Dissociative Identity Disorder - Signs and Symptoms

Signs and Symptoms

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), DID includes "the presence of two or more distinct identities or personality states" that alternate control of the individual's behavior, accompanied by the inability to recall personal information beyond what is expected through normal forgetfulness. In each individual, the clinical presentation varies and the level of functioning can change from severely impaired to adequate. The symptoms of dissociative amnesia, dissociative fugue and depersonalization disorder are subsumed under DID diagnosis and are not diagnosed separately. Individuals with DID may experience distress from both the symptoms of DID (intrusive thoughts or emotions) as well as the consequences of the accompanying symptoms (dissocation rendering them unable to remember specific information). The majority of patients with DID report childhood sexual and/or physical abuse, though the accuracy of these reports is controversial. Identities may be unaware of each other and compartmentalize knowledge and memories, resulting in chaotic personal lives. Individuals with DID may be reluctant to discuss symptoms due to associations with abuse, shame and fear.

The number of alters varies widely, with most patients identifying fewer than ten, though as many as 4,500 have been reported. The average number of alters has increased over the past few decades, from two or three to now an average of approximately 16. However it is unclear whether this is due to an actual increase in alters, or simply that the psychiatric community has become more accepting of a high number alters. The primary identity, which often has the patient's given name, tends to be "passive, dependent, guilty and depressed" with other personalities or "alters" being more active, aggressive or hostile, and often containing more complete memories. Most identities are of ordinary people, though fictional, mythical, celebrity and animal alters have also been reported.

A transient symptom in some cases is a word salad type of speech.