The narrator in Fight Club experiences symptoms of Dissociative Identity Disorder (DID), including insomnia, amnesia, time lapses, and the emergence of an alternate personality named Tyler Durden. DID is caused by traumatic experiences in childhood and involves dissociating parts of one's identity. The narrator realizes he and Tyler are the same person, and stages a confrontation to erase Tyler's personality from his mind. While the movie depicts DID inaccurately in some ways, it captures key symptoms like fugue states and the narrator's struggle between personalities.

1. Dissociative Identity Disorder
in Fight Club

2. What is
Dissociative Identity Disorder?
Dissociative Identity Disorder (DID)

Also called Multiple Personality Disorder.

Described as a psychiatric diagnosis in which a person
has two or more alternating personalities

Causes an inability to recall personal information or
activities relating to a personality or personalities. [1]
Mild dissociation
Very common among the general population
May be described as daydreaming or “running on
autopilot.”
Can be triggered by stress, and is thought by some to
be a way for the mind to distance itself from
experiences that are too difficult for it to process. [2]

3. DID in Real Life
Eleven-Man
In some cases, certain identities can interact with one another
internally. An article in Time Magazine refers to a patient
named Robert Oxnam, who was diagnosed with DID. He has
a total of 11 different personalities, many of them known to
one another but not to Oxnam himself. [3]

4. What is the cause of the
Narrator's DID?
Theoretically, the disorder is linked with extremely high stress
levels, often associated with traumatic experiences, and a
unique ability to sever conscious connections with
memories.[4] The narrator experiences this in the form of
insomnia. While he believes he is just laying awake at night,
his alternate personality is actually making soap.
A large amount of patients reportedly suffer from child abuse.[4]
Both the narrator and Tyler allude to the possibility that they were
abused at some point, and at separate times, they state that their
fathers left them when they were young.

5. Diagnosis
To help diagnose dissociative disorders, a psychologic
interview using special questionnaires made specifically to
identify dissociative disorders is conducted, along with a
medical examination that may physically determine the
cause of some symptoms.
In some cases, the patient may need to be sedated or
hypnotized in order to relax the person and draw out the
other personalities and repressed information. [4]

6. Symptoms
There are several symptoms related to DID, which include[1] [4]:

Varying levels of functionality

Time distortions, time lapses, and amnesia

Depersonalization and Derealization

Fugue States

Depression

Sudden anger/Irritability

Insomnia

Hearing the voices of other personalities
The narrator experiences many of these symptoms throughout the
movie.

7. Depersonalization
Depersonalization

Occurs when a person
experiences a persistent or
recurring feeling of being
detached from his or her body
and/or thoughts.

Often referred to as an “out-of-
body experience.”

Unlike patients with a
psychotic disorder,
depersonalized patients are
aware that their unreal
experiences are, in fact, not
real. [4]

8. Derealization
Derealization can be described as a change in the way one perceives and
experiences the external world, in a way that makes the world seem
unfamiliar or dream-like. Some patients describe derealization as a
sense of seeing the world from behind an immaterial barrier, as if it
was foggy or very far away. Unlike depersonalization, in which one
feels detached from his/her body, derealization deals with a feeling of
detachment from the outside world.[2][4] It is not a standalone
disorder, but rather a symptom of numerous psychiatric disorders. It
often co-occurs with insomnia and severe stress.
This symptom appears near the beginning of Fight Club,
and the narrator attributes it to his amnesia, stating “With
insomnia, nothing's real. Everything's far away.”

9. Fugue State
A fugue state, known formally as a
dissociative fugue, is one or more
episodes of amnesia relating to a
person's identity. During fugue states,
patients cannot recall their past and lose
their identity, and as a result, often
develop a new one. They usually set
out on sudden, unexpected travels.
Fugue states can last from a few hours
to more than a few months, and patients
may wander very far from their homes
and families, assuming a new job under
a new identity. [1][4]

10. Fugue State (Cont'd)
People who are in a fugue state are unaware of any apparent
change in their lives. However, they may become confused
about their identity, or their original memories may eventually
return. If this occurs, people usually become extremely
distressed and may confront others, causing intense conflict, as
the patients must face what they left behind. [1][4]
In Fight Club, the narrator constantly experiences fugue states, and
even begins noticing gaps in his memory. He also begins to wake up
in a different time and place than when he fell asleep, and becomes
very suspicious of his association with himself and Tyler.

11. How is it acquired?
While there is no proven cause of DID, studies have shown
that the number of diagnoses has risen. DID frequently
occurs alongside other psychiatric issues, such as insomnia
and anxiety disorders. Studies have also shown that DID is
clearly not exclusive to Americans, and can be diagnosed
outside of the United States if the symptoms are sought after.
According to the International Society for the Study of Trauma
and Dissociation, about 1% of the total population suffer
from this disorder, and it is speculated that about 7% have
untreated dissociative disorders. [5]

12. Treatment and Prevention
Safety is the first priority. Supportive care, drug treatment, and long-term
integration of identity states are the standard methods of treatment.
Many treatments aim to facilitate cooperation and collaboration among
the identities. Therapy is used to reconnect and rehabilitate the
personalities to restore social functioning. In serious cases, a change in
the very structure of the patient's self-consciousness may be needed.

13. Contact/Help Groups
Since DID is a generally
rare disorder, there are no
formal organizations or
support groups for this
condition. However, a
few online groups
claiming to have DID
have come together to
share their stories and
offer advice to others
with this disorder.

14. The Narrator's Experience
Begins with his insomnia. The narrator is not aware
Attends several support groups that Tyler is his alternate
for dying people, and he finds a personality.
release in crying with them, The two begin to use
which allows him to sleep. physical violence as a new
A fellow “faker” causes his form of “release.”
insomnia to relapse. More and more, the narrator
As a result, the narrator begins sees Tyler projected into the
interacting with an alter ego, world, giving the illusion
Tyler Durden. that he is a separate being
Unlike the passive, antisocial and influences the world
personality of the narrator, independently.
Tyler is much more eloquent
and animated.

15. The Narrator's Experience
(Cont'd)
However, his alter ego, Tyler, is very smart and aware of his
existence as an alternate personality. Tyler sets up the events in
the movie to occur in a way that wouldn't reveal to the narrator
that the two of them were the same person.

16. The Narrator Confronts his
Alter Ego

17. Mind Over Matter
Eventually, the narrator realizes that he and Tyler are
the same person, and the two personalities begin
struggling for dominance. In his desperation, the
narrator shoots himself in the cheek, staging a sort of
mock suicide that erases Tyler Durden's personality
from his mind.

18. Real or Reel?
While the storyline is farfetched, the creation and actions of the
narrator's alter ego can easily be categorized as DID. The narrator's
unconscious, international trips under a different identity would
undoubtedly be described as a dissociative fugue, and the insomnia
that arguably begins his alter egos actions is, for the most part,
accurately portrayed. The method which is used to cure his DID,
however, would be considered very radical.
It is rumored at one point in the movie that the narrator's alter
ego, and thus the narrator himself, was born in a mental
institution and sleeps only one hour every night, implying that
the narrator himself may have had a history of mental issues.
This is further supported by the fact that the narrator apparently
had fugue states since before the beginning of the movie.

19. Sources
[1] Mercks Manuals for Healthcare Professionals, 2009. Web. 22, March 2011.
http://www.merckmanuals.com/professional/sec15/ch197/ch197e.html
[2] Mayo Clinic, 2011. Web. 8, April 2011.
http://www.mayoclinic.com/health/dissociative-
disorders/DS00574/DSECTION=symptoms
[3] “Meet Robert. And Tommy And Bobby and Wanda ...” Time Inc. 2005. Web. 22,
March 2011.
http://www.time.com/time/magazine/article/0,9171,1112834,00.html
[4] Mercks Manuals Home Edition, 2009. Web. 22, March 2011.
http://www.merckmanuals.com/home/sec07/ch106/ch106e.html
[5] Prime Health Channel, 2010. Web. 8, April 2011.
http://www.primehealthchannel.com/dissociative-identity-disorder-symptoms-
diagnosis-treatment-and-statistics.html