According to the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), 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<unk>  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. In each individual, the clinical presentation varies and the level of functioning can change from severe impairment to minimal impairment. The symptoms of<unk>  amnesia are subsumed under a DID diagnosis, and thus should not be diagnosed separately if DID criteria are met. Individuals with DID may experience distress from both the symptoms of DID (intrusive thoughts or emotions) and the consequences of the accompanying symptoms (dissociation rendering them unable to remember specific information). The majority of patients with DID report childhood sexual or physical abuse, though the accuracy of these reports is controversial. Amnesia between<unk> es may be asymmetrical;<unk> es may or may not be aware of what is known by another. Individuals with DID may be reluctant to discuss symptoms due to associations with abuse, shame, and fear. DID patients may also frequently and intensely experience time disturbances. Around half of people with DID have fewer than 10<unk> es and most have fewer than 100; although as many as 4,500 have been reported. The average number of<unk> es 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<unk> es, or simply that the psychiatric community has become more accepting of a high number of compartmentalized memory components. Comorbid disorders The psychiatric history frequently contains multiple previous diagnoses of various disorders and treatment failures. The most common presenting complaint of DID is depression, with headaches being a common neurological symptom. Comorbid disorders can include substance use disorder, eating disorders, anxiety disorders, post-traumatic stress disorder (PTSD), and personality disorders. A significant percentage of those diagnosed with DID have histories of borderline personality disorder and bipolar disorder. Further, data supports a high level of psychotic symptoms in individuals with DID, and that both individuals diagnosed with schizophrenia and those diagnosed with DID have histories of trauma. Other disorders that have been found to be comorbid with DID are somatization disorders, major depressive disorder, as well as history of a past suicide attempt, in comparison to those without a DID diagnosis. Individuals diagnosed with DID demonstrate the highest hypnotizability of any clinical population. The large number of symptoms presented by individuals diagnosed with DID has led some clinicians to suggest that, rather than being a separate disorder, diagnosis of DID is actually an indication of the severity of the other disorders diagnosed in the patient. Borderline personality disorder The DSM-IV-TR states that self-harm, impulsivity, and rapid changes in interpersonal relationships "may warrant a concurrent diagnosis of borderline personality disorder." Steven Lynn and colleagues have suggested that the significant overlap between BPD and DID may be a contributing factor to the development of therapy induced DID, in that the suggestion of hidden alters by therapists who propose a diagnosis of DID provides an explanation to patients for the behavioral instability, self-mutilation, unpredictable mood changes and actions they experience. In 1993 a group of researchers reviewed both DID and borderline personality disorder (BPD), concluding that DID was an epiphenomenon of BPD, with no tests or clinical description capable of distinguishing between the two. Their conclusions about the empirical proof of DID were echoed by a second group, who still believed the diagnosis existed, but while the knowledge to date did not justify DID as a separate diagnosis, it also did not disprove its existence. Reviews of medical records and psychological tests indicated that the majority of DID patients could be diagnosed with BPD instead, though about a third could not, suggesting that DID does exist but may be over-diagnosed. Between 50 and 66% of patients also meet the criteria for BPD, and nearly 75% of patients with BPD also meet the criteria for DID, with considerable overlap between the two conditions in terms of personality traits, cognitive and day-to-day functioning, and ratings by clinicians. Both groups also report higher rates of physical and sexual abuse than the general population, and patients with BPD also score highly on measures of dissociation. Even using strict diagnostic criteria, it can be difficult to distinguish between<unk>  disorders and BPD (as well as bipolar disorder and schizophrenia), though the presence of comorbid anxiety disorders may help.
Dissociative identity disorder
Substance use disorder
Internalizing disorder
Bipolar disorder
Sexual masochism disorder
Major depressive disorder
Somatization disorder
Post-traumatic stress disorder