self harm.

They can, but they usually do not. Typically those with dissociative identity disorder experience symptoms for six years or more before being correctly diagnosed and treated.

Dissociation is a common coping mechanism, especially in the face of trauma. Many rape victims experience the crime as though they were floating above their bodies, feeling sorry for the person beneath them. Many of us find ways to detach ourselves from painful or unpleasant experiences.

However, people typically restore their usual perspective over time. Those with dissociative disorders experience persistent amnesia, depersonalization, derealization or fragmentation of identity that actually interferes with the normal process of working through and putting into perspective traumatic or stressful experiences.

Content Author

David Spiegel, M.D.

David Spiegel, M.D.

Professor and Associate Chair of Psychiatry & Behavioral Sciences
Director, Center on Stress and Health
Medical Director, Center for Integrative Medicine
Stanford University School of Medicine

Last Review Oct. 2020

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