Mythbusting Dissociative Identity Disorder (DID) with A Wheeler
Dissociative Identity Disorder (DID) is easily one of the most demonized, sensationalized, and misunderstood mental health disorders in the Diagnostic and Statistical Manual of Mental Disorders, or the DSM-5-TR*. The way DID has been portrayed in the media, especially horror, has played a big part. The disorder has been the unfortunate victim of stigma from directors like M. Night Shyamalan and Alfred Hitchcock in films such as Split and Psycho. In movies like these, the antagonists’ evil is rooted in their plurality*. Films, alongside the 80s controversy related to DID diagnosis, have the public and clinicians alike believing certain myths about the disorder.
It’s important to understand before you continue to read this, that I’m plural*. I have Dissociative Identity Disorder (DID), and one of the most formative and harmful experiences I had related to this disorder was a few years ago. I was a sophomore getting my undergraduate degree when I was taking an abnormal psychology class run by a professor, who is a practicing clinician, and spent an entire lecture telling my class that he did not think that DID was real. I found out a year later, after my own diagnosis, that several people who had been in that class were unsure if the disorder existed due to that professor’s rhetoric. Contrary to that professor’s beliefs, DID is very real. The rhetoric that it does not exist is not only incorrect, but harmful to those living with the disorder.
So, that’s the first myth busted: Dissociative Identity Disorder (DID) is, in fact, a real disorder. However, many clinicians or other professionals don’t believe it is real due to lack of experience or education, as well as the opinions that many professionals spread about the disorder.
The next big misconception I want to get into is the idea that Dissociative Identity Disorder (DID) systems* are inherently violent or murderous. This is a dangerous fallacy for systems* because if they reveal themselves as plural*, the situation could become unsafe. They may be met with fear or a barrage of invasive questions about whether or not they are dangerous. Telling someone you have DID, or think that you have DID, is a very sensitive subject. Thanks to stigma, it can often be a shame filled and anxiety inducing situation. Beyond the safety aspect of the issue, the idea that systems* are inherently dangerous just isn’t true. Of course, it is possible for systems to have anger holders or parts/alters* who will lash out against people. But having DID does not make you dangerous or violent.
In fact, more than 70% of systems* have attempted suicide more than once, and death by suicide is the leading cause of death amongst those living with Dissociative Identity Disorder (DID) (Matulewicz, 2016). Additionally, there is an elevated risk of non-suicidal self injury (NSSI)* with systems*. Some studies suggest up to 86% have a history of NSSI (Nesler et al., 2022)
That being said, and putting the system* component aside, I’d like to add that experiencing suicidality or NSSI* is not a reason for an individual to be treated as inherently dangerous. Both Dissociative Identity Disorder (DID) and suicidality are heavily stigmatized, and should be met with compassion instead of judgement.
Another myth that really grates on me is one perpetuated through media - the biggest offender being the 2016 movie Split. The main character in that movie is a patient with Dissociative Identity Disorder (DID), and there are small details that are vaguely accurate. However, one of the most egregious lies Split portrayed about DID has to do with external system dynamics. For those who have not seen the move, the main character has an alter* in their system* called “The Beast” who physically transforms when they come to front.
I am screaming from the mountaintops: THAT DOES NOT HAPPEN.
Don’t get me wrong, there are mountains of other problematic things to unpack in that movie. But I’ve had people ask me questions about switching* and if we physically change when we switch*. The answer is resounding no.
A switch* occurs when there is some sort of trigger. This trigger can be emotional distress, physical distress, or the current fronter* simply inadequately performing. For example, in my system, we have a pain holder who fronts* when our pain is at a high level because other alters cannot handle the body being in a high level of pain. This is just one of my examples, but I hope it demonstrates what a switch* is. When a switch* occurs, there isn’t usually a notable physical change. However, small things can occur. Such as vocal inflection or stims, the way we move - such as preferred walking speed - or the position we sit in might change.
However, my eye color, hair, skin color, height, build and major physical characteristics remain the same.
What can differ, though, is internal identity characteristics. One alter/part* may feel transgender* and the host* or most of the alters* could feel cisgender*, vice versa, or anything in between. The same goes for what pronouns each part uses, or the style of clothing they prefer. None of these things make a system* ‘fake’ or ‘delusional.’
To wrap up, I’d like to touch on the myth that Dissociative Identity Disorder (DID) is extremely rare. Is it rarer than disorders such as Major Depressive Disorder or Generalized Anxiety Disorder? Absolutely. But it’s also not an anomaly. An estimated 1.5% of the world’s population has DID, but it is also considered to be underdiagnosed due to a lack of clinical education, patient reluctance to report symptoms, and overlapping symptoms with other psychiatric disorders (Jain & Mitra, 2023.) DID is a trauma based disorder, and trauma is a common occurrence on an interpersonal and societal level. Not all trauma creates a DID system* as there is a particular developmental age window during which the trauma has to occur. But DID is far more common than many clinicians realize. From my own experience within the DID community, many systems* echo this sentiment.
As a system*, and as a public health practitioner and neuroscientist, I am imploring clinicians to seek further education on this disorder both professionally and from a community perspective. I have hope in the future that clinical education will become more inclusive as well. From the perspective of a film lover and filmmaker, I am begging directors and Hollywood to stop demonizing and sensationalizing an already misunderstood and complex disorder. The myths discussed above are not the only myths surrounding this disorder. However, in my opinion, they are some of the biggest. I hope that this information can become part of your clinical or advocacy toolbox. The next time you encounter a patient with DID, or someone who misunderstands the disorder, you can lead with empathy and help support and educate them.
*See “Term Definitions & Further Information” below to better understand the terminology used in this article.
TERM DEFINITIONS & FURTHER INFORMATION
Alters (or Parts): Alters (sometimes referred to as parts) are associated with Dissociative Identity Disorder (DID), but can be part of other dissociative disorders. Alters are dissociated states of self, and make up a system within a person with DID. They commonly have the ability to take executive control of the body (Reuben, 2016).
The Diagnostic and Statistical Manual of Mental Disorders - Fifth Edition Text Revision (DSM-5-TR): This is the most updated version of the manual that is used worldwide to diagnose mental disorders and illnesses. The text revised version includes new diagnoses, as well as polished diagnostic criteria, and more inclusive language.
Cisgender: Cisgender refers to an individual whose identity and/or expression aligns with the sex they were assigned at birth (Human Rights Campaign, 2023).
Fronter/Fronting: A fronter refers to an alter that has control of the body and is responsible for thoughts, emotions, and actions in the moment that it is fronting (Reuben, 2021).
Host: The host in a system is the alter that frequently has primary control over the body (Reuben, 2021).
Non-Suicidal Self Injury (NSSI): This form of self injury is a behavior that is common in patients with DID, as well as other dissociative and trauma disorders. It is a form of self-injury that does not have suicidal intent behind it.
Non-Suicidal Self Injury Disorder (NSSID): This is a disorder that is often diagnosed alongside other disorders - such as DID, personality disorders, other trauma disorders, and others.
Plurality: Plurality is the state of being multiple, where multiple individuals share one body. The cause can be connected to trauma; however, some individuals are born with plurality and it is their natural state. Plurality and Dissociative Identity Disorder (DID) can be comorbid, but plurality is not recognized as a mental health condition within the DSM-5-TR, whereas Dissociative Identity Disorder (DID) is.
Switch/Switching: A switch occurs in Dissociative Identity Disorder (DID) when an alter takes over the body, is given control by another alter, or has prominence over another alter (Reuben, 2016).
System: A system within Dissociative Identity Disorder (DID) is defined as a collection of alters within one body. Many individuals with DID refer to themselves as systems (Reuben, 2016).
Subsystem: Subsystems are systems within a system in Dissociative identity Disorder (DID.) There are two types of subsystems. The first is a subsystem where there are separate groups within one system. The second is when alters have their own alters (Reuben, 2016).
Transgender: Transgender is an umbrella term that refers to individuals whose identity and/or expression differs from the sex that they were assigned at birth (Human Rights Campaign, 2023).
References
American Psychiatric Association (Ed.). (2022). Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR). American Psychiatric Association Publishing. https://www.psychiatryonline.org/
Human Rights Campaign. (2023). Glossary of Terms. https://www.hrc.org/resources/glossary-of-terms
Launay, S., Geelhand de Merxem, R., & Hanak, C. (2023). Dissociative Identity Disorder: Between History and Culture. Psychiatria Danubina, 35(Suppl 2), 196–201.
Matulewicz, C. (2016). Suicide Risk in Dissociative Identity Disorder (DID). Healthy Place. https://www.healthyplace.com/blogs/dissociativeliving/2016/09/suicide-risk-in-dissociative-identity-disorder
Mitra P, Jain A. (2023) Dissociative Identity Disorder. National Library of Medicine. https://www.ncbi.nlm.nih.gov/books/NBK568768/
Nester, M. S., Boi, C., Brand, B. L., & Schielke, H. J. (2022). The reasons dissociative disorder patients self-injure. European journal of psychotraumatology, 13(1), 2026738. https://doi.org/10.1080/20008198.2022.2026738
Reuben, K. (2016). Alters in Dissociative Identity Disorder. Dissociative Identity Disorder Research. https://did-research.org/did/alters/
Reuben, K. (2021). Alter functions. Dissociative Identity Disorder Research. https://did-research.org/did/alters/functions
Reuben, K. (2021). Switching and Passive Influence. Dissociative Identity Disorder Research. https://www.did-research.org/did/identity_alteration/switching
Reuben, K. (2016). Systems and Subsystems. Dissociative Identity Disorder Research. https://did-research.org/did/alters/systems
*This article has been edited, approved, and fact-checked by Sage Nestler, MSW. He compiled all definitions and references.
