Treatment for dissociative identity disorder (DID) is associated with improvement in the research that exists, though that research is mostly follow-up and review rather than controlled trials. A 2014 review concluded that carefully staged, trauma-focused psychotherapy is associated with improved symptoms and functioning and fewer hospitalisations, while the research on medication is sparse. [brand-2014] This guide covers what the main studies found, what they did not show, and what to ask a clinician. Our overview of dissociative identity disorder covers what the condition involves and the three phases of treatment.
Does treatment for dissociative identity disorder work?
The research suggests that it does help, within limits on how firmly that can be said. A 2014 review, written to test the claim that DID treatment is harmful against the claim that it is helpful, found that phasic treatment consistent with expert consensus guidelines was associated with improvements in a wide range of symptoms and functioning, decreased hospitalisation and reduced costs of treatment. [brand-2014]
The same review reported that poor outcomes were associated with treatment that did not specifically engage with DID self-states to repair identity fragmentation and reduce dissociative amnesia. Its conclusion was that carefully staged trauma-focused psychotherapy results in improvement, whereas dissociative symptoms persist when not specifically targeted. [brand-2014]
What did the six-year follow-up find?
Patients did better on several measures six years on, according to their therapists. The Treatment of Patients with Dissociative Disorders (TOP DD) follow-up had 61 therapists answer questionnaires about their study patients’ stressors, quality of life, global functioning, victimisation and safety. [myrick-2017]
Over time, patients had significantly fewer stressors, fewer instances of sexual revictimisation and fewer psychiatric hospitalisations (Cohen’s d of 0.43), as well as higher global functioning. The authors concluded that, despite marked initial difficulties and functional impairment, patients benefit from specialised treatment. [myrick-2017]
| Source | Design | What it found |
|---|---|---|
| 2014 review (Brand et al.) | Review of the empirical support for and against treatment | Phasic treatment associated with improvement; harm claims rest on anecdote |
| 2017 six-year follow-up (Myrick) | Therapists’ questionnaires about their patients, 61 therapists | Fewer stressors and hospitalisations, higher functioning |
| 2019 systematic review (Sutar) | 5 placebo-controlled randomised trials, 214 participants | Modest evidence for two drugs for some symptoms; high heterogeneity, few trials |
Can therapy make dissociative identity disorder worse?
Some people claim it can, and the authors of the 2014 review argue the evidence does not support that. They concluded that claims treatment is harmful are based on anecdotal cases, opinion pieces, reports of damage not substantiated in the scientific literature, misrepresentations of the data and misunderstandings about DID treatment. [brand-2014]
They went further, writing that harm is far more likely to come from depriving people with DID of treatment consistent with expert consensus than from providing it. [brand-2014] That is the authors’ own conclusion, and it is worth weighing as one reading: the review’s authors work in this field, and the 2014 review and the 2017 follow-up share an author, Bethany Brand, so the two are not fully independent evidence. [myrick-2017]
Is there a medication for dissociative identity disorder?
Not in the research we could verify, which does not single out DID. A 2019 systematic review of medication for dissociative disorders found only 5 randomised placebo-controlled trials with 214 participants. The response rate was 68.42% (65 of 95) in the medication groups and 39.49% (47 of 119) in the control groups, but the pooled risk ratio was 1.59 with a 95% confidence interval from 0.76 to 3.30 (P = 0.21), so the pooled estimate was not statistically significant. [sutar-2019]
Crude response rates in the medication and control groups across 5 randomised placebo-controlled trials of pharmacotherapy for dissociative disorders (214 participants), Sutar and Sahu (2019). The pooled risk ratio was 1.59 (95% CI 0.76 to 3.30), which includes 1.
The review’s highlights list the response as higher than placebo for lamotrigine, paroxetine and naloxone, and negative for fluoxetine and naltrexone. Its conclusion was that paroxetine and naloxone are the only agents studied in randomised trials and found to have modest evidence, for depersonalisation symptoms and for dissociative symptoms comorbid with PTSD and borderline personality disorder, and that the results should be interpreted with caution given high heterogeneity and scanty literature. [sutar-2019]
Note what that does and does not cover. The trials were of dissociative disorders as a group, and the conclusions concern particular symptoms alongside other conditions, not DID itself. [sutar-2019]
What do these studies not show?
They cannot tell you which approach will work for you, or how much of any improvement is down to treatment. Five limits matter most:
- No comparison group is described for the follow-up. The six-year study reports therapists’ questionnaires about their patients, and its abstract does not describe a control group, so it cannot separate treatment from time. [myrick-2017]
- The sources overlap. The 2014 review and the 2017 follow-up share an author, Bethany Brand, so they should not be counted as independent confirmations. [brand-2014] [myrick-2017]
- The review argues a position. It was framed as testing two opposed claims and concluded for one, so read its conclusion alongside the other studies and not as the last word. [brand-2014]
- Reports come from therapists. The follow-up measures were therapists’ accounts, and the abstract does not say how many patients stopped treatment or could not be followed. [myrick-2017]
- The medication trials are few and mixed. Five trials, high heterogeneity and scanty literature limit what can be said, and the results were not specific to DID. [sutar-2019]
What should you look for in a therapist?
Look for someone who works in stages and has experience with dissociation, because that is the approach the evidence above is about. This section is our suggestion and is not something the studies tested.
Ask whether they work in phases, starting with safety and stability before any work on traumatic memory, and whether they have treated dissociative disorders before. The 2014 review links poor outcomes to treatment that does not directly address the dissociation, so it is reasonable to ask how they would. Our guide to DID versus borderline personality disorder covers a common misdiagnosis that can send treatment in the wrong direction, and complex PTSD covers the trauma side.
No screener on this site covers dissociation or DID yet. The self-assessment hub lists the seven we do have, and none is built for this question.
When to seek help
Speak to a doctor or a mental health professional if you lose stretches of time you cannot account for, feel unreal or cut off from yourself, or have found yourself in places with no memory of getting there. Seek urgent help if you have thoughts of harming yourself or feel unable to stay safe: contact your local emergency services or a crisis helpline.
How MyFreud can help
Between sessions, a record can help. Daily mood tracking in MyFreud shows how your days run, and the notepad is somewhere to note stressors, sleep and how a day felt. It does not replace a clinician.
Download MyFreud and start today: App Store or Google Play.