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To dissociate means to disconnect or separate. Everyone experiences this in a variety of ways throughout life. It may include immersing ourselves in a good book or daydreaming when we are bored and other similar responses. These involve mildly losing touch with reality. Those who are mentally ill with a dissociative disorder experience these symptoms to an extreme, symptoms which interfere with their ability to function.

Dissociative disorders are marked by a detachment of one’s self from reality. The individual experiences problems with remembering, with how they perceive themselves and their surroundings, with their identity, and their behavior. They may feel that they are experiencing what is commonly referred to as an out of body experience and may experience amnesia. There are three types of dissociative disorders: dissociative amnesia, depersonalization/derealization disorder, and, perhaps the most intriguing, dissociative identity disorder, formerly known as multiple personality disorder.

Dissociative identity disorder (DID) is associated with past, severe, traumatic events, including childhood abuse. It is diagnosed when the practitioner determines the existence of two or more personalities, with each personality having its own identity, behaviors, memories, and thought processes. In addition, each personality experiences memory lapses about current and past events, knowledge about themselves, and former dreadful events. The individual with DID must also experience substantial distress and problems functioning in their daily lives. Each individual personality has its own likes and dislikes, and may, in fact, have their own individual physical ailments, like allergies in one personality, but not the other. The personality may shift quickly and, just as quickly, shift back. These separate personalities develop involuntarily and can cause the individual to feel very different from what is real, including feeling like a small child, rather than an adult, or feeling like a man, rather than a woman.

There are numerous patient synopses written that detail these symptoms, including that of a 25-year-old woman who was hospitalized because she had extreme and sudden changes in her behavior and, what appeared initially to be, severe lapses in memory. She was confused about her life and was convinced that she was in a different hospital, hundreds of miles away. There were numerous diagnoses considered. Over time, though, they discovered that she had severe gaps in her memory, and her emotions and behavior changed drastically and suddenly. She would shift from an agreeable, mellow individual, to one that demonstrated hostility and was uncooperative. At one point in time, she was seen in the emergency room with a deep gash in her leg. She said that she suffered the injury when she was running and fell, details that were inconsistent with the severity of her injury. Eventually, another personality emerged that explained the injury was inflicted as punishment by her to the other personality because she allowed herself to be abused.

The primary cause of DID is frequent and severe trauma during childhood. Approximately 90% of people diagnosed with the disorder in the United States, Canada, and Europe were victims of abuse and or neglect as children. People with DID are prone to suicidal behavior and other self-harming tendencies. In fact, more than 70% of those diagnosed have attempted suicide. The recommended treatment is psychotherapy, with the purpose being to assist the individual in gaining control over their symptoms and to integrate the separate identities into one. While cognitive behavioral therapy and dialectical behavioral therapy are the most commonly used, many therapists prefer hypnosis. Medication is prescribed only to treat symptoms of a co-morbid diagnosis, like depression.

Mental disorders are controversial within society. This results from a lack of knowledge about mental health. People, especially teachers, frequently disagree with whether a child has attention deficit hyperactivity disorder, thinking that the child is simply undisciplined. We frequently hear that clinically depressed people just need to pull themselves up or snap out of it. Generally, people distrust what they do not understand and most people do not have even a basic understanding of mental illness. Unlike people who are physically ill, an individual with a mental disorder shows no outward appearance of illness – no bald head from cancer treatment, no shortness of breath from pulmonary failure, no disposing of needles because of insulin injections. Mental disorders are invisible illnesses. Consequently, people who are diagnosed are stigmatized. They become victims of violence, rather than victimizing others, as is a common belief. In addition, they resist being, what they consider to be, labeled, knowing it will negatively affect their lives. It is rare, though, for a mental disorder to be controversial within the psychological and psychiatric communities. Dissociative Identity Disorder is one such illness that professionals find much about which to disagree, leading to great debate and dispute.

Mental health professionals do not disagree on the dissociative element existing. There is an ongoing debate, though, about the actual existence of DID. Many psychiatrists doubt the existence of the illness, with others believing that the symptoms are the result of therapists training their patients, intentionally or unintentionally, to view their symptoms as belonging to a separate person. There are others, though, who specialize in the disorder and will go to the extreme of scheduling different appointments for individual personalities. Dissociative episodes vary in severity from one patient to another. It is likely that those who are quite ill suffer frequent dissociative episode and, when this happens, the individual has gaps in memory. But unlike the individual who suffers psychotic episodes, these disruptions are not apparent, and, consequently, receive far less attention. In fact, those, who believe that DID exists, point out that individuals suffering from it rarely complain because they frequently are unaware of fractures in their personalities and actions. Those who believe it exists point out that medical tests can differ from one personality to the next within the same person. Doubters will say that good actors can cause changes in medical tests. There is also the issue of celebrity and its impact on the sudden rise in cases. In one example, when the book and movie of the same name, Sybil, were released, the number of cases of DID increased dramatically. Unfortunately, it was later determined that Sybil was a fraud. Did the release of the book and the movie allow the people who actually have DID to come forward because they recognized their problems, or were they frauds like Sybil?

There is no doubt that children who endure repetitive abuse are impacted for life. The question is, does it cause the breaking of the individual’s identity into two or more parts in an effort to deal with the events of a past life? Unfortunately, most research into mental disorders involves those with which pharmaceutical intervention is beneficial. With DID, research is limited because there is no medication that makes any difference for the person. Does it exist? The debate will continue.