Dissociative identity disorder (DID) is a trauma-related psychiatric diagnosis that can develop during childhood due to repeated long-term trauma, usually before the age of 9-12. A trauma can be, for example, severe bullying, neglect, physical and psychological abuse, or sexual abuse.

Dissociative identity disorder means that you are split inside, you do not always have access to all your memories and experiences. This is because the brain, due to trauma, has set up amnesic barriers between the different experiences you have. DID is a defense mechanism that allows you to hide the fact that you are vulnerable when trauma occurs and so that you can live on, despite the horror.

Dissociation means to separate or split and involves disconnecting from reality in various ways. Everyone dissociates sometimes, it is completely normal. Daydreaming, driving on a routine and not paying attention to where you have driven and sometimes turning off your emotions is completely normal. The problem becomes when the dissociation becomes pathological, that is, sick, and you dissociate so much and often that it becomes an obstacle in everyday life. You can dissociate in several different ways, below are some of the symptoms of dissociative identity disorder.

Dissociative amnesia
Amnesia means memory loss. When you suffer from amnesia, you cannot remember parts of your life, usually stressful and traumatic situations but also everyday situations. Amnesia is not like ordinary forgetfulness, it becomes blank and you cannot recall the memory in any way. The amnesia can be from the present and from earlier in life. You can get amnesia for several reasons, but when it comes to dissociative identity disorder, it is often because your splits, also called sub-personalities, cannot remember what another split has done.

Identity variation and identity confusion
When you have dissociative identity disorder, you have two or more partial identities. The different partial personalities can have different names, ages, genders, interests and ways of being. The partial personalities can have different roles, such as functioning in and managing everyday life, while other parts can survive in times of trauma and not function at all in everyday life. You can therefore switch between being high and low functioning when you have DID. Having different identities also means that you can often get a feeling of identity confusion, that you don't really know who you are.

Derealization
When you experience symptoms of derealization, you feel that your surroundings are strange and unreal. You may experience visual hallucinations, or that your surroundings are moving. It may also mean that you do not recognize people you know or that your home feels foreign. You may feel like you are in a fog or unreality.

Depersonalization
Depersonalization is roughly the opposite of derealization. For example, you may feel that the self feels unreal, that you are outside your own body and that what is happening is not really happening or to you, or that the memories you have are not about yourself but someone else. You may also experience changes in sound and vision, for example that sounds may be perceived as higher or lower than normal and that you experience tunnel vision.

Derealization and depersonalization often occur simultaneously but can also be experienced separately. It is the most common form of dissociation.

Time distortion
When time distortion occurs, time can be experienced differently, for example, time can be experienced as going faster or slower than normal. You can experience time jumps, that time jumps forward several hours, or as if time stands still.

Dissociative fugue
Fugue means losing who you are, where you are and where you are going. When you are in a fugue, you may travel/leave your home without knowing where you are going or who you are.

Dissociative stupor
Stupor means that you are unable to move. For example, you may become stuck sitting or lying down for long periods of time and stop responding to stimuli such as touch, sound, light, and pain.

Dissociative seizures
Dissociative seizures can resemble epileptic seizures. Body parts or the entire body may twitch and shake.

Hypoarousal
Hypoarousal is lowered arousal, such as emotional or physical numbness (inability to feel pain). Feeling empty and absent, unable to think and speak, unable to move and respond, and possibly becoming extremely drowsy or even losing consciousness.

Hyperarousal
Hyperarousal is a state of heightened arousal, such as feeling tense, agitated, restless, alert, and easily startled. You may be easily startled and have emotional outbursts, severe difficulty sleeping, and problems with concentration and attention.

Dissociative identity disorder has a prevalence of 0.5-1.2%. Thus, about as common as schizophrenia, which has a prevalence of approximately 0.7-0.8%.

One way to look at dissociative diagnoses is through the theory of structural dissociation. When a child is born unintegrated, with the right conditions (no trauma and support from adults) the child will integrate their experiences into a coherent sense of self. If the child is exposed to trauma, the integration process is hindered and the child remains fragmented. Structural dissociation is when a person remains fragmented and becomes multiple unintegrated sub-personalities. This is due to trauma and regardless of the severity of the trauma. This theory also includes emotionally unstable personality disorder (EIPS) and post-traumatic stress disorder (PTSD).

There are three different structural dissociations. Primary structural dissociation, secondary structural dissociation and tertiary structural dissociation. In structural dissociation, we talk about ANP and EP parts. An ANP part means that the part functions in everyday life while an EP part is an emotional part that is not really functional in everyday life.

In PTSD, you have primary structural dissociation. This means that you have an ANP part and an EP part. You have secondary structural dissociation if you have, for example, Emotionally unstable personality syndrome (EIPS), complex PTSD or OSDD (Unspecified dissociative syndrome) and this means that you have one ANP part and several EP parts. If you have DID (Other specified dissociative syndromes in DSM-5), you have tertiary structural dissociation which means that you have several ANP parts and several EP parts.

Structural dissociation can be explained by the emotional part of the personality (EP part) and the apparently normal part of the personality (ANP part). The splitting of a personality can occur when a person's defense system is activated, in the event of strong stress or threat. An emotional part occurs when the defense system can no longer cope and the situation becomes overwhelming, the emotional part stays in the threatening and overwhelming situation while the apparently normal part continues life as if the overwhelming situation had not happened. The normal part does not integrate with the emotional part so the emotional part has no insight into daily life. Despite the fact that the apparently normal part does everything to keep the emotional part out, the emotional part will remind the normal part of its existence by creating flashbacks and nightmares. This is consistent with the diagnosis of PTSD (Posttraumatic stress disorder), DESNOS (Disorder of extreme stress, not otherwise specified) and OSDD (Unspecified dissociative syndrome). These diagnoses mean that you have an apparently normal part and one or more emotional parts. When it comes to DID (Other Specified Dissociative Disorders), there have been created several apparently normal parts and even more emotional parts.

People around a person with DID may not necessarily be able to tell the difference between the different personalities. To be diagnosed with DID, one must also have amnesia and recurrent memory disturbances, losing important personal information and everyday events. The memory loss can be explained by alters/subpersonalities taking over command of the body.

Some subpersonalities will be aware of each other and others will be unaware of the others. Sometimes one subpersonality can front and no one else will be aware, this is often the cause of amnesia in everyday life. Sometimes there will be an awareness between subpersonalities which means that others can know about what is happening. In the case of awareness between subpersonalities (co-awareness), the conscious subpersonalities usually cannot act on what is happening, on what the fronting subpersonality is doing. It can only watch, but it still happens that co-aware subpersonalities cooperate. There are different roles within the systems of someone with DID. Some common ones are, for example; child parts, protectors, helpers, fighting parts, parts that are ashamed, interjections and inner perpetrators, the variations are as wide as there are people with DID.

Dissociation is not the same as psychosis. However, there are overlapping symptoms, such as auditory hallucinations. The hallucinations in DID are often a dialogue between different alters inside, but in schizophrenia, for example, the auditory hallucinations are experienced as coming from outside (although they do not necessarily experience the voices as coming from outside).

Dissociative disorders not only come with emotional symptoms but also physical ones. For example, you may partially or completely lose the ability to move, lose sensation and sensitivity to pain. You may also experience blurred vision, be unable to speak, or become less responsive to light, sound, or touch. This is called psychosomatic or somatoform disorders.

A person can go through war and severe trauma without developing DID or other dissociative syndromes. It seems that unprocessed trauma and lack of emotional support from adults are the basis for developing DID or other dissociative syndromes.

Dissociating can be a frightening experience and creates a feeling of losing control even though you understand and recognize the symptoms and where they come from. It is difficult to accept the dissociations mainly because you cannot control them willfully and this leads to a feeling of uncontrollability. Even though you know that this strategy once benefited you and was needed, it is extremely difficult to deal with in the present.

It is common for your inner and outer selves to be out of sync. You may appear to be functioning well on the outside, but on the inside, you are in chaos. Dissociative symptoms are not dangerous in themselves, but they lead to, for example, suicide and self-harm more often than for people without DID.

The most important thing to say is that dissociation can be experienced in so many different ways and no matter how it is experienced it often creates a lot of suffering. The stigma in society doesn't help either and many films portray people with DID as violent perpetrators when the truth is that the vast majority of people with DID are the exact opposite.

How difficult it is to live with DID does not necessarily depend on how many sub-personalities a person has. Nor does it always mean that better integration makes the person with DID function better. It can even be a higher function because the sub-personalities are separated because the person then often does not have to deal with their strong emotions. But it can also be chaos, with an everyday life that is unsustainable and incoherent due to amnesia. Learning to understand and manage one's DID often requires long-term (several years) therapy. Most often, the goal of psychotherapy is to integrate the parts so that they communicate better and thereby function better. However, this requires that one is able to handle and live with their strong emotional outbursts. When two or more parts have been integrated and learned to cooperate, fusion can occur. Fusion means that the sub-personalities merge into one. However, fusion can be reversed, meaning that the parts split again if one is exposed to great stress or new trauma. Dissociation is difficult and often impossible to get rid of. You have to accept life with DID and try to make life as manageable as possible, often this means finding a way to work together between sub-personalities and emotions.

Based on what we know about DID today, it is caused by childhood trauma, other types of dissociative syndromes can be caused by other mental disorders such as panic attacks, depression or drug use. Dissociative syndromes are common when someone experiences extreme overwhelming stress, whether caused by trauma or not.

It is common for people with Dissociative Disorders to also have diagnoses of self-harm, eating disorders, depression and PTSD, as well as multiple suicide attempts. Unfortunately, many have also taken their own lives.