Dissociative identity disorder (DID), previously known as multiple personality disorder (MPD),[1] is an extremely rare mental disorder characterized

by at least two distinct and relatively enduring identities or dissociated personality states that alternately control a person's behavior, and is accompanied by memory impairment for important information not explained by ordinary forgetfulness. These symptoms are not accounted for by substance abuse, seizures, other medical conditions, nor by imaginative play in children.[2] Diagnosis is often difficult as there is considerable comorbidity with other mental disorders. Malingering should be considered if there is possible financial or forensic gain, as well as factitious disorder if help-seeking behavior is prominent.[ Most dissociative disorder cases have co-morbid mental disorders, with an average of 8 axis I and 4.5 axis II DSM diagnoses.[7] The psychiatric history frequently contains multiple previous diagnoses of various disorders and treatment failures.[24] The most common presenting complaint of DID is depression, with headaches being a common neurological symptom. Co-morbid disorders can include substance abuse, eating disorders, anxiety, posttraumatic stress disorder (PTSD) and personality disorders.[25] A majority of those diagnosed with DID meet the criteria for DSM axis II personality disorders such as borderline personality disorder;[19] a significant minority meet the criteria for avoidant personality disorder and other personality disorders.[26] Further, data supports a high level of psychotic symptoms in DID, and that both schizophrenia and DID have histories of trauma.[27] Individuals diagnosed with DID also demonstrate the highest hypnotizability of any clinical population.[22] The large number of symptoms presented by individuals diagnosed with DID has led to some clinicians to suggest that, rather than being a separate disorder, diagnosis of DID is actually an indication of the severity of the other disorders diagnosed in the patient. Causes The cause of DID is controversial, with debate occurring between supporters of different hypotheses: that DID is a reaction to trauma; that DID is produced iatrogenically by inappropriate psychotherapeutic techniques that cause a patient to enact the role of a patient with DID; and newer hypotheses involving memory processing that allows for the possibility that trauma-causing dissociation can occur after childhood in DID, as it does in PTSD. It has been suggested that all the trauma-based and stress-related disorders be placed in one category that would include both DID and PTSD.[28] Disturbed and altered sleep has also been suggested as having a role in dissociative disorders in general and specifically in DID, alterations in environments also largely effecting the DID patient.[

Treatment
There is a general lack of consensus in the diagnosis and treatment of DID[3] and research on treatment effectiveness focuses mainly on clinical approaches described in case studies. General treatment guidelines exist that suggest a phased, eclectic approach with more concrete guidance and agreement on early stages but no systematic, empirically-supported approach exists and later stages of treatment are not well described and have no consensus. Even highly experienced therapists have few patients that achieve a unified identity.[55] Common treatment methods include an eclectic mix of psychotherapy techniques, including cognitive behavioral (CBT),[19] insight-oriented therapies,[17] dialectical behavioral therapy (DBT), hypnotherapy and eye movement desensitization and reprocessing (EMDR). Medications can be used for co-morbid disorders and/or targeted symptom relief.[5][38] Some behavior therapists initially use behavioral treatments such as only responding to a single identity, and then use more traditional therapy once a consistent response is established.[56] Brief treatment due to managed care may be difficult, as individuals diagnosed with DID may have unusual difficulties in trusting a therapist and take a prolonged period to form a comfortable therapeutic alliance.[5] Regular contact (weekly or biweekly) is more common, and treatment generally lasts years not weeks or months.[5][19] Sleep hygiene has been suggested as a treatment option, but has not been tested. In general there are very few clinical trials on the treatment of DID, none of which were randomized controlled trials.[8]

Therapy for DID is generally phase oriented. Different alters may appear based on their greater ability to deal with specific situational stresses or threats. While some patients may initially present with a large number of alters, this number may reduce during treatment though it is considered important for the therapist to become familiar with at least the more prominent personality states as the "host" personality may not be the "true" identity of the patient. Specific alters may react negatively to therapy, fearing the therapists goal is to eliminate the alter (particularly those associated with illegal or violent activities). A more realistic and appropriate goal of treatment is to integrate adaptive responses to abuse, injury or other threats into the overall personality structure.[19] There is debate over issues such as whether exposure therapy (reliving traumatic memories, also known as abreaction), engagement with alters and physical contact during therapy is appropriate and there are clinical opinions both for and against each option with little high-quality evidence for any position.
What Are the Symptoms of Dissociative Identity Disorder?

Dissociative identity disorder is characterized by the presence of two or more distinct or split identities or personality states that continually have power over the person's behavior. With dissociative identity disorder, there's also an inability to recall key personal information that is too far-reaching to be explained as mere forgetfulness. With dissociative identity disorder, there are also highly distinct memory variations, which fluctuate with the person's split personality. The "alters" or different identities have their own age, sex, or race. Each has his or her own postures, gestures, and distinct way of talking. Sometimes the alters are imaginary people; sometimes they are animals. As each personality reveals itself and controls the individuals' behavior and thoughts, it's called "switching." Switching can take seconds to minutes to days. When under hypnosis, the person's different "alters" or identities may be very responsive to the therapist's requests. Along with the dissociation and multiple or split personalities, people with dissociative disorders may experience any of the following symptoms:

Depression Mood swings Suicidal tendencies Sleep disorders (insomnia, night terrors, and sleep walking) Anxiety, panic attacks, and phobias (flashbacks, reactions to stimuli or "triggers") Alcohol and drug abuse Compulsions and rituals Psychotic-like symptoms (including auditory and visual hallucinations) Eating disorders