Definitions

Augment: To add another medication or therapy to current medication.

Response: Some depressive symptoms improve, but you're still not back to your old self.

Remission: All of your depressive symptoms have improved and you feel like your old self.

Maintenance: Use of medication for at least nine months, sometimes years or even a lifetime, to prevent another depressive episode.

Treatment-resistant depression. Generally described as failing two or more adequate trials of antidepressants.

References for Article on Switching Antidepressants

Uhr M, Tontsch A, Namendorf C, et al. Polymorphisms in the Drug Transporter Gene ABCB1 Predict Antidepressant Treatment Response in Depression. Neuron. 2008; 57 (2): 203-9.

Kato M, Fukuda T, Serretti A, et al. ABCB1 (MDR1) gene polymorphisms are associated with the clinical response to paroxetine in patients with major depressive disorder. Prog Neuropsych Biol Psych. 32 (2):398-404.

Leuchter AF, Cook IA, Marangell LB, et al. Comparative effectiveness of biomarkers and clinical indicators for predicting outcomes of SSRI treatment in Major Depressive Disorder: results of the BRITE-MD study. Psychiatry Res. 2009 30;169(2):124-31.

Howland RH, Wilson MG, Kornstein SG, et al. Factors predicting reduced antidepressant response: experience with the SNRI duloxetine in patients with major depression. Ann Clin Psychiatry. 2008;20(4):209-18.

Young EA, Kornstein SG, Marcus SM, et al. Sex differences in response to citalopram: a STAR*D report. J Psychiatr Res. 2009 Feb;43(5):503-11.

Trivedi MH, Rush AJ, Wisniewski SR, et al: Evaluation of outcomes with citalopram for depression using measurement-based care in STAR∗D: Implications for clinical practice. Am J Psychiatry. 2006;163:28-40.

Geddes JR, Carney SM, Davies C, et al. Relapse prevention with antidepressant drug treatment in depressive disorders: a systematic review. The Lancet. 2003;361(9358):653.

Mueller TI, Leon AC, Keller MB, et al. Recurrence after recovery from major depressive disorder during 15 years of observational follow-up. Am J Psychiatry. 1999;156(7):1000-1006.

Judd LL, Paulus MJ, Schettler PJ, et al. Does incomplete recovery from first lifetime major depressive episode herald a chronic course of illness? Am J Psychiatry. 2000;157(9):1501-1504.

Kupfer DJ, Frank E, Perel JM, et al. Five-year outcome for maintenance therapies in recurrent depression. Arch Gen Psychiatry. 1992;49(10):769-773.

Simon GE, Von Korff M, Rutter CM, Peterson DA. Treatment process and outcomes for managed care patients receiving new antidepressant prescriptions from psychiatrists and primary care physicians. Arch Gen Psychiatry. 2001;58(4):395-

Weilburg JB, O'Leary KM, Meigs JB, et al. Evaluation of the adequacy of outpatient antidepressant treatment. Psychiatr Serv. 2003;54(9):1233-9.

Lin EH, Katon WJ, Simon GE, et al. Low-intensity treatment of depression in primary care: Is it problematic? Gen Hosp Psychiatry. 2000;22(2):78-83.

Trivedi MH, Fava M, Wisniewski SR, et al. Medication augmentation after the failure of SSRIs for depression. N Engl J Med. 2006;354(12):1243-1252.

Nierenberg AA, Fava M, Trivedi MH, et al A comparison of lithium and T(3) augmentation following two failed medication treatments for depression: a STAR*D report. Am J Psychiatry. 2006;163(9):1519-30.

Thase ME, Friedman ES, Biggs MM, et al. Cognitive therapy versus medication in augmentation and switch strategies as second-step treatments: a STAR*D report. Am J Psychiatry. 2007;164(5):739-52.

How to Switch Antidepressants. Pharmacist's Letter/Prescriber's Letter. 2006;22(220605). Available at: www.pharacistsletter.com. Accessed December 17, 2009.

back to: Finding the Right Antidepressant for Your Depression
~ all articles on switching antidepressants
~ all articles on depression

Learn the correct way to switch antidepressants and understand why you should never suddenly stop taking antidepressant medication.

There are three main ways your doctor can switch you to another antidepressant:^xvii

1. Stop then start. This involves tapering off the first drug until it is completely out of your system, then starting the new drug. This is primarily used for medications that could have dangerous interactions, such as a monoamine oxidase inhibitor (MAOI) and any other antidepressant, even another MAOI. Tapering off an MAOI requires at least 2two weeks before starting a different antidepressant.
2. Dual tapering. Your doctor gradually reduces the dosage of the old drug while simultaneously increasing the dosage of the new drug. Typically used when switching from an SSRI to Wellbutrin (bupropion), Remeron (mirtazapine), or a tricyclic antidepressant. Also when switching to or from Effexor (venlafaxine) and Wellbutrin, or Remeron; or to or from Wellbutrin or Remeron. In some instances, this approach may be used when switching from one SSRI to another.
3. Simultaneous switching. Halting the old drug and immediately starting the new drug. Typically used when switching from one SSRI to another or from an SSRI to Effexor.

Stopping Your Antidepressant? Beware the Risks!

So you've been on antidepressants for a few months and you're feeling great. "I don't need this depression medication anymore," you decide (without getting your doctor's opinion on the matter). The next day you trash the pills.

Big mistake!

Just listen to what happened to Emily, 34, when she quit taking her Effexor (venlafaxine) "cold turkey."

"It was the worst feeling of my life," she tells HealthyPlace.com. The first day she felt dizzy and extremely thirsty. By the end of the second day, she could barely walk or see because of the dizziness and had a headache so severe that any noise made her cry. She was also extremely nauseous. By the third day, her mother called 911 because Emily couldn't move without screaming.

Emily was suffering from something called "antidepressant discontinuation syndrome." The syndrome is associated, to various degrees, with nearly every antidepressant out there. It's called "discontinuation syndrome" because there's no evidence that antidepressants are addicting (in which case it would be called withdrawal). The condition is more common in people who take the drugs for six weeks or more.

Symptoms of antidepressant discontinuation syndrome include the dizziness, thirst, nausea and headache Emily experienced, as well as shock-like sensations throughout your body, insomnia, anxiety, agitation and, in rare cases, psychosis. Although the syndrome is thought to affect just one out of five people taking antidepressants and is not life threatening, it can sometimes be serious enough to require hospitalization.

The effects aren't limited just to antidepressants. When Amy, 36, decided last May that she no longer needed the Abilify (aripiprazole) she took with her antidepressant and Ritalin (methylphenidate), she stopped once the bottle was empty. "It was like I had the flu or something. I was that nauseous and achy," she recalled. She also had a daily headache. After a month of feeling miserable physically, her mood crashed. "I could tell it was not just a normal mood swing," she said. A few weeks later she resumed taking Abilify and within two weeks "everything was looking better."

As for Emily, after giving her medication for her headache and nausea, doctors started her on a low dose of Effexor, gradually increasing it to her regular dosage. "It was very scary," she says of the experience. "I thought I was going to die."

Bottom line? The only way to safely stop taking an antidepressant medication is for you and your doctor to slowly wean you off.

(Ed. Note: For an in-depth look at the best ways to treat depression, read the "Gold Standard for Treating Depression: Getting the Right Treatment for Depression. If you are looking for the best way to treat depression, here is the table of contents for that section. Plus watch depression treatment videos.)

About the Author

Debra Gordon, MS, is an award-winning medical writer with more than 25 years of experience writing about health and medicine. She lives and works in beautiful Williamsburg, VA. You can learn more about her at www.debragordon.com.

Dissociative identity disorder (DID) treatment can be long-term and difficult but it is possible. DID treatment should, ideally, always be conducted by professionals that specialize in dissociative identity disorder as it is a rare and challenging condition to treat. Dissociative identity disorder treatment primarily involves symptom relief as well as trauma therapy.

How Is Dissociative Identity Disorder Treated in Children?

While DID is not normally diagnosed in children, in the case where a child is showing signs of dissociative identity disorder or dissociation in general, the possibility of abuse should always be investigated. If abuse is suspected, reporting abuse to Child Protective Services (CPS) is required and immediate intervention by professionals is needed. (More on causes of DID)

Professionals to contact in addition to CPS include:

• A psychiatrist or behavioral/developmental pediatrician
• A social services representative
• A child abuse and sexual abuse (CASA) specialist

Dissociative Identity Disorder Treatment Goals

There are many dissociative identity disorder treatment goals. The goals of DID treatment include ensuring the safety of the patient, symptom relief as well as:

• "Reconnecting" all existing DID alters into one, well-functioning identity
• Allowing the person to safely express and process painful memories
• Developing new and healthy coping skills
• Restoring functionality
• Improving relationships

Dissociative Identity Disorder Treatment Types

Dissociative identity disorder is primarily treated with psychotherapy of various types. According to the Cleveland Clinic, the following are DID therapy types:

• Psychotherapy – often thought of as "talk therapy." This DID therapy encourages communication of conflicts and insight into problems.
• Cognitive therapy – involves changing dysfunctional thought patterns.
• Family therapy – helps to educate the family about the disorder, recognize its presence as well as work through issues that have developed in the family because of dissociative identity disorder.
• Creative therapies such as art or music therapy – allows the patient to explore thoughts, feelings and memories in a safe and creative way.

The classic therapeutic treatment approach as described by the International Society for the Study of Trauma and Dissociation (ISSTD) Treatment Guidelines, is called phase-oriented trauma therapy and consists of three phases:

1. Stabilization
2. Trauma-work
3. Integration

Sometimes medication is used in dissociative identity disorder treatment. Although no medication is specifically indicated for DID, medication can help with people who experience certain symptoms like severe depression or anxiety.

Finally, clinical hypnosis is also used in the treatment of DID. This process involves intense relaxation, concentration and focused attention to achieve an altered state of consciousness. This allows a person with dissociative identity disorder to explore thoughts, feelings and memories that may be typically hidden from his or her conscious mind. In this state, the therapist may be able to talk to each alternate personality (alter).

Is Dissociative Identity Disorder Curable?

As to whether dissociative identity disorder can be cured varies according to the individual and the individual's definition of the word "cured." Some people with DID are looking for ways to manage their alters in what they consider to be a healthy way and are reluctant to reconnect all their separate identities because they help the person to cope with life's difficulties and traumatic memories. For others, integrating all personalities into one healthy identity is what they are looking for. Each of these states can be attained with DID treatment but it can be a painstaking process.

article references

The criteria for a dissociative identity disorder (DID) diagnosis are defined in the Diagnostic and Statistical Manual of Mental Disorder, Fifth Edition (DSM-5). The DSM-5 is what doctors use as an authoritative reference when diagnosing patients with dissociative identity disorder. There are five DSM-5 criteria for dissociative identity disorder.

Criteria for Dissociative Identity Disorder in the DSM-5

The first DID criteria is:

1. Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to and thinking about the environment and self.

According to the DSM-5, personality states may be seen as an "experience of possession." These states "involve(s) a marked discontinuity in sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual." (Read about dissociative identity disorder alters)

One important change from the fourth to the fifth edition of the DSM is that individuals may now report their perception of personality shifts rather than limiting diagnosis to shifts that others must report.

The second dissociative identity disorder criterion in the DSM-5 is:

2. Amnesia must occur, defined as gaps in the recall of everyday events, important personal information and/or traumatic events. (Dissociative Amnesia: Deeply Buried Memories) This criteria for DID newly recognize that amnesia doesn't just occur for traumatic events but, rather, everyday events, too.

3. The person must be distressed by the disorder or have trouble functioning in one or more major life areas because of the disorder. This criterion is common among all serious mental illness diagnoses as a diagnosis is not appropriate where the symptoms do not create distress and/or trouble functioning.

4. The disturbance is not part of normal cultural or religious practices. This DID criterion is to eliminate diagnosis in cultures or situations where multiplicity is appropriate. An example of this is in children where an imaginary friend is not necessarily indicative of mental illness.

5. The symptoms are not due to the direct physiological effects of a substance (such as blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (such as complex partial seizures). This characteristic of dissociative identity disorder is important as substance abuse or another medical condition is more appropriate to diagnose, when present, than DID.
While these are the five, recognized, dissociative identity disorder DSM-5 symptoms, please see our article for the additional signs of DID, which are numerous.

article references

Although individual patient variability certainly plays a role in whether or not an antidepressant works, other issues are also at work here. For one, said Dr. Dunn, formulary and contract manager with SelectHealth, in Salt Lake City, Utah, doctors often don't use depression questionnaires to see if the depression drug treatment is working before giving up. They also don't give the antidepressant medication enough time to work. The STAR*D study, for instance, found it took, on average, about seven weeks of antidepressant medication for patients to reach full remission, with about 40 percent requiring eight or more weeks.^iv

Download copies of these depression and antidepressant self-monitoring charts and share the results with your doctor:

• Antidepressant Side-Effect Monitoring Chart
• Depression Symptoms Monitoring Chart

Second, patients often stop taking a drug once they start feeling better. Studies find that only 60 percent of people are still taking an antidepressant after three months; only 40 percent after six months. Yet clinical guidelines recommend continuing depression medication treatment after remission for at least six months, preferably 12. This is called depression maintenance treatment and studies find it can reduce the risk of relapse up to 70 percent.^vii

That's important because the ultimate goal of treatment is not just feeling better, or "responding" to the medication; but a complete cure, also called "remission." The reason? If you quit taking your antidepressant too soon, you're more likely to have a recurrence. In fact, studies show a relapse rate of 76 percent in people who quit treatment but still have some depressive symptoms compared to 25 percent of those who reach full remission. The danger here is that the more relapses you have, the more relapses you're likely to have.^viii,ix,x

When the First Depression Drug Doesn't Work

So if the first drug for depression doesn't work, what's a doctor to do? The first option is to increase the dosage, generally about four weeks after starting. Unfortunately, several studies find that doctors not only don't keep their patients on an antidepressant long enough, but also don't increase the dosages to levels shown to have the greatest benefit.^xi,xii,xiii

For example, say your doctor increased your dosage a couple of times and kept you on the antidepressant medication for seven or eight weeks. You're feeling better, but you're not in remission. Your doctor has several options:

• Add psychotherapy to the antidepressant
• Add another antidepressant
• Switch to a different antidepressant
• Add another medication, called "augmentation"

Antidepressants, medications for depression, don't work the same for each individual. Many times, depression patients have to try several antidepressants before finding the right one.

So what's the story? Why don't antidepressants work as well as, say, antibiotics?

Lots of reasons, says experts. First, unlike antibiotics, which can be tested against specific bacteria, there's no way to test an antidepressant against individual depressions. "Every antidepressant is a different molecule," says Bradley Gaynes, M.D., associate professor of psychiatry at the University of North Carolina's School of Medicine in Chapel Hill and one of the co-investigators of STAR*D.

That means, in terms of antidepressant side effects and efficacy, they affect people differently. For instance, two people taking the same depression drug at the same dosage may wind up with different amounts in their blood because of how their bodies metabolize the antidepressant medication. Or one may get very nauseous from the drug while the other feels just fine. Studies are emerging that suggest a significant part of resistance to a particular antidepressant may be related to genetic variations in certain proteins that carry the drug to the brain.^i,ii

The other thing, notes Dr. Gaynes, is that no single antidepressant is any better than another. It all depends on the individual patient. That means that choosing an antidepressant is often like playing roulette. You pick one and just hope it works. And that, notes Jeffrey D. Dunn, Pharm.D., formulary and contract manager with SelectHealth, inc., in Salt Lake City, Utah, can lead to poor outcomes and, on the part of patients, poor adherence.

So when choosing an antidepressant, says Dr. Gaynes, you and your doctor should consider issues like cost, side effects, safety and any other medical conditions you have. For instance, if you have insomnia, your doctor may recommend an antidepressant with some sedating effects, like Remeron. Conversely, if you have no energy, the energizing effects of an SSRI like Prozac might work better. If sexual side effects are a concern, Wellbutrin might be a better option, either alone or in addition to an SSRI.

Choosing Antidepressants Based on Science

While there is currently no objective "test" to predict how people will react to a specific antidepressant, researchers are beginning to investigate certain biomarkers, such as brain wave patterns, that may provide some clues.ⁱⁱⁱ

They are also learning that certain depression symptoms may predict who will respond to certain depression medications. For instance, one study found that people with more severe depression, other mental or physical health conditions, and "atypical" depression marked by "leaden paralysis" and extreme fatigue are less likely to respond to the antidepressant Cymbalta (duloxetine).^iv They also found that women tend to respond better to Celexa (citalopram) than men.^v

Ideally, someday there will be a simple blood test that tells your doctor which antidepressant will work best for you.

Special report on why people with major depression sometimes switch antidepressant medications, why you should never suddenly stop your antidepressant and how to change antidepressants safely.

Amy* was 21 and a college student when she experienced her first major depression. When she felt so bad she had to drop out of the school and move home, she finally saw a doctor. It was the golden years for Prozac (fluoxetine), one of the first selective serotonin reuptake inhibitors (SSRIs) to hit the market. With its relatively low risk of side effects and efficacy similar to those of the older antidepressants, Prozac was touted as a miracle drug for depression.

There was just one problem. It didn't work for Amy. She was part of a small percentage of people in whom Prozac triggered feelings of agitation, nervousness, and restlessness, a condition called "akathisia."

Thus began a journey through antidepressant land as Amy and her doctor struggled to find the right medication. She went through nearly all the SSRIs, including and Paxil (paroxetine), most of the tricyclic antidepressants, including Elavil (amitriptyline), Norpramin (desipramine) and Pamelor (nortriptyline), and the norepinephrine reuptake inhibitor Effexor (venlafaxine). Her doctor tried adding other medications to the antidepressants, including the anti-epilepsy drug Depakote (divalproex), the stimulant Ritalin (methylphenidate), the antipsychotic Abilify (aripiprazole), and even lithium, a medication which may help with depression but is typically prescribed for bipolar disorder, which Amy did not have.

When even a round of electroconvulsive shock therapy didn't fully pull Amy out of her depression, her doctor figuratively threw up his hands and said, "Let's go old school." He started her on one of the oldest antidepressants, the monoamine oxidase inhibitors (MAOIs) Parnate (tranylcypromine), together with Ritalin and Abilify - a combination that was both potentially risky and potentially beneficial. Bingo! Finally, the depression lifted.

"Throughout the whole process I was frustrated," she recalls. "I felt hopeless and helpless most of the time, like I would never find anything that would work for me."

Amy's story is not as unusual as it might sound. One of the largest studies ever conducted of antidepressant treatment for depression, the STAR*D (Sequenced Treatment Alternatives to Relieve Depression) found that only a third of patients fully recover from their depression on the first antidepressant tried. Most need at least two, sometimes three or more.

Living with a depressed spouse or being married to someone with depression can bring about many challenges.  Not only is it hard to understand what depression is like if you haven't experienced it, but communication can also be difficult for someone who is depressed. Your partner may be unwilling to ask for help, which can be doubly frustrating when you want them to get better. Here's what to do if you feel like living with a depressed spouse is ruining your marriage.

What’s It Like to Live with a Depressed Spouse?

Living with a depressed spouse can cause all sorts of problems. Firstly, many couples lose their ability to problem-solve when they cannot communicate, and depression makes talking and reasoning difficult for some people. Partners of people with depression may also need to take on the burden of extra household chores or childcare responsibilities, or else they may be the sole earner, which puts a financial strain on the relationship. Depression can also have a negative effect on sex and intimacy.

It's important to remember that all of this is temporary and that in most cases, depression is a treatable illness.

An individual’s experience of living with a depressed spouse is also dependent on the severity of their partner’s illness. Just like any serious illness, depression can cause a rift in a marriage, or it can unite couples, so they become even closer. Whether or not your spouse's depression has a negative impact on your relationship is dependent on how severe their depression symptoms are, as well as how you respond to and meet their needs.  

Tips for Managing When Your Spouse Is Depressed

Being married to someone with depression doesn't need to harm your relationship. As long as you stay on the same team, the experience could deepen your understanding of one another and improve your communication skills.

Here are some tips to help make living with a depressed spouse a little easier:

Let go of resentment

When you love someone with depression, remember that depression is the enemy, not your spouse. To maintain a strong and happy partnership, you should direct any feelings of anger or resentment you have toward the illness rather than to one another. For example, instead of saying, "I hate it when you refuse to communicate with me," you could say, "I hate it when depression makes it hard for us to communicate." This way, your partner doesn't feel attacked or blamed, but you can still make your feelings heard.

Encourage honesty and open communication

According to UK depression charity, Blurt, honesty is incredibly important when you're living with a depressed spouse, and it should come from both sides:

"It is better to be completely honest from the word ‘go.' It's a lot for the ‘well' person to take in too, so it's only fair that they are aware of our (the depressed person's) additional needs."

Encourage your partner to be honest with you, and don't be afraid to be honest back. If you're feeling worried or confused, share this with your spouse in a way that doesn't point the finger or make your partner feel ashamed.

You may need to be honest with other people in your lives, such as friends and family members, about your partner's illness. If you have children, you can tell them in an age-appropriate way that your partner is unwell and how depression affects them. You should always check with your partner before disclosing their illness to other people.

Encourage your spouse to get treatment

If you’re married to someone with depression, encouraging treatment for depression is one of the most helpful things you can do. In most cases, depression is highly treatable, and people who begin a course of antidepressant medication or therapy can start to feel better in as little as six weeks.

However, you can't force treatment on somebody who is not ready to seek help. Without being pushy, gently make your partner aware of their options, and let them know that you're there to help in any way you can – be it driving them to appointments, assisting them with daily tasks or providing emotional support.

Build your own support system

Living with depression may be incredibly difficult for your spouse, but it's also hard for you, too. While empathy, communication and support through treatment are important, you cannot pour from an empty cup. You must acknowledge and attend to your own needs, whether this means planning a day of self-care, taking time alone to process your emotions, or building your own support system of family and friends.

article references

Dissociative identity disorder (DID) causes are virtually always thought to be environmental and, specifically, related to early-life trauma. There are no known biological causes of dissociative identity disorder but DID does tend to run in families. While Putnam et al noted that 97% of patients with dissociative identity disorder reported a history of abuse, part of the controversy of DID, however, is that some clinicians claim that there is not a direct enough association between early-childhood trauma and dissociative identity disorder due to the bias in self-reporting.

What Causes Dissociative Identity Disorder (DID)?

The causes of dissociative identity disorder appear to be complex. People with dissociative identity disorder tend to have personal histories of recurring, overpowering, severe and often life-threatening traumas such as physical or sexual abuse before the age of nine; which is thought to be a key developmental age. The cause of dissociative identity disorder may also be extreme neglect or emotional abuse even if no overt physical or sexual abuse occurred. DID may also be related to a natural disaster, such as war. According to WebMD, findings indicate that parents who are frightening and unpredictable tend to raise children who experience dissociation.

Richard Kluft, an expert in dissociative identity disorder, suggests that DID is caused by four factors:

1. Individuals have an innate potential to dissociate that is reflected in the fact that they are easy to hypnotize (have a high hypnotizability rating).
2. Traumatic experiences in early childhood may disturb personality development, leading to greater potential for dividedness in mental or emotional areas.
3. Individuals may be denied the chance to spontaneously recover because of continued emotional and/or social deprivation.
4. The final presentation is shaped by mental or emotional and external factors, including social influences.

Why Does Trauma Cause DID in Some and Not Others?

Research indicates that dissociative symptoms are a psychological response to extreme environmental and interpersonal stressors. In order to survive this stress, the person separates his or her thoughts, feelings, actions and memories associated with the traumatic experience from his or her usual level of consciousness. Because everyone is different, some people who have experienced extreme trauma will experience this type of response while others will not. Some studies indicate that males are more likely to experience dissociation due to early-age trauma than females. (More dissociative identity disorder statistics and facts here.)

article references

The signs and symptoms of dissociative identity disorder (DID) vary depending on the individual. What drives them, however, is severe episodes of dissociation that manifest as multiple personalities brought about by severe, persistent periods of childhood trauma or neglect.

Even though there are many DID symptoms and signs, it is still very difficult to diagnose DID. It is estimated that people with dissociative disorders spend, on average, seven years in the mental health system before receiving an accurate diagnosis. This is because many of the DID symptoms people seek help for are similar to those seen in other mental health disorders such as depression, schizophrenia and anxiety. In fact, some of these disorders may co-occur with dissociative identity disorder.

Symptoms of Dissociative Identity Disorder (DID)

The official symptoms of dissociative identity disorder have been most recently defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. The following are the diagnostic symptoms of DID:

• Two or more distinct personalities exist in one individual; one personality is always present (Understanding Dissociative Identity Disorder Alters)
• Dissociative amnesia including gaps in the recall of important personal information and everyday events
• Severe distress and impairment in functioning because of the disorder
• The disturbance is not part of normal cultural or religious practices
• The disturbance can't be explained but substance use or another medical condition

You can read these real dissociative identity disorder stories and watch videos to understand the effect of DID symptoms.

Signs of Dissociative Identity Disorder (DID)

While the official DID symptom list is short, the signs of DID are numerous. Dissociative behavior is divided into two categories: detachment and compartmentalization. Detachment is "a voluntary or involuntary feeling or emotion that accompanies a sense of separation from normal associations or environment" while compartmentalization is "solation" or splitting off of part of the personality or mind with lack of communication and consistency between the parts."

People with DID often also suffer from borderline personality disorder symptoms, somatization disorder (physical symptoms without cause), major depression, posttraumatic stress disorder and suicide attempts.

The signs of dissociative identity disorder include a number of characteristics regarding the multiple personalities including:

• Personalities are discrepant (disagreeing) and often opposite.
• Each personality is well-ingrained with its own memories, behavioral patterns, and social relationships that govern its behavior.
• The transition from one personality to another is often sudden and brought on by stress.

Other signs of DID include:

• Amnesia or blackouts (in the absence of substance use)
• The person referring to him or herself as "we"
• The person being told that they did certain things to don't recall. The person may find unfamiliar objects or samples of strange handwriting.
• Sleepwalking and automatic writing (such as those in fugue states)
• Auditory hallucinations
• Phobias; fear, often undifferentiated
• Difficulty in parenting and responding to own children
• Problems trusting others
• Hostility and anger
• A sense of betrayal
• Problems with sexual adjustment
• Increased levels of sexual behavior
• Prostitution
• Substance abuse

Signs of DID in Children

Children are rarely diagnosed with dissociative identity disorder, but signs of DID in children include some of the above as well as:

• Appearing withdrawn, frightened or uninvolved
• Being considered "different" with an unclear reason as to why
• Erratic access to knowledge, information and skills that manifest as fluctuating abilities, moods, fears, preferences and anxieties
• Feelings of guilt and shame
• Inappropriate sexual behavior
• School difficulties
• Truancy
• Running away from home
• Delinquency

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