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What is DID/OSDD?
Dissociative Identity Disorder, or DID, is a dissociative disorder characterized by multiple separate personality states, amnesia, and dissociation. DID was formerly called Multiple Personality Disorder, or MPD, but this term is outdated and should not be used. DID develops almost exclusively in children 7 or under, but onset can range up to around 9 years infrequently. DID develops when a child still lacking in concrete identity undergoes extreme repeated trauma. Naturally dissociating, the child in pain replaces their self image with that of another, substituting another better suited to withstanding pain. Memories become fragmented to protect the core personality, who may not be made aware of abuse until later in life. These created personalities, or alters, may assume control separately or together.

OSDD stands for Otherwise Specified Dissociative Disorder, and it’s the last catch-all category in the dissociative disorders. The diagnosis DDNOS (dissociative disorder not otherwise specified) was used prior to the DSM-5.

What is Dissociation?
Dissociation is a natural coping mechanism that involves some degree of disconnect between the brain and reality. There are five different kinds of dissociation: depersonalization, derealization, amnesia (that can’t be explained by substances or medical causes), identity confusion, and identity alteration (switching between dissociated parts). Dissociation itself is not a bad thing; it’s the brain’s way of protecting itself from experiences that are damaging and is a natural response to stress. However, it can become a problem when it is chronic, causes distress, or interferes with a person’s ability to function.

What are Alters?
Alters are dissociated states of consciousness. For individuals with DID, they’re able to take executive control of the person, are associated with amnesia, and/or have their own unique identities. For individuals with OSDD-1, all three of those criteria apply to at least some alters at least some of the time. There can be as few as 2 alters and as many as hundreds! Alters can be distinct enough to have their own personalities, likes, dislikes, ages, genders, sexualities, memories, and even species. Alters might even react differently to medication or need different glasses prescriptions.

What is a System?
A system is a collection of alters within one body. The entirety of a system includes all of the alters within one body. Research suggests that males average 12 alters and females average 15 alters. However, systems can range in size from 2 alters to 100s of alters, although in very large systems it is unlikely that all alters will front frequently. Instead, alters in large systems are likely to become active mostly when needed or triggered, and they often present in pairs or small groups.

How to be a friend to someone with DID/OSDD
Whether your friend has just told you they have DID, or you’ve known for a long time, there are right and wrong ways to approach situations with them. Talk to your friend for specifics about them, this absolutely won’t apply to everyone but is a good place to start!

-Treat them like a human, like a person worthy of respect. Never ridicule, sensationalize, or dehumanize them.

-Understand that severe early childhood trauma causes DID, and that it’s likely not appropriate to ask for any details. Don’t press your friend for information, but be available to listen if you can.

-Understand that switching alters is often difficult to detect and you may not be able to distinguish them. Talk to your friend for specifics on how you should react.

-Know that dissociation is at the core of DID, and your friend will likely experience confusion, memory issues, and other dissociative symptoms. These are also not okay to mock and it is never okay to take advantage of these symptoms.

-As with any friend, know that you are entitled to time to yourself and space. People with DID have suffered through far more than anyone should have to, and may come across as “negative.” Support and care for them! Know that you should also be supported and that it’s okay to have space when you need it.

-Don't assume you have the same friendship with all members of the system. Your friend may seem very distant or not remember things about you; please do not take offense to this. You can definitely try to befriend the entire system, but recognize that they are all complex individuals and you will likely have very mixed results.

Communication is the most important thing!