community study was 1.5%. The prevalence ac ross genders in that study was 1.6% for
males and 1.4% for females. 
Development and Course
Dissociative identity disorder is associated  with overwhelming experiences, traumatic
events, and/or abuse oc curring in childhood. The full disorder may first manifest at al-
most any age (from earliest childhood to late life). Dissociation in children may generate
problems with memory, concentration, attach ment, and traumatic play . Nevertheless, chil-
dren usually do not present with  identity changes; instead they present primarily with over-
lap and interference among mental states (Cri terion A phenomena), with symptoms related
to discontinuities of experience. Sudden changes in identity during adolescence may ap-
pear to be just adolescent turmoil or the ea rly stages of another mental disorder. Older
individuals may present to treatment with what appear to be late-life mood disorders, ob-
sessive-compulsive disorder, paranoia, psycho tic mood disorders, or even cognitive dis-
orders due to dissociative amnesia. In some  cases, disruptive affects and memories may
increasingly intrude into aw areness with advancing age. 
Psychological decompensation and overt change s in identity may be triggered by 1) re-
moval from the traumatizing situation (e.g.,  through leaving home); 2) the individual’s
children reaching the same age at which the in dividual was originally abused or trauma-
tized; 3) later traumatic experiences, even seemingly inconsequential ones, like a minor
motor vehicle accident; or 4) th e death of, or the onset of a fatal illness in, their abuser(s).
Risk and Prognostic Factors 
Environmental. Interpersonal physical and sexual abus e is associated with an increased