Dissociative identity disorder can be a challenge to diagnose, because of similarities to other mental health disorders that include borderline personality disorder, schizophrenia, post-traumatic stress disorder, and other conditions. As a result, the process of diagnosing this disorder takes time and commitment from an experienced professional to get to the correct conclusion.
According to WebMD, the Diagnostic and Statistical Manual of Mental Health Disorders (DSM-5) lists the following requirements to diagnose dissociative identity disorder:
Diagnosing dissociative identity disorder
- Two or more separate identities or personalities, with persistent characteristics, patterns of thought, and beliefs about the environment and the self
- Amnesia, which includes gaps in memory of everyday events, personal details, and traumatic events
- Distress about the symptoms or inability to function in daily activities as a result of the symptoms of the disorder
- Existence of the disorder and its symptoms outside of typical cultural or religious practices
- Lack of alternative sources of the symptoms, such as blacking out from substance abuse or underlying medical conditions like seizures
The following paragraphs briefly discuss how each of these diagnostic criteria is tested.
1. Presence of two or more distinct identities
When diagnosing dissociative identity disorder, it’s not enough to simply observe that the person holds two different opinions about some topics or even that the person sometimes feels separated from personal emotions. For this disorder to be diagnosed, the individual must be observed to experience two distinct and specific identities that, over time, are consistent in various aspects of the personality, such as:
- How the individual identity looks at the world, the self, and others
- How the individual behaves or processes information
- How the individual relates to or feels about events
It can be challenging to maintain consistent patterns of behavior, beliefs, and relationships among multiple personalities if they are being staged. For this reason, it can take multiple observations, questions, and interactions with each personality to determine whether or not there are distinct identities, as opposed to simply conflicted emotions or thoughts, or even hallucinations.
Determining the answers to these concerns can be done through observation, as well as obtaining a full picture of the person’s experiences through their answers to questionnaires, such as the Dissociative Experiences Scale. Applying these practices, along with analyzing the other diagnostic requirements below, can help to create a complete understanding in the diagnostic professional’s mind of what is happening in the individual’s experience.
Several forms of amnesia are taken into consideration when looking at a person who may have dissociative identity disorder. First, the individual is assessed for issues with general memory. A person with any dissociative disorder is likely to have areas of amnesia, including:
- Gaps in memory regarding day-to-day activities
- Lack of memory of personal details and sometimes of other people
- Forgetfulness about the specifics of traumatic events, including completely forgetting that the event occurred
The other type of amnesia experienced in this disorder, as described in a study from Psychological Science, is amnesia about the other identities. This may be partial or in full. Sometimes, the individual experiences interactions between two or more of the distinct identities; however, more often, the identities are not aware of what is happening to each other.
3. Distress about the symptoms
As described by MedicineNet, some people may feign having alternate identities or personalities in order to get attention or achieve some benefit, such as leniency in a criminal case. While this is unacceptable, it can be challenging to know whether or not a person is trying to fake the disorder for personal gain.
The questionnaires that are used by professionals to diagnose dissociative identity disorder usually contain questions that allude to the individual’s inability to function in daily life. The mental health expert is also often able to observe the person’s daily behavior and determine whether or not the symptoms that the person appears to be experiencing are causing significant distress or dysfunction in the person’s life.
On the other hand, many people in the lives of those with dissociative identity disorder may suspect that their loved one is feigning the disorder. It can be disturbing to see a loved one behaving in this manner, and concerns about self-image or trust can sometimes make it hard to accept that something is really wrong. It is important to avoid self-diagnosis or for a nonprofessional to diagnose someone else. For mental health disorders of this complexity, professional observation and analysis are necessary.
4. Symptoms as separate from cultural practices
The Inquiries Journal attempts to explain the challenge of determining this element of the diagnostic process. First, other cultures that are collectivistic may not have the prevalence of this disorder because there are differences in the way those societies look at the behaviors and symptoms that, in individualistic cultures, are related to dissociation. On the other hand, some cultures may have different experiences of dissociative disorders. An example given in the journal is that people in Japan who have dissociative identity disorder are less likely to have personal abuse as the cause and have fewer alternate personalities.
On the other hand, the more specific meaning of this aspect of diagnosis is described in an article from Culture, Medicine, and Psychiatry, which explains that dissociation in some cultures is part of religious or spiritual practice. For example, some cultures and religious groups purposefully enter trance states, even using drugs to achieve them, to encourage dissociative experiences. People who experience the feeling of developing another identity as part of these rituals or practices are not diagnosed with dissociative identity disorder.
5. Lack of alternative sources of the symptoms
Recognizing whether other conditions or situations may contribute to the symptoms is an important part of diagnosing any mental health or physical disorder. In this case, the expert will look for other conditions that might explain the dissociative symptoms, such as:
- Seizure conditions, such as epilepsy
- Other mental health conditions, including depression, PTSD, and schizophrenia
- Substance abuse, including use of dissociative drugs like LSD, mescaline, or peyote
- Traumatic brain injury
As described by Mayo Clinic, there are multiple types of dissociative disorders, and these also must be ruled out in making a dissociative identity disorder diagnosis.
These elements of diagnosis for dissociative identity disorder are challenging and take a great deal of time to work through. However, it is important in any mental health disorder to strive for the most accurate diagnosis. With the tools of observation, questionnaires, and experience, the treatment professional can determine the correct diagnosis, helping to provide the most effective treatment and best hope for recovery.