294 Dissociative Disorders
der. The identities that arise during possessio n-form dissociative identity disorder present
recurrently, are unwanted and involuntary, cause clinically significant distress or impair-
ment (Criterion C), and are not a normal part  of a broadly accepted cultural or religious
practice (Criterion D).
Associated Features Supporting Diagnosis 
Individuals with di ssociative identity disorder typically present with comorbid depression,
anxiety, substance abuse, self-injury, non-epileptic seizures, or another common symp-
tom. They often conceal, or are not fully aw are of, disruptions in consciousness, amnesia,
or other dissociative symptoms. Many individu als with dissociative identity disorder re-
port dissociative flashbacks during which they undergo a sensory reliving of a previous
event as though it were occurring in the presen t, often with a change of identity, a partial
or complete loss of contact wi th or disorientation to current  reality during the flashback,
and a subsequent amnesia for the content of the flashback. Individuals with the disorder
typically report multiple types of interpersonal maltreatment during childhood and adult-
hood. Nonmaltreatment forms of overwhelming early life events, such as multiple long,
painful, early-life medical pr ocedures, also may be reported. Self-mutilation and suicidal
behavior are frequent. On standardized meas ures, these individuals report higher levels
of hypnotizability and dissociativity compared with other clinical groups and healthy con-
trol subjects. Some individuals experience transient psychotic phenomena or episodes.
Several brain regions have been implicated in the pathophysiology of dissociative identity
disorder, including the orbito frontal cortex, hippocampus, parahippocampal gyrus, and
amygdala.
Prevalence
The 12-month preval ence of dissociative id entity disorder among adults in a small U.S.