Dissociative identity disorder misconceptions

Improved understanding and balanced representation of personality disorders are needed to shift dissociative identity disorder misconceptions.

Kathryn Fletcher, Swinburne University of Technology and Kristi-Ann Villagonzalo, Swinburne University of Technology

While the media is an important source of information about mental illness, it can misinform the public if reported inaccurately, promoting stigma and perpetuating myths. And research shows negative images of mental illness in the media (fictional and non-fictional) result in negative and inaccurate beliefs about mental illness. For example, schizophrenia in the media is often portrayed as a being akin to Jekyll or Hyde, which is one of the many reasons dissociative identity disorder misconceptions exist.

“Multiple personality disorder” or “split personality disorder” are colloquial terms for dissociative identity disorder. Despite being colloquially named a personality disorder, it’s actually a dissociative disorder.

A personality disorder is a long-term way of thinking, feeling, and behaving that deviates from the expectations of the culture. Whereas in dissociative identity disorder, at least two alternate personalities (alters) routinely take control of the individual’s behavior. The individual is usually unable to remember what happened when an alter takes over: there are noticeable gaps in their memory, which can be extremely distressing.

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The popular TV series “The United States of Tara” actually does a pretty good job of portraying dissociative identity disorder. The main character has a series of alters and experiences recurrent gaps in her memory.

While it used to be considered rare, dissociative identity disorder is estimated to affect 1% of the general population and is typically related to early trauma (such as childhood abuse). People often have dissociative identity disorder misconceptions, commonly confusing it with schizophrenia. Unlike schizophrenia, the individual is not imagining external voices or experiencing visual hallucinations: one personality literally “checks out,” and another appears in their place.

While borderline personality disorder and bipolar disorder can look similar (mood problems, impulsive behavior, and suicidal thinking), there are several key differences.

Bipolar disorder is characterized by extreme mood swings – from severe lows (depression) to periods of high activity, energy and euphoria. The different mood states can seem like a personality change, but a return to the “usual self” occurs once mood stabilizes.

While depression is part of borderline personality disorder and bipolar disorder, those with bipolar disorder experience significant “up” mood swings. This is known as mania in bipolar I disorder and hypomania (less intense mania) in bipolar II disorder.

Bipolar mood episodes last longer (four days or longer for “ups” and two weeks or longer for “downs”), with periods of wellness in between, and are less likely to be triggered by external events. And bipolar disorder is more likely to run in families, disrupt sleep patterns, and psychotic symptoms (delusions, hallucinations) can occur during mood episodes.

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We all have ups and downs, but bipolar disorder is much more than that, with extreme, recurrent mood episodes that are not only distressing but have a significant long-term impact on key areas of a person's life. Positively, with the right treatment, good quality of life is entirely possible despite ongoing symptoms.

Schizophrenia, meaning “split mind” in Greek, is often confused with dissociative identity disorder. However, the “split” refers not to multiple personalities, but to a “split” from reality. People with schizophrenia may find it difficult to discern whether their perceptions, thoughts, and emotions are based in reality or not.

Hearing voices (auditory hallucinations) is a common symptom, along with seeing, smelling, feeling, or tasting things others can’t. Unusual beliefs (delusions), including some that cannot possibly be true (such as a belief that one has special powers), are also common. So too is disordered thinking, where the person jumps from one topic to another at random or makes strange associations to things that don’t make sense. They may also exhibit bizarre behavior including socially inappropriate outbursts or wearing odd clothing that is inappropriate to the circumstances.

Other symptoms of schizophrenia look a lot like depression, such as an inability to experience pleasure, social withdrawal and low motivation. Depressive symptoms are also present in schizophrenia, but are slightly different in that emotion is diminished altogether, rather than a depressed mood per se.

Unlike physical conditions, we don’t have a biological test that can magically tell us what mental condition we’re dealing with. Mental health practitioners are carefully trained to observe symptom patterns: the right diagnosis guides the appropriate treatment.

For example, first-line treatment of schizophrenia and bipolar disorder often focuses on medication. While dissociative identity disorder and borderline personality disorders are treated primarily with psychological therapy.

Mental health conditions are serious – whether disorders of personality, mood, or somewhere in between. Improved understanding and balanced representation of these conditions are needed to shift stigmas and end dissociative identity disorder misconceptions in the community.