Is Dissociative Identity Disorder A Mental Illness?
Among those with Dissociative Identity Disorder, there's some debate about whether it should be called a disorder at all. Some even view DID as evidence of mental health. When you consider that its development is regarded as an example of adaptive functioning by many of both those who live with it and those who treat it, it's easy to understand why some might dispute the mental illness label. Mental illness by definition implies maladaptive functioning - it interferes with and disrupts daily living. But Dissociative Identity Disorder is often described as life-saving. Which is it?
If I need to walk on two legs to survive, I learn to walk on two legs. If I need fire and tools to survive, I develop tools and learn how to use fire in ways that will benefit me. This behavior is adaptation.
-The Dissociative Identity Disorder Sourcebook, Deborah Haddock
When I was a child, Dissociative Identity Disorder was adaptive. Among other things, I needed to:
- Demonstrate high functioning - perform well academically and socially, for example - even in the face of stress that surpassed my tolerance threshold.
- Insulate myself from knowledge that would otherwise have incapacitated me with fear and dread.
- Appear normal, healthy, happy, and suppress behaviors that might draw attention.
- Align myself with accepted, approved versions of reality and move denied, forbidden versions of reality out of conscious awareness.
- Escape my environment.
I can't say for sure, but I suspect none of that would have been possible without Dissociative Identity Disorder. Though people with DID are all unique, I have no doubt most could come up with a similar list of ways DID helped them get through childhood. Still, there are ways in which DID was maladaptive in childhood. But for me, and I'm sure this is also true for many others with the disorder, it solved more problems than it caused.
Today, Dissociative Identity Disorder is maladaptive. It impedes functioning by:
- Separating me from parts of myself, from others, and from the world, causing internal and external loneliness and isolation.
- Interfering with my ability to track and manage time effectively.
- Creating barriers to intimacy.
- Disrupting daily life.
- Causing confusion and inconsistency.
Occasionally I find myself identifying upsides of having DID, ways in which it continues to be adaptive. I often joke, for instance, that we can get through a wide array of challenging situations because "there's someone for everything." But for the most part, I consider Dissociative Identity Disorder maladaptive in my life now. It creates more problems than it solves.
My perspective is that Dissociative Identity Disorder can be considered an example of both mental illness and mental health. I further believe that in childhood, it is more an example of mental health than mental illness. Whereas it's the opposite in adulthood. Not everyone agrees with me, though. What do you think? Should Dissociative Identity Disorder be classified as a diagnosable mental illness?
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Gray, H. (2010, September 16). Is Dissociative Identity Disorder A Mental Illness?, HealthyPlace. Retrieved on 2019, September 16 from https://www.healthyplace.com/blogs/dissociativeliving/2010/09/is-dissociative-identity-disorder-a-mental-illness
Author: Holly Gray
Thank you for your comment. What you said really touched me. Dissociative Identity Disorder is many things, but fair is not one of them. There's nothing right or okay about the fact that you're paying the price for other people's choices to this day. I try not to think about DID from that perspective because it makes me angry. But quite frankly, anger is appropriate.
Thanks for your comment.
For what it's worth, I don't believe having Dissociative Identity Disorder means insanity at all. I think it means that your mind was able to creatively protect you when no one else would. There's a kind of victory in that, I think.
"When a person does not have a continuous memory of their life because of the way their memories were stored during trauma and they continue to store memories this way into adulthood, it is a serious disorder in my opinion, although not one I am ashamed of at all anymore."
Shedding the shame is hard. Good for you for accomplishing that. I don't feel ashamed of it these days either. Though I do admit I sometimes feel insecure or embarrassed about something related to DID - like taking my son to his first day of middle school on what was actually the second day. That feels different than shame though.
Nothing about DID is clear cut. And as the poster above mentioned, folks dealing with it have faced enough without adding the burden of having to show proof of cause to get the help they need to deal with the reasons behind such extreme dissociation...
Which I suppose is another angle to look at this question from. Since dissociation is generally viewed to be a spectrum, and DID is the final stop, then does it become a mental illness simply by virtue of being so beyond the level that most people experience it at?
And maybe the medical model just isn't the whole story in this case?
Thanks for commenting.
I'm not sure what you mean when you say, " ... folks dealing with it have faced enough without adding the burden of having to show proof of cause to get the help they need ...." Specifically, I'm confused about the phrase 'proof of cause.' Do you mean cause of Dissociative Identity Disorder? If so, let me reassure you that proof of trauma history is not part of the diagnostic criteria for DID.
"Since dissociation is generally viewed to be a spectrum, and DID is the final stop, then does it become a mental illness simply by virtue of being so beyond the level that most people experience it at?"
Ah good question. I would argue that DID itself exists on a continuum. Some folks live with very high degrees of separation between parts, with very high degrees of dissociative amnesia. Other systems are more fluid, capable of freely sharing thoughts and information. Still, on a dissociative scale, Dissociative Identity Disorder is the most extreme manifestation. If it's a mental illness in part because of that - because it's " ... so beyond the level that most experience it at" - I would argue that's a legitimate component. It stands to reason, for instance, that time loss might be pathologized in a world where you can lose your job because of it. Whether or not time loss might be pathologized if no one cared if you went to lunch and didn't come back for three days I don't know.
"And maybe the medical model just isn’t the whole story in this case?"
If by "medical model" you simply mean "the various symptoms and features that together clinicians define as Dissociative Identity Disorder" then for the purposes of this blog, it is the whole story. By that I mean, I write about Dissociative Identity Disorder, not other forms of multiplicity. I've certainly heard of them, but I'm out of my depth on that subject matter and am therefore not equipped to address it. If, on the other hand, you're referring to other models of DID - sociocognitive? - well, that's another discussion altogether.
Thanks for your comment.
Your point about insurance is a good one, and in re-reading my post I see I should have either worded the last line differently or left it off altogether. Because while insurance is obviously important when discussing treatment, in this post I was speaking more to how those who have DID conceptualize it, and not whether insurance companies accept it as a disorder or not. I am comfortable with the term "mental illness." But not everyone with Dissociative Identity Disorder is. I've met folks with DID who are in therapy, who understand that as far as their insurance company is concerned they are mentally ill, but reject the label for themselves. I've heard DID referred to as Dissociative Identity Response, for instance, many times by people who accept that they need treatment but choose not to let the maladaptive features of DID define their condition.
So my question should not have been, "Should DID be taken out of the DSM and regarded entirely as adaptive functioning that doesn't need treatment?" though I see now that my last line might have implied exactly that. My intention was to ask, "If you have DID, do you accept the word disorder and/or the label mental illness? Or do you focus on how DID has served you and define it (for yourself) from that perspective as something other than a disorder?"