#DID and social media: What happens when a diagnosis goes viral

If you scroll through TikTok or Instagram and you might encounter a creator introducing their "system," listing out alters with names, ages, and personality traits. Some wear different clothes to represent different parts. Others use filters or voice changes to depict internal switches. Hashtags include #DID, #MultiplePersonalities, or #PluralGang, reaching billions of views.

As a trauma psychologist, I’ve spent years treating individuals with complex dissociative disorders. I’ve also spent enough time online to recognize the impact that digital culture is having on how people conceptualize their inner lives. There are powerful possibilities here: social media can demystify mental health and create access for those who feel isolated. But what happens when information drowns out expertise? Or when entertainment and education get conflated? And to complicate it further, what happens when youth with very real struggles begin modeling their symptoms on algorithms rather than on their own experience?

The rise of self-diagnosis in the age of social media

The COVID-19 pandemic changed how we relate to ourselves and our mental health. With clinical services strained during the pandemic, many turned to online spaces for answers. According to Salter et al. (2025), self-diagnosis of psychiatric conditions, especially among adolescents and young adults, has exploded across platforms like TikTok and YouTube over the years. Conditions like ADHD, borderline personality disorder, Tourette's, autism, and DID have found massive digital audiences. In fact, videos tagged with #DID have been viewed more than 2.7 billion times (Salter et al., 2025).

What’s behind this? A mix of isolation, curiousity, algorithmic amplification, and real mental health need. For many, online content provides language and validation that's missing in their offline lives. But this boom in visibility hasn’t come without costs.

One of the most concerning trends in recent years is the gap between clinically accurate information about DID and how it is portrayed online. DID is a complex trauma-based disorder involving identity disruption, amnesia, and significant functional impairment. It typically arises in the context of repeated, early-life interpersonal trauma. Most people with DID don’t talk openly about their symptoms, and they don’t present with fully fleshed-out alters dressed in cosplay.

The reality is often quieter and difficult to narrate: blackouts, memory gaps, flashbacks, suicidal thoughts, and relational struggles. In fact, shame is highly correlated with dissociation (Rudy et al., 2022), and many people with DID resist or even reject the diagnosis. Online portrayals, in contrast, often depict DID as quirky, theatrical, and at times, desirable.

This is what Salter and colleagues (2025) refer to as imitative DID: a presentation that may involve real psychological distress but lacks the phenomenology, etiology, and internal conflict characteristic of genuine DID. These individuals often develop complex self-state systems influenced by online communities and fandoms, but without the amnesia, distress, and comorbidity typical of clinical DID (Boon & Draijer, 1993).

Photo by Alexander Shatov on Unsplash

There is a feedback loop happening between social media and clinical settings. People consume online content, identify with symptoms, label themselves, and at times present to therapy requesting affirmation of those self-diagnoses. Clinicians who hesitate may be accused of gatekeeping or invalidation. In some cases, there’s outright hostility toward any clinical skepticism.

As Chevalier (2024) argues, this looping effect can reshape how psychiatric diagnoses are understood not only by the public but also by professionals. And when this happens, the distinction between subjective identity and clinical syndrome becomes blurred.

To be clear, there is nothing inherently wrong with self-reflection or identity exploration. In fact, many people experimenting with self-state language online may be grappling with trauma, neurodivergence, or unmet relational needs. The problem is misinformation, not exploration.

The diagnostic stakes

It’s important to say clearly that we cannot and should not diagnose or disqualify anyone based how they present themselves online. Clinical diagnosis requires a detailed evaluation, often including structured interviews, standardized measures, and a comprehensive understanding of one's functioning and history. What we see online is a curated sliver of someone’s experience. Some individuals who post about their dissociative experiences may indeed meet criteria for Dissociative Identity Disorder. Others may be expressing identity exploration, trauma-related distress, or seeking belonging in ways that reflect real needs, even if they don’t fit neatly into diagnostic categories. To assume that all online expressions are fake is as misleading as assuming they all reflect DID.

DID is not an aesthetic. It’s a significant, often debilitating disorder with high rates of suicidality, hospitalization, and functional impairment. People with DID have extremely high rates of PTSD, substance use, eating disorders, and medical issues linked to chronic trauma (Felitti & Anda, 2010; Webermann et al., 2021). Many remain vulnerable to ongoing abuse into adulthood (McMaugh et al., 2024).

This is why accurate diagnosis matters. When clinicians use validated tools like the SCID-D (Steinberg, 2023) and MID (Dell, 2006), they can differentiate DID from conditions with overlapping symptoms like borderline personality disorder, psychosis, or an underlying dissociative disorder. But if we collapse everything under the umbrella of multiplicity, we risk mislabeling distress and missing opportunities for targeted care.

What should clinicians and educators do?

We need to stop reacting with moral panic. Dismissing all online self-diagnosis as fake or attention-seeking is clinically reckless. Many people exploring DID language are suffering. But we also cannot afford to treat self-diagnosis as synonymous with clinical diagnosis.

Here’s what we can do:

1. Show up online with credibility and compassion. Mental health professionals need to occupy more digital real estate. That doesn’t mean dancing on TikTok, but it does mean providing grounded, research-informed content that can be accessed by the public. It means writing, speaking, commenting, and showing up with nuance.

2. Validate distress. We can honor the pain behind someone’s self-diagnosis without automatically endorsing the label. That means asking better clinical questions and using validated tools. It also means being honest when symptoms don’t align with a diagnosis.

3. Teach about dissociation. Dissociation reaches beyond alters. It includes amnesia, depersonalization, derealization, and sensory numbing. Educating the public (and professionals) about these less sensational features can help create more accurate narratives about trauma and its effects.

4. Respect the intelligence of the public while upholding clinical rigor. People want information. They want language. They want to be understood. If clinicians and researchers aren’t providing that in accessible ways, someone else will. And they might be wrong.

Social media is not going away, nor should it. The democratization of mental health language has empowered countless people to seek care and find community. Clinicians need to recognize that the problem is not the internet. The problem is not having enough qualified, trauma-informed voices in digital spaces.

We need more psychologists, social workers, educators, and survivors to contribute to the conversation online. We need digital literacy campaigns that teach people how to discern credible sources. We need to train clinicians to understand online cultures rather than fear them so that they can better serve the clients who live in them.

Most of all, we need to stay curious. When a client walks in with a list of alters or uses language they learned online, we shouldn’t roll our eyes. We should ask: what are they trying to express? What pain is underneath this identity? And how can we support their exploration of memory, of emotion, and of the self?

References

Boon, S., & Draijer, N. (1993). The differentiation of patients with MPD or DDNOS from patients with a cluster B personality disorder. Dissociation, 6(3), 126–135.

Chevalier, O. (2024). "It starts on TikTok": Looping effects and the impact of social media on psychiatric terms. Philosophy, Psychiatry, & Psychology, 31, 163–174.

Dell, P. F. (2006). The Multidimensional Inventory of Dissociation (MID): A comprehensive measure of pathological dissociation. Journal of Trauma & Dissociation, 7(2), 77–106.

Felitti, V. J., & Anda, R. F. (2010). The relationship of adverse childhood experiences to adult medical disease, psychiatric disorders and sexual behavior. In R. A. Lanius, E. Vermetten, & C. Pain (Eds.), The hidden epidemic: The impact of early life trauma on health and disease (pp. 77–87). Cambridge University Press.

McMaugh, K., Roufeil, L., Salter, M., & Middleton, W. (2024). Incestuous abuse continuing into adulthood: Clinical features and therapists’ conceptualisations. Journal of Trauma & Dissociation, 1–16.

Rudy, J. A., McKernan, S., Kouri, N., & D'Andrea, W. (2022). A meta-analysis of the association between shame and dissociation. Journal of Traumatic Stress, 35(5), 1318–1333. https://doi.org/10.1002/jts.22894

Salter, M., Brand, B. L., Robinson, M., Loewenstein, R., Silberg, J., & Korzekwa, M. (2025). Self-diagnosed cases of dissociative identity disorder on social media: Conceptualization, assessment, and treatment. Harvard Review of Psychiatry, 33(1), 41–48. https://doi.org/10.1097/HRP.0000000000000416

Steinberg, M. (2023). The SCID-D Interview: Dissociation assessment in therapy, forensics, and research. American Psychiatric Association Books.

Webermann, A. R., Brand, B. L., & Kumar, S. A. (2021). Intimate partner violence among patients with dissociative disorders. Journal of Interpersonal Violence, 36(3–4), 1441–1462.

Understanding Shame-Induced Dissociation in Trauma Survivors

woman looking on wall mirror — Photo by Vinicius "amnx" Amano on Unsplash

POV: You're looking in the bathroom mirror when an old shameful memory suddenly surfaces. A sense of detachment creeps in and you feel like you're staring at a stranger. Your reflection stares back at you, unfamiliar. This is what shame-induced dissociation can feel like—a sudden rupture between the self and the present moment, often triggered by past trauma. For mental health providers, this visceral survival response to traumatic experiences is one we must understand to help our clients navigate it.

Shame is a deep sense of self-judgment that comes from believing one has failed or broken important social or moral rules (Cunningham, 2020). This emotion, intimately tied to identity, often triggers withdrawal and avoidance behaviors. For trauma survivors, particularly those exposed to interpersonal violence during childhood, shame can become pervasive and overwhelming (Matos & Pinto-Gouveia, 2010).

Research by Kouri et al. (2023) demonstrated that recalling shame-related memories elicited significantly higher dissociation levels than neutral memories. Participants reported experiences of depersonalization and emotional numbing when revisiting these moments, suggesting that shame operates as a gateway to dissociative coping mechanisms. Dissociation, in this context, acts as a mental escape from the pain of confronting a diminished self-image. For example, a person might find themselves zoning out during conversations, losing track of time, or feeling emotionally numb when reminded of past shameful experiences.

Clinicians must create a nonjudgmental space for clients experiencing shame-induced dissociation. This means fostering an environment where clients feel comfortable discussing difficult emotions without fear of criticism. It involves validating their experiences, using dual awareness techniques to keep them present, and gently challenging avoidance patterns while maintaining a compassionate stance.

The Moderating Influence of Experiential Avoidance

Experiential avoidance is the tendency to resist distressing thoughts, emotions, or sensations. This avoidance plays a key role in the connection between shame and dissociation, often intensifying dissociative responses. Kouri et al. (2023) found that individuals with high levels of experiential avoidance were more likely to dissociate when recalling shameful memories compared to those with lower avoidance levels.

This phenomenon is particularly pronounced in trauma survivors who internalize shame. As Dorahy et al. (2017) highlighted, internalized shame fosters a desire to withdraw from an internalized ‘contemptible self,’ amplifying the need for dissociative escape. In therapy, avoidance can present as “resistance” during sessions.

Reducing experiential avoidance helps lessen dissociation. Individuals with high experiential avoidance often struggle to remain present in therapy, reinforcing shame-driven dissociative patterns. Integrating approaches such as EMDR can help clients process distressing memories safely while fostering an increased tolerance for difficult emotions. Mindfulness-based strategies may also support clients in gradually confronting and integrating their experiences, ultimately reducing the need for dissociative coping mechanisms.

The Psychological Impact of Self-Reflection

For individuals with a history of interpersonal violence, literal and metaphorical mirrors can become sources of alienation. Studies have shown that mirror-viewing tasks—where participants confront their reflections while recalling traumatic memories—can heighten feelings of shame and dissociation (Caputo, 2010; Kouri et al., 2023). In these moments, the reflection becomes a painful reminder of a fragmented self.

Kouri et al. (2023) hypothesized that the mirror might amplify dissociative experiences. While their findings did not show a significant increase in dissociation compared to control conditions, participants often described a profound discomfort and estrangement from their reflections. Prior research (Freysteinson et al., 2018) also links sexual trauma histories to mirror-related disconnection.

Therapists might consider using controlled mirror-exposure techniques as part of interventions, helping clients re-establish a compassionate relationship with their self-image. For example, a therapist might guide a client through a mirror-viewing exercise where they describe what they see without judgment, gradually shifting their focus from self-criticism to self-acceptance. Over time, this approach can help reduce avoidance and foster a more integrated sense of self. Gradual desensitization and narrative therapy can support this process by providing structured opportunities to process shame while fostering a sense of safety and self-acceptance.

shallow focus of person holding mirror — Photo by Vince Fleming on Unsplash

Shame-induced dissociation represents a complex challenge for trauma-informed care. Its roots lie in the interplay between identity, avoidance, and self-perception, creating a cycle of withdrawal and fragmentation. As Kouri et al. (2023) emphasize, addressing these dynamics requires clinicians to focus not only on the traumatic events but also on the emotional states and self-concepts that perpetuate dissociation.

By incorporating approaches that target shame, reduce experiential avoidance, and repair fractured self-images, mental health providers can help clients reclaim a sense of self. These strategies empower individuals to confront and integrate their experiences, fostering greater emotional resilience. The journey is arduous, but with the right tools—such as EMDR, mindfulness practices, and compassionate self-inquiry—it can lead to healing and resilience.

References:

Kouri, N., D'Andrea, W., Brown, A. D., & Siegle, G. J. (2023). Shame-Induced Dissociation: An Experimental Study of Experiential Avoidance. Psychological Trauma: Theory, Research, Practice, and Policy.

Cunningham, K. C. (2020). Shame and guilt in PTSD. In M. T. Tull & N. A. Kimbrel (Eds.), Emotion in Posttraumatic Stress Disorder: Etiology, Assessment, Neurobiology, and Treatment. Elsevier Academic Press.

Dorahy, M. J., McKendry, H., Scott, A., et al. (2017). Reactive dissociative experiences in response to acute increases in shame feelings. Behaviour Research and Therapy.

Caputo, G. B. (2010). Apparitional experiences of new faces and dissociation of self-identity during mirror gazing. Perceptual and Motor Skills.

Freysteinson, W. M., et al. (2018). Body image perceptions of women veterans with military sexual trauma. Issues in Mental Health Nursing.

Where did you just go? An overview of dissociation

The British television series, Fleabag, offers a clever depiction of dissociation through its heroine's frequent asides to the camera. These moments extend beyond a dramatic device; they serve as a mechanism for the character to disconnect from her surroundings and shelter from the internal storm of her traumatic grief. This disconnection is further highlighted in the second season when her romantic interest, The Hot Priest, notices her in the middle of a quick aside to the audience and asks “What was that?” and points in the direction of the camera. “That thing you’re doing? It’s like you disappear.” Caught off guard, she looks at the viewer once more. “There!” he says. “Where did you just go?” “Nowhere,” she responds, but turns again to the camera with an alarmed look, perhaps knowing she’s been caught. I’ve often thought of the main character’s tendency to “disappear” during conversations as an expression of altered consciousness — a phenomenon known as dissociation.

Dissociation is a complex psychological concept with various definitions and interpretations that extend beyond the scope of this discussion. Historically, it was first described by theorists like Pierre Janet, who viewed it as the mind’s way of splitting off from trauma to protect against extreme pain. Janet’s theory laid the groundwork for many contemporary trauma theories that address healing through integration of the self (Schwartz, 2021). Modern psychology continues to grapple with defining dissociation. Different frameworks offer different perspectives ranging from ego state theory, various DSM-V diagnostic categories, to structural dissociation theory. Despite these theoretical divergences, dissociation generally refers to a disruption in the normal integration of consciousness, memory, identity, or perception.

Dissociation can occur in everyday life, such as becoming completely absorbed in a book or "spacing out" while driving on a familiar route. These quotidien moments of dissociation involve a normal, albeit temporary, disconnection from immediate surroundings. For example, the process of getting deeply immersed in a social media feed may be considered a form of dissociation (McQuate, 2022). During these moments, the brain remains active and engaged, often referred to as being on "autopilot" (Hamzelou, 2017).

Dissociation resulting from trauma is distinct and more profound. Traumatic dissociation involves unique physiological processes. Research indicates that traumatic dissociation is accompanied by hypoarousal—a state where the nervous system reduces its activity to a minimal level as a survival mechanism. This is part of an immobilization response to extreme threat, where the brain and body essentially "shut down" to protect the individual and preserve energy (Lanius et al., 2014).

Traumatic dissociation involves unique physiological processes.

To clarify the specific type of dissociation related to trauma, the term "dissociative hypoarousal" is sometimes used. This term encompasses both the psychological splitting of the self due to trauma and its biological manifestations. Dissociative hypoarousal can be defined as a biological phenomenon resulting from trauma that manifests in a fragmented self. It is characterized by alterations in consciousness, emotional numbing, and a presentation indicative of both personality splits and hypoarousal.

“That thing you’re doing? It’s like you disappear.”

When Fleabag’s protagonist appears to "disappear," she exemplifies dissociative hypoarousal. Her direct addresses to the audience are attempts to remain detached from her trauma. Each time she encounters reminders of her painful past, she shifts away from the experience, demonstrating the hallmark of dissociative hypoarousal.

Dissociative hypoarousal is often an internal experience, largely unnoticed by others. Like physical pain, it is subjective and can be difficult to articulate. Trauma survivors may find it beneficial to recognize their experiences as dissociative hypoarousal, a specific type of dissociation unique to their trauma.

Dissociative hypoarousal is often an internal experience, largely unnoticed by others.

In conclusion, dissociation is a multifaceted concept that ranges from everyday experiences of altered consciousness to profound disruptions resulting from trauma. Understanding the nuances of dissociative hypoarousal helps acknowledge the unique ways trauma can affect individuals, ultimately aiding in their healing and integration processes.