Multiple personality disorder, now labeled “dissociative identity disorder” (DID), is a psychological condition characterized by the presence of two or more distinct personality states that reflect an inability to integrate various aspects of identity, memory, and consciousness into a single coherent identity. The latest edition of the Diagnostic and Statistical Manual of Mental Disorders requires the following conditions for diagnosis:
- multiple distinct identities
- recurrent control of the person’s behavior by at least two identities
- an inability to recall important personal information
- the absence of a general medical condition or substance use that could otherwise explain the dissociative symptoms (American Psychiatric Association 2000)
According to publications by Frank W. Putnam (1989) and Richard P. Kluft (1984), identities are considered entities with a coherent sense of self that respond to certain stimuli with a consistent pattern of behavior and feelings. Many argue, pointed out Colin A. Ross in Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality (1997), that the distinct identities—“alters,” “subpersonalities,” or “personality states”—that characterize DID are not separate personality states per se but “fragmented parts of one personality” that individuals create to adapt to painful life experiences (Ross 1997, p. 144). Reports on the number of alternate identities vary considerably from two to several hundred with the average between thirteen and fifteen. The most common alters reported, according to Ross, are those of children, “protectors,” “persecutors,” and alters of the opposite sex. In addition often a host alter appears to control the body the majority of the time. Support for the notion of distinct personality states come from research suggestion differences in vocal patterns, handedness, respiration, and brain wave activity between alters; however, Scott O. Lilienfeld and Steven Jay Lynn (2003) have criticized this work because of naturally occurring variability among these factors and lack of controlled studies.
Epidemiological studies estimate that 6 to 12 percent of the U.S. inpatient psychiatric population and 1 to 3 percent of the general population meet DID criteria (Ross 1997). DID is consistently reported to occur more often in females, perhaps due to the increased rate of females seeking inpatient treatment. Individuals diagnosed with DID often meet criteria for mood and anxiety disorders. In particular there is a high comorbidity between post-traumatic stress disorder and DID (Ross 1997). J. Douglas Bremner and Elizabeth Brett confirmed this in their 1997 study when they found that dissociative symptoms occur more often in individuals with post-traumatic stress disorder.
Reports of DID in the United States have increased since the mid-1980s, although the cause of the increase is subject to speculation. Some, such as David Gleaves in his 1996 article “The Sociocognitive Model of Dissociative Identity Disorder: A Reexamination of the Evidence,” attribute the rise in reported cases to increased awareness and understanding of the disorder. Others, like Nicholas Spanos in his 1994 article “Multiple Identity Enactment and Multiple Personality Disorder: A Sociocognitive Perspective,” claim the rise in DID is the result of misdiagnosis, fabrication, or suggestibility through the use of questionable therapeutic techniques and media portrayal of DID. Nonetheless, research demonstrates that DID is reliably diagnosed across clinicians and settings (Ross, Duffy, and Ellason 2002; Latz, Kramer, and Hughes 1996). However critics question this reliability claiming that DID is reported by a small number of specialized clinicians.
The cause of DID is debated. The posttraumatic model was articulated by David Gleaves (1996), although several predecessors had connected DID and trauma by the early 1980s (Coons 1980; Greaves 1980; Spiegel 1984). Gleaves hypothesizes that DID is a posttraumatic condition in which dissociation functions as a coping strategy in response to overwhelming psychological pain brought about by childhood maltreatment. The high rates of self-reported physical and sexual abuse and/or post-traumatic stress disorder among those diagnosed with DID support this theory. Conversely the sociocognitive model introduced by Spanos (1994) posits that DID is a socially derived condition produced by therapeutic suggestion and sociocultural influences, such as the media. It is hypothesized that DID can occur in the absence of childhood abuse and that alters are role enactments created and maintained by social reinforcement. For example, role-playing studies, such as the 1985 report conducted by Nicholas P. Spanos, John R. Weekes, and Lorne D. Bertrand, demonstrate that features of DID can be elicited from participants without the disorder through subtle cues or suggestions. This evidence supports arguments that features of DID are known to the public and may be easily induced (Lilienfeld et al. 2003). Finally, some theorists combine these two positions, proposing that the cause of DID cannot be entirely iatrogenic or trauma induced and that multiple pathways should be considered (Ross 1997, p. 92).
Regardless of the cause, DID continues to be categorized as a major psychological disorder. Most agree that DID symptoms exist and cause significant distress regardless of origin. Continued research may provide clarification regarding factors that contribute to the development of DID, prevention, and intervention. Further it may be essential to consider that both models provide important information about the development and maintenance of DID that could lead to a more complex conceptualization of the disorder in the future.
SEE ALSO Anxiety; Mental Illness; Mood; Neuroticism; Personality; Post-Traumatic Stress; Psychotherapy
American Psychiatric Association. 2000. Diagnostic and Statistical Manual of Mental Disorders: DSM-IV-TR. 4th ed., text revision. Washington, DC: Author.
Bremner, J. Douglas, and Elizabeth Brett. 1997. Trauma-Related Dissociative States and Long-Term Psychopathology in Posttraumatic Stress Disorder. Journal of Traumatic Stress 10 (1): 37–49.
Coons, P. M. 1980. Multiple Personality: Diagnostic Considerations. Journal of Clinical Psychiatry 41 (10): 330–336.
Gleaves, David H. 1996. The Sociocognitive Model of Dissociative Identity Disorder: A Reexamination of the Evidence. Psychological Bulletin 120 (1): 42–59.
Greaves, G. B. 1980. Multiple Personality Disorder: 165 Years after Mary Reynolds. Journal of Nervous and Mental Disease 168: 577–596.
Kluft, Richard P. 1984. An Introduction to Multiple Personality Disorder. Psychiatric Annals 14: 19–24.
Latz, Tracy, Stephen I. Kramer, and Doreen L. Hughes. 1995. Multiple Personality Disorder among Female Inpatients in a State Hospital. American Journal of Psychiatry 152: 1343–1348.
Lilienfeld, Scott O., and Steven Jay Lynn. 2003. Dissociative Identity Disorder: Multiple Personalities, Multiple Controversies. In Science and Pseudoscience in Clinical Psychology, eds. Scott O. Lilienfeld et al., 109–142. New York: Guilford.
Lilienfeld, Scott O., Steven Jay Lynn, Irving Kirsch, et al. 1999. Dissociative Identity Disorder and the Sociocognitive Model: Recalling the Lessons of the Past. Psychological Bulletin 125 (5): 507–523.
Putnam, Frank W. 1989. Diagnosis and Treatment of Multiple Personality Disorder. New York: Guilford.
Ross, Colin A. 1997. Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality. 2nd ed. New York: Wiley.
Ross, Colin A., Colleen M. M. Duffy, and Joan W. Ellason. 2002. Prevalence, Reliability, and Validity of Dissociative Disorders in an Inpatient Setting. Journal of Trauma and Dissociation 3 (1): 7–17.
Spanos, Nicholas. 1994. Multiple Identity Enactment and Multiple Personality Disorder: A Sociocognitive Perspective. Psychological Bulletin 116: 143–165.
Spanos, Nicholas P., John R. Weekes, and Lorne D. Bertrand. 1985. Multiple Personality: A Social Psychological Perspective. Journal of Abnormal Psychology 94: 362–378.
Spiegel, David. 1984. Multiple Personality as a Post-Traumatic Stress Disorder. Psychiatric Clinics of North America 7 (1): 101–110.
River J. Smith