Dissociative Identity Disorder 293
identities. When alternate personality states are not directly observ ed, the disorder can be
identified by two clusters of symptoms: 1) sudden alterations or discontinuities in sense of
self and sense of agency (Criterion A), and 2)  recurrent dissociative amnesias (Criterion B).
Criterion A symptoms are related to disconti nuities of experience that can affect any
aspect of an individual’s functioning. Indivi duals with dissociative identity disorder may
report the feeling that they have suddenly  become depersonalized observers of their
“own” speech and actions, which they may feel po werless to stop (sense of self). Such in-
dividuals may also report perceptions of voices (e.g., a child’s voice; crying; the voice of a
spiritual being). In some case s, voices are experienced as multiple, perplexing, indepen-
dent thought streams over which the individual  experiences no contro l. Strong emotions,
impulses, and even speech or other actions ma y suddenly emerge, without a sense of per-
sonal ownership or control (sense of agency).  These emotions and impulses are frequently
reported as ego-dystonic and puzzling. Atti tudes, outlooks, and personal preferences
(e.g., about food, activities, dress) may sudde nly shift and then shift back. Individuals may
report that their bodies feel different (e.g.,  like a small child, like the opposite gender, huge
and muscular). Alterations in sense of self and loss of personal agency may be accompa-
nied by a feeling th at these attitudes, emotions, an d behaviors—even  one’s body—are
“not mine” and/or are “not under my control.” Although most Criterion A symptoms are