Diagnosis

Several well-researched psychological tests and structured interviews aid in
diagnosing a client. For a formal diagnosis of DID, the Diagnostic and Statistical
Manual of Mental Disorders: DSM-IV-TR (rev. 4th ed., 2000) states that the
following four criteria must be present: 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); at least two of these identities or personality states recurrently take control of the person’s
behavior; there is an inability to recall important personal information
that is too extensive to be explained by ordinary forgetfulness; and the disturbance
is not due to the direct physiological effects of a substance (such as
blackouts due to alcohol, drugs, or seizures).
The central paradox of multiple personality is that it is both real and not
real at the same time. It is not real in that the mind or personality does not
literally split. There is only one brain and one body. It is a creation of a person’s
imagination. At the same time, however, the person with DID experiences
very real separations and is not faking them. The perceived separate
parts must be dealt with as if they were separate, while teaching them the reality
that they must live in the same body and jointly suffer the consequences
of the actions of any one part.
Multiple personality goes unrecognized too often as a result of several
reasons. First, it has only received considerable attention since the early
1980’s. Second, it was wrongly thought to be extremely rare, so psychotherapists
were previously taught that they would probably never see a case of it.
Third, the trauma that causes DID produces so many symptoms, such as depression,
anxiety, hearing voices, and mood changes, that it is wrongly diagnosed
as schizophrenia, bipolar disorder, or something else. Fourth, there is
skepticism about its validity as a true diagnosis.
Alters can be categorized in various ways. Some are victims who took most
of the abuse. Some are persecutors who identified with the abuser and try to
control other alters internally. Some are functioning alters who handle work
or school. Alters may believe they are the opposite sex of the body and can
see themselves as almost any age. Some may know a great deal about other
alters. Others may only know of themselves and have no knowledge that others
even exist.
Because at least some alters are usually dissociated from other alters, the
person with DID will typically experience time loss when one alter has had
control of the body and a different alter, who does not know what has happened
previously, takes control. Dissociation is experienced in degrees.
When it is present to a lesser degree, DID patients hear voices inside their
heads. They are hearing alters talking. This may scare them when they first
experience it, or it may be so normal for them that they mistake these voices
for their own thoughts.