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1) What is Dissociative Identity
Disorder (DID)?
2) How does a person develop DID?
3) What are the symptoms of DID?
4) What is an alter?
5) Are alters really separate personalities?
6) Do people ever fake having
DID?
7) I think my friend or family
member may have DID – where can I get help?
8) Should I interact with
someone else’s alters?
9) How is DID treated?
10) Is DID curable? |
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1) What is Dissociative
Identity Disorder (DID)? DID
is a psychiatric diagnosis, but is different from many
other diagnoses in that it is a coping strategy for adverse
events in childhood. In an effort to cope with overwhelming
childhood trauma (usually abuse), some children spontaneously
develop different parts of the self. The child’s
repeated psychological efforts to ‘push away’ painful
events can cause parts of the self to become separate from
one another. These parts ‘hold’ the |
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| memories and experiences of what happened, so that the
child does not have to remember. When this happens, the
parts tend to develop their own identities (i.e., senses
of self). Thus, DID is a survival strategy for coping with
repeated childhood trauma. Exactly how the child achieves
the development of separate parts is not well understood.
Two points, however, are clear. First, despite having alters,
a person with DID does not have more than one person ‘inside.’ The
alters are ultimately part of a single self, and therapeutic
healing can unify that divided self. Second, not all children
possess the ‘ability’ to develop DID. Even
in the face of repeated childhood trauma, only some children
will develop alters. |
2) How does a person
develop DID? A person develops DID very early
in life to cope with overwhelming childhood circumstances.
Most commonly, these circumstances are childhood abuse
(physical or sexual) or severe neglect beginning early
in childhood by a primary caretaker. Nevertheless, there
are also some cases of DID occurring in individuals who
experienced painful and intrusive medical procedures
in early childhood. DID develops as a way for a
child to “block out” painful physical and
emotional experiences so they can survive those experiences
and/or stay connected to adults that they depend on for
their basic needs. In childhood DID, painful memories
are held by other aspects of the self so the child can
function in daily life without being burdened by memories
of child abuse or feelings of parental betrayal. |
3) What are the symptoms of DID? Although
the switching back and forth between alters is the best
known symptom of DID, this symptom is usually far less
frequent and much less visible than is shown in the United
States of Tara. There are many other prominent symptoms
of this disorder; however these lie more in the internal
experience of the person with DID rather than in observable
behaviors. Many individuals with DID do not have memory
of some or all of their childhood. Persons with
DID often have experiences of “losing time”;
they are unaware of what happened during certain hours,
days, weeks, or even years. This “time loss” causes
severe memory problems that are very distressing for individuals
with this disorder. People with DID also tend to have experiences
of feeling very disconnected from, or even outside of their
bodies (as if they are watching a movie of themselves).
They also frequently feel unreal, or that the world around
them is not real. Hearing a voice that talks to them or
hearing internal conversations is also commonly reported.
Many people with DID do not know that they have separate
parts, but almost all persons with this disorder feel confused
about their identity and find their reactions to certain
situations quite puzzling. Finally, many persons with DID
have long histories of depression, anxiety, suicidal feelings
and/or attempts, episodes of physically hurting themselves,
substance abuse, or eating disorders. Some are highly functional
in the world, hiding their pain and confusion from others,
while some visibly struggle with day to day life, like
the character of Tara. |
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4) What is an alter? An
alter is a part of the self that the person has ‘pushed
away’ or disowned. As noted above, the ‘pushing
away’ is usually an effort to push away memories
of intolerable abuse or feelings of parental betrayal related
to abuse. In childhood, the alters seem to readily cooperate
in this process of being ‘pushed away’ or ‘disowned’ Their
function is to protect the part of self that is most often
out in the world from these intolerable experiences. Later
in life, however, some alters may increasingly insist on
being able to ‘come out’ and do what they
want, or become quite angry at the ‘host’ personality
and harass her with internal name-calling or even by injuring
the body.
Often alters are only experienced internally as voices or other inner influences
and do not switch openly as in the United States of Tara. (Many individuals
with DID feel ashamed and do not want anyone to know they have different aspects
of themselves). Whether alters are seen or kept hidden, each alter has a particular
way of viewing self, others, and the world, as well particular ways of acting
and thinking. We can all relate to feeling differently about a particular situation
at various times, and feeling differently about ourselves. It is those “normal” differences
that can become the basis of various alters (e.g., one alter is a “good
girl” and another is a “bad girl.”). Other alters can
be based on fantasies. For example, a young girl being abused could come to believe
that if she were a boy, she would be safe, because boys are big and strong, and
thus develops an alter that is experienced as a “boy.”
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5) Are alters really
separate personalities? No, alters are not really
separate personalities. Alters are always part of a single
underlying self that has become divided in a desperate
effort to disown intolerable experiences. On the other
hand, there is little doubt that alters often appear to
be separate personalities. Moreover, both the alters
and the part of the personality out in the world most
often usually experience one another as being separate
personalities. In the treatment of DID, therapists work
to help clients to see that all the alters are part of
the self. |
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6) Do people ever fake
having DID? This question is often asked by
people who have difficulty believing that DID can be
real. Like most medical and psychological disorders,
DID can be faked. Occasionally, a person will fake
DID to avoid responsibility for their behavior; this
is called malingering. There are also a few individuals
whose yearning for attention is so extreme that they
deliberately fake having DID. This is called factitious
disorder. Occasionally, a person will be so confused
about her own identity that she incorrectly believes
that he/she has DID. This person has identity problems,
not DID. A therapist with specialized training in diagnosis
of dissociative disorders can help make an accurate diagnosis
of genuine versus faked DID. The vast majority of people
who exhibit symptoms of DID are not faking. In
fact, most persons with DID minimize and try to hide
their symptoms. |
7) I think my friend
or family member may have DID – where can I get
help?
A person with DID or who suspects DID, can benefit from
seeing a good therapist, preferably one with experience
in treating the disorder. He or she may click Find
a Therapist to
search for a therapist in his/her area who treats the disorder.
If no therapist is listed for a location, an individual
can contact his or her state psychological or psychiatric
association and ask for a recommendation. It is important
to find a therapist who follows recommended best practices
for treating DID. You can find those treatment guidelines
by clicking Treatment
guidelines.
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8) Should I interact with someone else’s alters? In many (but not all) cases, interaction with your friend’s or family member’s alters is inevitable. When that happens, the crucial issue is how (not whether) to interact with the alter. As with any behavior of a friend or family member, you should respond with respect and acceptance, as long as the behavior is not disruptive or unreasonable. It is crucial to be supportive and to avoid being rejecting. There is a reason that the alter has ‘come out,’ which may or may not be readily apparent. As with any symptomatic behavior, the best guide to what you should do will come from your friend’s or family member’s therapist. In all cases, your responses should be guided by respect, concern, and your awareness that you are dealing with a complicated situation that is best understood by a therapist who is experienced in the treatment of DID. Family consultation sessions with the therapist are often quite helpful. |
9) How is DID treated? DID is a complicated
condition that should be treated by a specialist, an experienced
therapist who has received training in the diagnosis and
treatment of DID. DID is most effectively treated in 3
phases. In phase 1 of treatment, the individual is taught
skills to decrease the frequency of his or her symptoms
(i.e., time loss, problematic switching, flashbacks, and
self-injury, substance abuse). Following this phase of
stabilization, phase 2 begins (if the individual desires)
and traumatic memories are slowly processed and resolved
with the help of the therapist. Resolving traumatic memories
means a person is able to remember a traumatic event and
tell someone what happened without becoming overwhelmed,
switching, or having flashbacks. In phase 3, the
individual learns to “own” his or her own history
and sense of self. For example, one alter can say, “The
experiences and history of that other alter are also mine.” Ultimately,
various parts will reach the point of no longer needing
the survival skill of “being someone else,” and
can become one whole person. He or she can develop new
life skills and abilities that allow for better functioning
without the need for alters. It is important to note that
integration does not mean that alters are “eliminated” or “killed
off.” Instead, there is a slow process during which
the separate parts of the self (i.e., the alters) unite. |
10) Is DID curable? Yes. DID is completely
curable in the majority of people, like many other problems
such as depression or anxiety. A small minority of individuals
may not be cured, but can be helped to function and feel
better. It is very important to understand that although
DID is curable, treatment may take several years |
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Info page |
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International Society for the Study of Trauma and Dissociation 8400 Westpark Drive, Second Floor, McLean, VA 22102
Telephone: 703/610-9037 Fax: 703/610-0234 E-mail: info@isst-d.org Copyright © 2004-2011 by ISSTD |
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