Dissociative identity disorder (DID), is a dissociative disorder, that hinders one’s perception of reality. This disorder can cause hallucinations and memory lapses. Individuals with DID have separate identities, also known as alters. Each alter has a distinct individual; they can have different genders, ethnicities, and personalities with varying histories, interests and more. Numerous alters will emerge as figures with influence from the patient’s life or social constructs. DID is developed as a way to detach from trauma, and maltreatment during childhood. The number of alters can vary significantly, with some individuals having up to 100 or more. Other signs of DID include anxiety, delusions, depression, disorientation, drug or alcohol abuse, memory loss and risky or dangerous behaviours. Symptoms of DID appear in early childhood between ages 5-10, but they are often overlooked or mistaken for other learning problems such as attention deficit hyperactivity disorder (ADHD).
Though DID is a recognized mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM), it is still viewed as controversial by medical professionals. This can be attributed to their question of the validity of diagnosis; there is currently no reliable diagnostic measure. However, they may run tests to evaluate one’s symptoms to rule out any physical issues such as head injuries or brain tumours. It is also an extremely rare disorder, afflicting 0.01%-1% of the population. Another concern medical professionals have had with reliable research on DID is the occurring instances of fabrication and exaggeration of experiences. However, studies have attempted to properly regulate falsification and concluded that there are differences between DID patients and faked trauma.
There have been limited studies on the difference in brain structure, though notable differences concluded. Patients with higher dissociative experiences scale (DES) scores who had experienced childhood abuse had a significant reduction in hippocampal volume. There are no discernible variations between did patients and BPD patients in terms of the overall anatomy of the brain. Gray matter (TG), left hemisphere gray matter (LG), and right hemisphere gray matter in the cortex were all less in those with DID than in healthy controls. The cortical thickness (CT) of LG and the left lobe was also notably smaller. Compared to healthy controls, DID-PTSD patients had diminished gray matter in the total frontal lobe, the left frontal lobe, and the right frontal lobe. The global surface area of the frontal lobe was diminished whereas the surface area of the right lobe was bigger in DID patients. The orbitofrontal cortex contributes to the emotion-perception link and the fear network. Abnormal, prolonged form in DID manifests from the reduced size of the orbitofrontal cortex in the right gray matter cortical volume (CV).
Differences in the frontal lobes, whose primary function is in emotion management, rational problem solving and motor control all translate to the different symptoms of dissociation and the creation of multiple personalities. Though smaller white tracts were reported in that area, there was an abundance of white matter in motor regions. These disparities in the interconnections between the primary motor cortex and other key activation centers all explain the differences in physical skills and mannerisms of the different alters. The bilateral hippocampal volumes, supramarginal gyrus size and angular gyrus size are also reduced, justifying DID patients’ occasional difficulty with expressions and self-awareness. These other neuroanatomical changes associated with DID, along with many more, are evidence proving it is a real disorder, though they are still currently unable to be a reliable biomarker.
DID has no cure, but treatments are available to alleviate symptoms. With psychotherapy being the most efficacious treatment, specialists work with patients to recognize the trauma and regulate behaviour differences all in an attempt to reunite the separated identities. Some professionals advise a combination of psychotherapy with hypnotherapy and guided meditation to retrieve repressed memories. It is important to identify triggers and patients may be given medication to relieve feelings of depression or anxiety. A strong support system is essential, as is openness and honesty to manage DID. Even with this disorder, Many are able to regulate emotions, cope with this order and still function in daily activities and be successful in jobs, home and social situations.
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