Dissociative Identity Disorder: Treatment and Recovery (2023)

The treatment plan for DID centers around talk therapy, where you can learn to understand your symptoms, their causes, and ways to manage dissociative episodes.

Dissociation — when someone temporarily disconnects from their surroundings or emotions — is more common than many people think.

According to a 2004 study, between 26 and 74% of people have symptoms of derealization and depersonalization during their lifetime (two types of dissociation), but only 1–2% meet the criteria for clinically significant episodes.

DID is a mental health condition characterized by extreme dissociation involving “switching” between two or more distinct identities.

Once known as multiple personality disorder, the causes and treatment options for DID haven’t always been well understood. This has lead to stigma and confusion among society and even experts.

That’s all changing though, thanks to more research, a better understanding of neurobiology, and people speaking up about their lived experiences. Now we have a better understanding of the treatments, tools, and self-care strategies that can help when living with DID.

What are DID treatments?

Most treatment plans for people with DID focus on talk therapy (aka psychotherapy). Talk therapy can help you understand why you dissociate and give you the tools to cope.

Other treatment options include medication for co-occurring issues and hospital visits.

Treatment aims to help you reduce and cope with the symptoms of DID, which include:

• Identity shifts. DID involves switching between at least two identities, also known as personality states, alters, multiples, splits, or plurals.
• Amnesia. This is different from occasional forgetfulness; it refers to a gap in time during everyday events, the inability to recall personal information, or forgetting your activities, such as waking up somewhere and not being able to recall how you got there.
• Depersonalization. This is the feeling of being disconnected from your physical self or having an “out of body” experience, like observing yourself from a passenger’s perspective or watching a movie of yourself.
• Derealization. This is the sensation of being disconnected from your physical environment, experiencing your surroundings as dream-like, or feeling like people and events aren’t real.
• Identity confusion. This means you may have a difficult time pinning down your core interests, goals, style, opinions, values, and beliefs.

Your treatment should also aim to help with any co-occurring issues, which might include:

• PTSD
• anxiety
• depression
• borderline personality disorder
• eating disorders
• sleep disturbances
• self-harm or suicidal thoughts
• substance use issues

We take a closer look at the treatment options below.

Talk therapy

For some people, living with the symptoms of DID can be frightening, isolating, or confusing.

Research has found that people with DID are more likely to harm themselves, and more than 70% of outpatients have attempted suicide.

For this reason, working closely with a compassionate, knowledgeable mental health professional is considered the first-line treatment for DID. Talk therapy has been shown to improve symptoms of DID in the long term.

Your therapist can help you understand what you’re experiencing and why. Therapy also gives you the space to explore and understand the different parts of your identity that have dissociated, and ultimately, to integrate them.

Dissociative disorders often stem from childhood trauma. In fact, as many as 90% of people with DID have a history of childhood abuse or neglect.

Dissociation is your body’s way of distancing you from an intolerable experience, which is an effective survival strategy in the moment — but over time, chronic dissociation can form separate identities from your “core” or “main” personality, leading to the symptoms of DID.

Besides helping you understand the reasons behind your dissociation, your therapist can help you deal with dissociative states and develop useful coping mechanisms.

Your treatment plan will be based on your own unique needs, but may include:

• education about dissociation and DID
• body movement therapy to release trauma that’s held in the body
• relationship support
• trigger management
• impulse control
• mindfulness and self-awareness
• coping methods to tolerate difficult emotions

Some specific therapies used to treat DID include:

• cognitive behavioral therapy (CBT)
• dialectical behavioral therapy (DBT)
• eye movement desensitization and reprocessing (EMDR)

Medications

There are no medications recommended to directly treat DID, at least not yet. But there are some options to help with co-existing conditions and symptoms, like anxiety, depression, and substance use.

Your doctor may prescribe an antidepressant medication, like a selective serotonin reuptake inhibitor (SSRI). Common ones include:

• fluoxetine (Prozac)
• sertraline (Zoloft)

Anti-anxiety meds may also be recommended, depending on your symptoms.

If psychosis is present, an antipsychotic medication might help you manage symptoms and feel more in control.

Hospital visits

If symptoms for you or someone you love are becoming severe, or suicide is a possibility, you can seek emergency medical attention at your nearby hospital right away.

This can help doctors rule out the possibility of an underlying condition, like a brain injury, and provide a safe, stable environment to talk about next steps.

In real life, an inpatient stay at a psychiatric facility is very different from what you’ll see in the media, which is often sensationalized.

An inpatient stay may last a few days to several weeks, which will give doctors ample time to work with you in individual and group therapy settings, discuss medications, and form a solid discharge plan.

Self-help strategies

(Video) Dissociative disorders - causes, symptoms, diagnosis, treatment, pathology

Balanced nutrition

There’s no recommended food protocol for DID, but a diet rich in whole, unprocessed foods is a great way to make sure that your body and mind are getting all the nutrients and energy needed.

Get daily movement

Thanks to a rush of endorphins, exercise may boost your mood and help release any stored up tension. It doesn’t have to be intensive, either.

If you’re trying to build a habit, start with just enough to get your heart rate up, like a brisk walk around your neighborhood. The Centers for Disease Control and Prevention (CDC) recommends 30 minutes per day, 5 days a week.

Get enough sleep

Do your best to maintain a sleep schedule and practice sleep hygiene before bed.

Try to get at least 8 hours of sleep each night so that your brain has time to rest and your tissues have time to repair themselves. In other words, it will help keep you performing at your optimal level.

Develop a meditation practice

While more research is needed on complementary treatments for dissociative disorders, a small 2016 study found that some symptoms improved for young participants enrolled in a mindfulness program over the course of 6 weeks. You could start by checking out some meditation apps.

Roll out your yoga mat

Yoga has long been studied for its positive effects on mood. Research has shown that a regular yoga practice can help people with trauma increase their emotional regulation, among other mental health benefits.

It might be important for you to seek a trauma-informed practice, because yoga can feel overwhelming for some people with a history of trauma.

Next steps

When symptoms of DID impact your everyday routine, it may feel difficult to — as they say — “live your best life.” The good news is, we understand a lot more about this condition than we once did.

Learning more about dissociation and DID can help you manage your symptoms.

To this end, trauma researcher Dr. Janina Fisher published a book in 2017 called “Healing the Fragmented Selves of Trauma Survivors: Overcoming Internal Self-Alienation.” The book offers information on the neurobiological basis of trauma and dissociation, along with treatment information for both therapists and clients.

See if you resonate with any of these resources:

• For an illuminating interview about DID, Med Circle talks with Encina, who has 11 distinct personalities. At the 54:10 minute mark, viewers meet one of her alters, Minnie, a 3-year-old girl.
• The System Speak podcast explores what it’s like for Emma, diagnosed at age 36, to live with DID. She regularly brings on experts to talk about managing symptoms and trauma recovery.
• Comedian Roseanne Barr, musician Adam Duritz, and retired NFL athlete Herschel Walker have all spoken about being diagnosed with DID. Walker wrote a book about it, called “Breaking Free: My Life With Dissociative Identity Disorder.”