Trauma and Dissociation: Dissociative Identity Disorder Explained
Dissociative Identity Disorder or DID is a disorder in which the identity and sense of self is disrupted into separate and distinct parts, and are experiencing as different identities with different mood responses, behavioral patterns, beliefs, and manner of being. DID is treated with slow progressive therapy including establishing safety, skill building like DBT, trauma processing like EMDR, all with ongoing constant assessment to maintain stability. I offer comprehensive trauma focused and skill building therapy for people with DID (Dissociative Identity Disorder). Learn more about that here.
Trauma and Dissociation: Dissociative Identity Disorder Explained
Understanding DID
Dissociative Identity Disorder (DID) was formerly known as multiple personality disorder, and underwent a name change to most effectively capture the root of this disorder: dissociation.
Dissociation is a normal stress response our body and mind use to help us survive distressing events we are unable to leave or fight off. These can be times when we are stuck, or the traumatic event is occurring in our home, or when we are young children and are unable to leave and care for ourselves.
Typically during a stress response, dissociation occurs to help minimize pain and terror for a brief period of time, so that once the threat has lessened we can then launch into action. Dissociation is usually a brief and temporary experience that helps us get to safety.
DID and Trauma
When traumatic experiences occur when we are very young, and are chronic or ongoing, it’s possible that dissociation gets activated frequently and for extended periods of time. Because this is a sensitive time of brain development, our brain can grow based upon the expectation of frequent dissociation. This can look like having frequent dissociative episodes even when they aren’t needed. This is a common symptom of PTSD and trauma related symptoms.
When these types of experiences occur for a prolonged period of time, during early childhood, and require substantial dissociation of the identity (i.e. at times needing to placate someone who is abusive and harmful, so separating the abused part of the identity from the placating prat of the identity), these symptoms and these circumstances can lead to Dissociative Identity Disorder.
Can you get did without trauma?
You can get DID without trauma, however it is highly unlikely that someone’s brain would activate a significant and prolonged dissociative response that develops into DID without a traumatic experience or ongoing traumatic experiences. However, having a traumatic experience is not required in order to be diagnosed with DID. Often people with DID dissociated during many if not all traumatic experiences and may not be able to recall them, wholly or in part. So they may not report having traumatic experiences or are always aware of traumatic experiences that may have led to DID.
Fortunately, people with DID do not have to remember traumatic events in order to get treatment and support.
DID is a trauma-related dissociative disorder
DID Symptoms
While popular media has a lot of exaggerated and provocative misrepresentation of DID symptoms, media are often very inaccurate in showing how DID symptoms are experienced and exhibited.
DID is primarily an dissociative disorder that is experienced, meaning most people on the outside may not recognize that someone has DID unless they are explicitly told so. Regardless, DID can significantly affect a person’s life in many ways.
DID symptoms include:
two or more separate personality states
disruption of identity
marked differences in sense of self
marked differences in sense of agency
with related changes in emotions, behavior, thoughts, beliefs, memory, perception, and sensory-motor functioning
Recurrent gaps in memory of everyday events, personal information, and traumatic events
In order to be diagnosed with DID, DID symptoms have to occur in ways that cause significant stress and disruption to daily living, as well as are not attributable to cultural or spiritual practices, or use of substances.
DID effects: How Does Dissociative Identity Disorder Affect Daily Life
The effects of DID are initially and most significantly experienced by the individual with DID. They might struggle to remember important information about themselves, about they’re day to day tasks and needs, their relationships, and their histories. This can significantly interfere with being able to effectively maintain employment and close supportive relationships that rely on an in tact and accessible memory in order to function.
An example of DID symptoms would be that when someone goes to work, one identity (also called “alter” as in “alternate identity”) is in charge of completing boring work tasks and knows exactly how and what needs to be done. But on the way to work, the person gets cut off in traffic, and an alter that is better equipped to handle safety concerns adn stress comes to the front (“fronting” is when an alter is “in front” and facing the outside world, transacting and interacting with everything outside of the body and mind space). But the safety alter may not hold information or memories related to work and are now unable to remember what and how to do their job.
Another example of DID effects is when someone is connecting with a close friend, and the alter that has fostered this relationship and really enjoys this relationship is not accessible, but a highly critical alter is fronting. This alter may say things to their friend that are hurtful and that the person otherwise wouldn’t express.
Sometimes due to the dissociation between identity states, this includes dissociation between skill sets. Those skill sets can include social skills and emotion regulation. So a highly critical alter may not have the skills to emotionally regulate their frustration and communicate effectively, and thus damage a relationship.
Dissociative Identity Disorder vs Bipolar
Is Bipolar the same as Dissociative Identity?
No, Bipolar and Dissociative Identity are different disorders. People can sometimes see similarities in that in both bipolar disorder and Dissociative Identity people exhibit distinct differences in emotional expression and behavior.
However, Bipolar disorder is when there is a destabilization of affect, meaning the person’s pervasive mood and energy can shift and fluctuate between high highs, and low lows (mania and depression) without prompting or triggers. Someone with Bipolar disorder maintains the same identity and sense of self with the same values, but may behave impulsively, or report certain ideas and beliefs they didn’t have before.
Dissociative Identity is when the distinct fluctuations between mood and behavior are due to different identity states, marked with dissociation from other identity states. It’s possible for different identity states to share the same mood and tone, or lack mood and tone altogether.
The primary difference is that Bipolar disorder is a destabilization of mood, and Dissociative Identity is destabilization of dissociation and identity.
DID responds well to slow, progressive therapy
How to Overcome Dissociation: How is DID treated
Dissociative Identity Disorder (DID) is treatable and can respond well to effective intervention. When treating DID, the primary focus is on establishing and maintain stable safety, emotionally and psychologically, and moving slowly with patience and ongoing assessment. The first place we start with treating DID is to assess the intesnity and frequency of dissociation, the integration and communication among alternate identities (also called “alters”), and current practice of self regualtory coping skills.
DID Treatment
The initial stage of DID treatment involves teaching and facilitating practice of varying self regulatory skills. Often, Dialectical Behavior Therapy is highly effective at teaching and reinforcing skills practice with emphasis on Distress Tolerance and Mindfulness skills.
Once skills are in place and practiced regularly, treatment can move toward trauma interventions. I engage EMDR (Eye Movement Desensitization and Reprocessing) by building in resource skills and assessing the way traumatic experiences has been held within the DID system. With coping skills plans in place to support someone with high distress and activation, EMDR helps a person process memories, whether in whole or fragments, as well as emotional states, sensation states, and core beliefs. EMDR uses ongoing assessment of someone’s window of tolerance, including dissociative symptoms, to help ensure the person remains well within a space of psychological presence and safety.
As well, when appropriate people work towards integration, which is when the system of alters build awareness of each other and the structure of the system, and can engage communication skills to share information, experience, and memories. This is also the time when we work to understand differing roles and patterns of behavior of alters, and make behavioral changes to better align with the person’s goals and personal values.
Some people with DID want to work towards fusion, in which alters fuse together and the boundaries between dissociated identities blur and disappear; essentially reducing the number of alters. This comes from work within the system to create and reinforce effective relating between alters and work toward goals and values.
There are many people who are not interested or do not want to work toward fusion and prefer to maintain stable and effective DID systems. It’s important that the mental health provider or therapist respects these wishes and works out of interest of the person’s goals without forcing any change that is unwanted. People with DID systems can live full meaningful lives without fusion.
Dissociative Identity Disorder or DID is a disorder in which the identity and sense of self is disrupted into separate and distinct parts, and are experiencing as different identities with different mood responses, behavioral patterns, beliefs, and manner of being.
DID is often caused by prolonged, relational-based intense trauma occurring in early childhood that required the person dissociate from different parts of themselves in order to survivor and function.
DID can impact a person’s functioning in daily living including difficulties with work, relationships, and self care. These difficulties can be reduced with effective work toward integration where the DID system effectively communicates among itself.
DID is treated with slow progressive therapy including establishing safety, skill building, trauma processing like EMDR, all with ongoing constant assessment to maintain stability. I offer comprehensive trauma focused and skill building therapy for people with DID (Dissociative Identity Disoder). Learn more about that here.
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