Dissociative identity disorder

Perhaps you’ve already heard of DID: Dissociative Identity Disorder. We’re hearing more and more about it in the media, and we can even find it in certain films (e.g. Split). As a result, both true and false information about this pathology is circulating. Let’s take a look at TDI together!

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1. WHAT IS DISSOCIATIVE IDENTITY DISORDER ?

Dissociative Identity Disorder (DID) is a mental disorder formerly known as Multiple Personality Disorder (MPD).

The disorder is characterized by the presence of one or more alters (identities) who take it in turns to take control of the person.

The different identities that can be found in DID are called “Alters”.

Alters are not all the same. They may not have the same gender, age or personality. They may also differ in language. One Alter may speak English while all the others speak French, for example. They won’t have the same beliefs, cultures or behavior. Each Alter has its own memories, with some retaining memories of traumatic events while others have none at all.

DID is a disorder that is still controversial in the scientific community. For a long time, it was mixed up with schizophrenia, for example.

Dissociation often stems from traumatic experiences in childhood, when identity is being formed.

Dissociation is a response to traumatic or stressful experiences which may be physically or psychologically threatening. It can also be seen as a coping strategy that helps people avoid the pain and emotional stress associated with traumatic events.

Two forms of DID :

There are two different forms of TDI : 

  • Possessive form of TDI : This form is represented by alters taking control of the host’s behavior.
  • Non-possessive form of TDI :The person remains present, but people verbalize that several alters are manifesting through them.

Prevalence and causes

Given the difficulty of diagnosing DID, its stigmatization and the complexity of the disorder, it can be difficult to estimate prevalence.

However, according to studies, 1 to 1.5% of people have been reported to suffer from DID.

DID is also more common in people who have suffered repeated childhood trauma, particularly sexual, physical or emotional abuse. Research shows that up to 90% of people with IDD have experienced childhood trauma.

These childhood traumas may have led to problems with emotional regulation and changes in brain development.

2. SYMPTOMS

→ Symptoms of DID include the presence of two or more alters who take control of a person’s behavior on a recurrent basis.

People with DID may also have significant memory gaps for traumatic or stressful events.

Some alters will have a traumatic memory, with the various memories that have weakened their identity, while other alters will have no memory of these events, retaining only the best.

In this way, alters with no traumatic memories are protected from the difficult things they may have experienced.

Other common symptoms of DID can include behavioral and emotional changes, flashbacks, nightmares and hallucinations. People with DID may also have difficulty forming healthy relationships and maintaining a stable self-image.

Dissociative Identity Disorder (DID) is a complex and rare psychological disorder characterized by a fragmentation of identity into several dissociated personality states.

People with DID often experience symptoms that can affect their daily lives and emotional well-being.

Here are some of the most common symptoms of DID :

Dissociative amnesia

People with DID often experience significant memory loss for parts of their lives. These memory losses are caused by dissociated personality states that are responsible for the events that occurred during that period.

Sleep disorders

Sleep disorders, including nightmares and insomnia, due to the anxiety and confusion surrounding their dissociated state.

Self-mutilation and risk behaviors

They may also engage in risky behaviors such as self-harm, eating disorders and risky sexual behavior. These behaviors may be linked to different personality states, beliefs, and needs.

Flashbacks and hallucinations

People with DID may experience flashbacks and hallucinations related to traumatic events that have caused the fragmentation of their identity into different personality states. These flashbacks and hallucinations can be very disturbing and difficult to manage. These symptoms are linked to Post Traumatic Stress Disorder (PTSD).

Personality changes

People with DID often have personality alterations that manifest as changes in behavior, attitude and beliefs. Different personality states may have different names, different ages, different voices and different ways of expressing themselves. For example, a woman in her early 20s may be a 3-year-old male alter.

Depersonalization and derealization

People with IDD may experience feelings of depersonalization and derealization. These reactions are often protective.

In depersonalization, the person feels as if he or she sees him- or herself from outside the body, and experiences all events without being anchored in the body.

While derealization is an altered perception of reality, people may feel that nothing around them is real.

Anxiety and depression

People with IDD can suffer from anxiety and depression due to the confusion and uncertainty surrounding their dissociated personality state.

Different personality states may have different beliefs, emotions and needs, which can make it difficult to understand oneself and communicate with others.

3. DIAGNOSIS

Diagnosing IDD can be difficult due to the complex and variable nature of the symptoms. People with IDD may be misdiagnosed with other disorders such as depression, anxiety, schizophrenia or bipolar disorder. Diagnosis can therefore take a long time.

4. TREATMENT

Psychotherapy :

Psychotherapy seems to be one of the most recommended solutions for dissociative identity disorder.

Common therapeutic approaches for DID include cognitive-behavioral therapy, interpersonal therapy, group therapy and dissociation-focused therapy. Therapy may also include stress management, relaxation and mindfulness techniques.

In psychotherapy, the aim is to try to bring the different personalities together into a single personality. If this is not possible, the aim is to enable the different alters to live together as harmoniously as possible.

- Cognitive-behavioural therapy :

Cognitive-behavioural therapy can help treat symptoms such as depression and anxiety by helping the person to change negative thoughts and behaviours.As we saw earlier, dissociative identity disorder is closely linked to other psychological disorders.

Cognitive-behavioral therapy will help the person to manage the emotions associated with these disorders.

Work on post-traumatic stress can also be undertaken, with the alters holding the traumatic memories. Right from the start of therapy, the person learns to differentiate between the different alters, or at least some of them.

- Group therapy :

Group therapy can be useful for people with IDD, as it can offer emotional and social support. Group therapy can also help improve social skills, foster self-confidence and improve communication with others.

- Hypnosis therapy :

Hypnosis therapy can help explore dissociated memories and strengthen the links between different personality states. Hypnotherapy can be useful in treating symptoms such as anxiety, phobias and flashbacks.

Medication

Medications, such as antidepressants and mood stabilizers, can also be used to treat symptoms associated with DID.

5. PREVENTION

Preventing DID is challenging because risk factors are often beyond the individual’s control. However, efforts to prevent childhood trauma and abuse are crucial to reducing the risk of developing DID.

When trauma occurs, timely and appropriate intervention can help reduce the long-term negative effects on the person’s mental and physical health.

CONCLUSION

Dissociative Identity Disorder is a complex mental disorder characterized by the presence of two or more distinct identities or personalities that recurrently take control of a person’s behavior. People with DID also have significant memory gaps, particularly for traumatic or stressful events. This amnesia is due to the fact that these memories are only present in certain alters.

It is important to note that DID is a rare disorder and most people who experience trauma do not develop it. However, for those diagnosed with DID, psychological therapy can help improve the quality of life and reduce symptoms.

Ultimately, DID remains a controversial topic in the field of psychology and psychiatry due to its unique and complex nature. Nevertheless, mental health professionals continue to explore the underlying causes and treatments to help those affected by this disorder overcome their difficulties and lead fulfilling lives.

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FAQ

Virtual reality (VR) is an innovative technology that enables patients to be exposed to immersive and controlled environments, facilitating the management of numerous psychological and psychiatric disorders. Its use in mental health offers several advantages:
  • Gradual and Controlled Exposure: VR allows patients to confront anxiety-inducing situations in a secure environment, gradually adjusting the intensity of stimuli to promote habituation and emotional regulation.
  • Realistic and Reproducible Environments: Unlike traditional techniques, VR provides immersive scenarios that can be consistently reproduced, ensuring a coherent and effective approach.
  • Increased Patient Engagement: The interactive and immersive nature of VR enhances treatment adherence and motivates patients to continue their therapy.
  • Personalized Treatment: Virtual environments can be adapted to meet the specific needs of each patient.
  • Versatile Applications: VR is used to treat anxiety disorders (phobias, post-traumatic stress disorder, obsessive-compulsive disorders), addictions, mood disorders, and even cognitive remediation.
The use of virtual reality in healthcare is not new! It has been studied and utilized for over 30 years in the medical and psychological fields. As early as the 1990s, researchers began exploring its potential for treating anxiety disorders, particularly phobias and post-traumatic stress disorder. Since then, numerous scientific studies have confirmed its effectiveness in addressing various psychiatric, neurological, and cognitive disorders.
Today, VR is widely integrated into therapeutic and medical practices, with clinically validated protocols. It is used in hospitals, clinics, and psychologists' offices worldwide to provide patients with innovative, effective, and safe treatments.
To use virtual reality, one must immerse themselves in a virtual environment. There are several ways to achieve this.
In the past, the CAVE system (Cave Automatic Virtual Environment), a 3D setup consisting of multiple screen walls, was the primary method used. This system allowed users to be fully immersed in the virtual world, with their movements detected in real-time. However, this technology was expensive and not widely accessible.
Since around 2016, with the introduction of virtual reality headsets like the Oculus Rift and HTC Vive, VR has become much more accessible. These headsets immerse users in virtual reality through an enclosed screen that projects digital images. The user's head movements are tracked, enabling them to look around and interact with the environment as they would in the real world.
Today, VR headsets are wireless and standalone, providing maximum comfort and ease of use without requiring external sensors or cables.
A virtual environment is an immersive digital simulation created through virtual reality. It allows users to navigate in a 3D space that accurately replicates everyday situations or specific contexts.
In mental health, these environments are designed to help individuals gradually face certain situations, manage their emotions, or enhance cognitive skills. By interacting with these virtual spaces, patients can engage in meaningful experiences tailored to their needs.
You need to equip yourself with a virtual reality headset. Our software is compatible with Meta Quest 2, 3, and 3S. 
You will then only need an internet connection. 
Numerous studies confirm that virtual reality is safe to use. However, some restrictions are in place to protect users from potential adverse effects.
For instance, individuals with epilepsy and pregnant women should avoid this type of therapy.
As with any immersive technology, prolonged use may cause visual fatigue or mild discomfort, particularly for those sensitive to motion sickness. Therefore, it is recommended to take regular breaks and adjust session durations according to individual needs.
Virtual environments are designed to be gradual and controlled, minimizing the risk of excessive anxiety. Most users quickly adapt to immersion and experience the benefits of this innovative approach from the first sessions.
Anxiety disorders and phobias can be effectively treated using virtual reality. Patients are gradually and progressively exposed to anxiety-inducing situations in various environments while remaining in a safe space. This process helps develop a sense of habituation, ultimately reducing or even eliminating anxiety over time.
Behavioral and substance addictions can also be addressed through virtual reality. By incorporating synthetic stimuli into the environments that trigger craving responses, patients struggling with addiction can work on their cravings to diminish the urge to consume.
Additionally, multiple environments—such as bars, casinos, and social settings—enable cognitive work on dysfunctional beliefs associated with specific temptation scenarios.
Regarding eating disorders, virtual reality software helps target key etiological factors, such as body dysmorphia, allocentric lock (a tendency to focus on others rather than oneself), and food cravings.
Currently, our TERV (Virtual Reality Exposure Therapy) solutions include multiple software programs designed to address critical psychiatric, psychological, and neuropsychological determinants such as relaxation, cognitive stimulation, behavioral activation, and social skills training.
Reminiscence therapy is also a major therapeutic tool in treating depression. By allowing patients to relive sensations linked to past pleasurable activities (such as sports, driving, or traveling), virtual reality stimulates hypoactive brain areas, enhancing therapeutic success. VR serves as an excellent mediator for reigniting engagement in enjoyable activities.
Moreover, cognitive stimulation for elderly individuals is another area where virtual reality proves beneficial. By leveraging technology to make stimulation activities more engaging and accessible, patients and nursing home residents can improve executive functions and memory through specially designed applications.
Today, virtual reality in mental health care is advancing rapidly. Researchers, clinicians, and developers continue to explore new therapeutic targets to offer innovative and effective treatment solutions in the near future.
VR can be used by all healthcare professionals assisting patients with anxiety, phobias, post-traumatic stress disorders, addictions, or other psychological challenges.
It is particularly beneficial for psychologists, psychiatrists, neuropsychologists, specialized nurses, as well as psychomotor therapists, physiotherapists, dietitians, sophrologists, and hypnotherapists. With a wide range of immersive environments, VR enhances therapeutic approaches and provides innovative tools to improve patient care.
Healthcare providers incorporating virtual reality exposure therapy (VRET) expand their range of treatment options. VRET is a well-established therapeutic technique with scientific validation from cognitive-behavioral therapy research.
  • Professional Differentiation: Integrating VR into practice allows therapists to stand out from traditional treatment options.
  • Scientific Validation: VRET is backed by extensive research, reinforcing its credibility as an effective treatment method.
  • Improved Patient Engagement: The interactive nature of VR fosters greater patient involvement in therapy.
  • Time-Saving: VR provides direct access to various exposure environments without needing external logistics.

One of the considerable advantages of virtual reality is that it is effective on a wide spectrum of populations. Existing data from the literature on the subject shows us that it is entirely possible to expose a wide age group to virtual reality, with real therapeutic benefits.

The studies attest, in fact, to excellent feasibility and significant results; particularly in adults, in the treatment of anxiety disorders (including school phobia), autism, addictions, eating disorders, neuropsychological disorders, psychotic disorders and mood disorders.

The results are identical for adolescents with a significant added value concerning therapeutic engagement where virtual reality promotes adolescents' interest in their therapy.

Among elderly subjects, study results encourage the use of virtual reality with the aim of working on cognitive stimulation, on behavioral disorders but also on anxiety.

One of the major advantages of virtual reality is its effectiveness across a broad spectrum of the population. Existing literature on the subject shows that virtual reality can be used with individuals of various age groups, providing significant therapeutic benefits.
Studies confirm excellent feasibility and significant results, particularly among adults in the treatment of anxiety disorders (including school phobia), autism, addictions, eating disorders, neuropsychological disorders, psychotic disorders, and mood disorders.
The results are equally promising for adolescents, with a notable advantage in terms of therapeutic engagement, as virtual reality enhances their interest and participation in treatment.
For older adults, research supports the use of virtual reality to improve cognitive stimulation, behavioral disorders, and anxiety management.
However, people with epilepsy and pregnant individuals are not advised to undergo this type of therapy.
Yes, all our environments are grouped within a single application.
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