Mental Health Awareness Month: On Dissociative Identity DisorderMay 09, 2023
Dissociative Identity Disorder (DID)
Our minds are amazing.
The emotional infrastructure that resides within allows for all kinds of incredible things designed to protect us from the intolerable. The ability to adapt to chaos, terror, heartbreak, and abuse is particularly notable when these things characterize our developmental years (although this doesn't mean that adults cannot adapt...they just do so in different ways than children do).
DID is one of those conditions that highlights our unique capacities to endure until we have the power to change our circumstances.
What is DID?
Dissociative Identity Disorder is a condition that most agree generates as a result of pervasive childhood trauma that persists throughout the developmental years. For those who develop DID, trauma had typically begun around the age of 5 years or younger and continued in the context of absent or abusive caregiving environments.
Conflicting demands that exist within an unsafe caregiving environment forces the fragmentation of reality for survival. For example, maintaining the relationship to a caregiver is a childhood imperative, even if the same caregiver is abusive or neglectful. Finding safety and success at school means that the child must separate themselves from the reality of home. In simple terms, each part of self is designed to meet the unique demands of each context. Given the incompatibility of varying circumstances traumatized children are placed in when they are young, they can become highly skilled at compartmentalizing parts of themselves, their memories, and who they know themselves to be.
Our minds create these grooves that automate our thinking, emotions, and behavior. These grooves then create a space between parts of self, which can then result amnesic barriers between those states. Additionally, state-dependent learning renders each part of self a specialist of sorts. Each part develops skills that are specific to environmental demands. One part of self might be a great student, another might be skilled at pacifying unsafe people, while another might be the designated trauma memory holder.
State-dependent learning basically means we retain and recall information that we learn in any given state when we return to that same state. This is helpful when the parts of self who carry those skills are in the context that demands them; it is problematic when a part is placed in a situation in which they are not capable of managing it, particularly if there is amnesia between them.
One thing I would like to add here is that we all have distinctive parts of ourselves that manage the varying demands of life. We might have a part of us that is responsible for parenting, another for working, and another for play or prosocial behaviors. All these contexts have different requirements. I certainly feel and behave differently when I am wearing my therapist hat versus my parenting hat. The difference is that I can move between these states fluidly, with memory, and with ownership. They all feel like me. My point is that fragmentation is normal.
There is a misconception that this disorder is rare, which contributes to the perception that it is mysterious or bizarre.
It is estimated that 1-3% of the population meets criteria for DID (please see below for references). It is not a rare condition, although it is most certainly underreported. Additionally, only 6% of those with DID express their symptoms overtly or share their internal experiences with others. Sometimes people aren’t aware that other people do not share this kind of internal life or they may not be aware that there are distinctive aspects of self residing within them (because the point of DID is to not know about them and the past until the person is in a place to handle the history. Naturally, this makes diagnosing or detecting it very challenging.
This is a diagnosis of hiding. Hiding from self. Hiding from the knowledge of the past. Relief comes with unveiling what was once hidden in a way that is manageable.
Symptoms of DID include:
Large gaps in autobiographical memory
Day-to-day amnesia or "lost-time"
Feeling detached from self, the body, or the world
Changes in day-to-day functioning
Anxiety and panic
Unexplained body aches or pain
Self-harm and suicidality
Classic symptoms of PTSD
This is not an exhaustive list of experiences, but it captures some of them.
As is true for a lot of conditions, the way in which this disorder is represented in the media is generally distorted. There are movies like "Split," "Carrie," or other Jekyll and Hyde themes that often vilify people with dissociation. The reality is, someone with this kind of condition is more likely to be a victim of crime than someone who perpetrates it.
Another misrepresentation of DID is that it somehow divorces people from responsibility for their actions. There is typically a lot of fear and shame about things someone may have done or did in a dissociated state. It’s not something that people celebrate by any means.
Additionally, dissociation is a normal part of being alive. Daydreaming, light hypnotic experiences (like when you are driving and miss your exit or don't remember getting from point A to point B) or having difficulty recalling a traumatic experience are things most of us can relate to. Granted, this is different from layered and structured dissociation experienced by someone with DID. However, most of us have the capacity to separate ourselves from things we can't or don't want to tolerate on some level.
Here is a video I like to share in my trainings. It is of Kim Noble, an artist who resides in the U.K. who has DID. I appreciate her explanation of her experience.
TRIGGER WARNING: Some of her art depicts graphic scenes of childhood sexual abuse.
Many people with DID are highly functional people who are also professionals, parents, and are going through life in a normal way. The experience is often more internal than something that is on display, so much of the time you would never know that you are interacting with someone who has this condition.
For example, here is link to an article written by a therapist with DID:
In the spirit of Mental Health Awareness Month, I wanted to shed some light on DID. Living with it is no walk in the park and I carry enormous admiration for my clients and others who have built themselves a life even in the context of the severity of their trauma histories. In fact, the kind of trauma that is experienced by those with DID is often so severe, it's unbelievable.
Just because something is unbelievable doesn't mean it's untrue.
For mental health providers who are interested in expanding their expertise in working with dissociative disorders, join our membership community! Here is a link to learn more: https://www.theorendaproject.org/communities
Bailey, T. D., & Brand, B. L. (2017). Traumatic dissociation: Theory, research, and treatment. Clinical Psychology: Science and Practice, 24(2), 170–185. https://doi.org/10.1111/cpsp.12195
Brand, B. L., Myrick, A. C., Loewenstein, R. J., Classen, C. C., Lanius, R., McNary, S. W., Pain, C., & Putnam, F. W. (2012). A survey of practices and recommended treatment interventions among expert therapists treating patients with dissociative identity disorder and dissociative disorder not otherwise specified. Psychological Trauma: Theory, Research, Practice, and Policy, 4(5), 490–500. https://doi.org/10.1037/a0026487
Ducharme, E. L. (2017). Best practices in working with complex trauma and dissociative identity disorder. Practice Innovations, 2(3), 150–161. https://doi.org/10.1037/pri0000050
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