What is dissociative identity disorder?

If you have any of the symptoms described below, check with your doctor.

“You have dissociative identity disorder”, the psychiatrist told me. My mouth hung open in disbelief. This was the third psychiatrist I had seen in six months for evaluation, and this one was on the roster of official court ordered psychiatrists for the county. I had gone to him on my own hoping for a different diagnosis, and was sorely disappointed. Images of Sybil, or an out of control alter frothing at the mouth, flashed into my mind. I worried that I would be seen by others in this light. I knew very little about DID at that time, and had no idea how wrong my misconceptions of it were.

DID has been called a “chronic form of post-traumatic disorder.” Certainly the symptoms of PTSD are encapsulated in the personality states of the person with DID. Learning what symptoms may occur, and how to deal with them, while maintaining a healthy lifestyle, is the challenge for the person in recovery.

What symptoms are known to occur? The symptoms of DID may include:

Depression, mood swings, suicidal ideation, sleep disorders, panic/phobia attacts, addictions, compulsions, auditory or visual hallucinations (during flashbacks), eating disorders, headaches, amnesias/time loss,trances, and depersonalization.

Fortunately, the symptoms in reality do not usually come all at once, and good therapy makes DID one of the most treatable psychological disorders. But therapy often means looking at severe childhood trauma, the basis of why the disorder is being utilized, and grieving over and resolving the trauma with time and patience. How does a person with DID do this?

1. Most trauma experts now recognize that memory work should go SLOWLY, especially at first, to help maintain functionality. Gone are the days when a person is encouraged to “abreact all of their trauma.” This is considered retraumatizing. Instead, intrasystem co-operation (getting to know the inside alternate personalities, and making friends with them), and doing memory work utilizing cooperation inside to stay grounded, are giving better results. The goal is to prevent “memory flooding”, which may make the person feel that they are re-experiencing the childhood events in a nonstop manner. Giving reality orientation to personalities that are “stuck in the past” can help tremendously. I have found that I NEEDED the cooperation of my inside people BEFORE I went into memories. I needed my intellectual ability to ground myself to keep myself from being retraumatized; instead, as I came close to child alters inside who hold painful memories, I encouraged them to “look around and see that they are safe”, to touch something in the here and now, to reground. Grounding techniques were some of the FIRST things I learned in therapy, and have been immensely helpful.

2. Antidepressant therapy: I don’t know how anyone can deal with severe childhood trauma and not need at least some antidepressant therapy, if only for a period of time. The amount of grieving that occurs when remembering is tremendous. I had absolutely NO memories of my life before age 19, and thought that the blanks were normal. As this time has been filled in, with both GOOD and terrible memories, I have gone through periods of deep grieving. The help of a good psychiatrist who understands trauma and recovery can be invaluable.

Also, having crisis numbers, and the numbers of support people when depression becomes overwhelming, or the urge to self harm occurs, can be invalueable. Some clients may need hospitalization for a short period if the depression or self harm feelings become too severe. Having safe options and planning BEFOREHAND for a crisis, is best.

3. Mood swings: this is called “switching into a different personality”. Different personalities may hold different “affect” or mood, and may have been solely created to hold the pain from being beaten, or traumatized, in early childhood. Others may hold the rage that may have been unacceptable to express at the time. When these personalities “switch out”, they may display a huge change in mood, or affect, from the host , or main presenting, personality. It is important to allow alters inside with deep feelings a safe place to vent their feelings, and discuss where the feelings came from. For example, in therapy an anger alter may be able to talk about their rage at being brutalized, and this will help to eventually defuse the amount of rage over time. Journaling feelings, doing collages, and working through the trauma that CAUSED the pain or rage will help immensely. In my experience, behind the rage I often held the immense hurt and depression caused by the abuse.

4. Compulsions, addictions, alcohol use, eating disorders, etc. When a person is in deep emotional pain, they may try to find ways to “numb” this pain, or to cope with it. Each person will be different. In my own life, I became a compulsive reader and binge eater at times when I was trying to block feelings. Others in my family used alcohol or drugs to distance themselves from feeling pain. Looking at the urge to distract from pain, and the origin of the pain, will help with decreasing these behaviours. Some compulsions, such as being a workaholic, are highly rewarded in our society, but if they interfere with family life or social functioning, they may need to be examined.

I have personally found that my need to distract will often increase just before dealing with a painful memory or feelings, and that once the memory or feeling is resolved, the need to

distract lessens. There are also excellent organizations to help with addictive behaviors, such as Alcoholics anonymous, narcotics anonymous, and similar groups.

5. Auditory and visual hallucinations: These are known as “flashbacks.” It can be disconcerting to awaken at 2 am, convinced that your abusive step father is standing in the room; or to be driving and suddenly have an internal “video replay” in your head of a trauma event. Certain scents may trigger a memory, such as the cologne an abuser wore, or certain sounds. The best way that I have found to deal with these is reorienting myself to the here and now. At 2 am, I turn my light on, and check the corner, letting my mind know that no one is there and I am safe. I “ask inside” if anyone is afraid, and why (this is called internal communication), and frequently discover that the flashback was triggered by a nightmare that a”little”, or younger personality state inside, had. I calm them (and myself) down, and the next day find a way to try and work on the memory, such as journaling, collaging, or talking with my therapist. I will negotiate at work to do this at the end of the work day. If I am driving, I pull over immediately so that I do not endanger myself or others (at the closest exit), and use regrounding techniques.

If an external trigger has caused the flashback, I first try to identify WHAT the trigger was, then do the same reorienting, self talk, and grounding.Over time, I have found that there are less and less flashbacks as the memories are being resolved.

6. Time loss: it can be disconcerting to be talking with your husband, and he brings up a whole conversation of which you have absolutely no recall. Or your sibling talks about the wonderful weekly lunches you had in college together, and you have no recall of either the lunches, or going to college! This is called amnesia, and it is a protective mechanism. It will also occur with “switching”, when a personality state that is not co-conscious (communicating with) the host personality comes out. I have found that becoming co-conscious, talking to, and listening to, other personality states inside has helped greatly to decrease the amount of amnesia. This takes time, patience, and the willingness to hear unpleasant truths about early childhood at times. I have found that when I show my internal personalities respect, that in turn, they will be kinder to me. Ignoring them, calling them names, or insisting that they don’t exist in the past has usually been a set up for trouble, and more time loss. Each person will find their own best way to establish co-consciousness, with the help of a qualified therapist.

Other things that have helped me cope with this symptom include: having a calendar book, which I use to mark important dates and tasks. Otherwise, my “poor memory” (and switching) will get the better of me. At work, I also make notes to myself about important tasks, and check frequently. I also teach ALL presenting personalities the job role, so that if I switch, no one knows and the job gets done competently. Co-consciousness has helped greatly here.

7. Depersonalization and derealization: these two “de”s of PTSD are extremely uncomfortable when they occur. The person will feel as if they are watching themselves from far away, or from above; or as if they are walking and talking from underwater or “inside a bubble”, for example. This is a normal part of the re-associating process, and the person needs to realize that these symptoms may occur. Panic may also occur. There are excellent medications to alleviate anxiety, and the survivor may need to utilize them from time to time. These symptoms have tended to occur more for me when I am stressed, working extra hours, or ignoring my inside needs. They can be a "call for attention” from a personality that has been ignored or shoved aside for too long.

This has been a look at some of the major symptoms of DID, and some ideas on coping with them. As a person progresses in healing, they will often find that some of the symptoms will fade over time, others will recur if new memories are brought out. Overall, though, the symptoms do resolve over time and with healing. DID is a response to trauma; once the trauma memories are resolved, the person will regain their functioning and the ability to enjoy life.