Identity confusion can happen with and without DID. for example someone with alzehimers gets confused as to who they are and who the people around them are and frequently get lost because they cannot remember who they are, where their home is and so on.

Amnesia victims have Identity confusion. Something happens where they don't know who they are. about a year ago there was a case on a news show maybe dateline where this man went to get groceries and suddenly didn't know who he was, what happened to cause his memory loss but walked away because he had no idea where he was and who he was or any relatives the homeless shelter where he ended up helped him to begin a new life in another state with a new name and so on. A year later he was featured on a program and someone recognized him as being the person on the tv show and called in. The guy has since been reunited with his original family but he lives now with the new family and life he had after the amnesia took his memory because he still cant remember being the person in the first state. He may never get his memory back no one knows for sure.

As for alteration going by the explaination above the person does not have to have DID but it does happen with it.

A person who would not normally shoot up with drugs suddeny does it ignoring all the risk factors. Like for example a friend who doesn't normally smoke cigarettes, she knows what they can do and cause and so she does not smoke BUT yet in certain circumstances like being out at a popular dance bar here She will disregard the risks of smoking and her health (asthma) and will smoke even though health wise it is very dangerious for her to. Its an added bonus or thrill to her.. the smoking isnt a normal every day behavior for her just in that situation she goes for it even though she knows she will experience an asthma attack.