Dissociative Identity Disorder

What is Dissociative Identity Disorder?

Dissociative identity disorder (DID), used to be known as, “multiple personality disorder”, is an extreme form of complex trauma. Dissociative identity disorder is on the extreme end of the trauma diagnosis spectrum; It is however different from other forms of trauma such as combat trauma or borderline personality disorder in that while many disorders found in the DSM 4 & 5 can be related to histories of physical or emotional trauma, DID always has as one of its foundations – severe sexual abuse. Diagnostic and Statistical Manual of Mental Disorders (DSM) is the standard classification of mental disorders used by mental health professionals in the United States and contains a listing of diagnostic criteria for every psychiatric disorder recognized by the U.S. healthcare system. DID is a highly controversial diagnosis in the world of western psychology in that numerous clinicians are divided in acceptance of the diagnosis as a genuine psychological phenomenon. Many therapists simply do not believe that it is real and attribute it to other factors. Because of this reason few therapists actually have training to both recognize and treat DID as genuine.

Dissociative identity disorder has often been confused with schizophrenia by the public and because of Hollywood movies such as, “Psycho” and, “The silence of the lambs”; a film in which the villain, Dr. Lector refers to his cellmate as both, “schizophrenic” and as “multiple migs”. These diagnoses however are very different from one another as DID has been shown to be a direct result of traumatic experience (Van Der Kolk, 2014), whereas Schizophrenia can be purely biological in its origins.
A person who suffers with Dissociative identity disorder, will have experiences throughout their day or week of spacing out and periodically losing time. Losing time means that they will suddenly find themselves reading a book or taking a bath and not remember how they got into that situation, or what they might have been doing before. It is similar to the blackout of an alcoholic but without the alcohol. The problem however is that do not experience this as spacing out and will also not see it as close family or loved ones see it.

Diagnosing Dissociative Identity Disorder

Lynn had struggled with depression, anxiety and panic attacks for years. She had tried both individual therapy as well as inpatient programs, yet nothing seemed to work for her. She been given the diagnosis of borderline personality disorder. As her life became more and more out of control, she talk to one of her childhood friends and asked for help. When she told her friend about having these experiences of occasionally waking up in danger situations and not knowing how she got there, her friend seemed a little shocked by this. She asked whether she been to a therapist and suggested that she try another, but this time someone who specialized in trauma work. Lynn realized that in the past when talking with therapists, and her close friends, whenever people ask questions about her childhood, she often felt confused and unable to provide specific answers. When she would begin to look at her journal entries over the years there were distinct changes in handwriting, yet no therapist ever caught the dissociative piece. Instead they all focused on her anxiety and depression and difficulties in realtionships. She had also been to a psychiatrist been prescribed antidepressants. She really felt confused about this because she really did want to get better, while at the same time parts of her felt like she really was taking care of herself in the best possible way.

Lynn’s experience with the mental health system is not unusual for someone who is dealing with a dissociative disorder. In fact, most DID patients see several therapists and have an average of seven diagnoses before finally finding someone who understands the dissociative aspect of their behavior. Unfortunately, this can often mean many years of ineffective treatment and loss of financial resources. Confirming the diagnosis of DID is not easy, however one of the difficulties lies in the nature of dissociation, which compartmentalize his behavior and experiences that would normally be connected. Also, the dissociative personality system is usually set up to avoid detection. As dissociation is really a defense mechanism.

ADD or Disassociation?

People with DID are often misdiagnosed as having ADD or ADHD, when in fact they are dissociating (spacing out a lot as a defense mechanism). That’s right spacing out is a defense mechanism. If you grow up in a household where horrible things are always happening, things over which we have no control, and are often forced to participate in, our best defense is to go away in our minds and in our bodies to a fantasy place. Our best defense is not to be in the present, not to be in our bodies, in order not to experience pain that might be happening.

The reason we dissociate is to avoid feelings or sensations within the body. For a person with DID, feelings or body sensations that you focus on or that get triggered by something in the environment can lead to flashbacks, so it is best not to have them. The remedy or coping strategy then becomes dissociation. Dissociation, for your garden variety people, means spacing out into non-essential details, other people’s lives, projects, etc.

Dissociation is the polar opposite of mindfulness. However, for someone with DID, dissociation means not only spacing out at times, but not feeling ones body, not being present in certain types of physical experiences, avoiding emotions at times, and not being present for shifts in consciousness that happen. Someone with DID will often shift out of one personality (called alters by therapists) to another. This is often not happening consciously by choice but more as an unconscious survival strategy to cope with anxiety and the different threats or situations in life. Creating sub-personalities appears to a be a common strategy for young children who are experiencing extreme trauma as a way of coping with the unbearable experiences of pain, or rather, to be in the experiences of pain but to not be present with their experience.

What kinds of treatment works and what does not work with Dissociative identity disorder?

Working with Trauma requires a different set of skills than working with other types of issues. Dissociative identity disorder is a serious form of trauma and a very controversial diagnosis. According to numerous studies over the last 20 years, many which are cited by Dr. Bessel Van Der Kolk and others; methods such as, Cognitive Behavioral Therapy and Exposure therapy are completely ineffective at resolving trauma. And while they may reduce a few related symptoms, they cannot resolve trauma.

Some of the most effective treatments used for Trauma, PTSD, and DID today are shown to be Somatic Therapies, also known as body based therapies (Soma is the Greek word for body). Somatic therapy studies the relationship between the mind and body in regard to a person’s psychological past. The theory behind somatic therapy is that trauma symptoms are the effects of instability of the ANS (autonomic nervous system). In other words, our past traumas disrupt the ANS.

According to somatic psychologists (Ogden, 2015; Levine, 2015), our bodies hold on to past traumas which are reflected in our body language, posture and also expressions. In some cases past traumas may manifest physical symptoms like pain, digestive issues, hormonal imbalances, sexual dysfunction and immune system dysfunction, medical issues, depression, anxiety and addiction. Some studies show up to fifty percent of people entering into addiction treatment having some form of trauma.

However, through somatic psychotherapy the ANS can again return to homeostasis. This therapy has been found to be quite useful in providing relief to disturbed patients and treating many physical and mental symptoms resulting from past traumas.

Somatic psychology confirms that the mind and body connection is deeply rooted. In recent years’ neuroscience has emerged with evidence that supports somatic psychology, showing how the mind influences the body and how the body influences the mind.

Some examples of some researched Somatic therapies are:

  • Eye movement therapies such as EMDR and Brainspotting.
  • TRE- Trauma Release exercises
  • MBCT -Mindfulness Based Somatic Therapy
  • Sensorimotor Psychotherapy
  • Traditional forms of Meditation
  • Some forms of Yoga

While there are many more, these are some of the most well researched forms. For more information on the specific details of these therapies please look at our methodologies section in How we Work.

 

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