What Is the Biggest Risk Factor for Dissociative Identity Disorder?

Dissociative Identity Disorder

Sensationalized in films and TV, such as Sybil, Split, and The Three Faces of Eve, dissociative identity disorder—once called multiple personality disorder—remains one of the most misunderstood mental health issues. The condition is characterized by a disconnect between memories and a person’s sense of self and involves the presence of at least two distinct identities within a single individual. These identities—known as splits or alters—have a profoundly negative impact on a person’s quality of life. Yet, many people refuse to believe the condition is real.


Dissociative identity disorder (DID) is one of 3 types of dissociative disorders—the other 2 types are dissociative amnesia and depersonalization/derealization disorder. Approximately 2% of the general population are affected by dissociative disorders. DID is more commonly diagnosed in women and is estimated to affect up to 1% of people. In DID, which involves multiple distinct identities, these splits or alters can have different names, mannerisms, genders, ethnicities, memories, interests, tones of voice, and speaking patterns. Many people with DID are unaware of their alternate personalities.


In general, the criteria for a diagnosis of dissociative identity disorder include:

  • The existence of two or more distinct identities with accompanying changes in memories, behaviors, interests, and thinking
  • Gaps in memory, including everyday activities, past traumatic events, and people
  • Significant distress and problems in everyday life as a result of these alters

For a DID diagnosis, these out-of-character behaviors, thinking patterns, and interests cannot be the direct result of mind-altering substances, a religious practice, or a medical condition.

Other signs and symptoms of dissociative identity disorder include headaches, out-of-body experiences, self-harm, and suicide attempts. One study in the journal Psychiatry that analyzed 236 people with DID found that 72% of them had attempted suicide. Violent behavior may also be present and is more commonly seen in men. These symptoms can make it extremely challenging to navigate everyday life, careers, academics, and relationships.

People with DID may also have co-occurring mental health problems, such as:

  • Anxiety, panic attacks, phobias
  • Insomnia and other sleep disorders
  • Depression
  • PTSD
  • Borderline personality disorder
  • Substance use disorders
  • Mood instability
  • Compulsive behaviors
  • Hallucinations
  • Eating disorders


What makes someone vulnerable to such a complex disorder? Experts say experiencing physical, sexual, or emotional abuse during childhood is the biggest risk factor for developing DID. Dissociation is believed to be a way for children to cope with, or compartmentalize, the ordeal of ongoing adverse childhood experiences.

In a study in the Canadian Journal of Psychiatry, researchers interviewed over 100 people with DID and found that during childhood 90% of them had suffered sexual abuse and 84% had suffered physical abuse. More than half of these individuals reports that the sexual or physical trauma commenced before they reached their fifth birthday. On average, the abuse lasted a decade.

Experiencing physical, sexual, or emotional abuse during childhood is the biggest risk factor for developing dissociative identity disorder (formerly called multiple personality disorder). Click To Tweet

Other risk factors for DID include childhood exposure to war, violence, or natural disasters.


Brain imaging offers clues about the development of dissociative identity disorder. A study in The American Journal of Psychiatry found that key structures in the brain involved in memory and fear have decreased volume in people with DID. The volume of the hippocampus was over 19% smaller and the amygdala was 31% smaller in those with DID compared with healthy individuals.

A 2020 systematic review of the neuroimaging findings related to DID also showed smaller volume in parts of the frontal lobes involved in fear learning and the parietal lobes involved in personal awareness. People with DID had heightened levels of white matter, which plays a role in communication in areas involved in feelings, memory retrieval, and perception. The study authors concluded, “The neuroanatomical evidence for the existence of DID as a genuine disorder is growing and the structural differences seen in DID patients’ brains, as reviewed in this report, contribute to that growth.”


Treatment for DID often includes psychotherapy to work through any past childhood trauma, learn to manage symptoms related to the condition, and blend alternate personalities into a single one. One technique that has shown benefits for trauma survivors is EMDR (eye movement desensitization and reprocessing). Some people with DID have shown improvement with hypnosis. In fact, research shows that hypnosis played a pivotal part in successfully treating the first-known case of the disorder in the 1830s. In treating DID it is also critical to address any co-occurring disorders, which may involve medication and natural therapies.

Dissociative identity disorder and other mental health issues can’t wait. At Amen Clinics, we’re here for you. We offer in-clinic brain scanning and appointments, as well as mental telehealth, clinical evaluations, and therapy for adults, teens, children, and couples. Find out more by speaking to a specialist today at 888-288-9834 or visit our contact page here.



    Comment by Yvonne Weiss — May 20, 2022 @ 3:27 AM

  2. Thanks for giving a scientific view on such a controversial topic.

    Comment by Dorothee — May 20, 2022 @ 3:36 AM

  3. Love Brain MD

    Comment by Dianne Pickett — May 20, 2022 @ 3:41 AM

  4. After my divorce I experienced nearly a year of derealization which was such a strange sensation since I felt like I was floating through a cardboard cutout of the world around me. When I explained my symptoms to my friend he looked it up and found depersonalization description but I didn’t identify with not recognizing myself, it was the rest of the world that seemed unreal to me. In a funny way I was actually happier than I had been for years once I was finally on my own and single again. I feel like what pulled me out of that state was becoming more spiritual and I would combine praying/meditating while walking through the park or some place calming. Combining my gratitude for nature and my new freedom with a sense of new purpose in a prayer helped me find balance and the hollow disconnect went away but I had to do this walking prayer thing nearly every day for it to go away permanently. The walking and eating out helped me feel more grounded in reality and experiencing the world through my 5 senses. Probably the feeling of isolation for the years during my marriage caused this strange episode after the fact but even though it was annoying it was also a learning experience and it helped me appreciate having friends around and finding a beautiful path with God in this life.

    Comment by Ermie — May 20, 2022 @ 6:49 AM

  5. Your articles are very informative and a big help to me in my practice.

    Comment by Mary C Dermody — May 20, 2022 @ 7:00 AM

  6. What supplements do you recommend for DID?

    Comment by leah Yaffa Ominsky — May 20, 2022 @ 7:23 AM

  7. I survived severe childhood physical and mental abuse. I’m almost 50 and was diagnosed a year and a half ago. Navigating this is very challenging as I’ve had several suicide attempts after a TBI. Do you have clinics elsewhere in the US? Or suggestions on what kind of professionals to seek out?

    Comment by Sonya — May 20, 2022 @ 5:12 PM

  8. Hi,
    This is an interesting article. I met someone years ago when I was receiving in-patient treatment in the mental health unit of a hospital here in Arlington County, Virginia who had this particular problem and she noted that one of her personalities would sometimes become violent but the others were not. During a group therapy session, she noted that she often had difficulty controlling how angry she would sometimes become, even to the point of being very violent and was so scared that she would not ever get out of the hospital and be well enough to go home. The other patients in the small group therapy session simply tried to be supportive and I will pray for her today. I sometimes wonder how some of the other people that I met so very long ago managed once they returned to their homes, jobs, etc., and I’m very grateful that I was successfully treated for clinical depression and severe anxiety but I do not have this particular disorder. (I was simply being treated for severe anxiety, i.e., “panic attacks,” and perhaps a degree of PTSD related to having been in two car accidents a very long time ago plus a degree of clinical depression and severe fatigue, the fatigue being just a symptom of leading a busy life as I was working full time and coping with the news of a loved one’s serious illness (cancer diagnosis).

    I have been very blessed to have made a full recovery from my clinical depression (it was either cyclothymia, a moderate or milder form of manic depression, or major clinical depression), the problems with panic disorder were successfully treated wih medication along with the clinical depression. I took medications for years but the best antidepressant that I took caused migraines.

    I finally decide a few years ago to stop taking all of that medicine and I now manage my anxiety by getting outdoor exercise or working out in my home or at a local gym, I reduced by a great extent the amount of caffiene which I let myself ingest via coffee, tea, or sodas (I look for caffeine free soda or tea or coffee products), try to maintain a healthier diet. Anxiety, in my case, I now feel is better managed by exercise, breathing exercises, aerobic forms of exercise such as walking, hiking, riding my mountain bike or, working out at a local sports and fitness club near my home. I also walk to run necessary errands such as picking up the dry cleaning, going grocery shopping, or picking up a greeting card at a local Hallmark or drug store.

    Finally, I also had a lot of support through “cognitive restructuring” or “talk therapy” with a licensed, clinical social worker. During the years that I took prescription medication for severe anxiety and clinical depression, my medications were prescribed by a professional psychiatrist who was great in educating me more about the chemical side of exactly how some of these very strong antidepressants (such as the SSRI, selective serotonin reuptake inhibitors), or Wellbutrin (a different class of antidepressant that impacts a number of other neurotransmitters such as dopamine) work with respect to the biochemical aspects of treating depression.

    The Wellbutrin worked great for the depression but unfortunately sometimes triggered very bad migraine attacks so I decided several years ago to go off all antidepressants and now feel that I am better off without any of the blasted antidepressants, anti-anxiety drugs, etc., and I still occasionally see a social worker for talk therapy if I feel the need for someone to talk to who can be more objective about some of my challenges than any individual person could with respect to simply coping with the ordinary everyday things that we all sometimes face plus anything unusual that may be going on with respect to managing my symptoms so that they don’t manage me!!! I am one blessed and fortunate person and I know it although sometimes I have to push a little bit harder to get thru a “to do” list if I am very tired but that’s OK. I think I have learned quite a lot about how to cope with the everyday challenges that most folks go through in life.

    I have seen Dr. Amen’s programs on PBS and I think he makes a lot of sense and is very good at explaining how diet and exercise brain scans, etc., can help doctors to help people who have various challenges ranging from Alzheimer’s or senile dementia to clinical depression and I enjoy reading the information that you all send out from time to time in my email inbox.

    I am doing very wel these days and I thank you for the information. I think the very best way to cope with some of these mental health challenges is to simply take the best possible care first of one’s physical health and then learn to recognize it if you start to feel a bit overwealmed. That’s when I try to recognize that I’m getting a bit too emotional about things or I will just sit down and write down what’s running thru my head and keeping a journal helps. Also, if I’m busy or focused on a project but remember I need to make a phone call, run an errand, finish a cover letter or need to read something or do something else, I will pause and add things to my “to do” list when I think of them and that allows me to take the distraction of suddenly realizing that I need to another another item to my “to do” list for the day while I am busy working on getting other things done. So, staying reasonably well organized is helpful in coping better for all of us, including those who may struggle with such challenges as depression or even something as very challenging and rare as this “DID” type of mental health challenge you noted in the above article.

    I was very interested to learn about the differences in the physical structure of the brain for someone with DID compared to the average person whose brain does not seem to have some of these structural differences noted in the article. That may be a big part of the problem with this particular problem or DID disorders. I would hope that someone who did not go thru some of the childhood trauma that you noted in the article but whose brain structure was consistent for someone born with an increased risk of developing this disorder would be able to cope well within a good, supportive environment both as a child and later on in life as a young or middle aged adult.

    Anyway, thanks again for the information. It is really great outside today, a beautiful spring day and I am eager to get outside and get on with my chores. Thanks agan for the information and have a great week. Take care!

    Arlington, Virginia

    Comment by Barbara Day — May 21, 2022 @ 6:38 AM

  9. Hello Sonya, thank you for reaching out. We currently have 10 locations nationwide: https://amenclinics.com/locations/. We’d be happy to give you more information, as well as needed resources and referrals, please contact our Care Coordinators: https://amenclinics.com/schedule-visit/.

    Comment by Amen Clinics — May 23, 2022 @ 3:12 PM

  10. Hello Leah, thank you for reaching out. For more information about supplements and recommendations, contact our team at BrainMD Health: https://brainmd.com/contact

    Comment by Amen Clinics — May 23, 2022 @ 6:31 PM

  11. Excellent post!

    Comment by Doug Morris — September 16, 2023 @ 10:30 PM

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