What pathology is the diagnosis of DID attempting to capture?

Dissociative identity disorder (DID) is arguably the most misunderstood and sensationalized diagnosis in psychiatry. It is often depicted in terms of dramatic identity fragmentation—multiple people living in one body, each with distinct names, personalities, and preferences. But strip away the theatrics, the cultural metaphors, and the imposed conceptual frameworks, and you’re left with a simple, serious question:
What, exactly, is this diagnosis trying to describe? What is the underlying pathology?

To answer that, we have to peel back the language.

The problem isn’t “identity”. It’s structure.#

The current name—dissociative identity disorder—frames the issue as one of fragmented identity. But this is a surface-level interpretation. “Identity” is not a stable, well-defined psychological construct; it is a vague and highly culturally-contingent term that can encompass values, preferences, roles, narratives, and self-perception (Hammack 2008​ ). Framing this disorder as a problem of identity embeds major cultural bias into how the condition is defined, recognized, and treated. The result is a narrative that may be compelling but ultimately obscures the actual mechanism.

Beneath the label, DID is attempting to describe a particular kind of pathological compartmentalization.

This is a process wherein memory, emotion, perception, and self-experience become functionally divided into mutually inaccessible compartments. These compartments are not mere mood shifts or fleeting states—they are rigid and persistent dissociative boundaries that prevent integration. It is this fragmentation of self-processes, not identity per se, that lies at the heart of the pathology (Nijenhuis et al. 2010​ , Van der Hart et al. 2004​ ).

In essence, DID is a disorder of internal disconnection—not between “people”, but between fundamental elements of consciousness.

The etiology: adaptive origins, pathological persistence#

Dissociative identity disorder does not develop randomly. Research consistently shows that it arises in the context of severe and repeated early childhood trauma, particularly when that trauma occurs in environments marked by disorganized attachment (Liotti 2006​ ; Lyons-Ruth et al. 1999​ ; Farina et al. 2019​ ). These are not just difficult childhoods—they are situations where the child experiences chronic fear and is unable to rely on their primary caregiver for protection or emotional regulation.

In such environments, the child cannot escape the source of distress, nor can they process or resolve it. As a result, the child’s mind may adapt by partitioning overwhelming experiences away from conscious awareness. This defensive dissociation is not pathological in itself—it is an adaptive mechanism. It allows the child to maintain basic psychological stability by separating the unbearable from daily functioning. In this way, dissociation is a survival strategy (Lyons-Ruth et al. 2006​ ).

However, when these patterns of compartmentalization become rigid and automatic, especially during critical periods of neurodevelopment, they can persist into adulthood. The protective strategy becomes maladaptive. Instead of helping the individual function, these dissociative barriers begin to interfere with memory, perception, emotional regulation, and self-awareness. At this point, the adaptive structure becomes a chronic disorder—defined by involuntary and persistent divisions within the self (van der Hart et al. 2006​ ; Lanius et al. 2010​ ).

It’s important to clarify that pathological compartmentalization is not the root cause of dissociative identity disorder, but its structural outcome. The rigid divisions observed in DID emerge from more fundamental defensive processes—such as disavowal, affect phobia, and state-dependent encoding—that prevent the integration of perception, memory, and emotion. These mechanisms function to protect the developing mind from intolerable experience, but when they become chronic and automatized, they give rise to persistent dissociative structures. As Van der Hart et al. 2004​  argue, trauma-related dissociation reflects a failure of integration among distinct psychobiological systems that constitute personality, maintained over time by phobic avoidance and integrative deficits. Understanding compartmentalization in this way—as a downstream expression of earlier disruptions—helps clarify the architecture of the disorder without reducing it to a surface phenomenon.

DID, then, is best understood as a neurodevelopmental disorder that emerges when the normal integration of consciousness, memory, and sense of self is disrupted by extreme early adversity. It is not about identity confusion. It is about the failure of integration in the face of overwhelming stress and disorganized caregiving.

The cultural overlay: identity as interpretation#

As one’s awareness of of their fragmented internal experience emerges, the next challenge is how to describe it—both to oneself and to others. Structural dissociation of this kind is inherently internal and invisible. Organically, unless one is in distress, there are often no outward signs of switching, and even when shifts occur, they may not be recognizable to outside observers. The experience is subtle, fragmented, and difficult to express.

To make sense of this complexity, one may adopt the dominant cultural narrative for conceptualizing such experiences: that of “multiple people in one body”. This metaphor gained traction because it offered a dramatic and legible way to communicate internal divisions. The idea dates back at least to 19th-century case studies like those of Louis Vivet, whose shifting behaviors were interpreted through the lens of multiple personalities (Ellenberger 1970​ ). In the 20th century, high-profile cases such as Sybil (Schreiber 1973​ ) and The Three Faces of Eve (Thigpen and Cleckley 1957​ ) helped solidify the concept in the public imagination. These portrayals did not merely reflect psychiatric thinking—they helped define it, shaping both popular and clinical understandings of what dissociation “looks like”.

This theatrical framing soon came to dominate how the disorder was recognized. In the early stages of the disorder’s cultural recognition, only the most dramatic cases—those who visibly enacted the “multiple identities” narrative—were acknowledged and studied. This created an epistemic filter: dissociation was only recognized when it presented as overt, personified switching. These cases sparked clinical interest and public awareness, and as this metaphor spread, it gave others—whose experiences of compartmentalization were less visible—a framework through which to recognize their own symptoms. By making the disorder legible, the metaphor opened the door to research and theoretical development and helped disseminate the core concept of compartmentalization across both clinical and cultural contexts.

In that sense, the metaphor served a purpose. It made an invisible disorder visible. It gave people a way to articulate otherwise inexpressible internal divisions and it provided clinicians with a working model for engaging with fragmented internal experience. But what began as a communicative scaffold slowly hardened into diagnostic expectation. Today, therapeutic models such as Internal Family Systems (IFS) and other parts-based therapies encourage individuals to conceptualize internal states as distinct “parts” or subpersonalities (Schwartz 1995​ ). While originally intended as metaphors for internal dynamics, these frameworks have increasingly been taken literally in dissociative disorder spaces. The “multiple identities” framing became the dominant lens through which dissociation was interpreted—one that emphasized performance over mechanism, and identity over structure.

Organically, not everyone naturally conceptualizes their dissociative symptoms as “alters”. But as the “multiple identities” model became dominant—through media, therapy, and diagnostic language—individuals who might not have initially framed their experiences this way began adopting the narrative. This looping effect (Hacking 1995​ ) reinforced the model: the more people used the framework, the more it became embedded in clinical and cultural expectations, including in the DSM itself.

Importantly, the phenomenon of severe internal compartmentalization has not always been understood through the lens of multiple identities. Throughout history, various schools of thought have described the same underlying dissociative structure without invoking the notion of separate selves. In psychoanalysis, Leonard Shengold’s Soul Murder documents cases that can be interpreted as dissociative identity disorder, describing the experience as “living in compartments” (Shengold 1979​ , Shengold 1989​ ). Similarly, Philip Bromberg’s work explores dissociation as the coexistence of mutually unlinked self-states that lack reflective awareness of one another—but without personification (Bromberg 1998​ , Bromberg 2006​ ). These perspectives frame dissociation as a structural and developmental failure of integration, not as identity fragmentation. Even Pierre Janet’s early work on dissociation (Janet 1907​ ) focused on the splitting of consciousness and the formation of “automatisms”, again without invoking the metaphor of multiple persons. These alternative frameworks suggest that the theatrical “multiple identities” interpretation is not intrinsic to the phenomenon—it is a cultural and historical overlay.

Today, we are at a point where we can move beyond this metaphor. We now understand the underlying mechanism: a failure of integration, driven by early trauma and attachment disruption. The theatrical framing may have once served a purpose, but it has also introduced cultural bias into how the disorder is perceived, diagnosed, and treated.

Removing the language of “multiple identities” allows us to see DID more clearly. It is not a disorder of identity, but of structure. It is not about becoming other people—it is about becoming divided from oneself. As our understanding deepens, our language should evolve to reflect that clarity.

Why the name matters#

If we misidentify the pathology, we risk reinforcing it. When DID is framed as “multiple identities”, it substitutes metaphor for mechanism. While this framing can offer relief by making internal experience more legible for some, it also risks encouraging dramatized expressions of dissociation and obscuring the underlying structural dysfunction. Just as importantly, individuals with severe internal compartmentalization who don’t relate to the concept of “alters” may reject the diagnosis entirely or never seek help. The true pathology—compartmentalization, not identity—gets lost in translation.

This confusion also opens the door to misidentification. Individuals who do not exhibit trauma-driven structural dissociation may still resonate with the narrative of internal multiplicity and adopt that framework for their self-concept. And because diagnostic criteria are behaviorally defined, someone can meet the threshold for a DID diagnosis without experiencing the underlying mechanism the diagnosis was meant to capture. This becomes particularly relevant in the context of the plurality movement, where individuals may identify as “plural” or as having multiple selves—often without trauma, amnesia, or distress (Schechter 2024​ ). While this framework may serve important functions for identity exploration or coping for some, it is categorically distinct from the involuntary, trauma-based fragmentation seen in true DID.

To understand DID as a culture-bound diagnosis is not to question its validity, but to recognize that language shapes perception. The identity-based framing transforms structural dissociation into metaphor—and when metaphor is mistaken for mechanism, diagnostic clarity suffers. This is why naming matters. Not because language must be rigid, but because diagnoses must remain anchored to mechanism. The goal isn’t to invalidate meaningful frameworks for self-understanding, but to preserve clarity around what the underlying dysfunction this disorder is attempting to capture.

So what is DID?#

At its core, DID is:

• A disorder of compartmentalization, not identity.
• A structural disconnection between states of memory, perception, and emotion.
• A protective adaptation that becomes a pathology when it rigidifies.
• A cultural construct (“multiple identities”) layered over a real phenomenon (severe internal compartmentalization).

The diagnosis is trying to capture a deep and persistent fragmentation of the self—not as a narrative, not as a role-played system, but as a psychological architecture designed to survive overwhelming experiences.

What it often ends up capturing, however, is the narrative that society has learned to tell about that architecture.

It is time to revise that story.