Few psychiatric diagnoses are as disputed as dissociative identity disorder
Diagnoses of multiple personality disorder soared to around 50,000 in North America by the 1990s, then collapsed amid lawsuits and retracted memories. Renamed dissociative identity disorder, the condition is still argued over: some see a response to severe childhood trauma, others a learned behaviour shaped by therapy, culture and media.
DID is defined by at least two distinct personality states, often called alters. Supporters of the trauma model regard it as a natural reaction to severe early abuse or neglect; the DSM-5-TR says trauma usually starting before age 5 or 6 raises the risk, and across many regions about 90 percent of those diagnosed report several kinds of childhood abuse. Critics favour a sociogenic model in which the condition is learned, shaped by suggestion in therapy, cultural beliefs and exposure to depictions of it.
Popular ideas owe much to Sybil, a supposedly true story that later proved fraudulent. After the diagnosis entered DSM-III in 1975, cases multiplied, closely bound up with the satanic panic. Therapists used hypnosis, believing they were uncovering alters and buried memories of ritual abuse, while memory researchers warned they were creating false recollections. The FBI could not confirm the allegations against caregivers. When patients recovered, withdrew their claims and won lawsuits against therapists, diagnoses dropped sharply, and DSM-IV renamed the condition. In the 2020s cases rose again after viral videos spread on TikTok and YouTube.
The DSM describes memory gaps beyond normal forgetting, but Richard McNally found that patients reporting amnesia between alters performed normally on objective memory tests. After publications fell in the early 2000s, Pope and colleagues called DID an academic fad in 2006, while Boysen and colleagues in 2012 judged research steady but short of convincing evidence.
Studies in the US and Turkey put lifetime prevalence at 1.1 to 1.5 percent of the population, and 3.9 percent among psychiatric inpatients in Europe and North America, though some argue those numbers are too high and others too low. Women are diagnosed 6 to 9 times more often than men, other conditions frequently coexist, and care relies on psychotherapy and support, with medication for related symptoms. Presentations vary by culture: where possession is familiar, alters may appear as spirits, deities or ghosts.
Source: Dissociative identity disorder
