344 CHAPTER 8
Dissociative identity disorder (DID)
The dissociative disorder characterized by
the presence of two or more distinct alters
(personality states or identities), each with
their own characteristics and history, that
take turns controlling the person’s behavior.
Dissociative Identity Disorder
Dissociative identity disorder, once known as multiple personality disorder, may be
the most controversial of all DSM-IV-TR disorders. First we examine what dissocia-
tive identity disorder is, then some criticisms of the DSM-IV-TR diagnostic criteria,
and then factors that may contribute to the disorder. In the process of examining
these factors, we delve into the controversy about the disorder.What Is Dissociative Identity Disorder?
The central feature of dissociative identity disorder (DID) is the presence of two or
more distinct alters (personality states or identities), each with its own characteristics
and history, that take turns controlling the person’s behavior. For example, a person
with this disorder might have an “adult” alter that is very responsible, thoughtful and
considerate and a “child” alter that is irresponsible, impulsive and obnoxious. Each
alter can have its own name, mannerisms, speaking style, and vocal pitch that distin-
guish it from other alters. Some alters report being unaware of the existence of
other alters, and thus they experience amnesia (because the memory gaps are
longer than ordinary forgetting). Perhaps the most compelling characteristic
of alters is that, for a given patient, each alter can have
unique medical problems and histories: One alter might
have allergies, medical conditions, or even EEG patterns
that the other alters do not have (American Psychiatric
Association, 2000). Stressful events can precipitate a
switch of alters, whereby the alter that was the domi-
nant personality at one moment recedes and another alter
becomes the dominant personality. Although the number
of alters that have been reported ranges from 2 to 100,
most people diagnosed with DID have 10 or fewer alters
(American Psychiatric Association, 2000). Table 8.7 lists
the DSM-IV-TR diagnostic criteria for DID, and Table 8.8
provides further information about the disorder. Case 8.4
presents the alters of someone with DID, which had previ-
ously been called multiple personality disorder (MPD).CASE 8.4 • FROM THE INSIDE: Dissociative Identity Disorder
In Robert B. Oxnam’s memoir, A Fractured Mind, his various alters (11 in all) tell their
stories. The following excerpts present recollections from two of the alters, beginning
with Robert:
This is Robert speaking. Today, I’m the only personality who is strongly visible inside and
outside.... Fifteen years ago, I rarely appeared on the outside, though I had considerable
infl uence on the inside; back then, I was what one might call a “recessive personality.”
Although [Bob, another alter] was the dominant MPD personality for thirty years, [he]
did not have a clue that he was affl icted by multiple personality disorder until 1990, the very
last year of his dominance. That was the fateful moment when Bob fi rst heard that he had an
“angry boy named Tommy” inside of him.
(Oxnam, 2005, p. 11)
Another alter, Bob, recounts:
There were blank spots in my memory where I could not recall anything that happened for
blocks of time. Sometimes when a luncheon appointment was canceled, I would go out at
noon and come back at 3 P.M. with no knowledge of where I had been or what I had done.
I returned tired, a bit sweaty, but I quickly showered and got back to work. Once, on a trip
to Taiwan, a whole series of meetings was canceled because of a national holiday; I had zero
memory of what I did for almost three days, but I do recall that, after the blank spot disap-
peared, I had a severe headache and what seemed to be cigarette burns on my arm.
(Oxnam, 2005, p. 31).Table 8.7 • DSM-IV-TR Diagnostic Criteria for
Dissociative Identity DisorderA. The presence of two or more distinct identities or personality states (each with
its own relatively enduring pattern of perceiving, relating to, and thinking about
the environment and self ).B. At least two of these identities or personality states recurrently take control of
the person’s behavior.C. Inability to recall important personal information that is too extensive to be
explained by ordinary forgetfulness.D. The disturbance is not due to the direct physiological effects of a substance
(e.g., blackouts or chaotic behavior during alcohol intoxication) or a general med-
ical condition. Note: In children, the symptoms are not attributable to imaginary
playmates or other fantasy play.
Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders,
Text Revision, Fourth Edition, (Copyright 2000) American Psychiatric Association.