A Short Introduction to Dissociative Identity Disorder
Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder, is a complex psychological condition characterised by the presence of two or more distinct personality states or identities within a single individual. These different identities, also known as alters may have their own names, ages, histories, and mannerisms. DID is often a result of severe trauma during early childhood, usually extreme, repetitive physical, sexual, or emotional abuse.
DID is understood as a coping mechanism or trauma response and is listed in the DSM-5. When a child experiences overwhelming trauma, dissociation can serve as a form of psychological escape. The child essentially compartmentalises the traumatic experiences; these compartments, or dissociations, can evolve into separate identities.
Each identity may have its own unique behaviours, memories, and ways of viewing the world. Often, there’s a primary identity that carries the individual’s given name and is not aware of the presence of other alters. The various identities can alternate control over the individual’s behaviour and thoughts, which can cause significant disruption in their life. This is known as fronting.
Causes and Risk Factors
DID is strongly linked with severe trauma during early childhood, usually before the person is 6 years old. The development of DID is a complex interplay of factors, which may include:
- The most common cause is extreme, repetitive trauma, such as physical, sexual, or emotional abuse, particularly in childhood.
- A predisposition physiologically or developmentally to struggle to cope with the trauma, some people are naturally more prone to dissociation and may use it as a defence mechanism against trauma.
- Certain environmental and social influences, such as dysfunctional family dynamics or unsupportive surroundings, can contribute to the development of DID.
The symptoms of DID can be broad and varied but generally include:
- Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.
- Amnesia induced gaps in memory about everyday events, personal information, and traumatic events.
- Depersonalisation which is a feeling of detachment from oneself.
- Derealisation which is the feeling as though the world around you is unreal.
- Identity confusion and being unsure of who you are.
- Impaired functioning which presents as a difficulty to function in daily life due to these symptoms.
Diagnosing DID can be challenging and a lengthy process. In the UK it requires a thorough evaluation by a doctor, psychiatrist or trained mental health professional. The diagnostic interview includes a detailed history, current presentation, psychological assessments and physiological testing to rule out other conditions.
The primary treatment for DID is long-term integrative psychotherapy.
This treatment can include aspects of:
- Psychotherapy techniques such as cognitive-behavioural therapy (CBT) and dialectical behaviour therapy (DBT) are used.
- Family therapy where it is safe to do so, to educate and equip family members in strategies to help the individual.
- Medication, while there’s no specific medication for DID, accompanying symptoms such as depression or anxiety may be treated with medication.
- Creative therapies, such as art therapy, movement therapy, and music therapy can be helpful in expressing thoughts and feelings.
- Coping and support Strategies, for example teaching skills to cope with the dissociative symptoms and improve overall functioning.
The above should culminate in a phased treatment approach/plan/direction:
First phase treatment should focus on education and normalisation of what the person is experiencing and why. Interpersonal understanding, safety and acceptance between and of parts/ alters, and practical tools to help with stabilisation and safety.
Second phase of treatment focuses on the “painful tough stuff”. This phase will require a constant to-ing and fro-ing from phase one to two. The work in phase two by its nature is destabilising and therefor it is important to revisit phase one regularly sometimes staying in phase one for a period of time.
Third phase is probably the most controversial phase and should always be directed by the client and NEVER the therapist or other health professional. This phase is integration. Integration is exactly what it says on the tin, it is the process of bringing together the alters into one identity. Sometimes partial integration happens spontaneously whilst working in phase two. Integration can be a really difficult and scary thought for clients and it is my view that integration doesn’t need to be the end goal, put an option. Clients also need to understand that a lack of integration doesn’t mean they have failed in the therapy room, success should be measured by their ability to be aware of and process with the traumas they have endured.
My final thoughts as a therapist who specialises in Dissociative Identity Disorder
Dissociative Identity Disorder is a complex and often misunderstood condition. My role with my clients is to believe them, hold a safe space, educate, de-stigmatise, empower, and support them on this extremely difficult and long journey. Understanding, patience, and comprehensive care are crucial for individuals experiencing DID, with the right support and treatment, individuals with DID can work towards leading a healthy and fulfilled life.
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***This article is for information purposes only it is not a diagnostic tool.
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