The amazing history of dissociative identity (DID), some say, dates back to Paleolithic cave paintings in the images of shamans. Others suggest that the history of dissociative identity disorder dates back to reports of demonic possession that are now thought to be incidences of dissociative identity disorder. Either way, it's clear that dissociative identity disorder has a long history and is not a new concept (while the terminology now used may be new).
The Early History of Dissociative Identity Disorder
In 1791, the first detailed account of "exchanged personality" was written about a 20-year-old German woman who began to speak perfect French, behave like a French aristocrat and spoke German with a French accent. When she was the "French Woman" she remembered everything she did but as the "German Woman" she denied any knowledge of the "French Woman."
DID was focused on for study between 1880 and 1920 and in 1944, 67% of all known cases had been reported during that time. Case reports of dissociative identity disorder then fell off dramatically perhaps due to the increased diagnosis of schizophrenia and due to the rise of Freud.
The 20th Century History of Dissociative Identity Disorder
In the 1970s, the diagnosis of dissociative identity disorder rose dramatically after the publication of the extremely popular book, Sybil, in 1973 (Dissociative Identity Disorder: I’m Not Sybil). In the 1970s alone, it is thought that more cases of DID were reported than in all of history since 1816 and the famous case of Mary Reynolds. Between 1991 and 1997, over 500 cases of DID were admitted to a single dissociative disorders treatment center in Dallas, Texas.
Additionally, as more and more cases of DID were reported, more and more alternate personalities (alters) were reported in each case. The majority of cases noted by 1944 manifested with only two personalities, while there was an average of 15.7 alters noted in cases reported in 1997.
In current day, controversy still rages around DID, its diagnosis and whether the disorder even exists.
The History of Dissociative Identity Disorder in the "Diagnostic and Statistical Manual of Mental Disorders"
The history of dissociative identity disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM) goes back to its first edition in 1952. At that time, dissociative disorders were included as psychoneurotic disorders, in which anxiety is either "directly felt and expressed or . . . unconsciously and automatically controlled" by various defense mechanisms." Under this label, the following dissociative disorders were listed:
- Dissociated (multiple) personality
- Stupor (impaired consciousness wherein the person barely reacts to environmental stimuli)
- Fugue (pathological state of altered consciousness)
- Dream states
- Somnambulism (sleepwalking)
In the DSM-II, in 1968, dissociative identity disorder was called hysterical neurosis, dissociative type and was defined as an alteration to consciousness and identity.
In 1980, the DSM-III was published and the term "dissociative" was first introduced as a class of disorders. In the DSM-IIIs text revision (DSM-III-R), an essential feature of dissociative disorders was "a disturbance in the normally integrative functions of identity, memory, or consciousness . . ." This rather liberal diagnosis may be partially responsible for the vast uptick in diagnoses of the new diagnosis of "multiple personality disorder."
The DSM-IV, in 1994, addressed this somewhat as it included the specific criterion of amnesia to the diagnosis of multiple personality disorder, now renamed to dissociative identity disorder. The criteria for dissociative identity disorder was now:
- The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
- At least two of these identities or personality states recurrently take control of the person's behavior.
- Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
- The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.
The DSM-5 changed this definition to allow self-reports and specify that amnesia may occur with regards to everyday events and not just traumatic ones. For more on DID in the DSM-5, go here. You can see a list of the different types of dissociative disorders here.