Pablo Barona Cabello
For starters, let’s talk about the dissociation in “dissociative identity disorder”. Dissociation is losing control or disconnecting from some aspect of themselves. This isn’t the same as zoning out though; people who experience dissociation are completely separated from a sense of being, they’re disconnected from who they are or what is happening around them or to them. They feel “like watching someone else have things happen to them”.
DID is, thus, a condition that involves severe forms of dissociation, fragmenting the mind into different “personalities”. These personalities are referred to as ‘alters’, and the entirety of those alters make a ‘system’. DID is believed to be an extreme coping mechanism to protect someone from extreme trauma, often abuse, either physical, psychological or sexual, stemming from childhood.
People with DID have two or more personalities, whose degree of differentiation can vary. It can go from slight changes in behavior to extreme changes in being, like people who have alters that identify as kids, fairies or objects. This last part can and most likely will seem stupid to people reading, but the reasoning behind these different and over the top alters is very justifiable. It is believed that, since alters are brought into existence as a way to protect the main personality, they behave like whatever a personality needs to be protected. They also have gaps in memory, or even alternate memories that conflict with one another. There is around 2 percent of the population officially diagnosed with dissociative identity disorder.
Some of the symptoms of DID include switching between alters, who can have distinct personalities, mannerisms, voices, ages, genders and ethnicities. There is usually a main alter that uses the person’s original name. The alters tend to contrast heavily with each other, and they can even hate each other or not know of their existence
The diagnosis criteria are the following:
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A body must experience at least two distinct personalities with their own ways of interpreting themselves and the world around them
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The switch between personalities involves a change in the sense of self, consciousness, behavioral patterns, memory, cognition, motor function and/or sense of agency.
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They experience substantial and somewhat frequent gaps in memory that aren’t able to be explained by forgetfulness (they’re often produced by a switch between alters)
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All the symptoms mentioned above cause a lot of distress and can hinder their laboral, social and personal lives.
Certain personalities may rise up in specific settings or under some form of stress. Sometimes an alter switch is very apparent to the people around them, but it isn’t always the case.
People who have been diagnosed with DID are prone to mentioning hearing voices, having out of body experiences (also known as depersonalization), having multiple streams of thought at the same time, having emotional reactions they can’t explain, and/or feeling as if the world around them isn’t real (also known as derealization). They can also go through something called “dissociative fugue”, where they go somewhere without remembering how they got there. For example, waking up in another city with no idea how they did so.
DID can look and feel different depending on each person, so there is no real pattern to follow when trying to find out whether someone has it or not. If you’re concerned about a loved one having DID, ask the following questions to yourself.
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Do they switch between different styles of speech, dress or behavior?
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Have they mentioned any form of childhood trauma?
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Do they sometimes call themselves by different names?
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Do they say they feel out of control of their own thoughts and feelings or as if they’re
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feeling multiple emotions or streams of thought at once?
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Do they have intense emotional reactions they can’t explain or remember?
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Do they forget or misremember important facts about themselves or the things they do?
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Do they describe a feeling of dissociation from their surroundings or themselves, such as saying that what they’re seeing isn’t real?
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Do they struggle with symptoms like depression or anxiety?
These behaviors, though, can’t confirm a diagnosis, although they can hint at one. If you feel comfortable enough, talk to your loved one about your concerns.
The causes of DID are completely unknown, although doctors do believe a few factors can play a role in its development, including the following:
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Genetics: It’s theorized that a family history of dissociative disorders can increase the likelihood of someone having DID
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Trauma: the majority of DID patients have experienced intense physical, sexual or emotional abuse during their childhood. Dissociation may be a coping mechanism to deal with the trauma
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Predisposition: people prone to dissociative behaviors are more likely to suffer DID.
The primary treatment to deal with DID is psychotherapy, medication, a healthy lifestyle and a lot of social support.
Psychotherapy is a broad term that refers to a vast amount of therapeutic approaches. Some of the most common practices to cope with DID are:
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Individual psychotherapy: one-on-one sessions that help people better understand and manage their symptoms. Some forms of psychotherapy to treat DID are Cognitive Behavioral Therapy (CBT), Dialectical Behavior Therapy (DBT) and Eye Movement Desensitization and Reprocessing (EMDR).
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Hypnotherapy: A form of therapy in which the patient undergoes hypnosis in order to relive and bring up repressed and blocked memories, change behaviors or even try and merge all the personalities. This is often used alongside individual psychotherapy.
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Adjunctive therapy: also referred to as “add on” therapy, consists of strategies used alongside primary treatment methods to help boost progress. Some of those practices include art or movement therapy that help people connect with repressed parts of themselves due to trauma.
There are no medications approved for DID, although patients of this disorder also suffer other pathologies related to eating disorders, depression or anxieties or substance abuse, so doctors often help treat those secondary problems with medication. It’s also important to keep in mind that treatments are personalized and vary between every two individuals.
If you are concerned about your loved one going through DID, make sure to follow the following recommendations:
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Educate yourself
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Advocate treatment
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Stay calm
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Use empathy
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Be patient
And remember to also take care of yourself and find counseling of your own if you’re struggling to cope with their condition.
