By Gina Marchando, DMFT, LMFT, CHT, CIT, Clinical Director at The Ranch The media’s various portrayals of people with dissociative identity disorder (DID) have one thing in common: They get much of it wrong. Dissociative identity disorder, formerly classified as multiple personality disorder in the Diagnostic and Statistical Manual of Mental Disorders, is usually far from the fictional depictions we see in movies such as M. Night Shyamalan’s recent work “Split.” Below are some realities of this complex psychological condition.
Dissociative Identity Disorder Is a Coping Mechanism
Dissociation is not abnormal. It’s actually a very normal reaction to an abnormal situation. We’re all born with one personality structure, but if we’re subjected to horrific abuses, particularly sexual abuse, our psyche may split off in order to survive. As adults, we have emotional and physical tools besides dissociation to defend ourselves against perpetrators. But as children, when we experience a traumatic event and don’t yet have the skills to defend ourselves, one of three things typically happens: we die, we go into a state of psychosis or we dissociate. When dissociation occurs, we completely disconnect the mind and body. This allows us to live in our heads and only experience events intellectually. However, these traumatic experiences stay stored in our cells as well. The body doesn’t forget.
People With DID Experience Fragmentation
What the media often dramatically depicts as multiple personalities is actually a fragmentation of self that people with dissociative identity disorder experience. Different aspects of their personality – sometimes referred to as “alters” – become prominent depending on the situation and what coping mechanisms are needed. For example, a child who is abused at home may take on the “don’t speak unless you’re spoken to” role, being quiet, overly compliant, and pretending to be unintelligent. They’ve unconsciously learned that this is how they please their perpetrator and suffer the least abuse. The same child may be quite different at school – bright, outgoing and engaged in class discussions. They’ve learned that this is how they’ll succeed in that environment. These different aspects of the self can have widely different and sometimes contradictory behaviors, actions and feelings. The person is not necessarily aware of their different identities and their presentation of these because they’ve developed out of necessity for survival. The “amnestic barrier” inhibits individuals from learning of the different alters until later in life.
Dissociative Identity Disorder Exists on a Continuum
Dissociation exists on a continuum that can range from daydreaming to living in a constant dreamlike state with multiple identities. People with more severe forms of DID are plagued with time loss and memory lapses. Factors that determine the severity of dissociative identity disorder symptoms include: Age of Onset of Abuse – The younger the person is when the abuse occurs, the further up on the continuum they will move. Most people with dissociative identity disorder were abused before age 7. This age is sometimes referred to as “the golden age of reason” because our brains make the transition from “magical thinking” (right brain) to “rational thinking” (left brain). Dissociative identity disorder is a function of our right brain. If abuse occurs after age 7, a person is better able to access their left brain, which also includes different ego defense mechanisms, and therefore DID likely won’t develop. Severity and Repetition of Abuse – The more severe the abuse, the higher on the dissociative continuum a person might be. This is because the stakes or the need to survive is higher with more intense abuse. The more often abuse occurs, the further along a person will be on the continuum. Perception of Abuse – Each of us has our own perceptions of events. The perception that we might die is just as powerful as if our lives are in real danger. A person’s perception of danger will be more severe the more invasive the abuse is. Sensitivity – We all have our own level of sensitivity. It’s important to note that sensitivity is not a weakness, people’s levels just differ. If we are more sensitive, we are likely going to become more reactive and more fearful of abuse. Creativity and Intelligence – The ability to have your psyche split off into multiple facets is an extension of our creativity or right brain. The more creative a person, the higher they may be on the DID continuum. People with dissociative identity disorder are also usually brilliant. They may have very high IQs and can be very successful. Pain Tolerance – Some people are born with a better ability to tolerate physical and emotional pain. Our pain tolerance threshold depends on our brain. People with an organically lower pain tolerance are usually higher on the dissociative continuum due to the need to fracture their psyche in order to survive and accommodate additional pain. Defense Mechanisms – Our defense mechanisms are proportional to the number of experiences we’ve had. Because children have very limited experiences, they will have fewer defense mechanisms to help them cope with trauma. They haven’t yet developed the ability to gain insight into the perpetrator’s psyche, therefore have no other choice but to internalize the pain and negative messages and assume the blame, shame and guilt for their perpetrator’s actions. Lack of Resources – Not having a positive person or activity in one’s life to protect you or teach you healthy coping skills can make you more susceptible to long-term impacts of trauma. Inconsistent Patterns of Abuse – The more unpredictable or inconsistent the perpetrator’s behavior is, the higher up on the dissociative continuum a person will move. This is also where the dissociative individual’s need for control comes in. For example, we might think, “it’s just a schedule change,” but it can feel like the end of the world to a person whose sense of control was devastated at an early age. Vicarious Trauma – Though they might not climb all the way up the dissociative continuum, a person who witnesses abuse or trauma can develop a dissociative disorder, such as derealization (difficulty fully experiencing the surrounding environment) and depersonalization (detachment from one’s own body and thoughts).
Recovering From Dissociative Identity Disorder
Over the past 13 years, I’ve worked closely with people suffering from significant trauma, including those with dissociative identity disorder in both outpatient and residential treatment facilities. Recovery from dissociation looks different for each individual. The goal of treatment for an individual at the far end of the dissociative continuum with a diagnosis of DID isn’t to eliminate their alters but instead to repair the sense of self through increasing internal communication and cooperation in order to decrease time loss. The age-old belief of alters folding back into one another, or integration, is a long-term process. It occurs just as organically as the original split once the individual as a whole has sufficiently learned to assume each alter’s function. The internal family systems model of therapy works well for someone with a diagnosis of DID. This approach takes the stance that it’s natural for the mind to have various subpersonalities, but one’s central self should always be at the helm of this complex internal system. There are no “bad” parts, but no one part should have an extreme role. Therapies like dialectical behavior therapy, trauma work and approaches that address emotional regulation issues are also effective in treating dissociative identity disorder.