Dissociative Identity Disorder is a mental illness once known as Multiple Personality Disorder but redefined in the Diagnostic and Statistical Manual (DSM-IV) by the American Psychiatric Association in 1994. While it is diagnosed according to APA’s guidelines it continues to be a subject of considerable controversy in the mental health community. There are those who scoff at the diagnosis and refuse to believe that an individual can actually experience the fragmentation of personality that is necessary to develop DID.
None-the-less, it is a real illness and its development begins in the lives of everyday people just like those who will briefly be presented here. Though each of these are real persons who developed DID , were treated, and subsequently gave permission for minimal information to be used in this article, their names and intimate details of their healing journeys are not given in order to protect client privilege.
*A nine-year-old boy stares off into the darkness pretending that he is in a rocket ship headed for the moon while his uncle molests him. This night’s fantasy is just one of several that he has adapted to help him escape the horror of what he has been enduring at least one night a week, for several years. He will end living on the streets and enter the system as a juvenile felon, arrested for criminal trespass charges.
*A teenage girl rocks herself in a fetal position while lying in the doorway of an underground entry to the subway. Later, while being examined in the local emergency room she has no memory of how she ended up where she was found and seems moderately disoriented. She will be admitted to a short-term adolescent treatment unit for trauma intervention and long-term hospitalization. After her discharge, she will continue to withdraw until she is almost nonresponsive. She will ultimately suffer a psychotic breakdown from which she will emerge with a Dissociative Identity Disorder. Only after reaching young adult hood will she enter outpatient treatment as the result of a series of failed relationships which have resulted in deep feelings of lonliness.
*A man in his late twenties comes back from a fourteen month tour-of-duty during wartime. Two months previously he has witnessed his buddy be blown to bits by an IUD. Since returning home he seems depressed. He laughs when he should be crying, and cries in his sleep. He refuses to talk about what has happened. Three months later he will be rescued from an unsuccessful attempt at suicide and hospitalized for depression. After being discharged, he will seek outpatient therapy for his problems because of an ultimatum made by his wife that he either get help, or she is going to leave him.
What do all three of these people have in common? They have all been victims of a critical event that has directly impacted each of their lives . All three have exhibited symptoms of dissociative fugue in order to escape from their painful experiences. During episodes of fugue which can last from just a few hours to several months, these individuals and hundreds more like them, lose all memory of who they are and even begin the process of establishing new personalities that will ultimately lead to DID. As these fragmented personalities surface, each will each present as a different persona whose role will be to provide a way for the collective identities to survive. Fortunately, all three of the individuals presented here have eventually entered therapy to work toward healing and recovery.
The formation of Dissociative Identity Disorder is best understood to be the result of a person’s inability to handle the trauma resulting from deep emotional and sometimes physical pain such as that of molestation, rape, or primary victimization during a critical incident. Each distinct personality, also known as an alter, has the ability to control conscious thought and behavior while assuming a particular role due to the pain of the primary personality. Alters may be child-like, aggressive, theatrical, cocky, menacing, or quite docile. Sometimes they may write with a different hand or walk with a different gait. During the course of a therapy session, it is not uncommon for the identity that is currently in control to introduce himself by a different name, when asked. Some alters are very reluctant to make their presence known or engage in dialog, while others can be quite charming and pleasant to converse with.
Although the stereotypical picture of an individual with DID involves clearly defined personalities who emerge to take control for periods of time, some Dissociative Identity Disorders involve subtle changes in personality rather than actual full-blown personas. For example an individual who suffers with DID may exhibit child-like behaviors that alternate with attitudes that resemble a critical parent. There may not be clearly distinguished personalities who identify themselves. These unformed personalities are believed to be in the early stages of DID.
Distinct, but separate personalities, are usually completely unaware of each other, but during the course of therapy may be introduced to one another. When this happens, alters may either fight to gain control over one another, or openly announce their role of protector, refusing to let a “weaker” alter surface.
Individuals with DID often report having visual and auditory hallucinations which are believed to be the result of a conflict taking place between personas in the inner consciousness of the individual. For this reason, DID sufferers are sometimes misdiagnosed with Schizophrenia or even thought to be demon possessed.
Treatment for Dissociative Identify Disorder generally involves education, cognitive and behavioral psychotherapy, hypnosis, or in some cases, a combination of all three. DID patients who enter treatment frequently struggle with depression and anxiety which can be treated with medications designed to assist in the overall healing of the fragmented personalities.
The goals of therapy can be best understood when broken into four phases. These phases are not always accomplished in a linear fashion and individuals may even bounce between them during recovery. However, all of them are necessary pieces in the ultimate outcome of integration of all alters into one person.
1. Initial therapy begins with empathetic listening in order to build trust and attempt to connect with as many distinct personalities as possible in order to establish individual relationships that will pave the way for the work that must be done. In the beginning, alters are unwilling and unprepared to deal with the reality that they exist within one body, so early therapeutic inroads should not include attempts to educate them with heavy doses of reality.
2. The second phase focuses on identifying those alters who are more aggressive and may be potentially violent. Personalities that assume roles of protection or retaliation have been known to hurt others whom they perceive as threats. The goal is to help these alters work through anger and learn more effective ways to communicate the feelings associated with the roles they are playing.
3. The third phase involves making contact with the alter or alters who are the personalities who carry the memories of the event that have resulted in the personality splits. Before any real healing can occur, these personalities must be reached and helped to process their pain.
4. The ultimate goal, although a difficult one that can sometimes take years, is reunification of all the alters into one personality again. This only happens as each one heals, comes to understand the role that he has played, and accepts the reality that integrating is the best outcome for the whole person. There are cases where a limited recovery is accomplished and the few remaining alters learn to cooperate and be subordinate to one another as necessary. The later recovery is never the most desirable outcome of therapy.
Individuals who have been thoroughly assessed and accurately diagnosed with Dissociative Identity Disorder are not play-acting but experiencing severe emotional, mental, and cognitive distress as the result of the ordeals they have been subjected to and are ill-prepared to cope with. They should not be looked at as freaks in the mental health community, or treated as individuals who have developed a contrived and insincere form of fakery in order to gain the sympathy of those around them, or escape the punishment of criminal activity. They are individuals with a difficult form of mental illness and those who work with them need the skills and patience necessary, along with the support of the mental health community, in order to effectively work with them in therapy.
References
Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition. The American Psychiatric Association, 1994, Third Printing.
National Alliance on Mental Illness. March 2000, Accessed March 4, 2009. http://www.nami.org/Content/ContentGroups/Helpline1/Dissociative_Identity_Disorder_(formerly_Multiple_Personality_Disorder).htm
