History & current state of teen dissociative identity disorder
Oftentimes misunderstood and misdiagnosed, dissociative identity disorder (DID), formally known as multiple personality disorder, has played a leading role in some of Hollywood’s most iconic films such as Fight Club and Moon Knight. But more recently, dissociative identity disorder has been brought into the social media limelight. Over the past two years, mental health and wellness influencers on TikTok have also brought increased attention to DID. Unfortunately, these dramatic portrayals in film and social media posts about this mental health disorder have left many people confused about DID and dissociative disorders in general.
Mental health clinicians throughout the country note an increase in teens and young adults seeking treatment for self-diagnosed dissociative identity disorder (DID). Mental health professionals credit several popular TikTok videos describing what it is like for someone living with DID as the cause. Some people might argue that social media posts bring awareness to dissociative disorders, which could be considered a positive effect of the content, but the information provided through platforms such as TikTok often leads teens and young adults to misdiagnose mental health disorders on their own. In reality, assessment and diagnosis should be led by a licensed mental health professional. This article will give an overview of dissociative identity disorder, specifically in the teenage population, in order to help clarify misinformation and assumptions about the condition.
What is dissociative identity disorder?
Dissociative identity disorder is one of five dissociative disorders listed in the DSM-5. These disorders are characterized by a disconnection between a person’s thoughts, memories, surroundings, actions, and identity. The cause of dissociative behavior is still being researched, but the favored hypothesis is called the Trauma Model, wherein the mind subconsciously disengages from reality in order to preserve the individual’s sense of safety and security following repeated traumatic experiences. Experts suggest that the movement towards dissociative behavior in DID is an adaptive response to repeated childhood relational trauma that begins before age five.
Symptoms of dissociative identity disorder
The following symptoms are found in many people who are diagnosed with dissociative identity disorders. It’s important to note that many of these symptoms are prevalent in dozens of other mental health issues ranging from post-traumatic stress disorder to obsessive compulsive disorder or persistent depression. It’s critical to consult with a medical professional about your symptoms before self-diagnosing or choosing a treatment option.
- Mood swings
- Suicidal thoughts or attempts
- Sleep disorders (insomnia, night terrors, and sleep walking)
- Panic attacks and phobias (flashbacks, reactions to reminders of the trauma)
- Alcohol and drug abuse
- Compulsions and rituals
- Psychotic-like symptoms
- Eating disorders
- Time loss
- Out-of-body experiences
- Self-persecution, self-sabotage, and even violence (both self-inflicted and outwardly directed)
Dissociative identity disorder is marked by an extreme disconnection from reality that leads to the separation of the individual’s consciousness into various personalities. These personalities exist independently of one another, and oftentimes change within the individual without warning. Sometimes these personalities are aware of one another’s existence, other times they are not. Teens and young adults with DID will show extreme variations in personal preferences, opinions, and skills depending on which personality is present at the moment, and they frequently experience amnesia and confusion related to the actions and behaviors of their alternate personalities.
We discuss the official diagnostic parameters for DID below.
How do you know if you have dissociative identity disorder?
According to the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5), there are five criteria for the diagnosis of DID:
1. Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self
The existence of distinct identities and personality traits represent the most classic and characteristic presentation of DID. The frequency in which a person with DID will change from one personality to the next and the number of distinct personalities can vary depending on the individual. These distinct personalities are known as ‘alters’, and the individual can ‘switch’ back and forth between them, oftentimes unknowingly. Clinical research and observation has determined that only 5 percent of DID cases present with dramatic switches. In most cases, the switches in personality are more nuanced than what is typically depicted in the media.
This aspect of DID can be particularly difficult to discern in the child and teenage population. According to the American Psychiatric Association, ‘switches’ can easily be mistaken for normal childhood play and imagination, or be misinterpreted as other, more commonly known disorders such as major depressive disorder, bipolar disorder, schizophrenia, or ADHD.
Childhood and adolescence is a time of personality exploration and development. A teenager might act one way around their friends from school, and another way around their family. They might be shy and quiet in some social settings, but outgoing and talkative in another. These differences in behavior between varying social settings in teenagers is more often than not related to a lack of a cohesion in their sense of self, and is not what the DSM-5 is referring to when speaking of ‘distinct personalities’. In DID, these ‘alters’ have dramatic differences from one another, such as differences in gender identification, age, and speech.
Teens and young adults can experience a great deal of fear and confusion surrounding their experiences with DID. For this reason, teens in particular may be reluctant to self-report their experiences to parents, caregivers, and clinicians. Furthermore, while some alters can be soothing and comforting, some of the child’s alters can frighten them, giving the child further reason to avoid admission of their struggle altogether.
2. Dissociative amnesia including gaps in the recall of important personal information and everyday events
Episodes of amnesia in DID can be incredibly frustrating and embarrassing for individuals suffering from the disorder. Not being able to remember personal interactions and conversations, or not being able to recall core memories and relationships, can lead to shame and self-hatred.
Individuals with DID can experience fugue states, a unique type of amnesia wherein the person finds themselves in an unexpected place without any memory of how they arrived there. This can be incredibly dangerous and disorienting for the person experiencing the amnesiac event. Episodes of amnesia can become more frequent over time. For this reason, it is more difficult to discern these gaps in memory recall in younger patient populations. In children and teenagers, episodes of amnesia can be misinterpreted as the child being “spaced out” or forgetful. Many individuals with DID also report having out of body experiences, flashbacks, as well as auditory and visual hallucination.
3. Severe distress and impairment in functioning because of the disorder
Many people suffering from DID have greater difficulty performing their daily duties and responsibilities. For this reason, teenagers with DID are often misdiagnosed with ADHD along with other behavioral and mental health disorders due to their struggles with task and life management. Due to the distress that an individual with DID experiences on a daily basis, and the fact that the origin of their dissociation stems from repeated childhood trauma, many people with DID will have any number of dual diagnoses, such as major depressive disorder, generalized anxiety disorder, or PTSD. Research has shown that self-harm and substance abuse are typically found in a large majority of people with DID. This type of behavior is the child’s attempt to further distance themselves from the initial traumatic experience as well as the emotional difficulty in their life while contending with their symptoms.
Dissociation amnesia is a subconscious tool of self protection against overwhelming situations and feelings. When a child or teenager begins to experience dissociative episodes in educational and social settings, it can disrupt their learning and development.
4. The disturbance is not part of normal cultural or religious practices
There are a number of cultural considerations that need to be taken into account during the assessment and diagnosis of DID. For example, altered states of consciousness can be achieved during religious and spiritual ceremonies, but these types of altered states do not signify that the individual has DID.
Furthermore, the nature and understanding of identity varies across cultures. The “Western” conception of self places an emphasis on autonomy and singularity, while other cultures view identity and the self as more relational and less unified. Despite these cross-cultural differences in the conception of identity and self, research has shown that DID has been observed and successfully diagnosed in many different countries, all over the world.
5. The disturbance cannot be explained by substance use or another medical condition
Amnesiac events and changes in personality that are related to the use of psychotropic drugs and/or alcohol do not fall into the diagnostic criteria. Any other medical condition or injury that may have an effect on a person’s sense of self or psychological makeup are excluded from the criteria for diagnosis of DID. In other words, the validity of the diagnosis is heavily dependent on the individual’s relationship to childhood trauma and the dissociated self states that arise before the child’s sense of self is fully integrated. A study conducted in patients with DID in the United States, Canada, and Europe showed that 90% had been victims of childhood abuse.
Treatment for teen dissociative identity disorder
The presentation of DID can vary greatly from person to person, and treatment will be adapted to each person’s circumstances, symptoms, and symptom severity. Psychotherapy, or “talk therapy” can be effective in reducing symptoms and wellbeing. In a review of 8 treatment studies, treatment reduced dissociative symptoms as well as post-traumatic stress, depression, anxiety, and other symptoms.
It should be noted that while clinicians may prescribe pharmaceuticals such as antidepressants, anti-anxiety medications, and antipsychotic medications to help manage some of the comorbidities common in DID, there is no ‘anti-dissociative’ medication available for the treatment of dissociative disorder alone.
Therapy that utilizes trauma-informed care, by a licensed professional that specializes in trauma-based disorders, can first and foremost help to establish safety and stability for the patient. For many people with DID, this is imperative due to the high risk for self harm and injury that comes with a DID diagnosis. In fact, according to the DSM-5, more than 70% of people diagnosed with DID have attempted suicide at one point in their lifetime. This is the first and most important phase of treatment, ensuring safety and stability.
The second phase focuses on maintaining the stability achieved in phase one, and then moving towards the exploration of the patient’s trauma narrative in an attempt to resolve some of their trauma-related emotions, beliefs, and behaviors. This phase of the patient’s treatment needs to be done with the utmost amount of care. Exposure to past trauma narratives, if not done correctly, can lead to patients reverting back to dissociative behaviors. The last phase of treatment attempts to reintegrate the individual’s identities, and remove the reliance on dissociation as a coping mechanism.
DID: A controversial diagnosis
Despite dissociative identity disorder’s inclusion in official diagnostic manuals since the mid-20th century, and a long history of academic writing about the condition from some of the most foundational names in the history of psychology including Sigmund Freud, Pierre Janet, and Morton Prince, there is currently a large amount of controversy surrounding the legitimacy of the diagnosis within certain professional circles. These skeptics claim that the symptomology of teen dissociative identity disorder DID cannot be fundamentally related to trauma, and that the behaviors perceived in DID are more likely a result of other outside factors such as the influence of a therapist’s suggestions, media influence, as well as other sociocultural factors.
The suggestion that an individual would purportedly pretend to have multiple self-states and personalities based on influences other than childhood trauma is a relevant consideration due to the disorder’s newfound popularity on TikTok. The Research Centre for Trauma & Dissociation suggests there may be several reasons why an individual might “fake” the signs and symptoms of DID. Examples include “for external gains (financial benefits or justification for one’s actions in court) or for other forms of gratification (e.g., interest from others), while in many cases their motivation is not fully conscious. Getting a DID diagnosis, especially for teens, can also provide structure for inner chaos and incomprehensible experiences, and be associated with hope and belief it is real.”
The concern that this new proliferation of social media content about the disorder will create a rise in clinicians assessing for and possibly misdiagnosing the disorder, is a real one for many. With continued training for mental health professionals in trauma-informed care, which is becoming more prevalent throughout the mental health profession, distinguishing false from true cases of DID should become less of an issue. While skeptics argue that screening modalities and diagnostic tools are currently inadequate for proper diagnosis, the clinical understanding of teen dissociative identity disorder and its relationship to childhood trauma has in reality been strongly established, and the research has continued to widen in scope and validity over time.
Defenders of DID as a true diagnosis point out that the admission that child abuse and trauma is a pervasive societal issue, especially with the perpetrators of said abuse often existing within some of our most trusted institutions (schools, church, family). The link between these acts of violence against children and dissociative behavior is supported by years of clinical research, and to deny this connection can be seen as an unwillingness to admit to the gravity of the underlying problem.
Support for teen dissociative identity disorder at Charlie Health
If you or someone you know may be suffering from DID or any other dissociative disorder, there is help available at Charlie Health. Individuals with Dissociative Disorders spend an average of seven years in the mental health system before getting the correct diagnosis. For this reason, pursuing screening and possible treatment for mental health concerns, especially concerns for trauma-based disorders, are best done in collaboration with clinicians with the proper training and expertise.