Dissociative identity (DID)

Memory gaps are often the sign that leads to a diagnosis. A person might find notes they don’t remember writing, or not recall a conversation.

Some people with DID don’t notice when another part is present, so they can live with DID for years without knowing it.

Switches between parts are often subtle. Sometimes they are more noticeable. Switching can be a way of coping with discomfort, handling a feeling or problem, or communicating.

People usually feel they don’t control switching, though more control can become possible with long-term therapy.

Stress often makes switching more likely. Managing stress and limiting alcohol and drugs may help reduce how often it happens.

In one form, a part can feel like an outside being has taken over, and others may notice the change. In the other, parts are less obvious, and the person may feel detached, as if watching themselves in a film.

Possession experiences that are a chosen part of a culture or faith are not DID.

Anxiety, depression, self-harm, substance use and suicidal thoughts can come with DID, though not for everyone.

Because DID is rooted in trauma, good treatment also works on trauma symptoms, self-harm and substance use. See the Complex PTSD guide.

Many people with DID are caring parents, partners, friends and workers. They have strengths and gifts, and want them recognised, not only their struggles.

Daily life can still be hard, with stress on relationships, work, study and self-care. Support for the whole family can help.

DID is one of the dissociative conditions, which most professionals link to severe early trauma. Schizophrenia is a different condition.

The old phrase “split personality” causes a lot of this confusion. To learn about schizophrenia, see the Schizophrenia: understanding it guide.

People with dissociative conditions often face negative, critical portrayals in the media.

In a study of 173 people in treatment for dissociative conditions, only 3% had been charged with an offence in six months, and dissociation did not predict crime.

ISSTD notes that most people with dissociation are caring and unlikely to harm others.

Online, “plural communities” can include people who feel multiple for spiritual or personal reasons that are not about trauma. ISSTD notes this can feel very different from trauma-related DID.

People with trauma-related DID may not relate to these spaces, and may even find them upsetting. It is okay to look for a group that fits you.

Feeling detached from yourself or the world can happen in DID, but it can also happen without any separate parts. That is depersonalization or derealization.

See the Depersonalization & derealization guide.

A major 2012 review tested two ideas: that trauma causes dissociation, or that dissociation comes mainly from fantasy and suggestion. The authors found strong support for the trauma link.

The link held up when trauma was measured with objective records, and it was not explained by how imaginative or suggestible people were.

A group of researchers replied in 2014 that the trauma link was overstated. They argued that much of the evidence shows a connection, not proof of cause, and that memory and family environment also matter.

Both sides agree that family environment and biology play a part, and that DID involves real problems with a person’s sense of self.

Researchers report that people asked to fake DID can be reliably told apart from people with DID, using personality tests, forensic measures and body measures like brain scans, blood pressure and heart rate.

Brain scan studies have found different patterns in different parts of the same person, especially when trauma reminders are shown.

Careful prevalence studies have been done in Canada, Germany, Israel, the Netherlands, Switzerland, Türkiye and the United States.

Possession-type experiences, seen as a cultural form of DID, have been described in places including China, India, Iran, Puerto Rico, Singapore, Türkiye and Uganda.

According to ISSTD, treatment should

• Address dissociation and parts of self where relevant
• Build skills for feelings, relationships and daily life
• Help you understand your symptoms and their causes
• Move at a pace that doesn’t overwhelm you
• Prioritise safety and handling feelings first
• Respect you and your goals for therapy
• Work on trauma memories only when you are ready

Expert guidelines describe three stages: getting safe and steady, working through trauma, and integration, where dissociated parts of self come together and the person becomes more connected with others.

The first stage often takes longer for complex trauma, and also works on trust, relationships, self-esteem, self-harm and substance use.

In an online program for 111 people with DID or similar conditions and their therapists, participants learned about dissociation, emotion skills and safety.

Over one to two years, they had less dissociation and PTSD symptoms, better emotion control and less self-harm, with the biggest changes in those who self-harmed most.

Therapies used include cognitive behavioural therapy (CBT) and dialectical behaviour therapy (DBT), in individual, group or family formats.

The research is still limited. Most evidence comes from expert agreement and studies without comparison groups, so new approaches are still being tested.

For anything medical, consult with your clinical provider. See the Therapies for trauma guide for more.

Questions ISSTD suggests asking

• Have you treated my condition before?
• How do you work, and what approaches do you use?
• What training do you have in this area?
• Do you get supervision or consultation?

It can take several sessions to get past first nerves and know if a therapist feels right. Many survivors find trust hard, and a good therapist will understand.

ISSTD has a free “Find a Therapist” directory of its members.

Some people feel relief sharing about their parts or past. Others don’t want to. Being led by them builds safety and trust.

Focusing too much on parts or trauma can mean missing the whole person in front of you. Ask what support they want.

Try not to treat your loved one as only “sick”. People with DID have strengths and gifts too, and good relationships are give-and-take.

The past can feel like it is happening now, but it is not. Stay grounded yourself, and focus on what the person needs right now. If they are safe, a gentle reminder can help.

If a switch happens, it may feel like someone else is suddenly there, but it is still the same person. Stay calm and keep responding to what they need.

Memory gaps can make communication hard. ISSTD suggests a “communication book” where things can be written down and looked back on.

The “Our shared notebook” worksheet can be a starting point.

Everyone does best knowing where they stand. Healthy boundaries about money, intimacy, chores and parenting should be respected by all parts.

Trauma and dissociation are never an excuse for harm, and neither is supporter stress. If anger or violence is a problem, get professional help urgently.

Talk openly about safety at a calm time, including your own limits, and how to reach professional help in a crisis.

You can’t support someone if you are exhausted. Rest, take time out, and consider your own therapy if boundaries or self-care are hard.

See the Caregiver stress & burnout guide.