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Wednesday, June 18, 2008

Dissociative Identity Disorder

Well, hopefully it doesn't apply to you,Dissociative Identity Disorder (D.I.D.)*

But it might. We used to call it Multiple Personality Disorder. Some people think this label applies to Schizophrenia, but because you read this blog, you know the difference.

People who suffer from Schizophrenia may hear voices, but they don't usually have multiple personalities. These are both Axis I disorders, by the way, not personality disorders (Axis II).

And this is not Depersonalization Disorder, either, which is getting some press because Adam Duritz of Counting Crows (a popular rock band) is said to have it. (Read Dr. Deb). Depersonalization Disorder features persistent or recurrent experiences of feeling detached from one's mind or body, as if watching the self as an outside observer.

I first came upon Dissociative Identity Disorder when I met a client who had been a victim of incest, we're talking about 1984. (If you're faint-hearted you may not want to read on. I'm changing all the details for you, so this is total fiction, and it's a quick read, but nevertheless. . .upsetting).

The patient, age 40 at the time, recalled being a child of about six years old laying helpless on a sofa while her father molested her in every way imaginable. She grabbed onto a lace tablecloth that covered an end table and twirled it in her hand while he did this, all the while imagining that she was someone else, another child, complete with alternative personality, looks, parents, name, toys, friends, etc.

She played her fantasy so well in her head that she didn't feel (as much as she might have otherwise) what was happening to her. You can see why she did it, tranced out like that. She came to like this other self, so much in fact, that she often referred to herself as the other girl, used the other's name.

The patient became the other girl, too, had multiple selves. After all, the other girl didn't exist except in her head. And as confusing as this sounds, she could switch off all the time, unconsciously or at will. She experienced reality at different times as two different people.

Since that time I've treated only two others with this disorder who described similar circumstances, one sexual abuse, the other physical abuse. This ability to dissociate, to separate the self or ego, from what is happening in "real" time, is obviously the ego's defense system operating in a most sophisticated fashion.

Sometimes a person develops several personalities, in which case they are called, multiples. One identity suffers, so it helps to have a few who do not. Understudies.

Treatment's remarkable.

Anyway, I thought you'd like to be able to diagnose this for real, just in case you sometimes wonder,
Am I? Is she? Is he?
Here you go. 300.14 Dissociative Identity Disorder
A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).

B. At least two of these identities or personality states recurrently take control of the person's behavior.

C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.

D. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.


therapydoc

*You can read more about it in the Merck manual.

46 comments:

Clueless said...

I thought that DSM says you need 12 distinct personalities. There are many bloggers who have really good insight into their DID diagnosis and alters. I have some of them linked to mine. My abuse was severe and early enough that I very easily could have been DID, but I didn't. However, I relate to their abuse unlike those with my diagnosis. It is amazing what our mind can do to make us survive.

therapydoc said...

No way. I quoted exactly from the DSM-IV TR. Glad you survived, Clue.

linrob63 said...

I was hurt just one time by a stranger when I was a kid. And I have challenges still. An ongoing course of what I experienced just once is unimagineable to me. A child who survives in the way you described is brilliant...though I recognize that the ways we chose -- or ways that chose us -- to be 'ok' in the world are not adaptive once the abuse has ended. Still, it is briliant. And I hope she and others who survived in that way can learn to appreciate it as such.

Rae said...

I am a survivor of 10 years of incest, currently undergoing EMDR therapy. Many therapists have said I "dissociate" but none have ever "diagnosed" me with DID. Are they one in the same?

therapydoc said...

We tend to think of dissociating as disconnecting from others, withdrawing into our own world. The dissociative identity disorder is different, the dissociation in DID associated (attached) to another identity, a person adds another identity (or more) to the "self." You can add a skill, you can add an identity. Adding to self is multi-faceted.

Battle Weary said...

It's helpful to imagine dissociation on a continuum or spectrum...with normal dissociation (highway hypnosis) on one end, depersonalization around the middle, and DID on the other end.

It's also helpful to know that regardless of what movies and other media portray...the person with DID is not dangerous, scary, prone to violence, or crazy!

therapydoc said...

Right, Weary. Thanks.

Clueless said...

@Weary. That was great. I tell people that everyone disassociates or fragments to some degree, but it is on a spectrum; however, my low end I use daydreaming or zoning out.

I'm really glad you said what you did. I also find that most are quite intelligent. But, in someways that makes sense because it takes an awful lot of brain power to become DID.

blognut said...

I am a survivor of sexual abuse. Although I have not suffered from DID, I have often used the word "disconnected" to describe what I did to get through it. I disconnected myself from what was happening and just zoned out. This was a helpful discussion.

therapydoc said...

Dissociating is exactly that, Blognut.

Hadassah said...

law and order svu did a show this week with the main protagonist being a sufferer of DID - it ended up that she fooled everyone, even her therapist (is that possible) into thinking her DID was real, when really it was an elaborate set up to avoid a murder charge.

are sufferers really aware of the shift in personalities?

therapydoc said...

Yes, sometimes. Usually right where it's getting very uncomfortable. So therapy is slippery.

Tempy said...

As someone that copes with DID on a regular basis, it was refreshing to see an unbiased blog post on the matter. So thanks for putting this out there.

Katie's Blog said...

I've been diagnosed since 2007.

Maura said...

Thanks for this post - too often DID is unrecognized and/or misdiagnosed by the public and mental health providers alike, which creates more shame and confusion for patients and prevents us from getting timely and effective treatment. DID is a highly treatable disorder, when an appropriate diagnosis is made, and DID-specific treatment is implemented. Unfortunately, all too often such diagnosis and treatment eludes patients. I am an LCSW who was practicing as a therapist when my world seemingly 'fell apart' and I was diagnosed with DID (though I had struggled with years with a variety of symptoms). I am now in DID-specific treatment, and have taken a break from clinical practice. I can't recall one class in graduate school where DID was addressed, which only highlights for me the deficits that exist in training professionals to recognize and treat trauma-based disorders.
Thank you for raising awareness.

Anonymous said...

I'm a survivor of mother-daughter incest and numerous murder attempts by her. I've been dxed DD-NOS (Dissociative Disorder, Not Otherwise Specified), one of the most annoying diagnoses I can think of. It leaves you feeling as if you're neither fish nor fowl, with no place to go. Anyone I've ever met with this dx feels as if we've been tossed on a linguistic scrapheap.

I thank you for this dispassionate posting. In my area most of the doctors "don't believe in" DID. I must remember to try that tactic should I ever get cancer--just "don't believe in it". Yep, that'll work. {;>)

I'm not in therapy and don't expect to be so again because I've found it so colossally unhelpful. The few good therapists I've found have been unable to help with the original abuse issues, although (god love 'em) they've been helpful in dealing with at least *some* of the extensive damage done by their peers who seem to get angry and vengeful when one doesn't get better according to plan. I finally realized it was much better to simply avoid that professional grouping altogether rather than spend my time partially undoing iatrogenic damage. This is working much better for me.

Oh, that and the fact some bright light finally listened to me and started treating me for simple hypothyroidism, which I've had since my late 20's. I had every symptom in the book and do not miss the decades of dysthymia that condition caused. I now work part time, am about to celebrate my 30th wedding anniversary and have about as good a life as one can expect with all this unresolved junk at the bottom of one's soul.

Good blog. Thanks. Sorry for being long winded--and anonymous. Thanks for the latter option.

therapydoc said...

Anon, thanks for your story. It's so hard, what you lived through, and I think virtually impossible for people who haven't lived through abuse to really get. Then there's that temptation to treat without a really good assessment, without any true understanding. Put it all together and it spells, Therapeutic Failure. Patient Relapse. Thanks for nothing.

Wrenspirit said...

I'm a multiple. The stories I could tell you, both good and horrific about my life. I don't mean to sound rude, but why did you post this? Are you trying to reach out or just inform or ?

therapydoc said...

Oy vey. WREN, it's just to teach. And just in time. A month later we had the Bruce Ivins case. When I posted on him I didn't have to list the symptoms. You have them.

Next is a personality disorder, I'm just working it up.

Secret Shadows said...

I liked reading what you wrote about DID. It is very accurate, and I can identify with the little girl twirling the lace. Sometimes reality and what's in the moment are too much to face, and having the ability to dissociate into some thing, or some one, or some other place is a gift. Without it we surely would've gone crazy.

Sorry, didn't mention I have DID.

One other thing I would like to point out is that many of us with DID are just like anybody else. Most people that know me would never guess. Lots of people don't really understand what DID is. They only know what they see on television.

Thanks for addressing this issue. I want so much for people to truly understand DID, and you are helping with that.

Secret Shadows
http://secretshadows.wordpress.com

David Rochester said...

I also have DID, and am somewhat on the fence about this post ... on the one hand, it's kind of informative, and on the other hand, it kind of isn't. :-)

I wonder if you might consider linking to the ISSTD website, where people who might need help can find therapists specifically qualified to deal with trauma processing and recognition of dissociative spectrum disorders. This is not, I think, your field of expertise, but if someone came across this post who related to the DSM criteria posted, it might be helpful to redirect toward a source of help.

One problem many people with DID regularly encounter, as I'm sure you know, is the disorder being misdiagnosed, or the clinician simply not believing the client. Ever since the age of ten, I tried to describe to my mother and to several therapists the fact that part of my personality resided in a totally different person who didn't live in my body, and who in fact had a completely different life in another country, but who would come and take over my body on a fairly regular basis when I needed him for something. Why in the name of God this wasn't diagnosed as DID until I was 36 is anyone's guess; I could hardly have described it with more clinical accuracy.

Once I was directed to the right kind of therapist, who validated the diagnosis, I was able to tell her about the six other alters I also have, who just weren't as blatantly obvious as the primary alter.

Anyway, my point is that high-functioning DID clients are often misdiagnosed, and because of that, it might be a good idea to redirect to the trauma specialty website, where people may be able to find a clinician who really "gets" it. That's where I found mine, thanks to a recommendation from someone at the Jung Institute, and it's a great resource.

therapydoc said...

Thanks David. I'll get back to this.

DID Daughter said...

I'm the daughter of a person with DID. While working as a counselor in a homeless shelter, I also identified at least five clients I suspected of having DID. None of them were officially diagnosed as such. The overwhelming majority of our clientele suffered from serious mental disorders, and compared with the schizophrenic, borderline and antisocial personality disorder clients, the DIDs seemed unusually capable and sane. (Well, same was true of the heroin addicts.)

Many DID, including my parent, have a "bad" personality, who usually keeps memories of the worst abuses. Generally, this "bad" or powerful alter isn't really evil, but more of a protector of the more vulnerable alters.

There was one exception. One our clients at the clinic had a *truly* evil alter. He came out only at night, which happened to be my shift. His day alters were the sweetest, most helpful little boy types, beloved by all the other counselors, so no one would believe the night staff that this kid was a danger to himself and others. Until the night the police showed up. They'd arrested him for a series of murders.

This is why stupid plots like the Law and Order episode mentioned above make me so mad. (There was also a movie with the same plot, can't remember the name.) Most DIDs are not evil or criminal, and in the rare cases where one is -- like that murderer I knew -- there isn't even a question that his DID would get him off the hook for the crime. (Nor should it.)

Why does Hollywood have to aggravate the myth that DIDs "make up" their symptoms? The reverse is true. DIDs I know will do anything to hide -- from others, including therapists, and from themselves -- the truth about being multiple. Why make it harder for people to seek help?

therapydoc said...

Dear DID-D, Thanks so much for that comment. All true. I'm surprised, honestly, at how much these shows do actually do their research. But now and again they get it all wrong.

How about writing to the writers of the show? Maybe they can do a different episode that gets it right. Or write the episode yourself. That would feel pretty good, I should think.

Anonymous said...

A comment three months later. I date a wonderful woman with DID. She is co-concious. She is one of the smartest people I know. She's also pretty stable. Occasionally alters come out, based on specific triggers which can generally be avoided.

She had a therapist who focused on trauma and DID whom she and her alters trust, unfortunately she moved away, and doesn't feel safe addressing these issues with her new therapist.

Although very stable, she went to a trauma treatment center to try to work on some residual issues, and they told her she wasn't DID, that she had multiple regression states.

This post caught my eye, because of that new showtime show, which she enjoyed but frustrated me, because my experience with her wasn't like the show.

A diagnosis is just a label. She is who she is, and I accept her (all of her) regardless.

therapydoc said...

Sure, why wouldn't you? Everybody's got something.

BTC said...

Following the last commenter, it is worth pointing out that, as well as each person being somewhere being on a "dissociative scale", each individual's inner world also seems to differ considerably; some can actually "see" alters and a landscape within which they operate; for others its more of a "sense" or their (the alters') existence and interaction with the world.

This is just one example but given that there are so many differences in the "presenting condition" it's no wonder that therapists often misdiagnose (ie as schizophrenia or BPD) or simply deny the existence of the illness or the individual's sense of their own alters an inner world.

What is inexcusable is when a therapist tells a client that such a condition "cannot" exist and that they, the client must be mistaken as to their own reality - this is rather crazy-making in itself.

There are plenty of specialist DID/trauma therapists out there however who *do* see the patterns (which seems screamingly obvious to some of us) and are willing and more importantly able to treat this unique condition.

Great post and comments. Thanks.

BTC

therapydoc said...

Thanks for joining us, BTC, and for that extra info that makes these posts so much better!

Ivory said...

I agree with those of you who mentioned Hollywood and/or tv shows that make us what we are not.

I am DID, also and like therapydoc said, maybe I will write a movie that gets it right. Actually, my daughter wants to do that and has the talent.

Just recently I have begun researching DID - I didn't have the courage until now because I have internalized it all and blamed myself for everything.

Ivory

therapydoc said...

Write it, Ivory! It's the best therapy, or at least, for sure, up there.

Kym said...

Noone gets out of childhood undamaged. I let go of my should haves, would haves, could haves, let go of my regrets, my sense of entitlement and decided my life was in my hands. I didn't do it without missteps but I figured I would take the good parts and use the bad parts as a lesson in what Not to do.
On the other hand my sister never let it go. She is still angry 40 years later and it has cost her, her children and her happiness.

I am not angry anymore, I am just relieved that I was able to rise above it.

therapydoc said...

That's a big deal, letting go of anger. Thanks for writing, reminding people.

MultipleMe said...

I suppose I am a bit late to comment to this. I have been diagnosed with DID too.

I want to say thanks to those who commented who dont have DID but showed so much understanding. I only get that from a couple of good friends and my psychologist and sometimes I feel so ostracized.

For those of who were talking about movies/tv shows. I recently heard of one that was done very well - I havent seen it myself but I have been told I should. Its a TV Show called the United States of Tara.

To Ivory, even if you dont write a script. Therapydoc is right - writing does help. I keep a diary and it has helped me so much. I have recently started a blog which is an extention of my diary - hoping that maybe my story might help others not to feel so alone.

And maybe show people that just because I have DID doesnt mean I am crazy

red1226 said...

now that i am actually dealing with my trauma issues, i'm having to face the different ego states in my mind that i just "cut off." it is horribly difficult to figure out events and memories when i have like, five different versions of them that all seem real. My current therapist is trying to get me to listen to all of them so they can work together as a system, which makes logical sense. but in order to do that, i have to listen to them, and acknowledge their purpose and role...

I am not fully DID, but only because i remember mostly what i'm doing when other parts are in control... or at least i'm aware that i am not in control of myself. i truly wish they would all go away, and i could "cut them off" like i use to with anything i didnt want to think about.

even discussing the arguments flying around in my head out loud to my therapist makes me feel so crazy. sometimes i really think what i dont know wont hurt me, so why should i think about the traumas i endured as a child over and over again?

i often wonder -- what is the prognosis for people on the DID spectrum? are we in it for life? or do the parts eventually go away so we can live normal, sane lives?

therapydoc said...

We're all in it for life, struggle with it. I think the parts go away to a degree with resolution, and that sanity is surely possible. For most of us life feels pretty insane, however. It's our job to find it interesting, worth staying with it, learning from it, and passing what we know onto others, if not directly, than in some omniscient way.

Anonymous said...

There is a new website for those with depersonalization disorder: DepersonalizationDisorder.org

Squirrel Fantom said...

I think I had more of a Depersonalization Disorder. Many times I'd let myself leave myself and I could swear I could see what was happening outside. It was like I was standing over top of what was happening or outside of it. It's hard to explain, but this was definitely a great and informative read. Blogs and stories and comments like these help so much in the journey of healing. Especially to feel that I'm not alone and they are encouraging in many ways. I started my own blog last year coming out about this. I just started a new one that's more anonymous so that I could be more honest. I wasn't transparent and honest about a lot of things because I was scared of what the people I knew reading it would think. But in my new one I'm completely and frankly honest http://therealsquirrelfantom.blogspot.com/ Thanks so much again. Even to those who leave comments, it really helps a lot.

Inner Family said...

Thank you for this post. We are new to blogging and expected to see much more hostility, the kind that was around with the FMS movement.

We finally "came out" to our current therapist when the father died and new flashbacks started. We were so scared she wouldn't believe us, even though three experts all diagnosed us DID at separate times. (We have had other therapists tell us we're making it all up to get attention.) Not only did our therapist believe us, but she has other DID clients and said she was wondering, because she could see the signs even though we tried to hide them.

Although we hate what happened to give birth to our system, we have found so much love here too. I don't know what I would do without the others inside to help me.

Thank you for being so open-minded. I know it must be who you are, but thank you anyway.

Narrelle said...

hi there, thankyou for the insight very informative and easy to follow. I have a great friend that has been struggling with DID for many years. I would like some pointers on how i can help her through her not so good times. sometimes i can identify a couple of her identities but not definatively. how can i support her more. she wants to be left along for long periods of time. i know this is not good for her as it seems to take along time for her to come back. she is quite open with me as we have built a closeness but more often than not lately, short bursts of conversation about not much seems to be more frequent now. please help and thankyou so much for all those blogs before me.

therapydoc said...

That sounds like a great topic for a post. Let me work on it and if you have a minute, remind me in a month or two. I can get pretty busy.

hyacinth said...

as someone with DID, it is nice to see people talk about it and want to learn more, especially from singletons. for us it is very isolating and something I have to hide most of the time except when we are in therapy. what is your opinion regarding integration? do you feel that it should be the primary goal of therapy?
thank you

Flutterby said...

I appreciate the comments on this blog. Thanks for pointing out that some TV shows makes things worse by spreading misinformation. After 5 years of therapy, I integrated the different parts of myself. The therapist made a huge difference since he believed me and had experience working with DID. I am still in therapy learning how to function with out switching to a different personality. After integration seems as complex to me as being a multiple seems to be to others. I have a web page that shares my book and what I am doing now.
http://weareone-ruth.blogspot.com/

Tylas Raine said...

I love the title of this blog and this subject is of interest to me so I was searching for it and happened up it. I do hope all worked out well for you and your two DID patients.

Anonymous said...

I'm doing a research paper for my school on DID. I found this website in one of my searches and it really helped me get a better perspective on what its like with this disorder.

Healing said...

I am glad you have blogged about DID. I know this post was written back in 2008 but I think you wrote it well. I am a psych major and have done a few research papers on DID which included the history and evolution of DID. My goal is to be a therapist that specializes in severe trauma based disorders because there is just not enough therapists that work in this area. I also have DID.

therapydoc said...

It is a tough line of work. Best of luck!