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Key points
- Until recently, the number of people presenting for evaluation and treatment of DID has been decreasing.
- Clinicians should generally be supportive and validating, while at the same time holding a little skepticism.
- Complexity, nuance, and the middle ground have become equated with weakness and indecisiveness.
A number of mental health clinics across the country, including ours, have recently seen an influx of adolescents who are presenting with self-diagnosed Dissociative Identity Disorder (DID) and claiming that within themselves there are a number of different personalities that emerge at different times. Much of this seems to be driven by a small number of influential people on TikTok who have posted very popular videos in which they describe their DID in great detail.
Dissociative Identity Disorder, which previously went by the name Multiple Personality Disorder, is a psychiatric diagnosis that describes individuals who report the existence of at least two distinct identities or personalities within themselves.
These distinct personalities or “alters” can have different characteristics, ages, genders, and names. Often at least one of them tends to encourage the individual to do “bad things” to themselves or others. DID is generally thought to develop among people who have been exposed to high levels of trauma and abuse where the dissociation and formation of other personalities forms as a defense against experiences that are too emotionally volatile to process directly. Many individuals with DID are known to be fairly susceptible to being hypnotized.
Decades ago, these more bizarre aspects of the diagnosis coupled with movies like Sybil and The Three Faces of Eve propelled DID into the public spotlight. Yet despite the longevity of the diagnosis and its perseverance all the way to DSM-5, it remains highly controversial within the mental health community regarding the degree to which people believe it is “real” and how one most effectively treats it. Particularly debated is the degree to which a clinician should engage or encourage a DID individual’s alters in treatment.
Up until recently, the number of people presenting for evaluation and treatment of DID has seemed to subside, although some might argue that these folks have withheld their symptoms due to its controversy and non-acceptance. Research on DID has also lagged, perhaps for the same reasons. Thus, the recent increase has re-ignited some of these old and unresolved debates. Especially among those who were skeptical from the start about the validity of the diagnosis, the new surge of cases that may have been brought on through social media exposure has only hardened these positions.
And since a DID diagnosis has traditionally been nearly synonymous with a history of significant trauma and abuse, there is concern that these media-inspired presentations could lead to psychological witch-hunts to identify past perpetrators that never existed. Others, however, worry that simple dismissals of these adolescents as simply acting out the latest “fad” miss an opportunity to work with significant mental health challenges, even if their expression is being shaped through social media.
The story overall raises a number of important issues and angles, all of which can’t be addressed here. There is the intense ridicule and online bullying that has occurred against people who discuss their mental illness online, whether professionally diagnosed or not. There is the skepticism about the validity of psychiatric disorders in general that only gets stronger under circumstances like this.
But what is most pressing for clinicians like me who work with these youth is what should we as professionals do in these instances? And the answer, I’d argue, is actually remarkably simple – we do what we always do, which is gather more information while being both supportive and validating and at the same time holding a little skepticism about taking everything we hear at face value.
We may find out for one youth that the DID symptoms really never were part of that person’s life before watching TikTok but that underlying the elaborate presentation are genuine feelings of anxiety and identity disturbance. For another person, maybe we find out that the DID symptoms have been present all along and it took TikTok to make the person feel safe enough to express them more openly. The latter doesn’t mean that we need to dive into a personal interview with each individual alter, but it does provide some important context through which we can build effective approaches to help.
Our world is increasingly polarized, pushing us to take “a side.” Real or fake. Right or wrong. Complexity, nuance, and middle ground has become equated with weakness and indecisiveness. But the reality, especially when it comes to the brain and its functions, is that things are complex and this kind of binary thinking often fails us, closing conversations that are better left open. The pathways through which our patients and clients find their way to our office are incredibly rich and diverse. We lump them into convenient politically-charged boxes at our peril, virtually begging our clients to reveal to us the deficiencies of our assessment shortcuts.
