Dissociative Identity Disorder (DID) in Teens: Signs, Symptoms, Causes, Diagnosis and Treatment

Dissociative Identity Disorder (DID) is characterized by the presence of multiple distinct identities or personality states within an individual, each with its way of perceiving and interacting with the world. According to a study by Paroma M., published in Stat Pearls in 2023 and titled “Dissociative Identity Disorder”, DID is a rare disorder associated with severe behavioral health symptoms, affecting approximately 1.5% of the population internationally. 

This disorder often arises as a response to severe trauma experienced in childhood, allowing teens to cope with overwhelming emotions and memories. Each identity has unique traits, making it difficult for the individual to maintain a cohesive sense of self.

Teens with DID  exhibit various signs and symptoms such as memory gaps, where important personal information is forgotten, and mood swings that lead to unpredictable emotional changes. Many teens also feel detached, experiencing moments of unreality or zoning out. 

The main causes of DID are linked to a history of severe physical, sexual, or emotional abuse during childhood, usually at the hands of a caregiver or attachment figure, according to Vedat Şar et al in a study published in the Psychology Research and Behavior Management titled “Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective”. Such experiences lead to dissociation as a coping mechanism, allowing teens to detach from painful memories. Chronic neglect and other traumatic events, like witnessing violence, can also contribute to the disorder.

Diagnosing DID involves a thorough evaluation by a mental health professional experienced in this complex disorder. The process typically includes clinical interviews to gather detailed information about symptoms and personal history. Clinicians use specific criteria from the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) to assess the condition.

Treatment for Dissociative Identity Disorder primarily focuses on psychotherapeutic techniques such as Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT), and Trauma-focused therapy, each tailored to meet individual needs.

What is Dissociative Identity Disorder?

Dissociative Identity Disorder (DID) is a mental health condition characterized by the presence of two or more distinct identities or personality states within a single individual, leading to significant disruptions in their sense of self and continuity of experience. Each identity has its unique traits, memories, and behaviors, resulting in a disconnect from the individual’s primary personality. Dissociation, in this context, refers to a psychological process where an individual separates their thoughts, feelings, and memories, often as a response to trauma or stress. 

DID is uncommon, affecting approximately 1-3% of the population, with a notable incidence among teens. Research by Sang-Hun, L., published in the Journal of the Korean Academy of Child and Adolescent Psychiatry in 2022 titled “Dissociative Identity Disorder in an Adolescent With Nine Alternate Personality Traits: A Case Study” indicates that teenagers are particularly vulnerable due to the developmental challenges they face, which exacerbate the effects of trauma. The case study presented in the research shows how a 16-year-old male patient developed DID with nine alternate personality traits after experiencing severe childhood trauma, including witnessing domestic violence and abuse.

A key feature of DID is memory transfer, where different identities hold distinct memories or experiences that others are unaware of. This leads to gaps in memory or knowledge, as certain identities do not share information, complicating the individual’s overall sense of self. For example, one identity might have different gender identities or personal histories that remain separate from the others.

What Are The Types Of Dissociative Identity Disorder?

The 2 types of dissociative identity disorder are possession and non-possession. According to an article published by Merck Manuals in 2023 titled “Dissociative Identity Disorder”,  these two forms help describe the different ways in which DID manifests in individuals. 

The main types of dissociative identity disorder include:

  • Possession: In this type, individuals feel that an external entity or force is controlling their actions, leading to behaviors that seem disconnected from their core identity.
  • Non-possession: This type involves the presence of distinct identities or personality states that coexist within the individual, each with its traits and memories, without the sensation of external control.

What are the Signs and Symptoms of Dissociative Identity Disorder in Teens?

The signs and symptoms of dissociative identity disorder in teens include unusual behaviors, identity confusion, headache, and eating disorders, per an article published by the National Health Service titled “Dissociative disorders”.

The signs of dissociative identity disorder in teens include:

  • Unusual behaviors: Teens with DID display behaviors that seem out of character or inconsistent with their usual personality, which confuses peers and family.
  • Identity confusion: A lack of clarity about who they are, leading to feelings of disorientation about their identity and life circumstances.
  • Amnesia: Gaps in memory regarding important personal information or events, particularly those related to trauma.

The symptoms of dissociative identity disorder in teens include:

  • Headaches: Frequent headaches occur, potentially as a result of stress or the mental strain of managing multiple identities.
  • Eating disorders: Some teens develop unhealthy eating habits or body image issues, which are associated with the trauma that underlies DID.
  • Sleep disorders: Problems such as insomnia or nightmares are common, and often linked to anxiety and unresolved trauma.

Also, Teens with DID frequently struggle with co-occurring disorders like depression, anxiety, and PTSD. A study published by lifespan.org titled “Guide to Co-Occurring Disorders in Adolescents” noted that up to 75% of adolescents with substance use disorders also have a co-occurring mental illness.

What are the Causes of Dissociative Identity Disorder in Teens?

The causes of dissociative identity disorder in teens include long-term physical, sexual, or emotional abuse during childhood, as noted in a 2023 article published by Mayo Clinic titled “Dissociative Disorders”.  Additionally, other traumatic, distressing, or painful events also contribute to the emergence of dissociative disorders. 

DID develops during childhood, before the age of 6, as indicated by the DSM-5-TR, because children are particularly vulnerable to dissociation as a coping mechanism when faced with overwhelming distress. Traumatic experiences such as physical, emotional, or sexual abuse lead to the fragmentation of identity, as the child learns to dissociate from painful memories to protect themselves. 

Also, negative parental behaviors, such as emotional unavailability or inconsistency, exacerbate feelings of insecurity and contribute to the development of DID. Medical procedures, especially invasive ones experienced at a young age, also trigger dissociative symptoms. 

How Is Dissociative Identity Disorder Diagnosed In Teens?

Dissociative Identity Disorder (DID) is diagnosed in teens through a comprehensive evaluation by a psychiatrist or psychologist. The diagnostic process begins with a physical exam to rule out any medical conditions that mimic dissociative symptoms. A neurological exam is also conducted to ensure there are no underlying conditions like autoimmune encephalitis, as mentioned in a study by Paroma M., published in Stat Pearls in 2023 titled “Dissociative Identity Disorder”

To gather important insights into the teen’s behaviors and experiences, it’s essential to talk to family members or close friends. They share details about the teen’s condition that the individual would find hard to explain, helping to create a clearer picture for an accurate diagnosis. 

Diagnosing DID in childhood is rare because the symptoms overlap with other conditions, such as ADHD or anxiety disorders, making it challenging to identify the disorder accurately. The DSM-5 outlines specific criteria for diagnosing DID, which include:

1. The presence of two or more distinct identities or personality states, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the self and the world.

2. Recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.

3. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

4. The disturbance is not attributable to the physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures). 

5. The symptoms are not better explained by another mental disorder, such as PTSD. 

What are the Treatments for Dissociative Identity Disorder in Teens?

The primary treatments for dissociative identity disorder in teens are intensive outpatient programs, psychotherapy, and medication. Each approach is important in helping teens manage their symptoms and work toward recovery.

1. Intensive Outpatient Program

Intensive outpatient programs (IOPs) provide structured treatment specifically designed for teens with dissociative identity disorder while allowing them to continue with their daily lives. These programs include group therapy, individual counseling, and skill-building sessions focused on coping strategies and emotional regulation. 

Charlie Health, in their 2021 article titled “How Intensive Outpatient Programs Help Teens” mentioned that IOPs offer a higher level of care than traditional weekly therapy, providing a holistic, multifaceted approach to treatment for teens experiencing DID.

2. Psychotherapy

Psychotherapy is a fundamental aspect of treating dissociative identity disorder. Techniques like cognitive behavioral therapy (CBT) and dialectical behavior therapy (DBT) are particularly effective in addressing the unique challenges of DID. CBT helps teens understand and change negative thought patterns that contribute to their dissociative experiences, while DBT focuses on building skills for emotional regulation and interpersonal effectiveness.

The process of psychotherapy is usually challenging and emotionally intense, as it requires confronting and processing past traumatic events, per the 2024 article by the American Psychiatric Association titled “What Are Dissociative Disorders?”. These therapeutic approaches are essential for processing trauma and integrating different identities, leading to improved mental health outcomes.

3. Medication

Medications also play a supportive role in the treatment of dissociative identity disorder, particularly in managing co-occurring symptoms such as anxiety and depression, according to an article published in 2023 by Mayo Clinic titled “Dissociative Disorder”. Antidepressants and anti-anxiety medications help stabilize mood and reduce distress, making it easier for teens to engage in therapy. In some cases, tranquilizers are prescribed to address immediate anxiety symptoms. While medication does not directly treat DID, it enhances the effectiveness of psychotherapy by helping teens cope with the emotional and psychological challenges associated with their disorder.

What does a person with DID feel like?

A person with Dissociative Identity Disorder (DID) experiences a profound sense of detachment from themselves and their environment, which leads to feelings of confusion and frustration. A study published by Rethink Mental Illness titled “Dissociation and dissociative identity disorder (DID)” notes that a person with DID feels as though they are observing their lives from outside their bodies, creating a disconnection that makes it challenging to engage with reality. 

This detachment is frequently accompanied by identity confusion, where a person struggles to understand who they are, especially when different identities emerge with distinct memories, emotions, and behaviors. The constant shifting between these identities is stressful, resulting in heightened anxiety and frustration as individuals grapple with the unpredictability of their experiences. 

Is dissociative identity disorder serious?

Yes, dissociative identity disorder (DID) is a serious mental health condition that has profound implications for an individual’s well-being and functioning. Those with DID face significant emotional distress, which leads to a higher risk of suicidal thoughts and behaviors. Research by Stacey M. et al published in the Delaware Journal of Public Health in 2022 titled “Trauma-Related Dissociation and the Dissociative Disorders: Neglected Symptoms with Severe Public Health Consequences” indicates that approximately 70% of individuals with DID have attempted suicide at some point in their lives. This alarming statistic shows the urgent need for effective treatment and support for those affected with DID.

Who is most affected by dissociative identity disorder?

The people most affected by DID are those who have experienced severe trauma, particularly during childhood. While anyone can develop DID, it is significantly more common in women than in men. This disparity is often attributed to the higher rates of trauma exposure, such as physical and sexual abuse, that women tend to experience. 

Also, A study by Vedat Sar et al published in PubMed Central titled “Prevalence of dissociative disorders among women in the general population” indicates that about 90 to 100% of women seek help for their symptoms and report their experiences, which leads to more frequent diagnoses. The manifestation of dissociative symptoms also differs by gender, with women often displaying more pronounced signs of dissociation, which attracts the attention of psychologists and other mental health professionals. 

Can you have BPD and DID at the same time?

Yes, it is possible to have both Borderline Personality Disorder (BPD) and Dissociative Identity Disorder (DID) at the same time. These two disorders co-occur, as they stem from similar backgrounds involving trauma and emotional dysregulation. Individuals with BPD experience intense emotions and unstable relationships, which leads to dissociative symptoms as a coping mechanism. 

According to a 2022 study published by Sage Choice titled “A systematic scoping review of dissociation in borderline personality disorder and implications for research and clinical practice: Exploring the fog”, BPD is diagnosed in 30% to 70% of DID patients and DID or other dissociative disorders are diagnosed in 41% to 72% of BPD patients. This significant overlap in diagnoses suggests that a person can have BPD and DID at the same time. 

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