DID is (mostly) a culture-bound disorder

It’s been nearly 2.5 years since I first started therapy for DID, and in that time I’ve gained massive amounts of insight into how my early childhood experiences have shaped my way of experiencing the world. Before I gained this insight, however, came confusion. Specifically, I truly didn’t understand how this fantastical-sounding diagnosis of DID that had been given to me by multiple mental health professionals applied to me and my experiences. In the years that followed my diagnosis, I spent a significant amount of time playing with my understanding of what DID is, and perhaps more importantly, what DID is not. At this point in time, I am very comfortable stating that DID is, first and foremost, a culture-bound disorder. DID is not a neutral description of internal experience—it is a culturally prescribed narrative framework that shapes, and sometimes distorts, how dissociation is interpreted and lived.

A culture-bound disorder is one where cultural factors significantly influence how the disorder is conceptualized, understood, and presented. In the case of DID, the way it is interpreted in the present day is just one way of understanding a specific set of experiences, which is shaped by cultural narratives and is not based on any definitive reality. This doesn’t mean DID isn’t real—in fact, I believe DID is very real to those who experience it. However, I believe that there are major cultural influences that shape how DID presents and is understood, and that needs to be acknowledged.

What the label of DID is attempting to describe is a post-traumatic reaction that is very complex, but in general terms, involves pathological and extreme use of compartmentalization as a coping mechanism. While DID is most often conceptualized as a disorder of identity, DID is more accurately conceptualized as a disorder of compartmentalization. Compartmentalization captures the essential mechanism underlying the disorder: the rigid separation of memory, emotion, and self-experience that results in barriers to conscious awareness. The personification of compartmentalized internal states as “different identities”—complete with names, ages, genders, and preferences—is not inherent to the experience of dissociation. It is a learned framework, shaped by cultural narratives about how dissociation should be understood and described.

Identity fragmentation is one possible outcome of dissociative compartmentalization, but it is not inherent to it. The dominant model of DID assumes that compartmentalization leads to “multiple identities”, but this is an interpretive layer imposed on a deeper structural process. At its core, compartmentalization is the rigid separation of memory, emotion, and self-experience—disruptions that can occur without any sense of distinct selves. While identity fragmentation is one way of interpreting dissociative compartmentalization, compartmentalization does not necessitate identity fragmentation. Compartmentalization captures identity fragmentation within its broader framework, but identity fragmentation alone does not fully encapsulate the complexity of compartmentalization.

Framing DID as a disorder of identity not only misrepresents the core mechanism—it also prescribes how people interpret and describe their internal states. This framing encourages the personification of compartmentalized experiences, reinforcing the belief that they are inherently multiple identities.

Because DID is conceptualized as a disorder of identity, it encourages a culturally mediated interpretation of one’s internal experience. In this way, it becomes nearly impossible to disentangle the underlying dissociative mechanisms from the interpretive frameworks layered on top of them. So while DID may not feel like a culture-bound disorder to those who live with it, it strongly fits the definition of one. And as with all culture-bound syndromes, those within the experience rarely recognize it as culturally shaped—because the narrative feels like the only possible explanation.

There is a huge cultural component to dissociative identity disorder—even though the underlying symptoms and experiences may be similar between those diagnosed with DID, how one comes to interpret those experiences can vary significantly. And once one chooses a specific conceptualization to understand and describe their experiences, this can further influence how their symptoms present, creating a positive feedback loop¹. Right now, there is one dominant cultural understanding of what DID is which encourages people to have a very narrow view of their disorder. I believe this is actively harmful to those who live with “dissociative identity disorder”². The current conceptualization of DID should be entirely reworked to not introduce cultural bias into the diagnostic criteria—a more cohesive diagnosis called Complex Dissociative Disorder I/II has been proposed, which I very strongly agree with.

So while the underlying phenomenon that the label of DID is attempting to describe is something that many people experience, simply conceptualizing those experiences in the particular way that the diagnosis of DID does shapes how one experiences those symptoms. The pervasive “multiple people in the same body” narrative is not an inevitable outcome of dissociation—it’s a product of cultural storytelling about how such experiences should be understood. It is entirely and unequivocally a product of our culture.