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Movies and literature have promoted a misconception about Dissociative Identity Disorder, but what does this disorder really consist of? What are its causes?
Dissociative Identity Disorder (DID) has become one of the most common conditions portrayed in fiction media such as movies and literature. Various authors have drawn inspiration from the limited knowledge about this condition to create characters and stories, such as „Dr. Jekyll and Mr. Hyde,” „Gollum” (The Lord of the Rings), „Psycho” by Alfred Hitchcock, or the recent „Split” by M. Night Shyamalan. It is undoubtedly a problematic issue that attracts the attention of a large audience, which is why some films inspired by this condition, commonly known as „Multiple Personality Disorder,” top the box office charts. However, this popular designation has contributed to a misconception about the nature of this disorder. Despite the considerable amount of information available, it remains one of the conditions with the least verified information, generating ongoing controversy. Some of the points that have sparked the most discussion about this disorder refer to its etiology or cause, as well as the veracity of its existence. Numerous criticisms have raised doubts about the nature of this condition. All this discussion has made DID one of the great challenges in psychology.
DID falls within the category of dissociative disorders. Some of the most characteristic dimensions of this type of pathology are dissociative amnesia, depersonalization, derealization, and alterations in identity. DID is a more generalized condition that can include each of these dimensions. Additionally, this dissociative phenomenon can occur at different levels, such as thoughts, emotions, behavior, perception, identity, consciousness, or sensorimotor functioning. Along with its distinctive diagnosis, it may be accompanied by various disorders or syndromes that hinder its detection and contribute to questioning its existence.
Dissociative Identity Disorder (DID) according to the DSM
The Diagnostic and Statistical Manual of Mental Disorders (DSM) defines this condition as „the presence of two or more distinct identities or personality states that recurrently take control of the individual’s behavior. Each of these identities has its own memories, relationships, and attitudes.” Each of the present personalities has a particular pattern of perceiving and interacting with the environment. Usually, two or more of these identities routinely take control of the individual, often accompanied by episodes of amnesia that prevent the recollection of everyday experiences. On the other hand, it has been defined as a failure to integrate various components such as consciousness, perception, memory, or identity. This integration error usually begins during early developmental stages.
Causes of Dissociative Identity Disorder (DID)
Regarding the cause of this disorder, various theories have been developed to provide greater clarity on the nature and genesis of this condition. Among these explanations, traumatogenic theories currently have the greatest theoretical support. Traumatogenic theories consider that this disorder is a response to a disruptive situation. In other words, DID occurs as a result of a traumatic experience during childhood and is considered by various authors as a more complex form of Post-Traumatic Stress Disorder (PTSD). However, since not all individuals who have experienced such experiences during their development develop this type of pathology, a vulnerability-stress model has been developed, defining the existence of a predisposition or vulnerability to dissociation after experiencing adverse events. A study conducted in North America and Europe found that 90% of people who developed this disorder had experienced physical, sexual, or emotional abuse during childhood or had suffered parental neglect. These studies showed that adverse experiences during early developmental phases can interfere with the integration of different experiences into a single identity. Furthermore, another study found that childhood sexual abuse experiences were most strongly associated with the development of this disorder. Following this perspective, dissociative phenomena would arise as a consequence of isolating memories associated with these adverse experiences, giving rise to progressively more complex identities that are split from the rest. Thus, DID would not arise as a result of fragmentation of a person’s real identity but as a consequence of a developmental error in that identity due to the existence of segregated mental states, resulting in different identities.
DID and attachment
Currently, the influence of early relationship characteristics on the development of various symptoms and defensive mechanisms is widely accepted. Dissociative disorders have also been linked to disorganized attachment patterns, characterized by the presence of contradictory simultaneous actions, disorientation, and withdrawal generated by interaction patterns between the parent and child that lack a sense of security. Authors such as Bach have described the relevance of the primary caregiver during early development as a relational experience that contributes to the development of a „continuing self,” that is, an integrated identity. From this perspective, the dissociative phenomenon is considered an interpersonal defense – involving the onset of a different relational experience – and an intrapsychic defense – resulting from the blockage developed towards adverse episodes, capable of influencing natural evolutionary development and inhibiting the ability to mentalize, i.e., the cognitive ability to understand and interpret one’s own behavior and that of others, a fundamental function for adequate performance in social interaction. Furthermore, neuroimaging studies have shown that situations of abuse associated with this attachment pattern are linked to intense fear and stress responses that result in sustained activation of the hypothalamic-pituitary-adrenal axis (HPA), generating sustained neural activation patterns.
Symptoms of Dissociative Identity Disorder (DID)
In most cases, DID is a chronic and debilitating disorder that can affect every area of affected individuals’ lives. Furthermore, it is important to highlight the high frequency with which it is associated with other psychological symptoms or syndromes that cause greater distress and incapacity. The main symptoms of DID include: presence of multiple identities, with some of these identities having knowledge of others and even interacting with each other through intrapsychic dynamics. Thus, affected individuals may report hearing voices. Depersonalization, a sense of being detached from oneself, as if seeing oneself as a different person. Amnesia, which can involve gaps in memory of previous periods, forgetting recent everyday events, or loss of acquired skills such as using a particular instrument. Other symptoms, in addition to the more common manifestations within DID, include headaches, depressive symptoms, anxiety, substance abuse, sexual dysfunction, and more.
Rafael Fenoy Castaño, psychologist at Aesthesis Psychologists Madrid
References:
Bru, M. T., Santamaría, M., Coronas, R., & Cobo, J. V. (2009). Trastorno disociativo y acontecimientos traumáticos. Un estudio en población española. Actas Esp Psiquiatr. Vol. 37(4):200-204. https://www.actaspsiquiatria.es/repositorio/10/58/ESP/14143+4.+1174+esp.pdf
Figueroba, A. Trastorno de Personalidad Múltiple. https://psicologiaymente.net/clinica/trastorno-de-personalidad-multiple#
Martínez, C. (2011). Mentalización en Psicoterapia: Discusión Sobre lo Explícito e Implícito de la Relación Terapéutica. http://www.scielo.cl/scielo.php?pid=S0718-48082011000100010&script=sci_arttext
Muñoz, A. Trastorno de identidad disociativo (personalidad múltiple). https://www.cepvi.com/index.php/psicologia/articulos/trastorno-de-identidad-dis
