Source: Abnormal Psychology, University of Florida
Tags: dissociative identity disorder, DID, multiple personality disorder, dissociative amnesia, dissociative fugue, depersonalization, derealization, repressed memory, alters, psychogenic amnesia
Difficulty: Intermediate | Prerequisites: Somatic symptom disorders notes, basic understanding of trauma and PTSD
Dissociative disorders involve disruptions in the normally integrated functions of consciousness, memory, identity, and perception. The central idea is that certain mental processes that should work together become split off or disconnected. Interest in dissociation has risen and fallen over the past century, from early fascination by figures like Charcot and Freud, through a long period of neglect during the dominance of behaviourism, to a renewed interest sparked by Ernest Hilgard's "hidden observer" concept. These disorders remain among the most controversial in clinical psychology, with active debate about whether conditions like DID are genuine trauma responses or products of suggestion and cultural expectation.
Dissociative disorders involve a breakdown in the integration of consciousness, memory, and identity. They range from identity fragmentation (DID) to memory loss without brain injury (dissociative amnesia) to feeling detached from oneself (depersonalization/derealization disorder). Most are linked to severe trauma, particularly childhood abuse, and treatment centres on reintegration and processing of traumatic memories.
Dissociation
A process in which components of mental experience (consciousness, memory, identity, perception) become split off from one another. Janet's original definition: components of mental experience are separated from consciousness but remain accessible through dreams and hypnosis.
Hidden Observer (Ernest Hilgard)
The concept that the mind operates in two modes simultaneously: an active mode (conscious plans, voluntary actions) and a passive receptive mode (registering and storing information without awareness). In most people, these modes are seamlessly integrated. In dissociative disorders, they remain split and operate independently.
Dissociative Identity Disorder (DID)
Formerly called multiple personality disorder. The person appears to have more than one distinct identity or personality state, each with its own way of viewing the world and controlling behaviour. Many individuals have more than a dozen alters.
Think of it as: the mind creates separate "selves" as a coping mechanism, usually in response to severe childhood trauma.
Alter
A distinct identity or personality state within a person with DID. Alters can differ in age, gender, facial expression, speech, interpersonal style, and even physiological responses.
Child Alter
The most common type of alter. Does not age as the individual ages. Often created during traumatic experiences to take on the role of victim while the host personality escapes psychologically.
Persecutor Alter
An alter that inflicts pain or punishment on other alters through self-mutilative or dangerous behaviours. May believe it can harm others without harming itself.
Protector/Helper Alter
An alter that offers advice, performs functions the host cannot, and sometimes controls switching between alters or acts as an observer reporting the thoughts of all other alters.
Dissociative Amnesia
Significant periods of memory loss without the formation of new identities. The person typically cannot remember facts about their life or personal identity and is usually aware of large gaps in their memory. Thought to have psychological rather than organic causes.
Psychogenic Amnesia
Amnesia arising in the absence of any brain injury or disease, presumed to have psychological causes.
Organic Amnesia
Amnesia caused by brain injury from disease, drugs, accidents, or surgery. Usually involves both anterograde and retrograde amnesia, and the person typically retains their personal identity.
Retrograde Amnesia
Inability to remember information from the past.
Anterograde Amnesia
Inability to remember new information.
Dissociative Fugue
A subtype of dissociative amnesia in which the person travels to a new location and may assume a new identity, with no memory of their previous life. They may behave normally in the new environment. The person may suddenly return to their old identity with no memory of the fugue period.
Depersonalization/Derealization Disorder
Frequent episodes of feeling detached from one's own mental processes or body, as though watching oneself from outside. Occasional depersonalization is common (e.g. during sleep deprivation), but the disorder is diagnosed when episodes are frequent enough to impair functioning.
Korsakoff's Syndrome
Global retrograde amnesia resulting from chronic alcohol abuse, in which the person cannot remember much personal or general information over a period of years or decades.
Ataque de Nervios
A culturally accepted reaction to stress among Latinos involving transient loss of consciousness, convulsive movements, hyperactivity, assaultive behaviours, and impulsive acts. DID symptoms may appear as part of this syndrome.
Each personality may have distinct facial expressions, speech characteristics, physiological responses, gestures, interpersonal styles, and attitudes
Alters are usually different ages and genders and perform specific functions
People with DID report amnesia during periods when other alters are in control; sometimes amnesia is one-way (one alter is aware of the other but not vice versa)
May discover unfamiliar objects, lose belongings, or be approached by strangers who claim to know them
PTSD is highly comorbid with DID
Self-injurious behaviour is common, often prompting treatment
Children with DID show erratic school performance, antisocial behaviour, early substance use and sexual activity, unstable emotions, and PTSD symptoms
Most DID patients are adult women
Children and adults with DID report hearing voices and feeling their actions are being controlled by other personalities
Rarely diagnosed before 1980; increase in reported cases followed its inclusion in DSM-III
Some earlier schizophrenia diagnoses may actually have been DID, as schizophrenia criteria became more specific
Most mental health professionals remain reluctant to give this diagnosis
Most patients with DID have previously been diagnosed with at least three other disorders
Added "or an experience of possession," making the criteria more applicable across cultures
Transitions between identities can be self-reported, not only directly observed
Memory problems include everyday events, not just traumatic experiences
Abnormal possession-form DID is experienced as involuntary, distressing, uncontrollable, and in conflict with social, cultural, or religious norms
DID diagnosed more frequently in the U.S.; Latinos more likely to be diagnosed
Debate: the U.S. may be too quick to diagnose, while other countries may be underdiagnosing
Trauma model: DID is a coping strategy used by people who experienced intolerable trauma they were powerless to escape. Most patients self-report childhood sexual or physical abuse (usually chronic, by a parent or family member). Other traumas associated with DID include kidnapping, natural disasters, war, famine, and religious persecution.
Alters are created to help cope: child alters take on the victim role; protector alters provide safety and nurturance absent from caregivers
Retreating into alters becomes a chronic coping mechanism
Patients are usually highly suggestible and hypnotisable, and may use self-hypnosis to dissociate from trauma
Sociocognitive view: alters are not discrete entities but metaphors patients adopt to understand their subjective experiences. Identities are created as patients adopt the narrative of DID as an explanation for their lives. They are not deliberately faking, but playing a role that helps them cope, reinforced by attention from others. Some critics argue DID is a creation of psychotherapy and media, not a naturally occurring condition.
DID may run in families, suggesting a possible genetic component
Goal: integrate all alters into one coherent personality
Process: give voice to each alter, help them become aware of one another, determine each alter's function, help each confront the underlying trauma, negotiate unification
Rebuilding the capacity for trusting relationships is critical, since trust has been fundamentally destroyed by the original trauma
Hypnosis is sometimes used
Possession-form DID may require culturally adaptive treatments
Cannot remember facts about their lives or personal identities
Typically aware of large gaps in memory
Psychogenic amnesia rarely involves anterograde amnesia; primarily involves retrograde amnesia for extended periods
In psychological amnesia: person loses personal identity and forgets personal information but retains memory for general knowledge
In organic amnesia: person typically forgets both personal and general information but usually retains personal identity
Person travels to a new place, may assume a new identity, behaves normally, and does not find it strange that they remember nothing from their past
May suddenly return to old identity as though nothing happened, with no memory of the fugue period
Autobiographical memory loss may be especially long-lasting and resistant to relearning
Can last days or years; may be a single episode or recurrent
Dissociation used as a defence against intolerable memories or stressors
Often follows traumatic events
Amnesia for a specific event may occur because extreme stress prevents encoding or processing at the time
Generalised retrograde amnesia for one's entire past and identity appears to be rare
Difficult to distinguish genuine amnesia from fabrication, especially in legal contexts
Amnesia may genuinely result from intoxication or brain injury
In homicide cases, amnesia claims are common when victims are close relatives, killings appear unpremeditated, and the killer was in a state of extreme emotional arousal
Clinicians sometimes use hypnosis to recover memories, but hypnosis can create false memories
Treatment involves psychotherapy to help patients recall and process the underlying trauma
Average onset at age 23
Usually comorbid with another psychiatric diagnosis (depression is most common)
History of childhood emotional, physical, or sexual abuse is commonly reported
Not enough strong empirical evidence that dissociative disorders are valid diagnoses
Argument that DID can be artificially created in suggestible clients by clinicians
Controversy intensified after accounts of recovered repressed memories of childhood abuse
Proponents: evidence for repressed memories comes from studies of confirmed or self-reported abuse survivors who claim to have forgotten their abuse
Opponents: question study methods and conclusions. Were subjects too young to form stable memories? Did they truly forget, or only partially remember?
People are highly suggestible; question wording can create memories, and repeated questioning can make people "remember" events that did not occur
Elizabeth Loftus demonstrated that false memories (e.g. being lost as a child) can be implanted in adults
Techniques mimicking psychotherapy (e.g. showing family albums while telling a fabricated story) increase suggestibility
Richard McNally found that individuals reporting recovered memories of abuse (or alien abduction) show a greater tendency to form false memories in lab experiments
Jennifer Freyd countered that standard cognitive tasks do not measure the specific cognitive phenomena involved in repressed memories; people who dissociate may be better at keeping threatening information from explicit awareness, especially when attention can be redirected
"DID means the person has a 'split personality' like schizophrenia." DID and schizophrenia are entirely different disorders. DID involves distinct identity states; schizophrenia involves psychosis (delusions, hallucinations, disorganised thought).
"All recovered memories of abuse are false." The evidence is genuinely mixed. Some recovered memories may be accurate; others may be products of suggestion. The controversy is unresolved.
"People with dissociative fugue know they have amnesia." They typically do not. They behave normally in their new environment and are not troubled by the gap in their memory.
"Occasional depersonalization means you have a dissociative disorder." Brief depersonalization is common and normal (e.g. during extreme fatigue). The disorder is only diagnosed when episodes are frequent and functionally impairing.
⚠️ Know the difference between DID and schizophrenia. This is one of the most commonly tested distinctions.
⚠️ Be able to distinguish psychogenic amnesia from organic amnesia (direction of memory loss, retention of identity vs. general knowledge).
⚠️ The sociocognitive model vs. the trauma model of DID is a likely essay or short-answer topic.
⚠️ The repressed memory controversy (Loftus, McNally, Freyd) is high-yield exam material.
⚠️ Know the DSM-5 changes to DID: addition of possession experiences, self-reported identity transitions, and memory problems beyond trauma.
True or False: In DID, amnesia between alters is always bidirectional.
Fill in the blank: Ernest Hilgard's __________ concept describes a passive mode of consciousness that records information without awareness.
True or False: Dissociative fugue involves assuming a new identity and travelling to a new location.
Fill in the blank: The __________ view of DID argues that alters are metaphors patients adopt, reinforced by clinical attention and cultural narratives.
True or False: Organic amnesia typically causes loss of personal identity while preserving general knowledge.
Q: What is the central goal of treatment for DID?
A: Integration of all alter personalities into one coherent personality, achieved by giving voice to each alter, helping them become aware of each other, working through the underlying trauma, and negotiating unification.
Q: How does psychogenic retrograde amnesia differ from organic retrograde amnesia?
A: In psychogenic retrograde amnesia, the person loses personal identity and personal information but retains general knowledge. In organic retrograde amnesia, the person typically loses both personal and general information but retains personal identity (e.g. they know their name).
Q: What did Elizabeth Loftus demonstrate about memory?
A: Loftus demonstrated that false memories can be implanted in adults through suggestion, such as convincing them they were lost in a shopping centre as children when they were not. This has significant implications for the reliability of recovered memories.
Q: What are two arguments used by the sociocognitive model to explain DID?
A: (1) Alters are not discrete entities but metaphors patients use to understand their subjective experiences. (2) The role of having multiple identities is reinforced by clinical attention and cultural exposure (therapy, media) and is not deliberately faked but is a way of coping with stress.
Q: What cultural presentation of DID was added in the DSM-5?
A: The DSM-5 added "or an experience of possession" to make the diagnostic criteria applicable to non-Western cultures and certain subgroups within Western cultures, where DID commonly presents as pathological possession.
Dissociative disorders connect closely to PTSD (childhood trauma is the most commonly cited cause of DID), somatic symptom disorders (both involve psychological distress expressed through non-psychological channels), and the broader debate about memory reliability, which surfaces again in forensic psychology. The sociocognitive model of DID connects to social psychology concepts of role adoption and suggestibility.
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