Dissociative Identity Disorder explained by Bethany Brand - Front-rank researcher and clinician talks about dissociation, trauma, and treatment

By: Tom Cloyd - 5 minute read

(Published: 2025-10-26; reviewed: 2025-10-26:1850 Pacific Time (USA))

Bethany Brand PhD

Bethany Brand PhD, Towson University

 

Dissociative identity disorder (DID) is hardly unknown, thanks to florid depictions in movies and popular books. But such depictions lead to false beliefs and needless fears, because in truth the disorder is more covert, subtle, and complex than most people imagine.

One of the first beliefs to be corrected is the long-standing idea that DID is rare. A major reason for this belief, historically, is that people with DID typically try hard to remain essentially invisible. But, in truth, the lifetime prevalence of DID is several times that of schizophrenia.1

Esteemed researcher and clinician Bethany Brand2 describes DID in this podcast interview3 done for the American Psychological Association.

 

Page contents…

Listen to the whole podcast (or read the transcript) online

DID is a mental disorder characterized by dissociative self-states. To understand what this means, we must first understand the meaning of “dissociation”. Dissociation is a mental state characterized by a separation from one’s physical location, feelings, or sense of being a whole person.

There are two sorts of dissociation: normal and pathological. Any time our mind is focused on something apart from what we’re doing, we’re experiencing normal dissociation. It can surely cause problems, such as when we miss a turnoff while driving because we are thinking about whom we are preparing to meet.

Pathological dissociation is significantly different. It occurs as a result of having experienced serious psychological trauma, especially chronic childhood trauma. It involves a fundamental disconnection from what one is feeling and memories of what one has felt.

The emergence of DID is intimately associated with vulnerabilities inherent in childhood development. Abusive experiences, occurring repetitively over time, tend to lead to emotional disconnection and can lead to dissociative amnesia, a state in which what happened is no longer readily accessible in memory. There can be benefits to this in the short-term, but eventually it’s seriously dysfunctional.

The formal diagnostic criteria for DID require the presence of dissociative self-states. This means that a person’s sense of self is fragmented into parts, and this, of course, includes memory of their history.

Popular media presentations of DID typically show highly visible shifts from one self-state (also called alter) to another. In actuality, such radical changes in speech, behavior, etc., are rarely seen. In addition, common media representations usually depict highly deviant behavior - hypersexualization or violence, for example. This is simply inaccurate.

These misrepresentations are damaging to those with DID. Brand’s current research is showing that people with DID experience serious fear and distress when anticipating or encountering expectations in other people based on such misleading depictions.

There is also the problem of personal misunderstandings - of people with DID not understanding why parts of their lives make little or no sense. People know them whom they don’t recognize, for example, and this can be frightening. Or they have memory lapses that are inexplicable and surely dysfunctional. This is usually quite distressing.

Mischaracterizations also occur with mental health professionals, because the clear majority of people with DID are misdiagnosed with schizophrenia, or bipolar disorder. Co-occurring disorders are common in DID - severe depression, addictions, and PTSD, for example, but they are not the primary diagnosis.

Misassessments by mental health professionals do not have to happen. There exist several well-validated assessment tests that can be used, as well as detailed structural interviews that can lead to better understanding of exactly what is happening with someone who comes in for help. But these tools are not used enough.

Because there’s so much going on with people who are living with DID, the first concern in treatment is always stabilization. Various self-harm behaviors, including suicide attempts, are quite common. Then there’s the problem of sleep disturbance, which has distinct undesirable side effects. So, the initial focus in treatment necessarily is on increasing personal safety.

A special aspect of this concern for stabilization concerns the problem of shame. Catastrophically negative views of oneself are inherently destabilizing and so must be addressed as part of the general attempt to get control of destructive symptoms.

The second stage of treatment, addressing traumatic memory, although not possible for everyone, must be approached carefully and can be managed successfully. The experience and skill of the therapist is critical, as this work is painful and there’s typically a lot of grief involved because there have been so many losses for the abused person.

In both stage 1 and stage 2 work, assisting the various parts of self to become more aware of and cooperative with each other is critical, and facilitates the stabilization and trauma processing work.

In the final stage of treatment, stage 3, the focus is on normalization - learning to function in normal ways that are productive and healthy.

Three sorts of medications can be helpful in symptom management: antipsychotics (which can have a calming effect), antidepressants, and anxiolytics (anti-anxiety medications). Unfortunately, commonly used anxiolytics can be addictive, and addiction in general is a common problem in DID.

Regarding dissociation itself, there unfortunately exists no medication that is in any real way helpful.

Major advances in assessment and neuropsychological understanding of DID have not prevented the persistent denial of the reality of dissociative identity disorder by a few professionals in mental healthcare. But several notable attempts to show that it can be faked have all failed. Moreover, professional assessment tests can readily detect real versus fake trauma and dissociative disorders. In addition, recent work with brain scans have achieved exactly the same clear distinction. It is clear now that there is no real basis for denying the reality of trauma and dissociative disorders.

Understandably, significant numbers of the general public the professional mental health community are intensely uncomfortable with the topic of chronic severe abuse of children, which is how DID comes about. The topic is one that many people want to avoid.

Avoidance, however, doesn’t make the reality of DID go away. It has been found and diagnosed all over the world, even in places where people have never heard of it or seen movies about it. Scientific assessment tools confirm that it’s found everywhere.

References ^

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5 – fifth edition (5th ed). Washington, D.C: American Psychiatric Association.

Speaking of Psychology: What is dissociative identity disorder? With Bethany Brand, PhD - Episode 191. (2022). Retrieved October 25, 2025, from: <>

Notes ^

  1. APA (2013), p. 103. ^

  2. Dr. Brand is a psychology professor at Towson University, one of Maryland’s public universities. She specializes in the dissociative disorders, their assessment and treatment, and educating the public about their nature. She also has a clinical practice, and serves as an expert witness in court. ^

  3. Speaking of Psychology…, (2022). ^

 

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