Dissociative Identity Disorder (DID) & Addiction | Symptoms, Risk Factors, & Dual Diagnosis Treatment

While substance use disorder (SUD) can be devastating on its own, it is often experienced by those with other mental disorders. These co-occurring disorders often play off one another, potentially deepening the harmful effects of both conditions.

Dissociative identity disorder (DID) is one such mental health disorder that, when it occurs alongside a SUD, necessitates specialized treatment to address both conditions during the same program.

Dissociative Identity Disorder/Substance Use Disorder Dual Diagnosis

Formerly known as multiple personality disorder, DID is a severe form of dissociation that interferes with a person’s thoughts, memories, feelings, and actions. It can affect their sense of identity or self, resulting in the development of two or more distinct personalities. 

These personality states will then switch, influencing a person’s behavior and thinking. Lapses in memory are extremely common.

While DID has a low prevalence, being found in only about 1.5% of the population, those who have the disorder very often have co-occurring or comorbid conditions ranging from SUD to post-traumatic stress disorder, major depression, eating disorders, and others.

Self-Medication

Those with DID may turn to substance abuse to self-medicate, using substances as coping mechanisms to reduce the discomfort associated with their DID. Or the abuse may escalate due to a compromised identity and impaired self-control.

Alternatively, heavy or prolonged use of substances may aggravate existing or dormant mental health conditions, causing their effects to increase greatly as addiction deepens.

Symptoms Of Dissociative Identity Disorder

There are two main forms of DID: possession and non-possession.

Possession

In possession form, the different alternate personalities inside an individual seem to take them over entirely. Each distinct identity is clear and obvious to those nearby and each may have different names, voices, and mannerisms.

Non-Possession

In non-possession form, the competing identities remain mostly internal. A person may hear voices or have conversations inside their head between their different personalities. 

Or, they may begin to feel like a passenger in their own body while doing or saying things that don’t line up with their normal behavior. Non possessive DID is sometimes misdiagnosed as schizophrenia for these reasons.

Other signs and symptoms of DID include:

• dissociative amnesia (short or long-term memory loss)
• intense headaches
• hallucinations
• depersonalization
• depression
• anxiety
• self-harm
• suicidal behavior
• sexual dysfunction
• flashback hallucinations
• emotional unavailability and unreliability
• difficulty responding appropriately to everyday events
• impaired ability to maintain personal relationships
• increased likelihood of developing other mental health conditions

Symptoms Of Substance Use Disorder

Common signs and symptoms related to substance use disorder (addiction), including alcohol use disorder, include:

• substance cravings
• distraction or obsessive thoughts
• devoting increasingly large amounts of time to getting and using substances
• using more of a substance over time to compensate for tolerance
• using or drinking more than you intended 
• spending more money on substances than you intended
• withdrawal from social connections and other interests
• failure to meet work, school, or family responsibilities
• taking risks related to substance use (drunk driving, theft, entering dangerous situations)
• using the substance despite mental or physical harm
• feeling that you need to use the substance to prevent withdrawal symptoms
• being unable to stop using the substance, even if you try

DID & SUD Risk Factors

Dissociative disorders such as DID are not thought to be genetic. Instead, mental health professionals believe they develop as a result of past traumatic experiences, especially trauma experienced as a child. 

These traumatic events, including war, kidnapping, torture, sexual abuse, and childhood abuse, can be so disturbing that the mind will dissociate in order to protect itself, potentially leading to the formation of multiple personalities and other mental health problems.

Alternatively, risk factors for substance use disorder can include:

• genetic predisposition to addictive behavior
• the presence of other mental health disorders
• being exposed to substance use at a young age
• growing up with a lack of parental involvement
• trauma, especially childhood trauma

Dual Diagnosis Treatment For DID & SUD

When an individual enters rehabilitation with a dual diagnosis, it’s important that treatment be carefully tailored by clinicians to fit their situation. Both addiction and mental health disorders must be addressed simultaneously. 

This integrated approach will require special care and attention and is likely conducted in an inpatient setting.

Treating Dissociative Identity Disorder (DID)

While there is no cure, DID can be successfully managed. It is generally treated with various forms of psychotherapy as well as the use of antidepressants or anxiolytics. 

The ultimate goal of treatment is to help the person process traumatic memories, integrate their separate personalities, and keep them and those around them safe once they leave rehabilitation.

Specific DID therapies can include:

• cognitive-behavioral therapy (CBT)
• eye movement desensitization and reprocessing (EMDR)
• dialectical behavior therapy (DBT)
• hypnosis
• family therapy
• meditation and relaxation

Treating Substance Use Disorder

Addiction treatment is designed to help individuals end drug abuse and manage withdrawal symptoms under the care of a healthcare professional before entering into therapy and other treatment services. 

Treatment options for substance use disorder include:

• medical detox
• medication-assisted treatment
• motivational interviewing
• cognitive behavioral therapy
• peer support programs

If you or a loved one are experiencing dissociative symptoms with co-occurring substance abuse, professional help is available. Please contact Ark Behavioral Health to learn more about dual diagnosis treatment programs.