The Intersection of Race, Gender, and Geography in Dissociative Identity Disorder

Abstract
Background
Dissociative identity disorder (DID) is a childhood onset posttraumatic biopsychosocial syndrome characterized by identity alteration symptoms in which one loses a sense of agency and ownership over some thoughts, feelings, memories and behaviors. Prior work has noted gender differences in DID prevalence with women often exhibiting higher rates of diagnosis compared to men. However, most research on DID is conducted on relatively homogenous samples with limited demographic variability. Specifically, the potential for racial/ethnic or geographic influences – or appreciation for intersectional relationships – on DID symptoms remains relatively unexplored. Therefore, the present study investigated the associations between race, gender, and geography on DID diagnosis.

Methods
The present analysis utilized data collected as part of an online platform, TestMyBrain.org, a web-based neurocognitive testing environment. Participants (n = 7,013) provided demographic information (e.g., race, ethnicity, and gender) and completed the Multiscale Dissociation Inventory (MDI). Geographic location of participants was derived from participant IP address and recoded to continental region to examine geographic associations with DID. General linear models were completed to investigate associations between race/ethnicity, gender, and participant geographic location with a provisional self-report DID diagnosis (MDI identity dissociation subscale score >14) and MDI identity dissociation continuous subscale score.

Results
Linear models revealed a significant main effect of race/ethnicity on DID diagnosis (χ² (5, N=7013) = 96.699, p < .0001). In general, individuals from marginalized groups (American Indian or Alaska Native, Asian, Black or African, Native Hawaiian or Pacific Islander) showed higher rates of DID compared to individuals from the White group with notable between-group differences among marginalized individuals. Specifically, Asian and American Indian or Alaska Native individuals had higher DID prevalence rates compared to multiracial individuals. We also observed a significant main effect of gender (χ² (2, N=7013) = 26.775, p < .0001) such that genderqueer individuals reported higher rates of DID compared to men and women, and men reported higher rates of DID compared to women. We also found varying rates of DID diagnosis by geographic location (χ² (4, N= 6947) = 101.64, p < .0001). Such that individuals in Africa, Asia, and Oceania had higher rates of DID compared to the Americas and Europe. Linear models revealed nearly identical results for the MDI identity dissociation continuous score. Additionally, within geographic locations, there were significant main effects of race/ethnicity on identity dissociation scores for individuals from Africa (F(4,114) = 2.987, p = .0218), the Americas (F(5,3472) = 4.069, p = .0011), Asia (F(5,999) = 4.889, p < .001), Europe (F(5,1984) = 7.09, p < .001), and Oceania (F(5,349) = 2.568, p=.0268).

Conclusion
The results suggest that race/ethnicity, gender, and geographic location are linked to varying rates of DID diagnosis and identity alteration symptom severity. Groups with potentially the highest rates of DID (Black, Indigenous, people of color, genderqueer individuals) are underrepresented in current empirical research on DID. This highlights the importance of considering various demographic factors in DID research. Future work should explore the contributing factors to these differences to develop effective prevention and treatment strategies for specific groups.