Alters in Dissociative Identity Disorder (MPD), OSDD and Partial DID

    (DID) was previously known as Multiple Personality Disorder (MPD), and is sometimes incorrectly called "split personality" or even "dissociated personality", and it is characterized by the presence of more than one distinct sense of identity within a single human body. The alternate identities in people with DID are commonly known as alters, or dissociated parts of the personality.

    What are Alters?

    Other terms for alter include: alternate identity, dissociative identity, distinct personality state, distinct identity, personality state, personality, dissociated part, self-state, part, part of the mind, part of the self, dissociative part of the personality. [1],[2] [6]:121

    Alter Identities in Dissociative Identity Disorder and OSDD - photos of their internal body image and external presentation
    Alter identities may vary in gender, age, roles and attitudes.
    Each alter here has a different perception of their appearance (top row), compared to how they actually look (bottom row)
    Image © Jessica Clark MultiplicityAndMe.

    A person with Dissociative Identity Disorder (DID), or a similar form of (previously called Dissociative Disorder Not Otherwise Specified, or DDNOS-1) has a fragmented personality. A person with DID experiences himself or herself as having separate identities, known as alters, or alternate identities, and previously known as personalities.[1]:292, [6] Alters take over control of the person's body or behavior at various times. [1] Each can function independently. All the alters together make up the person's whole personality. Alters typically develop from dissociation caused by prolonged early childhood trauma, although attachment problems and persistent neglect in very early childhood are also known factors.[6]:189-191 Once a person has DID, new alters can be created at any age, but are less commonly created in adults. People with alters may refer to their alters as "parts inside, aspects, facets, ways of being, voices, multiples, selves, ages of me, people, persons, individuals, spirits, demons, others," etc. [6]:121 Alter identities are sometimes incorrectly referred to as ego states, or even alter egos, but these states exist in people without alters and do not involve amnesia, dissociative symptoms, or clinical distress.[1], [2] [6]:129


    Some people who daydream for hours at a time create inner characters within their mind, this type of dissociation is known as (MD) when it becomes problematic, or immersive daydreaming when it is not problematic.[43] Groups of inner characters based on fictional sources and/or based on real people/idealized versions of real people are particuarly common in MD. MD is far less recognized than DID and OSDD, this has led to some maladaptive daydreamers to confuse their inner characters with alters, and because alters are unique to DID and OSDD1b, this has caused some people to incorrectly self-diagnose DID or OSDD-1b instead of MD.[43] Maladaptive daydreaming is a behavioral addiction which was first recognized as a probable mental disorder in 2002, by DID specialist Eli Somer. ADHD is extremely common in people with MD, and ADHD's memory problems that can be mistaken for amnesia. The information here on types of alters is relevant only to alters; the differences between the inner characters found in maladaptive daydreaming and alters found in DID/OSDD1 can be found on the Maladaptive Daydreaming Scale page. Inner characters in MD do not follow the same subjective logic or creation/fusion rules as alters caused by DID, for example alters can only fuse together as a result of extended healing, alters do not form in response to minor stressors but only as a survival strategy.

    Characteristics of Alters

    Alters may have
    • different ages, for instance much younger or older;
    • a different gender to the physical body;
    • different names, or no name;
    • different roles or functions, either related to daily life or to trauma;
    • different attitudes, and preferences, e.g, in food, or dress
    • a different perception of their appearance, for e.g., different hair or skin color, body shape;
    • different memories, e.g., some may remember trauma or events in daily life that others have amnesia for;
    • psychobiological difference to others, e.g., different vision, medication responses, allergies, plasma glucose levels in diabetic patients, heart rate, blood pressure readings, galvanic skin response, muscle tension, laterality, immune function, EEG readings, etc. [1]:293, [6]:120-121, [7]:18, [7]:52, 24:[74]

    Different alters have shown different results in neuroimaging tests, including functional magnetic resonance imaging activation, and brain activation and regional blood flow and differences in PET scans. The variability between alters is measurably greater than variability between non-dissociative people who are attempting to simulate alters. [6]:121

    Because many alters have a very different perception of their body, they may disown it, or believe strongly that it is a different chronological age, and refer to as "the body" rather than "my body".[6]:120,140 Alters who believe that they have their own, separate physical body, can result in refusing to seek medical care, and self-harm or suicide attempts, in the belief that they will be unaffected since it is not "their" body which is harmed. This can even involve attempting to kill off "others". [6]:132, 140

    Negotiating with Alters

    This video describes how to negotiate with alters, focusing on alters who are determined to harm or kill the host (the person with DID). These internally homicidal alters may be unaware of the fact that they will also die if the host's body dies.

    Types of Alters

    Types of alters in #dissociativeidentitydisorder Common: Apparently Normal Parts (ANP) / Host,Child alter,Internal Self-helper (ISH),Introjects,Opposite-sex alters,Persecutor,Protector,Sexual Alter,Suicidal Alter or Internal Homicide,Teen alter. Less Common: Animal Alter,Baby and infant alter, Caretaker/Soother, Demon, Demonic and 'Evil' Alter, Fragment, Military or Political Alter, Nonhuman Alter, Robot or Machine Alter, Shell, Spirit, Ghost, or Supernatural being Alters,Sub-parts. No particular types of alter are needed for a DID diagnosis, most people will only recognize a few types. Some people with DID may not recognize any, or may have types not listed. Types of alters depend on what each person needed to survive.
    Types of Alter Personalities (Parts) in Dissociative Identity Disorder
    License: CC BY-ND 4.0.

    All alters can be broadly classed as either Apparently Normal Parts of the Personality (ANPs), or Emotional Parts of the Personality (EPs).[24]:31 In additional, each can have one or more type or role, for example a child alter may also be a protector.[24] People who are "very fragmented" (have a very large number of parts) may also have alters that are a complex mixtures of ANP and EP.[24]:78

    Apparently Normal Parts (ANPs)

    Apparently Normal Parts of the personality have previously been called a "host personality"/"host", and may also be called a Daily Living Part. This is the identity who manages every day life and does not normally hold trauma memories. [9][10] There may be more than one ANP managing daily life at any one time, each with different roles. [9]:30 An ANP may be emotionally unconnected to, or amnesiac for, past traumatic events.[15]:101

    Emotional Parts (EPs)

    Emotional Parts of the Personality (EP) "hold traumatic memory, often being stuck in the sensory experience of the memory and unaware of the passage of time.[9]:21 Tasks involving daily life are managed by ANPs instead, e.g., working, cooking and parenting.[7]:19 All identities within a person can be categorized as ANPs or EPs. Despite their name, some EPs are not emotional.[7]:30

    List of Types of Alter

    Animal Alters

    Abused children may develop animal parts/alters because they identify with animals and consider them friends. Animal parts may be able to express emotions that the Apparently Normal Parts can"t. Animals like tigers may function as protectors, growling when an Apparently Normal Part is distressed. [16]:65 Alters may also become to believe they are animals because abusers either told them they were or treated them like animals, e.g., dog alters. Some abusers are known to force children to act like animals, for example making them bark or use a dog bowl for food.[18] Animal alters may also be created if the person was forced to harm others, as a way of containing the guilt of having to act in a way which feels more violent and animal than human. Complex trauma can leave even a non-dissociative person feeling "inhuman".[16]:65, [23] Animal or animal-like alters should be accepted, and treated just like any other alter.[9]:69, [6]:133,[6]:139 Animal alters can be taught that they are actually part of a human body, and can adapt. For example, a snake alter may be created when a child has arms and legs bound, and be tricked into believing that, like a snake, they do not have arms or legs.[9]:69 Animal alters often have a definite gender and can present, and be accepted, as human, without the person necessarily being aware they are communicating with an animal alter or any alter at all.[18]:55

    Abuser alter/ Persecutor

    See Persecutor. For abuser alters that may have taken on aspects or beliefs of a past abuser, see Introject. [7]:18

    Baby and infant alters

    These alters are pre-verbal (cannot yet express themselves with words). They may remain the same age, or grow older in age and begin to take on more responsibilities. [11]:140 Their trauma memories consist primarily of emotions and bodily sensations.[9]:223-224


    Caretaking alters are a type of a protector, they help manage and care for other alters, and sometimes external people (for example children). [24]:83 They are often motherly, and may be modeled on a real person. [16]:61-62 Caretaking alters lack awareness of self-care and become exhausted easy; they only have a limited role and have little capacity for play, exploration or socializing. [24]:83

    Child alters / Littles

    Often nicknamed "littles" or "little ones" are a common type of alter. Several child alters exist in most people with DID. Child alters often talk in a child-like way, but unlike a biological child they can normally understand abstract concepts and long words. They are often found to hold memories of child abuse which occurred at around the age the child alter feels he/she is. [7]:18 Some may have the speech or appearance of a very young child, the youngest being unable to talk, read or write. [7]:18 Child alters may gradually age of may remain the same age. Some child parts may hold feelings of terror and pain, while others may be playful and fun-living and have only positive memories. [16]:60 A child alter may also be an idealized representation of the "perfect child" from the "perfect" family, for example the "good boy". [7]:18 Child alters should not be confused with the concept of having an "inner child", which applies to non-dissociative people. [6]:129

    Core / Original

    Core personality or core self is a term rarely used now in scientific information. Instead, all people including people with DID are believed to be born with multiple original discrete "behavioral states", which fuse into a single core personality by around age 5/6 during a relatively normal early childhood, but in DID this process is disrupted and the behavior states either remain separate and begin to become increasingly independent, or they split off futher alters. [6] Despite this, some people with DID do identify as having a core self/original personality, and people with DID are not required to perfectly fit current theory in order to meet the diagnostic criteria. For example Chris Costner Sizemore, whose MPD was described by the 1950s movie The Three Faces of Eve, experienced "Eve White" as being her original personality.[7]:11 (Years later, Sizemore discovered an additional 21 alters/parts, which she described in her books). The DSM-III description of Multiple Personality included the term "original personality", described as usually the "subpersonality" whose name was the same as the person's legal name, "original persoonality" which was removed in the DSM-IV (1994).[56]

    In the ICD-11's Partial DID,[3] and in OSDD-1a as described by the theory of structural dissociation,[54] only one distinct dissociative part (ANP) is present, and this is the part dominant in daily life, and physically in control almost all the time.[3],[54] These sources do not include the concept of a "core" or "original", and instead describe this part as an ANP or host, which is also the term used for the alter(s) physically in control most of the time. See Apparently Normal Part of the Personality for [3], [54]

    Dead alter

    Usually this is an alter hidden from the rest of the system, often in a memory of a trauma in which they felt they were being killed. The child who survives a near-death experience may develop a "dead alter" to contain this experience.[16]:64 Alters can"t really die or be killed since the person"s brain is still alive, their feelings will still leak through into other alters. "Dead" alters can be revived.[9]:35

    Demon, Demonic and 'Evil' Alters

    Demon and demonic alters are a type of spirit and supernatural alter but are not actually supernatural beings and may result from spiritual abuse and an abuser who blames the child for the abuse.[6]:170 In abusive groups, a young child can be severely traumatized in order for abusers to intentionally create an alter, and the alter can be tricked into believing they have been possessed by, and have become, a demon. Some survivors report being dressed to look like a "demon" with costumes and theatrical makeup, and being told to look in the mirror and told that they are a demon. Hallucinogenic drugs may also be used to cause supposedly "spiritual" experiences. [9]:68,337 Some demon alters may be told they are animals. They may be very intimidating, with names such as Demon, Lucifer, Satan or Devil, however they should be able to engage with psychotherapy, and all alters should be accepted.[16]:61 These "demonic" or "evil" alters may have the role of maintaining loyalty to the abusive cult which created them, in order to keep the whole person alive. They are often a form of protector known as a persecutor.[11]:142 [9]:337-338 These alters are usually hurt children who have been tricked into believing they are "evil", and may have been tricked or forced into harming others. With "patience, persistence and kindness" they can be allowed to choose a different role once the person is safe from abusers. Attempts to banish them using religious techniques such as "deliverance" or exorcism do not work permanently, can be harmful and may prolong any internal war between alters and preventing healing.[9]:338-339, [6]:170-171
    Possession Trance Disorder, a diagnosis in the World Health Organization's ICD-11 manual (code 6B6C) has similarities with DID, and includes a required diagnostic criterion which can include a demon:

    "Trance episodes are attributed to the influence of an external ‘possessing’ spirit, power, deity or other spiritual entity." — ICD-11 [41]
    The DSM-IV equivalent was a proposed disorder called Pathological Possession Trance, which was merged into the DSM-5 DID criteria by adding the wording "or an experience of possession".[1]

    For Christian perspectives on healing trauma, including experiences of people with Dissociative Identity Disorder and alters who see themselves as demons, see Not Demons but Dissociation by a priest with dissociative identities, and Christian resources for Healing (archive page).

    Disabled alter

    Alters may be disabled when the person's body is not, for example a blind or mute alter may be created in response to an abuser's instructions, e.g. "Don't talk", "You didn't see anything", resulting in involuntary psychosomatic symptoms which come and go, rather than a permanent physical injury. These disabled alters can regain their sight, hearing, or mobility, etc. during healing, for example, after working through the memories that caused their disabilities or when switching to a different alter personality. [9]:34-35 This psychomatic expression of the impact of trauma typically results from somatoform dissociation, which is when psychological trauma or conflict is expressed as physical rather than psychological symptoms; the Somatic Dissociation Questionnaire 20 (SDQ-20) is a screening tool for DID that assess physical symptoms only.[6] Severe physical symptoms may result in the additional diagnosis of Functional Neurological Symptom Disorder (DSM-5), formerly known as Conversion Disorder, which can also occur without DID. Psychogenic or non-epileptic seizures are particularly common physical symptoms in people with DID, but can occur in other people.[6]

    Louis Auguste Vivet, who lived in France in the 19th century, was one of the first people described with Dissociative Identity Disorder, and also experienced paralysis. Vivet had long episodes of disabling leg paralysis and sometimes total paralysis which came and went; this was related to psychological trauma caused by a snakebite rather than physical injury. Before the snakebite, Vivet had already DID, which was highly likely to have been caused by early and prolonged childhood abuse, which included him developing a thief alter to survive after being abandoned and left homeless at age 8. [55]

    "Louis Auguste's case of DID was documented during the 1880s by his attending physicians. Louis was abused during childhood, became a thief when he was eight and sentenced to a rehabilitation centre. Louis was bitten by a viper at the age of 17 and experienced leg paralysis, then he was transferred to an asylum to study tailoring. At age 18, he was released from the asylum, went to visit his mother, and continued his agricultural work. Unfortunately, he was admitted back into an asylum as he suffered from a conflicting range of symptoms such as total paralysis to completely no symptoms. This hemiplegia was however noted as odd as the patient could walk while under hypnosis by the attending physician. During his hemiplegic and antagonistic state, Louis was noted to not have any recollection of his stay in the asylum when he was 17, but had total recollection when he reverted back to his calm state. There were also records of him inexplicably losing and finding objects he had no memory of, alternating personalities shown through complementary actions of thievery and of diligent agricultural work, and differing somatic symptoms.10,11 Louis manifested symptoms of DID which include a disruption of identity and episodic memory loss not caused by substance."12 — Surawijaya et al. (2023)

    Disabled alters are more likely in people with related physical disabilities, for example the case of Margo, a woman with psychogenic blindness caused by DID also had physical eye problems, and had a child alter who could see.

    Famous people (introjects)

    Like alters based on fictional characters or people known to the person with DID, these alters are internalized representations (introjects). They are rarely described by psychotherapists and psychiatrists, except when referring to survivors of ritual abuse. Examples in military/political abusive groups include child alters who believe they are Hitler, famous doctors, generals, or other military leaders. [9]:337 There may be several alters who each believe they are the actual person they are based on, and are unaware of one another - e.g., several "Hitler" alters in the same person. [9]:337 In ritual abuse with 'religious' beliefs, alters may believe they are Jesus, or supernatural beings like God or Satan. [9]:325, 327.

    Unsurprisingly, a person who has an alter claiming they are a famous person may be misdiagnosed as having Schizophrenia or a Psychotic Disorder, because claiming to be a famous person is common is psychotic disorders with delusions. Psychotherapist Alison Miller gives the highly unusual example of a person who developed alters that were copies of Axl Rose and rest of Guns'N'Roses band - and was misdiagnosed with Schizophrenia as a result. [10]:2 In DID/DDNOS, however, an alter can adapt their beliefs if presented with clear evidence that they are not that person, for example that Hitler is dead and the Nazis lost the war, because logical thinking remains.[9]:101 Note: Delusions can also exist in people with DID/DDNOS if they have a Psychotic Disorder or Schizophrenia as well.

    Fictives/Fictional characters

    Alters may be created which are internalized representations (introjects) of fictional characters. Some people with DID refer to alters based on fictional characters as fictives although this term was not used in literature on DID until 2021, before then fictives were described in many case studies and books, but had not been given a collective term.[9],[32],[35],[43] People with Maladaptive Daydreaming (MD) often have groups of inner characters based on fictional sources, but these are different to alters in DID because they cannot physically take control or interact with other, outside people, and are not split-off parts of the person's own personality, although there are other differences as well.

    Like any other alter, alters who are fictives can physically take control of the person's body.[1] The characters that alter personalities are based on may come from sources like nursery rhymes, fairy tales, children's stories or books, music, games, movies and other sources.[36]:493, [43] One good description of therapy with several alters based on fictional characters comes from a case of DID in Turkey published in 1997: a woman aged 45 with a severe abuse history was found to have Dissociative Identity Disorder, and two of her alters were based on the classic story Snow White.

    "Two identities had been formed from childhood imaginary playmates: "Pamuk Prenses" (Snow White) and "Kraliçe" (The Queen). They both enjoyed parties at nights where the Queen looked after, protected and controlled the young "Pamuk Prenses" and enviously competed with her at the same time. Snow White danced and sang. When Snow White took control she saw her husband and children as "the relatives of that poor woman in the neighborhood" (Sad Halimé [another alter])... These identities had been formed at about the age of twelve; they knew the other personalities, but they saw themselves as distinct from all the others. — Tutkun & Sar (1997) [32]:151

    Some abusive groups/cults have been known to traumatize children in order to force them to create alters based on particular characters which suits the needs of the abusers. Ritual abuse survivors in particular report being forced to create alters based on many different fictional characters, including:

    • characters from Lewis Carroll's story Alice in Wonderland, which has been made into several movies [39]
    • An “everyday life” alter based on the character “Samantha” from an episode of the TV show "Bewitched" [36]:523
    • Charles Wallace and Meg (from Madeleine L'Engle's 1962 book A Wrinkle in Time) - as part of MK-Ultra ritual abuse[37]:70:72
    • Peter Munk (a character from a German fairytale) who is "unemotional, obedient, lacking in self-awareness" and motivated to avoid pain, reported in a German survivor of ritual abuse during the "cold war" [35]:80
    • Sleeping Beauty, who believed she was dreaming when actually working as a government agent (as part of MK-Ultra) [37]:217,272
    • Tinker-Belle (from Peter Pan), in a survivor of Monarch programming/ritual abuse [38]:108-109
    • The Wizard of Oz, including the scarecrow (who was told he had "no brain", he was obedient and suggestible), the cowardly lion (who held the emotion of fear), tin man (who was told he had no heart - meaning no empathy, and as such was able to be a trained killer following someone else's orders)[39]:62

    All alters may adapt and change over time, and some may even choose to take on the form of fictional characters if that serves a helpful purpose. Dr Colin Ross, a well known psychiatrist and Dissociative Disorders specialist, states that a group of demonic alter personalities in a survivor of Satanic Ritual Abuse chose to transform their identities to become Ewoks (from Star Wars) as part of healing.[33]:153


    Some alters are very limited in their role, for example they may only have a small number of emotions, hold particular isolated memories or have a very limited job. These 'partial' alters are sometimes known as fragments. [10]:280 Fragments can either have a range of emotions but only a limited life history, or a more substantial life history but be unable to feel a range of emotions (for example, always sad, either angry or fearful). Special purpose fragments are even more limited, for example existing to carry out a very limited role and never acting beyond that. Memory fragments hold a very limited knowledge of an event, and only experiencing very limited emotions. [4]:xii:xiii Several fragments together may hold a single event. [11]:6, 143

    Gatekeeper alter

    This type of alter has the job of keeping traumatized alters from appearing. [16]:58 They may also hold back memories or control which alters can take control of the body, and when. [9]:54

    Host, Presenting Part, Front Person, or Fronter

    The personality part/alter that "has executive control of the body for the greatest percentage of time during a given time period."[4]:xiii A person with DID will have more than one host over their lifetime. [16]:59 See Apparently Normal Part of the Personality.


    This term covers many different kinds of alter who are not primarily responsible for everyday life, they often hold trauma memories. They often have been so separated from everyday life that they are unaware of the years that have passed and often do not know that the body has physically grown up. [9]:30 See Emotional Part of the Personality.

    Internal Self-helper (ISH)

    These alters are helper parts. They have extensive understanding of different alters and how they work together, and often help by explaining things to the therapist. [16]:64 Also known as Managers or sometimes Inner Self-Helpers.

    Introject / Copy Alter

    These alters believe may they are another person entirely, such as an abuser or a close relative. [9]:34 They have the characteristics of another person, for example a paternal introject with the behaviors and views of a person's abusive father. [7]:18 Introjects which are mimicking abusers are trying to "keep you inline" in order to protect you from external abusers.[9]:33
    "Introject" is a term used in general psychology to refer to taking on and internalizing the views and thoughts of others without reviewing them.[17]:259 This is part of normal development in early childhood, these introjected parts/aspects of a person can be either healthy and helpful, or abusive. For example, an adult verbally abused as a child may have an introject which states "nobody likes you" or "it's a dog eat dog world" - both of these would negatively affects a person's likelihood of making friends. In people without DID/DDNOS, introjects will not be alters, but become incorporated (introjected) into their personality. Introjects can change with psychotherapy.
    Also see maladaptive daydreaming (inner characters created by daydreaming, which are not alters).

    Manager Alter/System Manager

    See gatekeeper and internal self-helper.

    Military and Political Alters

    Alters may be soldiers of different ranks, or believe they are well known political leaders. These alters are often been created within abusive groups with a particular set of political/military or religious beliefs, the alters are indoctrinated to force them to take on the beliefs of the group.[9]:61-63 They may have titles of military ranks, like generals, or names like Hitler. Groups which are known to have carried out ritual abuse using dissociation to create alters include the US government (e.g., MKUltra, which included many Nazi doctors operating on behalf of the CIA), neo-Nazi groups, and white supremacists including the Ku Klux Klan. [9]:18, 54
    See demon, demonic and 'evil' alters, for alters which are copies of actual people see introject.

    Opposite-sex alters and different gender identites in alters

    Some alters may have a different gender identity, and/or genuinely believe that their body has physically different sexual organs than it actually does, for example a male alter in a physically female body, who may or may not be aware of having no penis (a severe level of dissociation is present in DID, which may include amnesia for puberty, somatoform dissociation causing a lack of bodily sensations, "out of body" experiences, and/or severe subsconscious avoidance of the body). Opposite sex alters are usually more like a young girl's idea of how a boy would be an actual boy, or a young boy's idea of how a girl would be, based strongly on cultural norms or stereotypes. Normally they have personality traits which associated with the gender of the opposite sex. A female alter in a male body may be very fearful or frightened, and a male alter in a female body may be very angry, feel physically strong, or be very brave. An alter may be have an opposite gender because of sexual abuse, for example a male alter does not have vagina, so will not fear being vaginally raped as the female body was. A female alter may be created in a male because that alter was forced to take on a female role in having sex with men, although opposite-sex or differently-gendered alters do not automatically mean that child sexual abuse was the cause. Trance logic is characteristic in DID, and involves beliefs that are not delusional but also not in keeping with physical reality, as described above; another example would be for an alter to believe that they do not live in the same body as the patient or the other alters, and may be invested in killing off others, wrongly believing that they can live on without a body. [9]:34-35

    Nonhuman Alters

    Alters are the result of severe dissociation; they are "constructed by the 'logic' of dream or trance",[30]:184, and can be strongly influenced by a person's culture.[1]:294 As a result, alters can take any form; some alters may not view themselves as human, and may either feel (or fully believe) that they are not part of a human being. They may view themselves as having a different physical form (or no physical form at all, for example a spiritual being [6]), this is recognized within the DSM-5's description of DID. [1]:294 Prolonged and severe interpersonal trauma can leave a person feeling "no longer human", and has been reported in people with Complex PTSD and OSDD, for example as a result of being a prisoner in a concentration camp, being a political prisoner in a country with a poor human rights records, or as a result of severe child abuse. [16]:65, [23] Given the trauma history of the vast majority of people with Dissociative Identity Disorder and OSDD, it is unsurprising that parts of the mind may have taken on a nonhuman identity. Some examples include alters that identify as animals, demonic or 'evil' alters, spirits, ghosts or spiritual beings,, mythical figures,[1]:294,[30]:184 robots or machines, or even inanimate objects [9]:47. Some people with DID or DDNOS refer to such alters collectively as "otherkin", although the word otherkin can have different meanings, including meanings not relevant to Dissociative Disorders.

    Object Alter

    Alters which identify as inanimate objects are a type of nonhuman alter, for example a tree.[24]:80 Alters can also be hidden inside animate objects, for example inside natural-looking structures in the inner world, e.g., mountains, trees, lakes or rivers. [9]:49


    A common type of alter, often acts in a harmful way but there is a protective logic behind a persecutor's actions. [7]:17-19 Persecutors often have a distorted view of reality, and may disrupt therapy or intentionally injure the person's body, for example to punish child alters for disclosing abuse that has been kept secret. All alters "should be treated with equal kindness," despite their behaviors, and persecutors are often seen as "misguided protectors" which can be negotiated with.[9]:41, [28] Some persecutors may threaten to "kill off" the ANP (host) and appear to have no positive or protective intentions, however these can still be engaged with.[29]:95 Some persecutors may be introjects of abusers. Download Therapeutic alliance with abuser alters in DID for more information on responding to a persecutor.


    Protector Alter Identities in Dissociative Identity Disorder - defending you from threats

    Protector alters are common, there are three main types: 'fight' parts, persecutors and caretakers. The 'fight' parts and persecutors are types of EP which have defensive intentions, despite their often self-destructive behaviors such as self-injury or eating disorder behaviors.[24]:82-83 The term 'fight' does not necessarily refer to violence, but to the 'fight' reaction present in PTSD, which often involves verbal aggression.[1]:143 A diagnosis of DDNOS or Dissociative Identity Disorder is not associated with crime or "wild aggression".[26] [27] Therapist Jo Ringrose, who has considerable experience of working with alter identities, states that violent alters exist, but has never met one. [27]:8

    Protector Alter Identities in Dissociative Identity Disorder - defending from threats

    Protector alters try to manage rage and anger, and avoid feelings of hurt, fear or shame. They focus on perceived threats, and find dependence, emotional needs and close relationships (attachment) threatening. Protectors may view themselves as a very tough child or teenager, a powerful animal, or a physically strong, adult male. They can act internally, or show external hostility, e.g., telling a therapist that other alters don't need them and warning the therapist to leave them all alone.

    Defensive "acting out" may be directed at a therapist or others close to the person; the ANP may have no behavioral control or memory of it. However, the "whole person" (all alters collectively) should still be held responsible for the behavior of all parts.[6]:132 A protector may follow an alter that is "needy and searching desperately for attachment" in order to protect it.[24]:87

    Internal perceived threats may include the crying and dependency needs of a traumatized child part, which an internal persecutor may silence with rage or self-harm. [24]:82-83 Protector parts may see the partner of an ANP (host) as a threat, for example the partner initiating sex may cause a switch to a protector alter, who perceives it as an attempt to rape, and fights off the partner. [24]:74 Communication and negotiation can improve safety, and no attempts should be made to "get rid" of any alters.[6]:132-133, [6]:139

    “With DID patients, if they feel hostility or aggression they take it out on themselves with self-harm... They’re self-destructive and repeatedly suicidal, more so than any other psychological disorder. So that's what's typical – not this wild aggression, or stalking women..." — Dr Bethany Brand [25]

    Psychotic Alter

    Some alters have psychosis or psychotic symptoms. However, many symptoms which appear psychotic are not. For example, visual flashbacks may be mistaken for hallucinations, and strange body sensations (body memories) which are physical flashbacks of past trauma can be mistaken for tactile hallucinations. [12]:64 Hearing "voices" is a common experience in people with DID/DDNOS, the "voices" are alters trying to talk, and occasionally may come from outside the person's head rather than inside, which is more common. "Thought snatching" (taking away your thoughts) can be caused by the actions of alters. Beliefs caused by trauma can be mistaken for paranoia, for example a person may be told that a "bug" has been implanted by abusers to record any dislosures they make. Working through the memory of the trauma will resolve the paranoia that it caused. [9]:129

    Some people who have been abused within ritually abusive groups may have alters who are trained (programmed) to produce psychotic-like symptoms under certain circumstances.[9]:142 It is possible to have an alter with a psychotic disorder, or to have schizophrenia as well as DID/DDNOS. [1]:291-307 This appears to be relatively rare. Schizophrenia is a common misdiagnosis for people with Dissociative Identity Disorder, although many people with DID/DDNOS believe they are going "crazy" they do not have a break with reality.[7]:58-59 Abusive groups are known to have created alters who carry out "jobs" which make a person appear either "crazy" or learning disabled, for example scrambling or garbling words and numbers so they cannot be understood, hearing high pitched sounds and feeling "lost in a maze" in the back of your head, making your mind go foggy or misty or being spatially confused and unsure what the truth is.[9]:78, 80-81 Anti-psychotic medication will not "remove" alters but can make the communication needed to heal more difficult.[9]:129

    Robot or Machine Alter

    Alters who believe they are robots or machines, and have no understanding of emotions, have been reported in survivors of ritual abuse. These alters were told they were robots or machines, and were not allowed to feel any emotions, were trained to follow instructions and not to think, and may have been made to believe that they cannot move.[9]:68 If a large number of similar robot parts exist, it is more effective for them to agree to fuse (integrate together permanently) rather than repeating the same therapy with each. Robot and machine parts are actually part of a person, and can be helped to feel more human, and to learn how to think for themselves, rather than just responding to the instructions past abusers gave. [9]:142-143

    Sexual Alter

    Sexual alters may be created to handle sexual abuse and rape, and to keep that knowledge away from other parts. One alter or group of alters may handle sexual abuse from men or boys, while others are created to handle sexual abuse and rapes from women or girls. [22]:77


    A shell alter is an Apparently Normal Part (host alter/front person) which handles daily life and is designed to hide the existence of other alters from the outside world. [10]:33 Shell alters do not exist in DID, they only exist in one form of DDNOS (now renamed to Other Specified Dissociative Disorder). The apparently normal part (ANP) is a shell through whom the inside parts/alters act. The inside parts can come near the surface, temporarily blending with the ANP. The inner parts are not regarded as separate, distinct states although amnesia may exist between them. [7]:9, [9]:5 If DDNOS is caused by ritual abuse and mind control, the shell alter is not supposed to know about the others.[9]:5

    Spirit, Ghosts, Supernatural beings and 'Possession" Alters

    These types of alters are referred to directly in the DSM-5 diagnostic manual, underneath the diagnostic criteria for Dissociative Identity Disorder. Some people have alters which are all spirits, ghosts or supernatural beings such as angels or genies. These are regarded as possession-form identities, if a person is consciously aware of the actions of the alter then the person may describe themselves as feeling "possessed" by an outside person, spirit, deity (god), demon, or a "ghost", for example of a person known to them who has died. [1]:292 Possession-form alters are not part of normal cultural possession experiences, they are involuntary, recurrent and distressing. [1]:294 Animal alters are also common in this form of dissociation.[1]:293 People can also have one or more of this type of alter along with other types, for example child alters or protectors.

    Alters who believe they are spiritual or supernatural beings should be treated in the same way as any other type of alter identity, with psychotherapy (talking therapy). Exorcisms are known to be harmful and ineffective in treating complex dissociative disorders, and attempts should not be made to "get rid" of alters. Instead they should be understood as a way of coping with traumatic life experiences. [6]:170-171


    An alter may have another dissociated part inside, which has a different role or function. [9]:141


    A subsystem is not a type of alter but the name for a group of very closely related alters which may have formed by splitting off all at the same time, either splitting off from an existing alter undergoing massive new trauma (effectively this means an alter has their own group of alters), or from the ANP/host being extremely traumatized by a new trauma. A subsystem can also form by alters splitting off from an existing alter at different times, which is not necessarily due to major trauma but is still psychologically essential for survival. When a new trauma is not bearable for either the existing alter or a new alter, the feelings and/or memories are split across several new alters instead, these alters may be extremely limited fragments, for example holding only part of a memory.[9],[10],[11] People who are polyfragmented typically have multiple subsystems, but having subsystems is not an indicator of being polyfragmented.[6],[9],[10],[11]

    Suicidal Alter/Internal Homicide

    A common type of alter.[24]:79 If somone with Dissociative Identity Disorder or DDNOS is suddenly suicidal, this may be due to the influence of a suicidal alter, although the ANP (host) themselves may be feeling suicidal.[24]:75, 306 According to the DSM-5 psychiatric manual, over 70% of out-patients with DID attempt suicide and multiple attempts are common. Amnesia can make it difficult to assess the suicide risk, and there may be amnesia for a suicide attempt. [1]:295 Some alters may be unaware that they share the same body as the ANP, and believe that killing off the ANP or others will not harm them; this increases the suicide risk further.[6]:132, 140 See persecutor for alters who are threatening to kill the ANP (host).
    See Negotiating with alters

    Teen alters

    Teenaged or adolescent alters may occur in people who had significant trauma during those years, or they may be child alters who have grown older.[7]:18

    Twin alters

    Twin alters are two alters of the same age who are normally opposites of each other in views and behaviors. Twin child alters are common, for example one may love the abuser, be eager to please and have only positive views towards him/her, and another may hold angry and rejecting views towards the abuser. [16]:61

    Number of Alters

    This varies widely between people, the minimum needed for diagnosis is two different dissociated (disconnected) parts/identities, e.g., one alter plus a host or main identity, or two alters without a host identity.[1]


    In 1984, influential research found approximately half of people with DID had ten alters or less, and half had eleven or more.[13] The DSM-IV (published in 1994) repeated this, adding that "[t]he number of identities reported ranges from 2 to more than 100", and stating that adult women averaged 15 or more alters, and men had an average of 8.[40]:485-486 Howell (2011) states "[t]he number of parts [alter personalities] in a DID system usually ranges in the teens. In some cases ... there are also polyfragmented multiples who have many, many parts — perhaps close to a hundred or more parts".[16]:58 In recent years there has been little focus on reporting the number or characteristics of alters in clinical research. The number of alters is not mentioned in the DSM-5 (published in 2013).[1] The number of alters a person with DID is aware of often increases during treatment; one study, in 1988, found an average of between 2 and 4 identities at diagnosis, with between 13 and 15 emerging during the course of treatment.[20],[21] This does not mean that treatment in some way caused new alters to be created. Instead it is understood that existing alters feel able to emerge from hiding, they may emerge naturally during psychotherapy if there is something they wish to communicate or if something triggers them. [7]

    Polyfragmented Dissociative Identity Disorder or OSDD

    A person with DID or DDNOS is said to be polyfragmented if they have a very large number of alters or parts. Some professionals refer to people with over 100 alters/parts as polyfragmented multiples,, although others use the term polyfragmented to refer to "dozens" of alters.[5],[9]:4,[16]:58 This large number typically include many personality fragments. Several different parts may use the same name, or have no name.[16]:16 Alters or parts may be arranged in many different ways internally, e.g., hidden behind other parts, or within a hierarchy of parts arranged in layers or levels.[10]:49 A large number of alters and fragments results in less obvious physical signs of switching. [9]:27

    Trauma which is "severe and long-lasting" produces the most splitting, creating large numbers of fragments and alters. [7]:19 Such large numbers are likely to be caused by highly organized abuse, e.g., cult abuse, ritual abuse, pedophile rings, or other form of extreme, sadistic abuse which extends over long periods of time and often involves multiple perpetrators. [7]:4, [9]:133 A person with large numbers of fragments and less active alters can heal at least some of them fairly quickly. This is because many of them will have similar roles and functions, this allows them to fuse together (permanently integrate) relatively easily. Kluft and Fine (1993) describe how a patient who had been severely traumatized had a protector alter for each of the 300 fragments holding her memories and pain. These protectors were all carrying out the same role, and had the same information as each other, so they decided to fuse together, into just one. The fragments holding the memories and pain needed to spend time processing the most significant traumas first, and gradually fused into groups of up to 10 at once.[8]:126 Polyfragmented DID was previously called Complex Multiple Personality Disorder (Complex MPD),[4],[8]:306 but has never been a separate diagnosis. People who have publicly described their experiences of being polyfragmented include artist Kim Noble,[9]:xii and Truddi Chase, author of When Rabbit Howls.

    How alters are created

    Alter identities are created to manage either overwhelming trauma, or changes in everyday life that cannot be managed by any existing identites. Some people have been able to recall and describe the child abuse which directly caused a particular alter. The child's beliefs and culture are known to influence spontaneously created alters, for example a Native American man described having animal and spirit alters which were created by a mixture of starvation, severe beatings and hallucinogenic herbs or drugs. His wolf alter was created after beatings for failing to communicate with the "wolf spirit", the wolf alter took on the characteristics he attitrubed to wolves: widsom, cunning and wolf-like behaviors. The wolf alter both allowed for the trauma to be handled and was able to use its characteristics to diagnose illness and manage complex life situations. [18] Additional alters can also be created by traumatization in adulthood if the person already has a complex dissociative disorder. For example, an alter created to handle sexual abuse may be unable to cope with increasing levels of abuse, and may create other alters to handle some of that abuse. [22]:77

    Organized perpetrator groups may intentionally create alters and train them to do particular jobs. In ritual abuse, abusers intentionally severely abuse the child until an alter develops. [10]:54 If the alter refuses to comply with the "job" or role they are given then the abuse continues until another alter is formed, who then faces the same dilemma. Eventually an alter must agree to ensure survival. [10]:54

    Co-conciousness and Amnesia

    Co-onsciousness involves two or more alters each being aware of the other's presence, and being able to both be consciously aware and sharing memories for some situations or particular period of time, although some episodes of amnesia typically still occur. One alter is normally in "executive control" (physical control of the person's body), while another is able to watch, listen, and think about what is happening even though they cannot take physical control. The alters who are co-conscious with one another will not necessarily behave as one. Co-consciousness is an important way of reducing amnesia and improving co-operation and functioning in everyday life.[7] A person with continual co-consciousness will not "lose time" in the present, but may meet the diagnostic criteria for Dissociative Identity Disorder because they still have some amnesia for past events. If there is no amnesia for past or present events, then a person with alters is likely to fit the criteria for Other Specified Dissociative Disorder (type 1b).[1], [2] Co-consciousness was first recognized in the early 1900s by Morton Prince.[7] In addition, some alters may have one-way amnesia, where an alter is aware of the actions of another, but the awareness and memories are not shared in both directions.[4] When the first set of diagnostic criteria was published for Multiple Personality in 1980, both an awareness of "lost periods of time" and co-consciousness were part of the description, although no amnesia criterion existed.[56]

    At any given moment, one personality will interact verbally with the external environment, but none or any number of the other personalities may actively perceive (i.e., "listen in on") all that is going on. - DSM-III, 1980 p.257.

    Do Alters exist in OSDD?


    This depends on the form of OSDD. OSDD is complex and includes many different possible presentations of dissociative symptoms, including two forms of Other Specified Dissociative Disorder type 1 (previously known as DDNOS) that are very similar to DID, and which are both regarded as "almost DID",[1],[6] and one of these forms of OSDD has alters.[6]:125-126 OSDD-1b, as it has become known, [43] has alter identities, formally known as distinct personality states, plus the same additional symptoms found in DID but there is no recurrent or persistent amnesia, either for significant parts of the past or for events in the present, [13]:409,[43]. Alters in OSDD-1b are as described in the information about alters in DID, there is are no additional distinguishing differences. In OSDD-1b, DID criterion B ("amnesia") is not met but all other DID criteria are fully met.[1]


    The other form of OSDD-1 is commonly called OSDD-1a, and involves recurrent episodes of amnesia and the same additional symptoms found in DID, and dissociative parts which are not alters [1],[43] - this is because they are not as distinct as alters (meaning that DID criterion A is not met).[1] The new ICD-11 diagnosis of Partial Dissociative Identity Disorder (P-DID) is equivalent to OSDD-1a, and also has dissociative parts but not alter identities.[3] The dissociative parts in OSDD-1a and Partial DID are formally known as less distinct personality states, and very rarely take physical control of the person's body but strongly intrude on the person's everday experiences; people with OSDD-1a may describe their dissociative parts as "other me's", other "aspects" or "facets" of "me", other "selves", different "ages of me" or "me but a different me", but in DID people who are aware of their alters describe generally experience them as "not me"/"nothing like me" (there is less sense of identification with them due to the extra dissociation, they seem very unfamiliar to the self or completely "ego alien").[1],[6]:132 The dissociative parts in OSDD1a are not any more (or less) significant than alters in DID or OSDD1b, and they are not any more (or less) significant than the different parts of a personality present in healthy people, the difference is the degree of dissociation from one another and the degree of independence or elaboration present. The same types of roles and functions are found in both the dissociative parts in OSDD-1a and alters in OSDD-1b and DID.

    Having both distinct and less distinct parts

    People with DID may have both alters and less distinct dissociative parts/personality states, in this case when all the other DID criteria are fully met, a minimum of just two personality states/identities need to be clearly distinct, for example either the "regular" person (ANP or host) plus a minimum of one distinct alter, or two distinct alters (if there is no main ANP or host). Any number of less distinct parts that exist in addition to two (or more) distinct parts would still meet the first diagnostic criteria for DID. Fragments is an older term used to refer to less distinct dissociative parts, regardless of whether someone has DID or OSDD.[4]

    "Parts" is a term commonly used by some therapists and by some people with DID, and this term applies equally for alters and less distinct personality states/dissociative parts, and the treatment approach is the same for both.[6],[54] "Parts" is also used by some people to refer to dissociative parts of the personality in BPD, PTSD, and Complex PTSD, and/or for non-dissociative parts of the personality in healthy people ("everyone has 'parts'").[54] While the term parts is very commonly used in DID and OSDD, the DID treatment guidelines for adults (2011) state that it can be helpful for therapists to use the same terms as a patient, but that the terms that are used should not "reinforce the belief that alters are separate people/persons rather than a single human with divided self-aspects", in DID this is particularly important because in some people with DID there may be alters/parts that are not be aware that they share a physical body with others, resulting in serious safety problems: some people with DID have been found to have taken accidental overdoses of medication because alters believed that each of them needed to take a separate dose (alters commonly have their own sense of body image, and may not realize have a single shared body).[6]:121 This extreme degree of dissociation is one of the more obvious examples of the differences between alters in DID/OSDD1b and dissociative parts or states in BPD or C-PTSD.

    Less distinct dissociative parts vs alters

    A list of characteristics that determine if a dissociative part is distinct enough to be considered an alter is not in either the DSM or ICD diagnostic manuals, but is described by the Structured Clinical Interview for Dissociative Disorders, which is the "gold-standard" clinical interview for diagnosing DID, OSDD and other dissociative disorders. However, using a list of characteristics found in alters is only one of several ways of distinguishing if there are alters present; others more readily available include:

    • The DSM-5 uses "sense of self" and "sense of agency" to distinguish distinct personality states (alters), these are described in considerable detail in the full DSM-5 and DSM-5-TR DID section (pages 291 and 292), but are not in the desktop version, which contains only the diagnostic critera.[1]:291-292
    • The presence of an alter taking over during a clinical session or assessment is helpful (the alter can be asked about themselves for example) but not essential for diagnosis
    • No single characteristic is essential for alters, for example not having a separate name or choosing a name for a part do not change whether a dissociative part is considered to be an alter.[1] Uncertainty over whether DID or OSDD is present is expected to be diagnosed as OSDD, and the diagnosis can be later changed to DID if the criteria are fully met. Uncertainty over which dissociative disorder is present, including whether a complex dissociative disorder is present, is usually caused by a lack of informtion, and Unspecified Dissociative Disorder can be diagnosed in these cases.
    • The Dissociative Experiences Scale self-report questionnaire typically gives higher scores for people with DID compared to OSDD-1b or OSDD-1b, and gives higher scores for OSDD compared to Complex PTSD or Borderline Personality Disorder in someone without OSDD. This is not a definite diagnosis but a guide, and may identify amnesia in people not consciously aware of or underreporting their amnesia. [6]
    • The Dissociative Disorder Interview Schedule (DDIS) and Multidimensional Inventory of Dissociation, (MID) both of which are freely available at no cost, can distinguish between DID and OSDD or Partial DID, both rely on a trained clinician's observations (there is no single "wrong" answer, they rely on patterns of responses not a fixed cut-off score), although both the MID tool and DID treatment guidelines for adults give clinicians additional guidance.[6]
    • How overt or obvious a dissociative part appears is not a criteria in distinguishing whether they are an alter, approximately 4% (just under 1 in 20) of people with DID have florid DID, meaning dramatic and obvious differences between alters or parts, and the remainder have covert DID. People with comorbid Histronic Personality Disorder and DID are also known to present with striking differences between alters, which puts these patients at risk of being mistaken for having imitative DID (an imitation of DID in a patient wrongly self-diagnosed with DID); the combination of HPD and DID together can be difficult for experienced clinicians to correctly diagnose, despite appearing to others as "obvious multiple personalities".[50]
    • A set of proposed alternative diagnostic criteria were published in A New Model of Dissociative Identity Disorder by Dr Paul F. Dell, creator of the MID diagnostic tool and co-author of the current DID treatment guidelines for adults. While this alternative criteria was not adopted for the DSM-5, it might be useful in determining if DID or OSDD is more likely, and has been peer-reviewed. The aim of this proposed criteria was to avoid the difficulties clinicians found in determining if personality states were distinct enough to fulfil the DID criteria (i.e. if alters were present or not). This is an academic paper but describes in detail, with examples, many of the different odd experiences common in DID and OSDD. [52] See A new model of DID (pages 10-12).
    • Overall clinical picture also informs the diagnosis, including whether the dissociative symptoms are persistent/recurrent and problematic, if posttraumatic symptoms are also present (which may affect only some parts/alters), passive influence (partially dissociated intrusions), hearing voices, fugue states or episodes of amnesia, spontaneous age-regression, depersonalization, derealization, subtle signs of dissociation, if they have a known trauma history (including strong reactions to being asked), and the presence of symptoms that are either denied or disowned, for example because of very brief periods of amnesia may occur during the discussion. A known trauma history is not essential for a diagnosis of DID or OSDD, although DSM-5 criteria B recognizes that some people with DID have amnesiac gaps in their memories of specific traumas. The Dissociative Experiences Scale and clinical interviews designed for dissociative disorders all cover these key aspects.[6], [58]

    The research on OSDD consistently states that Dissociative Identity Disorder may first appear like OSDD rather than DID because there is not quite enough evidence to be sure of a DID diagnosis (for example, there is not enough evidence of whether a dissociative part is distinct enough to be an alter), so some people initially classed as OSDD will later be re-classed as DID.[6],[13] The same treatment guidelines apply to both forms of OSDD-1 and to DID.[6]

    Dissociative parts in BPD

    People with Complex PTSD, PTSD, and Borderline Personality Disorder (BPD/EUPD) may have dissociative parts, but they are not alters. The dissociative parts in trauma-related BPD also differ significantly from the dissociative parts found in people with OSDD-1a, which are both more clearly defined (elaborated) and act more independently (emancipation) than those in BPD. People with Complex PTSD, PTSD including dissociative PTSD, BPD, Dissociative Amnesia and Depersonalization/Derealization Disorder do not have alters as a result of these disorders, alters are only present in people with DID and OSDD-1b.[1],[6] Non-dissociative disorders do not have the degree of dissociation found in dissociative disorders, and this degree of dissociation is needed for alters to form because alters are fully dissociated split-off parts of the self.[1],[6]

    The Theory of Structural Dissociation of the Personality (TSDP or Trauma-related Structural Dissociation of the Personality) describes trauma-related dissociation covering the spectrum from PTSD through to DID, and placing each disorder at one of three levels, beginning with PTSD at the first level. DID is the only disorder at the third level, and is described as Tiertary Structural Dissociation. Complex PTSD, trauma-related BPD and OSDD are all at the second level, Secondary Structural Dissociation, but that does not mean the dissociative parts in all these disorders can be alters. TSDP states that the degree of elaboration and emancipation distinguishes dissociative parts in OSDD-1a from those in C-PTSD and BPD, meaning the degree of different characteristics present, and the degree of independence.[54] The Haunted Self, which contains the most detailed description of structural dissociation, states that common dissociative parts found in BPD are a coping ANP, and more than one EP, e.g., abuser rage, victim rage, passive victim, or zombie parts, which are not elaborated or emancipated enough to be alters.[54]:227-229 TSDP does not use the term "alter" directly, instead it focuses on characteristics of ANPs and EPs, and has been criticized for not clearly stating criteria that distinguish EPs from OSDD from the less elaborated and emancipated EPs found in BPD and Complex PTSD. The theory of structural dissociation is a non-diagnostic model and treatment approach, and does not have any diagnostic guidance, instead it is a way of understanding disorders with differing symptoms that all involve trauma-related dissociation. The Haunted Self states: "Our clinical observations suggest that dissociative parts in BPD patients have less emancipation and elaboration, and lesser degrees of identity confusion and alteration than in DID and DDNOS [OSDD}... Alternations among dissociative parts in BPD occur between a typically depressed, empty ANP, and enraged or overwhelmed EPs that are fixated in past trauma, which may account for affective instability and reactivity."[54]:122-123

    See also:

    Healthy Multiplicity

    The presence of alters alone is not enough for a person to be diagnosed with a mental "disorder". For a dissociative disorder to be diagnosed the person must have either clinically significant distress or impaired functioning in a major area of life resulting from the dissociation, and meet the additional diagnostic criteria as well. [1,2] This means that it is possible to be mentally healthy and a multiple, this is referred to as "healthy multiplicity".

    Some people incorrectly assume that the primary goal of treatment for Dissociative Identity Disorder (and similar forms of OSDD) is to either remove "alters" or to fuse into a single identity. This is not correct; removing alters is not possible and fusing them into a single identity is not the core focus, although some people may do this. There are different options in treatment, including resolution and the of majority people with do not fully integrate, only around a third do.[6] Psychotherapist Dr Alison Miller states that multiplicity is called a "disorder" in psychiatry but it is actually a "valuable, creative asset" which makes a person "well adapted to living with ongoing trauma". [10] Miller states that multiplicity "is not an inferior way of being" and has some advantages. Advantages may include having some alters which do not have the distraction of emotions or managing everyday life, so, they are able to have a single focus and do amazing things are like special being able to memorize large amounts of information (savant abilities). Some multiples whose alter personalities are extremely cooperative prefer to stay as a community of coordinated alters rather than seeking integration into a single identity.[10]

    Dr Colin Ross, a well known expert on treating Dissociative Disorders, states that the intrusive actions of "part selves" (alters) is not the actual problem, and recognizes healthy multiplicity as possible.

    "the problem in MPD is not the intrusion of part selves as such, it is with the degree of amnesia, conflict, self-destruction, and dysfunction in the psyche. The problem is not the multiplicity, it is the degree of pathological dissociation. In MPD the part selves are personified to an abnormal degree. There is a big difference between someone with active classical MPD, and an individual with healthy multiplicity." — Dr Colin Ross [14]

    Alternative terms for DID/OSDD

    A person with multiple identities caused by DID or the very similar dissociative disorders OSDD-1 and Partial Dissociative Identity Disorder may sometimes referred to themselves using other terms, e.g.:

    • a multiple, or variations (multi-minded, having multiple parts or multiple selves, having multiplicity, etc.) [6],[9],[10],[30],[44]
    • a system (a personality system of dissociative identities),[6],[9],[10] emphasizing a desire to work together, or an acceptance/awareness of "one another as legitimate aspects of the self," which is a core aim in therapy. [6],[9],[10]
    • a system name [52] may be chosen to collectively refer to all alters or parts, and to avoid confusion when only a particular alter identifies with the person's legal name
    • a plural or plural system [45],[46],[53]
    • a survivor, emphasizing strength and overcoming adversity
      "The therapist should foster the idea that all alternate identities represent adaptive attempts to cope or to master problems that the patient has faced".[6]
    • dissociative or variations of it, e.g., having dissociative identities (e.g. the #dropthedisorder movement), dissociative system, this may be used to emphasize a range of dissociative symptoms beyond alters and amnesia, and may help avoid confusion with personality disorders (DID, OSDD, and MPD were always classed as dissociative disorders, not personality disorders),[1],[6],[7] Dissociation is found in many non-dissociative disorders, including PTSD, Complex PTSD, Depression, Anxiety, Panic Disorder, and some people with BPD, although dissociative system is generally used only by people with DID/OSDD.[1],[3],[6]
    • fragmented, meaning a fragmented personality/fragmented sense of identity [6]
    • complex, e.g. a complex person or having a complex personality structure, some people with DID/OSDD have a history of being described as "too complex" by mental health clinicians who do not have training in DID/OSDD, and DID and OSDD are frequently described as "the only complex dissociative disorders" (CDD). However, many mental health patients have Complex PTSD, other complex disorders, or complex presentations of symptoms from multiple disorders.
    • without any label, emphasizing uniqueness or complexity that cannot be fully described by any specific term and/or rejection of the medical model.[52]
    • other terms may also be used [6],[45],[46]

    Words like system, multiple or plural are not unique to DID/OSDD and have other meanings, [7],[46] but they are commonly used by people with DID or OSDD to depathologize or normalize experiences, or to more accurately describe their inner experience.[6],[30],[52]:188,[53] Some people who experience long-term emotional distress, including psychiatric survivors or people who follow the Mad Pride movement, reject all psychiatric labels including terms based on the medical model such as dissociative, and see their experiences as a creative adaption, a survival mechanism, "a different way of being", a form of neurodiversity, or even a psychological injury caused by trauma rather than an alternative to a "mental disorder", and prefer using alternative terms or descriptors.[6],[52]:188 The terms multiple, plural, system, survivor, and dissociative are equally appropriate whether a person has dissociative identity disorder or a similar form of OSDD/partial DID, these umbrella/broader terms have extra advantages including allowing for diagnostic uncertainty (e.g., when a diagnosis is suspected rather than confirmed), a way to describe experience when a diagnosed person may not have accepted/fully accepted their clinical diagnosis, if someone is self-diagnosed but unsure if DID or OSDD best fits their symptoms, if someone is in therapy but seeking to avoid a formal diagnosis (talking therapy for both OSDD-1 and DID follows the same approach so identifying which it is not essential), and it can also be less stigmatizing or feel less uncomfortable for a person with dissociative identity disorder in particular to use a less medical or less specific term, or to avoid a term that includes the word "disorder".

    None of these terms should be automatically assumed to mean DID and all are used by both self-diagnosed and professionally diagnosed people, and many are used by therapists working with clients who have DID or OSDD.[10]
    Origins of these terms include a wide mix of non-medical and medical sources, and go back decades.

    Terms and their Origins
    • Multiple
    • Multiple personality/Multiple Personality Disorder — The name for DID in the American DSM diagnostic manual before 1994, and in the World Health Organization's ICD manual until 2019. [1],[40],[41]
    • Multiple Voices, a newsletter, and Multiple Parts, a magazine — Both of these written predominantly by people with MPD or DID.
    • a multiple — First Person Plural: Multiple personality and the philisophy of the mind (1995): a non-fiction book exploring MPD
    • a multiple/being multiple — First Person Plural: My Life As A Multiple (1999): the New York Times best-selling book by Cameron West describing his life with DID.[44]
    • Multiplicity — the experience of having dissociative identity disorder or OSDD/DDNOS, in the book Attachment, Trauma and Multiplicity (2002) [30]
    • System
    • Personality system, internal system, or internal personality system — the person with all their alters, meaning all parts/alters collectively [6],[7],[9],[10],[30]
    • A "system of alternate identities" — used to refer to the "whole person" (all alters together) rather than only the ANP/host, in the DID treatment guidelines for adults (2011) [6]
    • "the alternate identity system" — all alters together, described as "an organized, subjecively "logical," rule-bound set of interacting and/or conflicting states" in the DID treament guidelines for adults (2011) [6]
    • Dissociative system — A person with DID, OSDD-1 or partial DID [6],[7]
    • Traumagenic system — A person with DID, OSDD-1 or partial DID, emphasizing their known history of trauma (all DID/OSDD is traumagenic)[6],[7]
    • Plural
    • plural — Dictionary meaning "more than one"
    • First person plural — A grammar term meaning "we", which has been recognized as being used by some people who are aware of and/or able to communicate with their alters since at least 1988.[48]
    • First Person Plural: Multiple personality and the philisophy of the mind (1995) — a non-fiction book.
    • First Person Plural: My Life As A Multiple (1999) — Best selling book about having DID.[44]
    • First Person Plural — A British user-led charity for people with Dissociative Identity Disorder and OSDD (1997-2023).[45],[47]
    • being "a plural" — Used by someone with Dissociative Identity Disorder who is part of the Mad Pride movement (2018).[52]
    • plural selves — as an alternative term for DID, and a way of reflecting that all people have different aspects of their self.[53]
    • Survivor
    • survivor — Abuse survivor, trauma survivor, or trauma survivor with a complex dissociative disorder
    • dissociative survivor — An abuse survivor or trauma survivor who is dissociative as a result, e.g. has a complex dissociative disorder
    • Dissociative or dissociator
    • Dissociative or dissociator — A person who dissociates frequently, used by the DID Sourcebook (2000) [7]
    • Dissociative system — Typically a person with DID, OSDD-1 or partial DID [6],[7]


    1. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-5. (5th ed.). Washington, D.C.: American Psychiatric Association. ISBN 0890425558.
    2. World Health Organization. (1992). The ICD-10 Classification of Mental and Behavioural Disorders. Version: 2015. Retrieved May 17, 2015.
    3. World Health Organization. (2023). ICD-11 for mortality and morbidity statistics (Version 01/2023). Retrieved June 25, 2023.
    4. Braun, Bennett G. (1986). Treatment of Multiple Personality Disorder. American Psychiatric Pub, ISBN 0880480963.
    5. Chu, James A.. (2011). Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders, 2nd edition. John Wiley & Sons, ISBN 1118015061.
    6. International Society for the Study of Trauma and Dissociation. (2011). [Chu, J. A., Dell, P. F., Van der Hart, O., Cardeña, E., Barach, P. M., Somer, E., Loewenstein, R. J., Brand, B., Golston, J. C., Courtois, C. A., Bowman, E. S., Classen, C., Dorahy, M., ̧ Sar,V., Gelinas,D.J., Fine,C.G., Paulsen, S., Kluft, R. P., Dalenberg, C. J., Jacobson-Levy, M., Nijenhuis, E. R. S., Boon, S., Chefetz, R.A., Middleton, W., Ross, C. A., Howell, E., Goodwin, G., Coons, P. M., Frankel, A. S., Steele, K., Gold, S. N., Gast, U., Young, L. M., & Twombly, J.]. Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12, 115–187. Doi: 10.1080/15299732.2011.537247.
    7. Haddock D, (2001). The Dissociative Identity Disorder Sourcebook. McGraw-Hill, ISBN 0737303948.
    8. Kluft, R. P. & Fine, C. G. (1993). Clinical Perspectives on Multiple Personality Disorder. American Psychiatric Pub, ISBN 0880483652.
    9. Miller, A. (2014). Becoming Yourself: Overcoming Mind Control and Ritual Abuse. Karnac Books. ISBN 1782412182.
    10. Miller, A. (2011). Healing the unimaginable: Treating ritual abuse and mind control. Karnac Books. ISBN 1780499094.
    11. Oksana, C. (2001). Safe passage to healing: A guide for survivors of ritual abuse. HarperPerennial. ISBN 0060969962.
    12. Putnam, Frank W. (1997). Dissociation in Children and Adolescents: A Developmental Perspective. Guilford Publications Incorporated. ISBN 1572302194.
    13. Dell, P. F. (2010). Ch 24 The Long Struggle to Diagnose Multiple Personality Disorder (MPD). In Dissociation and the Dissociative Disorders: DSM-V and Beyond, p. 383.
    14. Ross, C. A. (1991). The dissociated executive self and the cultural dissociation barrier. Dissociation, 4(1). pp. 055-061.
    15. Barlow, M. R. & Freyd, J. (2009). Adaptive Dissociation: Information processing and response to betrayal. In: P. Dell & J. O'Neil (Eds), Dissociation and the Dissociative Disorders (pp 93-106). New York: Taylor & Francis.
    16. Howell, E. F. (2011). Understanding and Treating Dissociative Identity Disorder: A Relational Approach. Routledge. ISBN 1135845832.
    17. Sharf, Richard (2015). Theories of psychotherapy & counseling: Concepts and cases. Cengage Learning. ISBN 1305537548.
    18. Hendrickson, K. M., McCarty, T. & J. M. Goodwin. (1990). Animal alters: Case reports. Dissociation, 3(4), p. 218-221.
    19. Smith, S.G. (1989). Multiple personality disorder with human and non-human subpersonality components. Dissociation 2(1), p.52-56.
    20. Coons, P. M., Bowman, E. S., & Milstein, V. (1988). Multiple personality disorder: A clinical investigation of 50 cases. Journal of Nervous and Mental Disease, 17, 519-527.
    21. Maldonado, J. R., Butler, L. D., & Spiegel, D. (2002). Treatments for dissociative disorders. In A Guide To Treatments That Work, 2nd Edition. New York: Oxford University Press.
    22. Galton, G., & Sachs, A. (Eds.). (2008). Forensic aspects of dissociative identity disorder. Karnac Books. ISBN 1780494378.
    23. Lovelace and McGrady (1980); Timerman (1981) as cited in Herman, J. L. (1992). Complex PTSD: A syndrome in survivors of prolonged and repeated trauma. J Trauma Stress, 5(3), 377–391. doi:10.1007/bf00977235 pp.385-386
    24. Van der Hart, O., Nijenhuis, E., & Steele, K. (2006). The Haunted Self: Structural dissociation and the treatment of chronic traumatization. WW New York: Norton & Company.
    25. Fawcett, K. (2015, March 12). What Is Dissociative Identity Disorder? US News. Retrieved from
    26. Peterson, J. K., Skeem, J., Kennealy, P., Bray, B., & Zvonkovic, A. (2014). How often and how consistently do symptoms directly precede criminal behavior among offenders with mental illness? Law and human behavior, 38(5), 439-449. doi: 10.1037/lhb0000075
    27. Ringrose, J. L. (2012). Understanding and Treating Dissociative Identity Disorder (or Multiple Personality Disorder) Karnac Books. ISBN 1781811415.
    28. Blizard, R. A. (1997). Therapeutic alliance with abuser alters in DID: the paradox of attachment to the abuser. Dissociation, 10 (4), pp. 246-254
    29. Goodman, L. A., & Peters, J. (1995). Persecutory alters and ego states: protectors, friends, and allies. Dissociation, 8(2), pp. 091-099
    30. Mollon, Phil (2002). Dark dimensions of multiple personality. In Sinason, V. (Ed), Attachment, Trauma and Multiplicity: Working with dissociative identity disorder. (pages 177-196). Psychology Press. ISBN 04151955561 / 041519556X.
    31. Kluft, R. P. (1984). An Introduction to Multiple Personality Disorder. Psychiatric Annals, 14(1), 19–24. doi:10.3928/0048-5713-19840101-05.
    32. Tutkun, H., & Sar, V. (1997). Treatment of Dissociative Identity Disorder in Turkey. Dissociation, 10(3), p. 148-156.
    33. Ross, C. A. (1995). Satanic ritual abuse: Principles of treatment. University of Toronto Press. ISBN 0802073573, 9780802073570.
    34. Lacter, E. P. (2011). Torture-based mind control: psychological mechanisms and psychotherapeutic approaches to overcoming mind control. In O. B., Schwartz, J., & Schwartz, R. W. (Eds.). (2011). Ritual abuse and mind control: The manipulation of attachment needs (pp. 57-142). Karnac Books.
    35. Schwartz, R. W. (2011). "An evil cradling”? Cult practices and the manipulation of attachment needs in ritual abuse. In O. B., Schwartz, J., & Schwartz, R. W. (Eds.). (2011). Ritual abuse and mind control: The manipulation of attachment needs (pp. 39-56). Karnac Books.
    36. Fotheringham, T. (2008). Patterns in Mind-Control: A First Person Account. In Noblitt, J. R., & Noblitt, P. P. (Eds) (2008). Ritual abuse in the twenty-first century: Psychological, forensic, social, and political considerations (pp. 489-538). Robert Reed Pub. ISBN1934759120, 9781934759127.
    37. Hersha, L; Hersha, C., Griffis, D., & Schwarz, T. (2001). Secret weapons: Two sister’s terrifying true story of sex, spies, and sabotage. Far Hills, New Jersey: New Horizon Press.
    38. O'Brien, C., & Phillips, M. (2005). Trance Formation of America: The True Life Story of a CIA Mind Control Slave. Reality Marketing Inc. ISBN 0966016548.
    39. Sullivan, K. (2006). Unshackled: A Survivor's Story of Mind Control. Dandelion Books, LLC.
    40. American Psychiatric Association, (1994). Diagnostic and statistical manual of mental disorders: DSM-IV. American Psychiatric Association. ISBN 0890420629.
    41. World Health Organization. (2023). Possession trance disorder. ICD-11 for mortality and morbidity statistics (Version 01/2023). World Health Organization. Retrieved June 25, 2023.
      "Possession trance disorder is characterised by trance states in which there is a marked alteration in the individual’s state of consciousness and the individual’s customary sense of personal identity is replaced by an external 'possessing' identity and in which the individual’s behaviours or movements are experienced as being controlled by the possessing agent. Possession trance episodes are recurrent or, if the diagnosis is based on a single episode, the episode has lasted for at least several days. The possession trance state is involuntary and unwanted and is not accepted as a part of a collective cultural or religious practice. The symptoms do not occur exclusively during another dissociative disorder and are not better explained by another mental, behavioural or neurodevelopmental disorder. The symptoms are not due to the direct effects of a substance or medication on the central nervous system, including withdrawal effects, exhaustion, or to hypnagogic or hypnopompic states, and are not due to a disease of the nervous system or a sleep-wake disorder. The symptoms result in significant distress or significant impairment in personal, family, social, educational, occupational or other important areas of functioning." [41]
    42. World Health Organization. (2023). Dissociative Identity Disorder. ICD-11 for mortality and morbidity statistics (Version 01/2023). World Health Organization. Retrieved June 25, 2023.
    43. Christensen, E. M. (2022). The online community: DID and plurality. European Journal of Trauma & Dissociation, 6(2), 100257.
    44. West, C. (1999). First Person Plural: My Life as a Multiple. Hyperion: New York. ISBN 0786889780 (first edition).
      Available in electronic/kindle form, and in paperback or hardback. Sold in 22 different countries, with translations into multiple languages.
    45. First Person Plural. (n.d.). First Person Plural. Retrieved June 25, 2023.
    46. First Person Plural. (n.d.). Clarifying who FPPs beneficiaries are. Retrieved February 8, 2023.
    47. First Person Plural. (n.d.). History. Retrieved January 21, 2019.
    48. Loewenstein, R.J. (1991). An Office Mental Status Examination for Complex Chronic Dissociative Symptoms and Multiple Personality Disorder. Psychiatric Clinics of North America, 14(3):567-604.
    49. Steinberg M, Rounsaville, B, & Cicchetti, DV. (1990). The structured clinical interview for DSM-III-R dissociative disorders: A preliminary report on a new diagnostic instrument. Am. J. Psychiatry, 147:76-82.
    50. Draijer, N., & Boon, S. (1999). The imitation of dissociative identity disorder: Patients at risk, therapists at risk. The journal of psychiatry & law, 27(3-4), 423-458.
    51. Dell, P. F. (2006). A new model of dissociative identity disorder. The Psychiatric Clinics of North America, 29(1), 1-26.
    52. Cutler, E.S. (2018). Listening to those with lived experience. In Steinguard, S. (ed), Critical psychiatry: Controversies and clinical implications, 179-206. Springer.
    53. Barker, M.J. & Iantaffi, A. (2021). Hell Yeah Self Care! A Trauma-Informed Workbook. Jessica Kingsley Publishers: London.
    54. Nijenhuis, E.R.S, Steele, K. & van der Hart, O. (2006). The Haunted Self: Structural Dissociation And Treatment Of Chronic Traumatization. W.W. Norton & Company. ISBN 9780393704013.
    55. Surawijaya, A. K., Ryanto, A. F., Sanjaya, A., Gunadi, J. W., & Jasaputra, D. K. (2023). Dissociative Identity Disorder with Five Alters: A Case Report. Journal of Medicine and Health, 5(1), 64-73
    56. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders: DSM-III. (3rd ed.). Washington, D.C: American Psychiatric Association.

    Cite this page . Alters in Dissociative Identity Disorder and OSDD/P-DID. Retrieved from .

    This information can be copied or modified for any purpose, including commercially. A link back could be appreciated. License: CC BY-SA 4.0.
    Updated 2023.