What Is Dissociative Identity Disorder?

[Morning Glory]

What Is Dissociative Identity Disorder?

This brochure is copyright 1994 by the Sidran Foundation and is reprinted here for personal use only. Copies of this brochure are available from Sidran in packages of 50 for a small fee.

The growing recognition of psychiatric conditions resulting from traumatic influences is a significant mental health issue of the 1990s. Until recently considered rare and mysterious psychiatric curiosities, Dissociative Identity Disorder (DID) (until very recently known as Multiple Personality Disorder - MPD) and other Dissociative Disorders (DD) are now understood to be fairly common effects of severe trauma in early childhood, most typically extreme, repeated physical, sexual, and/or emotional abuse.

In 1994, with the publication of the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders-IV, Multiple Personality Disorder (MPD) was changed to Dissociative Identity Disorder (DID), reflecting changes in professional understanding of the disorder, which resulted largely from increased empirical research of trauma-based dissociative disorders.

Post-Traumatic Stress Disorder (PTSD), widely accepted as a major mental illness affecting 9-10% of the general population, is closely related to Dissociative Identity Disorder (MPD) and other Dissociative Disorders (DD). In fact, as many as 80-100% of people diagnosed with DID (MPD) also have a secondary diagnosis of PTSD. The personal and societal cost of trauma disorders [including DID (MPD), DD, and PTSD] is extremely high. For example, recent research suggests the risk of suicide attempts among people with trauma disorders may be even higher than among people who have major depression. In addition, there is evidence that people with trauma disorders have higher rates of alcoholism, chronic medical illnesses, and abusiveness in succeeding generations.

What Is Dissociation?

Dissociation is a mental process which produces a lack of connection in a person's thoughts, memories, feelings, actions, or sense of identity. During the period of time when a person is dissociating, certain information is not associated with other information as it normally would be. For example, during a traumatic experience, a person may dissociate the memory of the place and circumstances of the trauma from his ongoing memory, resulting in a temporary mental escape from the fear and pain of the trauma and, in some cases, a memory gap surrounding the experience. Because this process can produce changes in memory, people who frequently dissociate often find their senses of personal history and identity are affected.

Most clinicians believe that dissociation exists on a continuum of severity. This continuum reflects a wide range of experiences and/or symptoms. At one end are mild dissociative experiences common to most people, such as daydreaming, highway hypnosis, or "getting lost" in a book or movie, all of which involve "losing touch" with conscious awareness of one's immediate surroundings. At the other extreme is complex, chronic dissociation, such as in cases of Dissociative Identity Disorder (MPD) and other Dissociative Disorders, which may result in serious impairment or inability to function. Some people with DID(MPD)/DD can hold highly responsible jobs, contributing to society in a variety of professions, the arts, and public service. To co-workers, neighbors, and others with whom they interact daily, they apparently function normally.

There is a great deal of overlap of symptoms and experiences among the various Dissociative Disorders, including DID (MPD). For the sake of clarity, this brochure will refer to DID(MPD)/DD as a collective term. Individuals should seek help from qualified mental health providers to answer questions about their own particular circumstances and diagnoses.

How Does DID(MPD)/DD Develop?

When faced with overwhelmingly traumatic situations from which there is no physical escape, a child may resort to "going away" in his or her head. This ability is typically used by children as an extremely effective defense against acute physical and emotional pain, or anxious anticipation of that pain. By this dissociative process, thoughts, feelings, memories, and perceptions of the traumatic experiences can be separated off psychologically, allowing the child to function as if the trauma had not occurred.

DID(MPD)/DD is often referred to as a highly creative survival technique, because it allows individuals enduring "hopeless" circumstances to preserve some areas of healthy functioning. Over time, however, for a child who has been repeatedly physically and sexually assaulted, defensive dissociation becomes reinforced and conditioned. Because the dissociative escape is so effective, children who are very practiced at it may automatically use it whenever they feel threatened or anxious -- even if the anxiety-producing situation is not abusive.

Often, even after the traumatic circumstances are long past, the left-over pattern of defensive dissociation remains. Chronic defensive dissociation may lead to serious dysfunction in work, social, and daily activities. Repeated dissociation may result in a series of separate entities, or mental states, which may eventually take on identities of their own. These entities may become the internal "personality states," of a DID(MPD) system. Changing between these states of consciousness is described as "switching."

What Are The Symptoms Of DID(MPD)/DD?

People with DID(MPD) may experience any of the following: depression, mood swings, suicidal tendencies, sleep disorders (insomnia, night terrors, and sleep walking), panic attacks and phobias (flashbacks, reactions to stimuli or "triggers"), alcohol and drug abuse, compulsions and rituals, psychotic-like symptoms (including auditory and visual hallucinations), and eating disorders. In addition, individuals with DID(MPD)/DD can experience headaches, amnesias, time loss, trances, and "out of body experiences." Some people with DID(MPD)/DD have a tendency toward self-persecution, self-sabotage, and even violence (both self-inflicted and outwardly directed).

Who Gets DID(MPD)/DD?

The vast majority (as many as 98 to 99%) of individuals who develop DID(MPD)/DD have documented histories of repetitive, overwhelming, and often life-threatening trauma at a sensitive developmental stage of childhood (usually before the age of nine), and they may possess an inherited biological predisposition for dissociation. In our culture the most frequent precursor to DID(MPD)/DD is extreme physical, emotional, and sexual abuse in childhood, but survivors of other kinds of trauma in childhood (such as natural disasters, invasive medical procedures, war, and torture) have also reacted by developing DID(MPD)/DD.

Current research shows that DID(MPD) may affect 1% of the general population and perhaps as many as 5-20% of people in psychiatric hospitals, many of whom have received other diagnoses. The incidence rates are even higher among sexual abuse survivors and individuals with chemical dependencies. These statistics put DID(MPD)/DD in the same category as schizophrenia, depression, and anxiety, as one of the four major mental health problems today.

Most current literature shows that DID(MPD)/DD is recognized primarily among females. The latest research, however, indicates that the disorders may be equally prevalent (but less frequently diagnosed) among the male population. Men with DID(MPD)/DD are most likely to be in treatment for other mental illnesses, for drug and alcohol abuse, or incarcerated.

Why Are Dissociative Disorders Often Misdiagnosed?

DID(MPD)/DD survivors often spend years living with misdiagnoses, consequently floundering within the mental health system. They change from therapist to therapist and from medication to medication, getting treatment for symptoms but making little or no actual progress. Research has documented that on average, people with DID(MPD)/DD have spent seven years in the mental health system prior to accurate diagnosis.

This is common, because the list of symptoms that cause a person with DID(MPD)/DD to seek treatment is very similar to those of many other psychiatric diagnoses. In fact, many people who are diagnosed with DID(MPD)/DD also have secondary diagnoses of depression, anxiety, or panic disorders.

Do People Actually Have Multiple Personalities?

Yes, and no. One of the reasons for the decision by the psychiatric community to change the disorder's name from Multiple Personality Disorder to Dissociative Identity Disorder is that "multiple personalities" is somewhat of a misleading term. A person diagnosed with DID(MPD) has within her two or more entities, or personality states, each with its own independent way of relating, perceiving, thinking and remembering about herself and her life. If two or more of these entities take control of the person's behavior at a given time, a diagnosis of MPD can be made. These entities previously were often called "personalities," even though the term did not accurately reflect the common definition of the word as the total aspect of our psychological makeup. Other terms often used by therapists and survivors to describe these entities are: "alternate personalities", "alters," "parts," "states of consciousness," "ego states," and "identities." It is important to keep in mind that although these alternate personality states may appear to be very different, they are all manifestations of a single person.

[mistee]

The more i come here the more i learn to understand me
at times i just wished i had some better coping skills to go along with them it is either one extreme or the other still

still learnin

mistee
that is all i can say i really related to what u where sharing about

[Morning Glory]

mistee,

Coping skills take time. It is really hard to learn through all the emotions involved with PTSD and bipolar. Baby steps will get you where you want to be. DO NOT put pressure on yourself to do better. When I brought this to the top I was not saying that you had D.I.D., but just saying in that moment of your blackout this might be what happened.

Keep coming back and keep sharing. You are going to make it through this. I don't know if you have a higher power. Mine is God and He got me through all of this.

You're going to be ok.

Hugs,
MG

[ljmason]

HELLO-

Now, with no health insurance and a lack of supportive family members, can you please help me find out what to do about it?

I have been in counselling on and off since I was 12 years old- that's 25 years worth of mumbo-jumbo, some of which I actually agree with. I've only had one counsellor give a " possibly mildly disassociative" diagnosis a few years ago, but treatment wasn't prescribed at the time, and I actually didn't know that she'd made that diagnosis until about 6 months ago.

Is this what I mean about "putting on the smiley face", but rarely ever truly feeling it inside?

Truthfully, the only sensations I truly feel inside are anger, fear and sadness, overwhelming sadness. Sometimes I DO feel like I'm going crazy- I never know how I'm going to feel from one moment to the next. I could be fine one moment, and bawling my eyes out a few minutes later. Talk about mood swings!

Like I said, now what do I do with the extremely helpfull info you just gave me. Dear God, (and Morning Glory- pretty name by the way) I hope I can find some answers soon.

[Don W]

Thanks Morning Glory, The more you post the more I learn. If, I'm undrstanding correctly. We may or may not have a certain disorder but, many of them are so close they are difficult to seperate for the lay person like myself. I think this is right in line with some of our conversations about just starting to understand the human mind. Just to know that they are starting to be able to seperate these disorders is encouraging. I know this is another subject but, this is why I fear them convicting people with some of these surpressed memories. At least till they are sure, of what I have allways thought, that we can't inherit memories from others. Anyway, I think that your post offer hope. After all, they can't fix something till they discover it. Meanwhile, as others have posted, at least some of our questions are being answered as far why we think or feel what we do. Thanks again. Don W

[Morning Glory]

bump

[nandm]

Thanks MG, I hadn't seen that one. Very interesting though as disassociation is a tool I have used since an early age. It is how I survived the 12 years I worked as paramedic, including the tornado's and plane wrecks I worked during that time. It did help me to be really good at my job though as I was able to leave my emotions at the door and take control of the situation. It is also how I survived my childhood. Interesting to learn about it as I had never really put it into the context this article does. Thanks.

[barb dwyer]

This was very interesting, for sure.

then I looked at the date - wow.

[gina4]

This is very new for me,and I'm not even really sure how it works. I am somewhat of a mess right now, and I'm wondering if the mess inside my head will ever stop? years of therapy and I'm still a train wreck semi regularly. Thoughts?

[Morning Glory]

Welcome gina.

Are you seeing a specialist? Sometimes having the right therapist is really helpful.

I do not have DID, but I had repressed memories that caused me years of pain and dysfunction. I finally remembered everything. It took about 5 years when I was ready to face it.

I'm so sorry you are experiencing pain. Talking helps. Having others accept you just as you are also helps. Please feel free to start a thread and tell us your experiences. There is a lot of support here.

[BillyWeaver]

Originally Posted by Morning Glory

Welcome gina.

Are you seeing a specialist? Sometimes having the right therapist is really helpful.

I do not have DID, but I had repressed memories that caused me years of pain and dysfunction. I finally remembered everything. It took about 5 years when I was ready to face it.

I'm so sorry you are experiencing pain. Talking helps. Having others accept you just as you are also helps. Please feel free to start a thread and tell us your experiences. There is a lot of support here.

How did you all of a sudden remember the repressed memories?

Was it during therapy/counseling or on your own?

I am interested in learning about repressed memories...

[zanzibar]

I have not been diagnosed with DID but I do practice escapism a lot. My Dr. does not approve as I do this conciously when things build up in my mind. He explains that running away from memories does not work as they will find me in whatever world I put myself in. One of his concerns is that when I run out of places to run to it's going to hit me a lot harder than emalgimating those memories into my life and learning to live with them would. I know it's wrong but it's so much easier to go to another place in my head, as the thought of living with these memories for the rest of my life absolutely terrifies me. I don't mean that in a scared kind of way but in a way of concerns that I might never lead a "normal" life again. This is not memory suppression as escapism goes far deeper than that. It's hard to explain but for all intensive purposes I actually become someone else, and somewhere else. Which can lead to DID. I am attempting to stop but it's much like trying to beat an addiction. But with far differant side effects.