Editing Dissociative identity disorder (section)

==Signs and symptoms==
The full presentation of dissociative identity disorder can onset at any age,<ref name="American-Psychiatric-Association-2022" /> although symptoms typically begin by ages 5–10.<ref name="Gillig" /> DID is generally a disorder that develops in childhood. According to the fifth edition [text revision] of the ''[[Diagnostic and Statistical Manual of Mental Disorders]]'' (''DSM-5-TR''), symptoms of DID include "the presence of two or more distinct personality states" accompanied by the inability to recall personal information beyond what is expected through normal memory issues. Other DSM-5 symptoms include a loss of identity as related to individual distinct personality states, loss of one's subjective experience of the passage of time, and degradation of a sense of self and consciousness.<ref name = dsm/> In each individual, the clinical presentation varies and the level of functioning can change from severe impairment to minimal impairment.<ref name="Cardena">{{cite book |author1=Cardena, E. |author2=Gleaves, D.H. |year=2011 |chapter=Dissociative disorders |editor1=Hersen, M. |editor2=Turner, S.M. |editor3=Beidel, D.C. |title=Adult Psychopathology and Diagnosis |pages=473–503 |publisher=[[John Wiley & Sons]] |isbn=978-0-471-74584-6 |chapter-url=https://books.google.com/books?id=YBSqjV6wFQQC&pg=PA473 |via=google-books}}</ref><ref name = Mer2019Pro /> The symptoms of [[dissociative amnesia]] are subsumed under a DID diagnosis, and thus should not be diagnosed separately if DID criteria are met.<ref name=DSM5 /> Individuals with DID may experience distress from both the symptoms of DID (hearing voices, intrusive thoughts/emotions/impulses) and the consequences of the accompanying symptoms (inability to remember specific information or periods of time).<ref name = Spiegel/> The large majority of patients with DID report repeated childhood [[sexual abuse|sexual]] and/or [[physical abuse]], usually by caregivers as well as organized abuse.<ref name = APA2008>{{cite book |author1=Maldonado, J.R. |author2=Spiegel, D. | year = 2008 |chapter = Dissociative disorders – dissociative identity disorder (multiple personality disorder) |editor1= Hales, R.E. |editor2=Yudofsky, S.C. |editor3=Gabbard, G.O. | title = Textbook of Psychiatry | edition = 5th | publisher = [[American Psychiatric Association|The American Psychiatric Publishing]] | location = Washington, DC | isbn = 978-1-58562-257-3 | pages = [https://books.google.com/books?id=2RzFWRIAsPAC&pg=PA681 681–710]}}</ref><ref>{{Cite journal |last1=Dorahy |first1=Martin J. |last2=Brand |first2=Bethany L. |last3=Sar |first3=Vedat |last4=Krüger |first4=Christa |last5=Stavropoulos |first5=Pam |last6=Martínez-Taboas |first6=Alfonso |last7=Lewis-Fernández |first7=Roberto |last8=Middleton |first8=Warwick |date=2014 |title=Dissociative identity disorder: An empirical overview |journal=The Australian and New Zealand Journal of Psychiatry |volume=48 |issue=5 |pages=402–417 |doi=10.1177/0004867414527523 |pmid=24788904 |hdl=2263/43470 |s2cid=3609433 |hdl-access=free }}</ref> Amnesia between identities may be asymmetrical; identities may or may not be aware of what is known by another.<ref name=Mer2019Pro/> Individuals with DID may be reluctant to discuss symptoms due to associations with abuse, shame, and fear.<ref name = APA2008/>

Around half of people with DID have fewer than 10 identities and most have fewer than 100; although as many as 4,500 have been reported by Richard Kluft in 1988.<ref name = Hersen2012/>{{rp|style=ama|p= 503}} The average number of identities has increased over the past few decades, from two or three to now an average of approximately 16. However, it is unclear whether this is due to an actual increase in identities, or simply that the psychiatric community has become more accepting of a high number of compartmentalized memory components.<ref name = Hersen2012/>{{Failed verification|date=June 2020|reason=DSM-5 removed mention of this. I believe the source references DSM-IV from 1994. SCM argument given undue weight by SCM believers.}}

===Comorbid disorders===
The [[psychiatric history]] frequently contains multiple previous diagnoses of various disorders and [[therapy|treatment]] failures.<ref name=webmd>{{cite web |url=http://www.webmd.com/mental-health/dissociative-identity-disorder-multiple-personality-disorder?page=3 |title=Dissociative identity disorder (multiple personality disorder): Signs, symptoms, treatment |publisher=[[WebMD]] |last=Johnson |first=K |date=2012-05-26 |access-date=2012-08-03 }}</ref> The most common presenting complaint of DID is [[depression (mood)|depression]] (90%) that is often treatment-resistant, with [[headache]]s and non-epileptic seizures being common neurologic symptoms. Comorbid disorders include [[post-traumatic stress disorder]] (PTSD), [[substance use disorder]]s, [[eating disorder]]s, [[anxiety disorder]]s, [[personality disorders]], and [[Autism spectrum|autism spectrum disorder]].<ref name="Dorahy2014">{{cite journal |vauthors=Dorahy MJ, Brand BL, Sar V, Krüger C, Stavropoulos P, Martínez-Taboas A, Lewis-Fernández R, Middleton W |date=2014 |title=Dissociative identity disorder: An empirical overview |journal=Australian and New Zealand Journal of Psychiatry |volume=48 |issue=5 |pages=402–417 |doi=10.1177/0004867414527523 |pmid=24788904 |doi-access=free |hdl-access=free |hdl=2263/43470}}</ref><ref>{{cite book |title=Science and Pseudoscience in Clinical Psychology |vauthors=Lilienfeld SO, Lynn SJ |publisher=Guilford Publications |year=2014 |isbn=978-1-4625-1789-3 |page=141 |chapter=Dissociative Identity Disorder: A Contemporary Scientific Perspective |chapter-url=https://books.google.com/books?id=9Z0gBQAAQBAJ&pg=PA141}}</ref><!-- Galbraith ref replaced but text unchanged, commenting out since it may be useful in legal section.<ref name=Galbraith>{{cite journal |vauthors=Galbraith PM, Neubauer PJ |title=Underwriting considerations for dissociative disorders |journal=Journal of Insurance Medicine |volume=32 |issue=2 |pages=71–78 |year=2000 |pmid=15912905 |url=http://www.aaimedicine.org/journal-of-insurance-medicine/jim/2000/032-02-0071.pdf |archive-url=https://ghostarchive.org/archive/20221009/http://www.aaimedicine.org/journal-of-insurance-medicine/jim/2000/032-02-0071.pdf |archive-date=2022-10-09 |url-status=live }}</ref> --> 30-70% of those diagnosed with DID have history of [[borderline personality disorder]].<ref name="Shadows">{{Cite journal |last1=Reinders |first1=Antje A. T. S. |last2=Veltman |first2=Dick J. |title=Dissociative identity disorder: out of the shadows at last? |journal=The British Journal of Psychiatry |year=2021 |volume=219 |issue=2 |pages=413–414 |doi=10.1192/bjp.2020.168 |pmid=33023686 |s2cid=222182562 |doi-access=free }}</ref> Presentations of dissociation in people with [[schizophrenia]] differ from those with DID as not being rooted in trauma, and this distinction can be effectively tested, although both conditions share a high rate of  auditory hallucinations in the form of voices.<ref>{{Cite journal |last=Moskowitz |first=Andrew |date=July 2012 |title=Commentary on "Dissociation and Psychosis in Dissociative Identity Disorder and Schizophrenia" (Laddis & Dell) |journal=Journal of Trauma & Dissociation |volume=13 |issue=4 |pages=414–417 |doi=10.1080/15299732.2011.621017 |pmid=22651675 |s2cid=13465660 }}</ref> Disturbed and altered [[sleep]] has also been suggested as having a role in dissociative disorders in general and specifically in DID, alterations in environments also largely affecting the DID patient.<ref name="Kloet2012" /> Individuals diagnosed with DID demonstrate the highest [[hypnosis|hypnotizability]] of any clinical population.{{Citation needed|date=April 2025}}