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Dissociative identity disorder is characterized by the presence of at least two distinct and relatively enduring personality states. The disorder is accompanied by memory gaps more severe than could be explained by ordinary forgetfulness. The personality states alternately show in a person's behavior; however, presentations of the disorder vary. According to the DSM-5-TR, early childhood trauma, typically starting by 5-6 years of age, can place someone at risk of developing dissociative identity disorder. Across diverse geographic regions, 90% of individuals diagnosed with dissociative identity disorder report experiencing multiple forms of childhood abuse, such as rape, violence, neglect, or severe bullying. Other traumatic childhood experiences that have been reported include painful medical or surgical procedures, war, terrorism, attachment disturbance, natural disaster, cult, and occult abuse, loss of a loved one or loved ones, human trafficking, and dysfunctional family dynamics. There is no medication to treat DID directly. However, medications can be used for comorbid disorders or targeted symptom relief, for example antidepressants or treatments to improve sleep. Treatment generally involves supportive care and psychotherapy. The condition usually persists without treatment. The condition is believed to affect 1.1–1.5% of the general population (based on multiple epidemiological studies) and 3% of those admitted to hospitals with mental health issues in Europe and North America. DID is diagnosed about six times more often in women than in men. The number of recorded cases increased significantly in the latter half of the 20th century, along with the number of identities reported by those affected. However, it is unclear whether increased rates of diagnosis are due to better recognition or sociocultural factors such as mass media portrayals. The typical presenting symptoms in different regions of the world may also vary depending on culture, such as alter identities taking the form of possessing spirits, deities, ghosts, or mythical creatures and figures in cultures where normative possession states are common.