6 Topics on Dissociative Identity Disorder

All too often people diagnosed with a dissociative disorder, especially dissociative identity disorder (DID), face obstacles from clinicians. These barriers include mental health professionals who do not believe that DID exists or if it does it is extremely rare.

This article will examine some topics on commonly asked questions about DID and some of the research that backs them up.

The Definition of Dissociative Identity Disorder

While many who are afflicted with DID are aware of its definition, it is vital to give a complete description of this engaging disorder. The description below is broad and does not encompass every way DID may manifest in an individual.

Dissociative identity disorder is a condition where two or more personality states are present in one person that sometimes take control of the individual living with it. DID is listed in the Diagnostic Statistical Manual of Mental Disorders. Dissociative identity disorder has been recognized by the American Psychiatric Association for many years and is therefore a diagnosable disorder.

Dissociative identity disorder was known as multiple personality disorder until 1994 when the name was changed to reflect the realities of the condition. There are not multiple (many) personalities living inside the afflicted person, rather there is one person whose identity is fragmented.

Sometimes the alters in a DID system have distinct histories, lives. The alters may also have individual and self-images, ages, gender identities, and names. Normally there is one alter who fronts and is interrupted by the abrupt presentation of an alter but this is not always the case.

Alter Formation

People sometimes think that alters were formed and thus the personality of someone living with DID has a fragmented self. Actually, this is not the case. In dissociative identity disorder the self is not fragmented, it never integrated in the first place. (van der Hart, et al., 2006)

Children are born with different self-states each doing its own important task such as crying for food or cooing for attention. As the child grows, it uses the fragments of their personality to explore the world around them. With each passing day, under normal circumstances, children will move toward integration of all the parts of themselves.

The milestone of integration of the parts of the child’s personality states happens between the ages of 6-9 years.  

However, if the natural flow of the child toward integration is hindered or stopped by severe trauma, the child misses this important milestone in its growth. Thus, the child forms dissociative identity disorder.

Why can’t adults or older children form DID? This may help to answer this question. If a child is deprived of the milestone of learning to speak due to severe isolation away from hearing language spoken, they may learn to approximate normal speech but never speak fluently. So, too is the life of a child who has missed the milestone of integration of the self.

The Mystery and Controversy of Integration

To some in the DID community, saying integration is equivalent to uttering the “F” word, it just is not done in public. However, no one who has been diagnosed with dissociative identity disorder has not pondered the mystery of what it would be like to pull themselves into one cohesive self.

The controversy comes in when one addresses the idea of integration as such because many do not feel they want to integrate. Some have strong inhibitions because they feel that to integrate would be to kill or belittle their alters. Also, some feel that the alters are separate people and should be allowed to remain separate.

This author strongly disagrees with the above two trains of thought. For one, the alters cannot be destroyed. The only way to kill or murder an alter is to take one’s own life. The alters are you and you are the alters.

Second, I understand how much it feels like the alters are separate people and should be allowed to live their lives without being forced to integrate. However, they are not separate people. No matter what, if you open up your skull you will not see more than one brain and no other people exist within your brain. The alters are parts of you stuck in trauma time who were not capable of integrating in early childhood.

Structural Dissociation Theory  

There are only a few theories that explain what dissociative identity disorder is and how it forms. Structural dissociation theory is the best and most important of these.

Structural dissociation theory is perhaps one of the best descriptions yet of what alters are and how they form. In this theory asserts that no one is born with an integrated personality but coalesces into one personality as they integrate all the parts of themselves (as stated above).

The theory goes on to state that a severe trauma causes the main personality, known as the apparently normal part (waking self), to remain separated from emotional parts in what is known as primary structural dissociation. When the trauma is repeated multiple emotional parts form and remain separate from the main personality it is known as secondary structural dissociation.

Both primary and secondary dissociation are seen in people who form the devastating diagnosis of borderline personality disorder.

The theory goes on to state that there are is not only more than one emotional part with one apparently normal part, but rather, there are multiples of each part present in one person. This is tertiary structural dissociation aka dissociative identity disorder.   

The Prevalence of Dissociative Identity Disorder

There are those who claim that dissociative identity disorder is quite rare. They also state that not a significant number of people have been proven to have it to warrant research about DID.

But, research conducted by Foote et al, in 2006 dares to differ. These researchers interviewed 82 patients who had were nearly the same in demographic measures   

In the study, 82 patients of an outpatient clinic were randomly interviewed that did not differ significantly on any demographic measure or on the self-report measures of trauma and dissociation. Out of the 82 interviewed, 24 (29%) received a diagnosis of a dissociative disorder with 5 (6) of them receiving the diagnosis of dissociative identity disorder.   

These findings are not insignificant nor are they alone.

The International Society for the Study of Trauma and Dissociation (ISSTD) in their guidelines for treatment stated that DID and dissociative disorders are not rare. In fact, 1%-3% of the general population of the world have dissociative identity disorder (Johnson et. al, 2006)(Sar & Dugan, 2007).

There are currently 7.8 billion people on planet earth as of 2020. One to three percent of that number is an enormous amount of people living with dissociative identity disorder.

Exciting New Research on Diagnosing Dissociative Identity Disorder

We live in a tremendously exciting time for the diagnosis of mental health challenges. The use of functional magnetic resonance imaging (fMRI) machines has caused a revolution in the diagnosis of many disorders, including DID.

Research conducted by Reinders et. al, in 2019, found that by using fMRI imaging they could see biological markers that discriminated between people who had DID from healthy controls.

To do this they recruited 75 participants including 32 people with dissociative identity disorder and 43 healthy controls without DID. The researchers were able with an accuracy of 74% tell which people in their study had DID on the basis of their brain structure proving there is a biological basis to determine if someone actually had DID.

If this study is replicated, it will be an enormous step forward in the diagnosis of DID and perhaps end the endless string of misdiagnoses people with DID receive.

Conclusion

I hope that writing about some of the topics about DID has helped in the furtherance of people understanding more about the disorder.

There is no reason that people living with dissociative identity disorder cannot move on to live productive lives. Once treatment is initiated, it is only a matter of time before healing begins and it is my firm belief that integration begins the moment you step through a therapist’s office.

Dissociative identity disorder remains controversial, but research is beginning to break down the barriers that some clinicians have hidden behind for years.

“You may not control all the events that happen to you, but you can decide not to be reduced by them.” ~ Maya Angelou

References

Foote, B., Smolin, Y., Kaplan, M., Legatt, M. E., & Lipschitz, D. (2006). Prevalence of dissociative disorders in psychiatric outpatients. American Journal of Psychiatry, 163(4), 623-629.

Johnson, J. G., Cohen, P., Kasen, S., & Brook, J. S. (2006). Dissociative disorders among adults in the community, impaired functioning, and axis I and II comorbidity. Journal of psychiatric research, 40(2), 131-140.

Şar, V., Akyüz, G., & Doğan, O. (2007). Prevalence of dissociative disorders among women in the general population. Psychiatry Research, 149(1-3), 169-176.

Reinders, A. A., Marquand, A. F., Schlumpf, Y. R., Chalavi, S., Vissia, E. M., Nijenhuis, E. R., … & Veltman, D. J. (2019). Aiding the diagnosis of dissociative identity disorder: pattern recognition study of brain biomarkers. The British Journal of Psychiatry, 215(3), 536-544.

Van der Hart, O., Nijenhuis, E. R., & Steele, K. (2006). The haunted self: Structural dissociation and the treatment of chronic traumatization. WW Norton & Company.

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