Multiple identities in one body

On social media, videos about dissociative identity disorder (DID) are spreading. We even see some people filming their 'switches', the transitions from one personality to another, often in a spectacular way. These contents that get millions of views fascinate as much as they alarm. "There are a large number of teenagers who self-diagnose after seeing these videos, without undergoing a clinical evaluation," warns Elise Trierweiler, head of the liaison psychiatry clinic at CHUV. “What we observe online is often quite far from the clinical reality.” The phenomenon risks masking other psychological suffering or delaying appropriate care. Because behind viral images, dissociative identity disorder remains a rare and complex pathology, still under debate in the medical world. This disorder is characterised by the coexistence, within the same individual, of several dissociated identities, each with its own patterns of experience, perception, conception, and relationship to oneself, one’s body, and one's environment. Each identity can express itself in its own way, with its own memories and preferences.

One of the most common symptoms is amnesia: the person forgets events or may feel as if they are not responsible for their own actions. “These are not staged or simulations, insists the expert. These changes of state are involuntary, often triggered by stimuli that resemble trauma.”

This disorder is usually rooted in traumatic childhood experiences, a period when the personality is still developing. To survive and maintain the ability to function, the child dissociates himself psychologically. “It is an extreme but very effective protection mechanism”, explains Élise Trierweiler. 

A more nuanced reality

Popular narratives often refer to 'alters': multiple identities that coexist within a single person. But the clinical reality is more nuanced. "We prefer to speak of dissociated parts or personality states," says the specialist. Some of these parts handle everyday tasks, while others carry the wounds and emotional burden of trauma.

In viral videos, the different personalities are counted, each one receives a first name, has a story, or even a distinct function. “Counting and listing identities has no medical relevance. It often creates anxiety, even additional confusion. Our role is to help organise these personalities, not to build a gallery of characters.” Giving a name can nevertheless serve as a therapeutic tool. “It is not a magical revelation, but a supervised work, which allows us to identify the mechanisms at play and to reduce suffering.”

Slow, thorough and humane treatment

It is often by chance that the suspicion of a DID emerges, for example, during a consultation for another mental health issue. The diagnosis can take years. “These are long and demanding therapies. It’s a reconstruction of the self, a reunion of an inner system that has become dysfunctional. We approach traumas slowly. As with all patients in psychotraumatology, feeling safe is the priority.”

This disorder, still poorly understood, cannot be completely cured. The goal is more to stabilise it and teach the people involved to live with it, as one would do in the case of diabetes or schizophrenia. “There is no medication to treat dissociation itself. Some non-drug approaches are being studied; currently, psychotherapy remains the best documented approach. Symptoms such as anxiety, depression, sleep disorders, flashbacks, or panic attacks respond to specific medications.”

A disorder that remains marginal

This disorder still lacks consensus in the psychiatric community. Poorly understood, it is often misinterpreted. However, the recognition of its reality is progressing, notably thanks to neuroimaging research. “Different structural and functional presentations are observed in DID patients, particularly due to neurodevelopmental disorders associated with repeated and early exposure to traumatic events or severe emotional neglect. The images differ if it is a DID patient, a subject without dissociative disorder or a simulation test of a dissociative disorder. Today, there is a solid scientific basis for considering it seriously.” In Switzerland, there are no official statistics that allow precise quantification of the number of persons concerned. “Prevalence is currently estimated at around 1-1.5% of the general population, which equates to the prevalence of schizophrenia. These figures are probably underestimated. But in our services, DID remains extremely rare.”