Dissociative identity disorder (DID), formerly known as multiple personality disorder until its renaming in the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) in 1994, is among the most controversial and misunderstood conditions in modern psychiatry. The current, fifth edition of the DSM defines DID by the presence of two or more distinct personality states, or “alters,” that recurrently assume executive control of the individual’s behavior, accompanied by significant gaps in the recall of everyday events, personal information, and traumatic experiences that cannot be attributed to ordinary forgetfulness. The American Psychiatric Association identifies DID as fundamentally a trauma-response disorder, noting that “overwhelming experiences, traumatic events, and/or abuse occurring in childhood” are the primary etiological factors (Spiegel, Dave. “What Are Dissociative Disorders?” American Psychiatric Association, Oct. 2024).

The prevailing clinical model, sometimes called the trauma model or the theory of structural dissociation, holds that young children (typically before the age of six or nine, when personality integration normally consolidates) exposed to severe, chronic, and inescapable abuse may fail to develop a unified sense of self. Instead, the child compartmentalizes intolerable experiences into separate identity states, each holding distinct memories, affects, sensory perceptions, and even physiological markers such as differing handwriting, allergies, or visual acuity. Alters may take many forms, including child alters frozen at the age of trauma, protector alters who manage threats, persecutor alters who internalize the aggressor, and host alters who function in daily life while remaining amnesiac to the abuse.

The disorder gained significant public attention through Flora Rheta Schreiber’s 1973 book Sybil and Corbett H. Thigpen and Hervey M. Cleckley’s 1957 book The Three Faces of Eve, though both cases have since been the subject of scholarly reappraisal and, in Sybil’s case, accusations of therapeutic confabulation. The “memory wars” of the 1980s and 1990s produced fierce debate between clinicians who accepted DID as a genuine trauma sequela and skeptics who argued that it was “iatrogenic,” produced by suggestive therapy, hypnosis, and cultural expectation. Contemporary research using neuroimaging, however, has documented measurable differences in brain activity, connectivity, and hippocampal volume among individuals with DID, lending support to the trauma model.

Treatment typically involves long-term, phase-oriented psychotherapy aimed at stabilization, processing of traumatic memory, and eventual integration or cooperative functioning among alters. Comorbid conditions including post-traumatic stress disorder, depression, self-harm, and suicidal ideation are common, and diagnosis is frequently delayed by years or decades. Within this clinical framework, the novel positions Azra Kovacic, whose alters, including the dominant Daisy Rue and the figures of Katrina, Jonquil, and Phoebe, emerge in response to the paternal abuse she survived. Azra’s case is documented in Mrs. Semple’s journal observations: “Daisy’s madness would quickly become apparent” as she conversed with “invisible acquaintance[s]” (331).