What is DID?
Dissociative identity disorder is a rare mental health illness where a person has multiple distinct personalities (alters) that control their behaviour at different times.
It is caused by past trauma, usually sexual or physical abuse during childhood.
The person has problems with memory, identity, emotion, perception, behavior, and sense of self. The symptoms can potentially disrupt every area of mental functioning.
It is common for the person to have gaps in their life story,
Are there different types of identity disorders?
There are three types of dissociative disorders:
- Dissociative identity disorder – where a person has two or more separate identities
- Dissociative amnesia – gaps in memory involving an inability to recall personal information, usually of a traumatic or stressful nature
- Depersonalization/derealization disorder – when you persistently or repeatedly have the feeling that you’re observing yourself from outside your body or you have a sense that things around you aren’t real, or both.
How does the separate identity (alter) differ from the real /host person?
The alters can
- have different ages,
- can be male or female,
- each is called by their unique name,
- can speak or understand different languages than the person does,
- and have different attributes, talents, likes, and dislikes
- They have different voices and mannerisms
We have observed the following in a DID client that we worked with daily over a period of more than 10 years (2013-2023)
She was a victim of sex trafficking. She split into many different personalities through years of abuse. We worked with her for 5 years while she was still being trafficked. She managed to get out in 2018 and has since been in recovery. Individual psychotherapy has helped her to start dealing with all the trauma and put the pieces of her life together – it is called integration.
With integration, she discovered the following:
- each personality has a role in her life
- one comes out when she feels threatened;
- another acts like a live-in secretary to make sure she is on time at work or at appointments;
- another keeps a record and makes sure she takes her medication daily
- she uses some at job interviews or to perform tasks at work
- some personalities are little girls that play with dolls – through them, she experiences her lost childhood.
- each personality was created at a time of great distress to enable her to cope
- a new personality is created during a gang rape, to bear the pain and terror, while the person ”goes to the ceiling” and does not feel the hurt.
- Then after the incident, the person ”returns” and can carry on with life as if nothing happened, while the personality with the pain is stored deep in the subconscious.
- that some personalities are good for her and some are bad
- a personality that functions as a persecutor who tells you how bad, ugly, or shameful you are and encourages you to self-harm by cutting or suicide attempts
- a personality that acts as a protector or voice of reason – that helps control switching or reaches out for help during bad flashbacks. Some personalities are just passive observers who report on the person’s activities. Her passive observer/ helper always responds to guidance messages from her therapist by saying ”NOTED”.
- Interesting also that the host person does not necessarily pick up a bad habit that a personality might have acquired – for example, if a personality was often fed drugs prior to rape, the host person is able to live drug-free.
- she also reports periods of amnesia or a dissociative fugue. A dissociative fugue is a temporary state where a person has memory loss (amnesia) and ends up in an unexpected place.
- she will report in to say she found herself in the middle of a cemetery and she can’t recall going there.
- she has no recollection of which personality was involved when the amnesia happened.
- she has no recollection of what happened to her when she had the ”fugue” – the only person who knows what happened is the personality that wandered off.
- each personality has its own memory
- her life seems to be a huge broken puzzle and every personality is a piece that fits in somewhere.
- she has huge gaps in her memory like not knowing where she went to school or her real age.
- integration happens with severe pain and trauma as she – the host – is confronted for the first time with the traumatic events as they occurred.
- as integration happens, she meets the personality and when the memory is shared, she experiences it emotionally and physically.
- most memories return around about the time it occurred – for example, hers occur about 01h00 0r 02h00 during the night as a night terror. She was usually trafficked at night.
- personalities can be triggered by many things e.g. sound/smell/sight/ hearing/ skin sensations to ”come out”
- people: a man fidgeting with his belt, sudden touch by another person
- places: a park
- things: a man’s aftershave, or his colour tie, a billboard, a date on the calendar
when triggered she may lash out in defense, shut down and become quiet, or ”go to the ceiling” (dissociate) and let the personality handle the situation.
- each personality has its own talents and abilities
- she has a few that are creative and their art styles vary greatly from weaving, and landscape acrylic paintings to childlike crayon drawings
- some personalities are performers that either sing or dance very well in stage productions.
- they speak and understand a number of languages that the host is not familiar with.
Amazing as it may sound, there is still confusion in the world among learned people in the field of psychiatry if DID really exists. People with DID can be diagnosed as schizophrenic or with a personality disorder by mistake. Multiple Personality Disorder (MPD) was first introduced in DSM-III in 1980.
The aim of this article is to illustrate the complexity of working with a DID client. In the beginning, what the DID client tells you may be extremely confusing – but once the diagnosis is made – things start to make sense.
The DID client needs intensive psychotherapy to heal – usually from a few clinical psychologists and therapy can happen over many years.
They also need medication prescribed by a psychiatrist that works closely with the psychologist treating the patient.
The history of DID:
A detailed account of “exchanged personality” was written about a 20-year-old German woman in 1791. She began to speak perfect French, behave like a French aristocrat and spoke German with a French accent. When she was the “French Woman” she remembered everything she did but as the “German Woman” she denied any knowledge of the “French Woman.
The majority of cases noted by 1944 manifested with only two personalities, while there was an average of 15.7 alters noted in cases reported in 1997.
Dissociative identity disorder was added to the Diagnostic and Statistical Manual of Mental Disorders (DSM) first edition in 1952 as a psychoneurotic disorder. They described it as anxiety either “directly felt and expressed or . . . unconsciously and automatically controlled” by various defense mechanisms.
In the DSM-II, in 1968, dissociative identity disorder was called hysterical neurosis, dissociative type and was defined as an alteration to consciousness and identity.
In the 1970s, the diagnosis of dissociative identity disorder rose dramatically after the publication of the extremely popular book, Sybil, in 1973. Sybil Dorsett is a survivor of terrible childhood abuse who as an adult was a victim of sudden and mysterious blackouts. What happened during those blackouts has made Sybil’s experience one of the most famous psychological cases in the world.
In 1980, the DSM-III was published and the term “dissociative” was first introduced as a class of disorders.
The DSM-IV, in 1994, addressed this somewhat as it included the specific criterion of amnesia to the diagnosis of multiple personality disorder, now renamed to dissociative identity disorder.
The DSM-5 changed this definition to allow self-reports and specify that amnesia may occur with regard to everyday events and not just traumatic ones.
In the current day, controversy still rages around DID, its diagnosis, and whether the disorder even exists.