What is Dissociative Identity Disorder (DID)

Dissociative Identity Disorder FAQ[edit]

Are Multiple Personality Disorder and Dissociative Identity Disorder the same[edit]

Dissociative Identity Disorder, was referred to in the DSM as Multiple Personality Disorder until 1980, and still is called Multiple Personality Disorder in many parts of the non-English speaking world, where the ICD-10 is used, rather than the DSM. The ICD-10 retains the label of Multiple Personality Disorder. Both Multiple Personality Disorder and Dissociative Identity Disorder are the same thing.

Can anyone have more than one Personality[edit]

Everyone, even those with dissociative identity disorder only have one personality, and everyone has multiple parts to their personality. In dissociative identity disorder the parts are so dissociated, due to early and severe childhood trauma, that they meet the criteria for alters. A person with dissociative disorder not otherwise specified may have dissociated parts, but they are not dissociated and compartmentalized enough to meet the criteria for an alter. E. Howells explains this perfectly: "It is the degree of dissociation between self-states... that distant dissociative parts from normal parts of the personality". ^[1]

How does the Personality Split to form an Alter[edit]

The first thing to ask yourself is what is in the mind to begin with. Elizabeth Howell uses Putnum's term, which is "discrete behavior states" (DBS). The DBS does not have a sense of identity.

"In infancy, behavior is organized as a set of discrete behavioral states, such as states of sleep and waking, eating, elimination, and so on. These behavior states become linked over time and grouped together in sequences." Howells also says that "In essence the SUBSTRATE for the separation of the little girl on the ceiling and the other little girl whom she watches being raped is already there in the child's inner world." ^[1]

Abuse causes a trauma memory, as first ASD, then as PTSD. This abuse memory is the personality fragment, or what most just call a fragment. This is how it goes for all humans, and using the words split or fractured confuse the subject and makes it seem as if it only occurs in Dissociative Identity Disorder. The fragment did not exist before the trauma, and the part that was there already is not less than it was before the trauma, so saying split leads to mass confusion.

"The part of the personality that will take the abuse already exist in the child's inner world." ^[1] 87-88

What this quote by Elizabeth Howell means is that, if the part that is already present can't handle a trauma, and the memory is unprocessed (through the Hippocampus,) then we get a fragment. Of course then this part can then later take abuse as well.

All above can happen in all humans, but getting to Dissociative Identity Disorder now. This is where some of the DBS form their own identity. This happens when normal integration does not occur. Normal integration would be the linking of all those behavior states such as sleep, waking, eating, elimination, and so on. See how it only makes sense that Dissociative Identity Disorder occurs in those that suffer early and severe childhood abuse? The creation of an alter is not instant, as E. Howell describes. ^[1]

How do Alters get their Names[edit]

Naming can be done many ways. The host can name them, sometimes not being able to understand the alters real name, and an alter ends up being known by two names, but they don't change, it is just a communication issue. Most of the time an alter, once it is active has a name of some sort. It might be "Brat", "Dog" or whatever, but they have a name so they can communicate with each other. It is not always a nice name. An isolated alter who did not interact with those inside or who never came outside would have no need for a name. So naming is not in any set pattern - it's just a label to identify a part that has it's own identity.

Why is Dissociative Identity Disorder so Hard to Understand?[edit]

Dissociative Identity Disorder is one of the most complex and demanding topics in psychology, and easily the most complex of the fundamentally non-organic psychopathologies. There is also a fringe group of skeptics in psychology, that distort accurate information, making it more difficult for people to comprehend the concentric consensus of those who study and understand Dissociative Identity Disorder.

What is a Simple Explanation of Dissociative Identity Disorder[edit]

Every human starts out with an unintegrated personality. The process of normal integration takes place in childhood, and it takes a few years - it is not instant. When there is enough trauma and a lack of nurturing during early childhood, then the normal process of integration is interrupted. ^[1] Everyone's personality is made up of parts, but those with dissociative identity disorder have barriers around theirs due to early childhood abuse, so their parts are isolated and never integrated. ^[1] Therapy works to slowly dissolve trauma barriers and eventually coconscious between parts is gained, and then finally, after years of work, the parts of the personality will be able to integrate and can operate like a normal mind - which is not one part, but many parts of the personality working fluently together. There is no united self in any individual. ^[2]

Is the Host Alter a Complete Personality[edit]

A common misconception is that the host is a complete personality, but it is not. The host is simply another alter that needs all the other parts of the personality to communicate and work fluently so an individual can function normally.

Is any Alter or any part a complete Personality[edit]

Dissociative Identity Disorder is characterized by identity fragmentation, rather than a proliferation of separate personalities. In other words, no alter is a complete personality. It takes all the alters in a system to make up an individual.

How many Alters does a Person Usually Have?[edit]

The number of alters in a system can range from few to many. Systems that range in the teens is the norm, but those that suffered unimaginable abuse starting as early as infancy may have what is called polyfragmented Dissociative Identity Disorder with possibly hundreds of alters.

What does Amnesia have to do with Dissociative Identity Disorder[edit]

Amnesia is a DSM requirement, but as Paul F. Dell points out often, the DSM does not clarify what type of amnesia it refers to, and instead leaves it open, leaving the topic of amnesia in dissociative identity disorder, one of confusion. Instead of looking at the DSM's definition, let's look at what Dell has to say in his book Dissociation and the Dissociative Disorders - DSM-V and Beyond. ^[3]:319-321

• Overt: According the DSM, dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching. ^[3]:319-321 This can be considered to be overt or florid dissociative identity disorder.

• Covert: DES scores are lower in those with covert dissociative identity disorder than with overt dissociative identity disorder. These individuals are skilled at hiding overt symptoms. The overwhelming majority of individuals with dissociative identity disorder have this version. ^[3]:424

• Subtle: Less frequent and severe dissociation than individuals with either overt or covert dissociative identity disorder. ^[3]:424

• Polyfragmented: Most individuals with dissociative identity disorder have less than a dozen alters, however the far end of the spectrum is those individuals with polyfragmented dissociative identity disorder, having multitudes of distinct alters. ^[1]:57 "In general, the complexity of dissociative symptoms appears to be consistent with the severity of early tramatization." ^[4] "Extreme versions of dissociative identity disorder occasionally develop in response to particularly horrific ongoing trauma..." "In general, the complexity of dissociative symptoms appears to be consistent with the severity of early tramatization." ^[4]

What are Systems and Subsystem in Dissociative Identity Disorder[edit]

All the alters making up one individual is a system of alters. Large systems of alters are often broken into subsystems as a method of self-preservation and organization of trauma memories. Polyfragmentation often develops in children who suffered very early and extreme abuse, either at home or from ritual abuse. The organization appears to be unique to the individual.

Is Categorization in the DSM by Signs and Symptoms, or Cause[edit]

The DSM presents the minimum symptoms of Dissociative Identity Disorder that are needed to diagnosis it. Paul F. Dell, in his landmark 2006 study, ^[5] has described all the known signs and symptoms of Dissociative Identity Disorder. Etiology is a whole other matter. The models of Dissociative Identity Disorder attempt to create a construct of why and how Dissociative Identity Disorder is caused. There are three models accepted, as of 2013, and all are based on childhood trauma.

How common is Dissociative Identity Disorder[edit]

Dissociative Identity Disorder is found in all cultures and is probably more common than Schizophrenia. Studies report that Dissociative Identity Disorder has been identified in approximately 1% of the general population of North America. Reasonable estimates suggest that 5 to 58% of psychiatric hospital patients and 2 to 6% of the general population suffer from one of the Dissociative Disorders.

Does the person with Dissociative Identity Disorder know it?[edit]

Those with Dissociative Identity Disorder are often unaware of their mental disorder and the alters are often unaware of each other. The host alter that is usually in executive control is often the least aware. Think of it this way: if you have heart disease, you can have symptoms without knowing you have the disease. Once you enter treatment, the symptoms become clear as you are educated and you begin to work on healing. This is as true with mental disorders as it is with physical disorders.

What is Dissociation and what does it have to do with Dissociative Identity Disorder[edit]

Dissociation is a compartmentalization of experience, where elements of a trauma are not integrated into a sense of self. ^{[3]:4-810, 127} The lay persons idea of dissociation, that which exists in the normal mind, is not what is referred to in this document. True or pathological dissociation requires an experiencing self. ^[3]:233-234 Full dissociation (switching)is when an alter switches with the alter currently in executive control, resulting in amnesia for that alter. ^[1]:4-6 In full dissociation, there is complete amnesia between alters, which is a ^[3]:228 criteria for a diagnosis of dissociative identity disorder in the DSM. Partial dissociation is not limited to those with dissociative identity disorder. Parts of the personality influence each other, whether they are aware of others or not. Any part may intrude on, and influence the experience of the part that is functioning in daily life, without taking full control of functioning. ^[6]:27 In Dissociative Identity Disorder dissociative symptoms are felt when one alter intrudes into the experience of another. Intrusions occur in perceptions, ideas, wishes, needs, movements and behaviors. ^[6]:18 In partial dissociation, amnesia is not present. ^[3]:228 [Dissociated|Switching]] is not equivalent to amnesia. ^[3]:228-229

If I have Dissociative Identity Disorder do I need a Specialist?[edit]

As a patient, your task is to find someone who is proficient in diagnosing and working with your particular disorder - whatever that disorder may be. Dissociative disorders are a specialty, no different from the fact that a cardiologist is a specialist. If you showed symptoms of cardiac disease, then your general practitioner would refer you to a cardiologist, who is a specialist in what is wrong with you.

How do I find a specialist in Dissociative Identity Disorder[edit]

This is not an easy task. Even therapist that work with trauma, PTSD and the array of dissociative disorders, often have not knowingly come in contact with a patient with Dissociative Identity Disorder. You can email the ISSTD and they will give you a list of professionals in your area that have completed educational requirements to treat trauma, however this does not mean that they know how to treat dissociative identity disorder. Try searching for therapists in your area that treat Dissociative Identity Disorder, by putting key words into a search engine such as Dissociative Identity Disorder, EMDR, ego parts therapy, etc. See therapist for more information.

Does someone with Dissociative Identity Disorder have to act like what is in movies, TV or in a book?[edit]

Absolutely not. The movie A Beautiful Mind is a biographical film based on the life of John Nash, a Nobel Laureate in economics which portrays a man with schizophrenia. This does not mean that every person with schizophrenia will act the same, even if movies portrayed things exactly as they are. The same is true about any media presentation of an individual with dissociative identity disorder.

Why are there skeptics that don't believe in Dissociative Identity Disorder[edit]

The lack of trauma based education in schools, belief in the misinformation spread in popular literature, an organization called the false memory syndrome foundation (FMSF) who pushes misinformation, and a very small subculture of mental health professionals who are stuck in the past, are probably the leading causes of misinformation about Dissociative Identity Disorder. These people include: McNally, RJ; Lynn, SJ; Berg J; Piper, A.; Merskey, H; Merckelbach H; Giesbrecht T; Accardi M; Cleere C ; Van Der Kloet, D.; Lilienfeld SO. Perhaps the worst of them is the very prolific Scott Lilienfeld, who authors books to spread his propaganda and uses popular media meant for the lay person to tell his stories, such as Scientific American. The FMSF use a term they coined themselves - false memory, which is not based on clinical research or accepted theoretical formulation to push their agenda, which appears to be for the most part, the protection of child abusers. The skeptics who claim innocence, when their child reports their parents abuse, suggest that a therapists planted the information in their child's mind. This idea is perpetuated by the FMSF and is not in the DSM. Be wary of any information by those listed above or by those who are members or followers of the FMSF. There is no doubt that therapists made mistakes in the 70's and 80's, but today, poor therapy methods are no longer used by properly trained therapists and this argument is one that belongs in the history section.^{(citation needed)}

Is Dissociative Identity Disorder the only Mental Disorder with Alters?[edit]

Yes, it is. There are dissociated states in other mental illnesses, but none so dissociated that they have their own way of being - like an alter does.

References[edit]

1. ^ ^{a b c d e f g h} Howell, E.F. (2011). . . New York: Routledge
2. ^ Middleton, Warwick. "Owning the past, claiming the present: perspectives on the treatment of dissociative patients." Australasian Psychiatry 13.1 (2005): 40-49.
3. ^ ^{a b c d e f g h i} Dell, P. (2009). . . London: Routledge
4. ^ ^{a b} Chu, James A. Rebuilding shattered lives: Treating complex PTSD and dissociative disorders. Wiley, 2011
5. ^ Dell. A new model of dissociative identity disorder. Psychiatric Clinic North America, volume 29, issue 1, page 1-26. (doi:10.1016/j.psc.)
6. ^ ^{a b} Boon, S; Steele K, van der Hart O. (2011). Coping with Trauma-Related Dissociation. New York: W.W. Norton & Company. 039370646X