What is Dissociative Identity Disorder? Dissociative Disorders and CPTSD
Dissociation is a common phenomenon many people encounter in the forms of spacing out, daydreaming, or being on “autopilot” for tasks that require little cognitive effort. Experiencing dissociation alone does not necessarily indicate a dissociative disorder. A disorder is typically defined by the presence of clinically significant distress or impairment. Just as feeling sad does not equate to having a depressive disorder, dissociation alone does not equate to having a dissociative disorder.
Dissociative symptoms are frequently observed in trauma and stressor-related disorders, and complex trauma is linked to the development of dissociative disorders. Multiplied By One Org aims to uplift people experiencing dissociation across diagnostic categories.
“The phenomena of pathological dissociation are recurrent, jarring, involuntary intrusions into executive functioning and sense of self.” – Paul F. Dell, PHD.
This page provides an overview of dissociative disorders. It is intended for educational purposes only and not as medical advice or a self-assessment tool.
What is Dissociative Identity Disorder, or DID?
Dissociative Identity Disorder (DID) is characterized by the presence of two or more separate personality states (dissociative identities), accompanied by gaps in personal agency and sense of self. This means that the person experiencing DID has the impression that certain thoughts, actions, and emotions don't belong to them, as they are sourced from another distinct identity.
You may see DID referred to as Multiple Personality Disorder or Split Personality Disorder. These terms are outdated and inaccurate, as DID is a dissociative disorder, not a personality disorder. The new term came into use in 1994.
People with DID describe their experiences in a variety of ways. Some see themselves as multiple people or entities coexisting within one body, while others view themselves as a person composed of independent parts or sides. Dissociative identities may be called alters, parts, headmates, friends, voices, and more. Some people with DID use the term system to describe themselves collectively.
Each identity within a DID system has a unique experience of the world and distinct relationships with self, body, external individuals, and the environment. This comes with differences in thinking, feeling, moving, sensing, understanding, and interacting. Identities may be experienced covertly through intrusions of feelings, thoughts, and sensations that don’t feel like they belong to the individual. They can also be experienced overtly as different identities taking control of consciousness and functioning, also known as switching.
DID often involves experiences of amnesia, which can include the inability to recall traumatic events, the recent past, daily life details, or the activities of different alters. Amnesia is a diagnostic requirement according to the American Psychiatric Association (APA), but it is not included in the World Health Organization (WHO) definition of DID. Even without total amnesia, people with dissociative identities often feel a lack of ownership of particular memories, as if the remembered event happened to somebody else.
You may see DID referred to as Multiple Personality Disorder or Split Personality Disorder. These terms are outdated and inaccurate, as DID is a dissociative disorder, not a personality disorder. The new term came into use in 1994.
People with DID describe their experiences in a variety of ways. Some see themselves as multiple people or entities coexisting within one body, while others view themselves as a person composed of independent parts or sides. Dissociative identities may be called alters, parts, headmates, friends, voices, and more. Some people with DID use the term system to describe themselves collectively.
Each identity within a DID system has a unique experience of the world and distinct relationships with self, body, external individuals, and the environment. This comes with differences in thinking, feeling, moving, sensing, understanding, and interacting. Identities may be experienced covertly through intrusions of feelings, thoughts, and sensations that don’t feel like they belong to the individual. They can also be experienced overtly as different identities taking control of consciousness and functioning, also known as switching.
DID often involves experiences of amnesia, which can include the inability to recall traumatic events, the recent past, daily life details, or the activities of different alters. Amnesia is a diagnostic requirement according to the American Psychiatric Association (APA), but it is not included in the World Health Organization (WHO) definition of DID. Even without total amnesia, people with dissociative identities often feel a lack of ownership of particular memories, as if the remembered event happened to somebody else.
What is Other Specified Dissociative Disorder, or OSDD?
“Other specified” disorders exist in all diagnostic categories to describe clinically significant symptoms that do not meet the diagnostic criteria of a specific disorder. Other Specified Dissociative Disorder (OSDD) can refer to any mix of dissociative symptoms that are significant enough to warrant a diagnosis.
In the APA’s framework, somebody experiencing dissociative identities without amnesia may be diagnosed with OSDD. You may see subthreshold presentations of DID like this referred to as OSDD-1.
What are Depersonalization & Derealization?
Depersonalization describes feeling detached from one’s self and body. It may be experienced as watching oneself in third person, or feeling numb physically and/or emotionally. Depersonalization may feel like “I am not real.”
Derealization describes feeling detached from other people, objects, and the world. It may cause the world to feel dreamlike, distant, foggy, or distorted. Derealization may feel like “the world is not real.”
Experiences of depersonalization and derealization can be upsetting and frightening. They can be a part of a variety of conditions, including PTSD, anxiety disorders, and of course, dissociative disorders. Substance (drug or alcohol) use or withdrawal can also trigger depersonalization and derealization. A diagnosis of Depersonalization-Derealization Disorder (DPDR) may be made when experiences of depersonalization and/or derealization are chronic, involuntary, and disruptive to an individual’s wellbeing.
Derealization describes feeling detached from other people, objects, and the world. It may cause the world to feel dreamlike, distant, foggy, or distorted. Derealization may feel like “the world is not real.”
Experiences of depersonalization and derealization can be upsetting and frightening. They can be a part of a variety of conditions, including PTSD, anxiety disorders, and of course, dissociative disorders. Substance (drug or alcohol) use or withdrawal can also trigger depersonalization and derealization. A diagnosis of Depersonalization-Derealization Disorder (DPDR) may be made when experiences of depersonalization and/or derealization are chronic, involuntary, and disruptive to an individual’s wellbeing.
What is Maladaptive Daydreaming?
Immersive daydreaming on its own is not a cause for concern. For most people, it can be refreshing and healthy to allow space for your imagination to blossom. Daydreaming becomes maladaptive when it causes distress or interferes with a person’s everyday functioning.
The term Maladaptive Daydreaming (MD) was coined by Dr. Eli Somer in his 2002 article on the subject. People experiencing MD may lose hours or days to daydreaming, or use it to replace human interaction. MD can sometimes feel compulsive or involuntary, but people experiencing it can differentiate between fantasy and reality.
Currently, Maladaptive Daydreaming is not a diagnosable mental health disorder, but some researchers are advocating for its inclusion in future diagnostic manuals. For now, it is associated with various mental conditions including PTSD, dissociative disorders, ADHD, autism, and OCD.
The term Maladaptive Daydreaming (MD) was coined by Dr. Eli Somer in his 2002 article on the subject. People experiencing MD may lose hours or days to daydreaming, or use it to replace human interaction. MD can sometimes feel compulsive or involuntary, but people experiencing it can differentiate between fantasy and reality.
Currently, Maladaptive Daydreaming is not a diagnosable mental health disorder, but some researchers are advocating for its inclusion in future diagnostic manuals. For now, it is associated with various mental conditions including PTSD, dissociative disorders, ADHD, autism, and OCD.
What is Post Traumatic Stress Disorder?
Posttraumatic Stress Disorder (PTSD) refers to the lasting negative effect that trauma has on wellbeing. Trauma can encompass a wide range of events and circumstances. This includes but isn’t limited to: abuse, violence, childhood neglect, systematic marginalization, natural disasters, and serious accidents. Both isolated events and chronically stressful situations can be traumatic.
PTSD involves a pattern of re-experiencing, avoidance, and hypervigilance. People with PTSD can re-experience trauma in the form of intrusive memories, images, body sensations, flashbacks, and recurring nightmares. To protect themselves from re-experiencing, they avoid internal and external reminders of their trauma. These reminders are often called “triggers.”
Dissociation is a common experience in trauma survivors. The APA’s most recent definition of PTSD describes flashbacks as a dissociative experience in which a person re-experiences their trauma as if it were happening in the present. Dissociative amnesia surrounding the traumatic event(s) is also common. PTSD can be diagnosed with the specifier “with dissociative features” when it involves extensive depersonalization and derealization.
PTSD involves a pattern of re-experiencing, avoidance, and hypervigilance. People with PTSD can re-experience trauma in the form of intrusive memories, images, body sensations, flashbacks, and recurring nightmares. To protect themselves from re-experiencing, they avoid internal and external reminders of their trauma. These reminders are often called “triggers.”
Dissociation is a common experience in trauma survivors. The APA’s most recent definition of PTSD describes flashbacks as a dissociative experience in which a person re-experiences their trauma as if it were happening in the present. Dissociative amnesia surrounding the traumatic event(s) is also common. PTSD can be diagnosed with the specifier “with dissociative features” when it involves extensive depersonalization and derealization.
What is CPTSD and how does it differ from PTSD?
Complex Posttraumatic Stress Disorder (CPTSD) refers to a subtype of PTSD that can develop as a result of severe, prolonged trauma, also known as complex trauma. The situations that create CPTSD are often difficult or impossible to escape. Trauma that occurs during childhood is more likely to result in CPTSD than trauma that occurs during adulthood.
CPTSD includes all symptoms of PTSD, along with severe and ongoing problems with regulating emotions, negative beliefs, and relating to others. This can look like angry outbursts, depressive symptoms, and persistent feelings of guilt, shame, disgust, and horror. Complex trauma survivors often internalize negative ideas about themselves or the world. The emotional wounds created by complex trauma create immense difficulty forming and maintaining healthy relationships.
Though the ICD-11 lists CPTSD as a distinct diagnosis, the DSM-V-TR includes it in the standard definition of PTSD. Regardless, some people find that the CPTSD label best describes their experiences.
CPTSD includes all symptoms of PTSD, along with severe and ongoing problems with regulating emotions, negative beliefs, and relating to others. This can look like angry outbursts, depressive symptoms, and persistent feelings of guilt, shame, disgust, and horror. Complex trauma survivors often internalize negative ideas about themselves or the world. The emotional wounds created by complex trauma create immense difficulty forming and maintaining healthy relationships.
Though the ICD-11 lists CPTSD as a distinct diagnosis, the DSM-V-TR includes it in the standard definition of PTSD. Regardless, some people find that the CPTSD label best describes their experiences.