glossary and FAQ
terms distinguished in my personal lexicon marked with a (*).
what is Dissociative Identity Disorder (DID)?
Dissociative Identity Disorder (DID) is a psychiatric diagnosis that may be applied to individuals if their experiences and/or presentation appears to align with its diagnostic criteria. It is also, by extension, a psychiatric construct utilised for researching individuals that appear to suffer from its pattern of traits, to determine their possible causes in conjunction and how they may best be managed and/or treated.
DID is currently classed as a dissociative disorder in the ICD-11 (2018), DSM-5 (2013), and DSM-5-TR (2022). Dissociative disorders as a diagnostic category observe "disruption of and/or discontinuity in the normal integration of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior" (DSM-5-TR) which "may be complete, but is more commonly partial, and can vary from day to day or even from hour to hour." (ICD-11).
DID is widely described as a chronic and/or complex dissociative disorder since the late 90s and early 2000s, particularly by clinicians such as E.R.S Nijenhuis, Otto van der Hart and Kathy Steele, R.J. Loewenstein, R.P. Kluft, C.A. Ross and Vedat Şar. This turn of phrase tends to denote a distinct presentation of experiencing relatively enduring "alternating psychophysiological states which are discrete, discontinuous, and resistant against integrative tendencies" (Nijenhuis) — also known as dissociative parts of the personality, such as those posited by the Theory of Structural Dissociation (van der Hart, Nijenhuis, Steele).
Likewise, DID is diagnosed when "marked discontinuities in the sense of self and agency" (ICD-11) in the form of "the presence of two or more distinct personality states or an experience of possession" (DSM-5-TR) is observed or, most commonly, subjectively reported. To fit this criteria, one's 'personality states' are expected to experience their "own pattern of experiencing, perceiving, conceiving, and relating to self, the body, and the environment" and appear to "recurrently take executive control of the individual’s consciousness and functioning in interacting with others or with the environment" (ICD-11). Alternatively, they may be evidenced via "impaired sense of self and impaired sense of agency"; "auditory, visual, tactile, olfactory, and gustatory [hallucinations]"; "perceptions of voices"; "multiple, perplexing, independent thought streams over which the individual experiences no control"; "lack of sense of agency"; "ego-dystonic and puzzling" sudden vanishing or inhibition of thoughts, emotions, speech and actions; sudden shifts in "attitudes, outlooks, and personal preferences", and alterations in sense of self or in perceptions of one's body (DSM-5-TR). Substantial memory loss or dissociative amnesia is typically a concurrent diagnostic criteria, and stereotypically associated with barriers between dissociative parts of the personality.
what is DID not?
DID is not a perfect metric for defining a class of people, nor does it convey any kind of exclusive experience — there is no inherent difference between an individual diagnosed with DID and one who is not that could not also be present between two individuals that are diagnosed with DID.
This is because psychiatric diagnosis is generally subjective to each assessing clinician and what an individual was able to present during assessment (two individuals with functionally identical symptoms may still recieve disparate diagnoses due to any number of factors, such as their socioeconomic class, race, gender, or the ideology of their clinician); every person that falls under DID's diagnostic criterions does so with their own unique pattern of symptoms and experiences that arose due to their unique life experiences; and because DID is, like all psychiatric diagnoses, ultimately a practical social and medical construct for facilitating research, insurance, and communication, as opposed to a scientific reality (see reification).
what is reification?
Reification is a fallacy that concerns when something that is abstract is treated as if it were 'real'. With regards to psychiatric diagnosis, this is an issue when diagnostic constructs are percieved as 'real' categories of human being or 'real' diseases that dictate the behaviours and experiences of its people, rather than simply a practical and de-contextualised approximation for practical reasons (1, 2, 3). The reification of psychiatric diagnosis can disempower and provide injustice to people that bear psychiatric diagnoses, as well as dissuade criticism of the psychiatric system that categorises and defines psychopathology(ies).
what is Multiplicity and Plurality?
Widely speaking, these terms may refer to either:
- the perception of oneself as an individual made up of multiple selves, parts, or entities; or a body that houses multiple selves, parts, or entities,
- or the culture, community and/or social movement that advocates for / practices identifying as such.
(* Personal Lexicon:) I use Multiplicity to convey the self-concept and identity of possessing multiple selves or parts that altogether make up one individual, and Plurality to convey the self-concept and identity of being more-than-one (including experiences of spirituality and channelling). Ultimately these are both opt-in terms and frameworks however, and the use of these words or similarity to one model to the other does not inherently mean anything about a given individual. (/*)
Due to how the DID diagnosis is constructed and conveyed, there is a large overlap between the DID communities and Multiple/Plural communities for as long as the diagnosis has existed. Individuals with DID have, for the longest time, been expected or encouraged to see themselves as bodies that house multiple entities, and come today, often appear to benefit from conceptualising themselves as an individual made up of multiple parts, to make their internal mechanisms intelligible.
There is (and always has been) widespread debate about what forms of Multiplicity/Plurality are 'real' or acceptable. It is my opinion that experiences of complex dissociation that may qualify you for a DID diagnosis are distinct from the socioculturally-embedded processes of conceptualising one's self and sense-making with regards to one's experiences (that may lead to Multiple or Plural self-concepts). It is also my opinion that the perception of oneself as 'one' is also socioculturally-embedded and subjective — a fact widely overlooked — and that no self-concept is more or less 'real' than any other, only more or less normative, common, or widely accepted. As such, I do not believe it is necessary to qualify for DID diagnosis or experience complex dissociation to conceptualise oneself as Multiple or Plural in any way that may be helpful or reassuring. I am not (and nobody should be) the sense-making police.
what is derealisation, identity confusion, etc.? how are dissociative symptoms categorised and defined?
what is DID treatment? what is final fusion and/or functional multiplicity?
Treatment for DID generally concerns a three-stage process derived from the treatment of Complex PTSD presentations, that 1) establishes safety, stability, and targets symptom reduction; 2) confronts, works through, and integrates traumatic memories; and 3) integrates and rehabilitates the individual with their life so that they may work with their past and present towards their future (ISSTD).
Treatment 'goals' for DID, however, are often split into two, generally characterised by if the individual completes this process having ceased to consider themselves as Multiple due to 'complete' integration and coordination of their dissociative parts (called final fusion), or if the individual continues to see themselves as Multiple as they integrate and coordinate with themselves (called resolution or functional multiplicity). I have problems with this bipartite model and believe it is widely unhelpful.
I believe it is most helpful to conceptualise the goal of DID treatment as the pursuit of integrated functioning (a term already used within clinical literature) — i.e. the pursuit of integration (reducing dissociative dysfunction) and coordination within one's self and with their life, irrespective of how one comes to conceptualise their identity(ies) during and after the process. This is especially so, as it is misleading to assert there is a 'complete' and 'incomplete' product of treatment; recovery from posttraumatic disorders and lifelong dysfunction is not a process with an 'end', and it is wrong and unjust to assert that dysfunction is only truly addressed once an individual has adopted a normative 'singular' self-concept.
Integrated functioning conveys both sides of the traditional bipartite treatment goal model in equal, allowing for greater fluidity and freedom for every individual that may benefit from DID treatment, and is generally a kinder way to convey the struggles individuals under the DID label may face.
i feel like i have dissociative parts, but i'm not sure, i'm unsure about assessment, and i don't know what to do.
Check out my survivors page — I have a good handful of hotlinks to where I've answered questions about DID and its percieved exclusivity. I also have a nice array of resources across there and on my recommendations page for coping with mental health struggles related to dissociative parts or anything else that may have been percieved as such.
My ultimate advice is do what feels right, and don't trap yourself in any unhelpful psychiatric or community-defined box. Use any resource, framework, or language that appeals, and ignore the internal impostor: nobody is transgressing, and tools were made for those who benefit from them. It's also OK to experiment and change your mind later. Maintain your agency and self-respect, and be free. I hope everything feels better soon.
any other terms or concepts that you would like explained? contact me!
i am also always happy to amend my definitions to make them more accessible, just let me know.