Identifying Dissociative Identity Disorder

This is an article I wrote (copyright 2008) for a simplified explanation for the layperson titled:

Identifying Dissociative Identity Disorder

(for the helping professional)

Dissociation is a coping mechanism, and a very practical one for all of us at times. Who hasn't spaced out during a boring classroom lecture and found themselves staring out the window, daydreaming in another place and time? Fortunately, when we space out we generally come back completely and easily with little effort or effect on our life. For someone with a dissociative disorder it's not that simple. That's why it's called a disorder.

When a child is very young and they are severely abused they learn often to cope by dissociating. Once one learns to cope that way, they continue to cope tha way because that's what they know and it works for them. When someone is abused for the first time at an older age, they cope differently. Often, their diagnosis will be post traumatic stress disorder, or complex-post traumatic stress disorder.

When the abuse is severe and the trauma is more than the child can handle and “alter” (or alternate personality) is created or appears and takes the abuse. This alter appears to others as a separate personality. The term “host” refers to the actual 3D person, the term “alters” refers to the various personalities that may be present or available.

Often the presence of alters is confused with the hallucinations of a schizophrenic. This is very dangerous as it can not only lead to the D.I.D. Not being treated, but also can lead to dangerous medications being prescribed for the wrong diagnosis.

Antipsychotic medications do nothing to eliminate alters. Occasionally someone with D.I.D. can benefit from medication for a mood disorder or anxiety on a short term basis while in therapy. But schizophrenia is a “brain disease” that can chemically be altered with antipsychotic medication. D.I.D. is completely different and can only suffer the uncomfortable and potentially damaging side effects. This kind of medication can be used only if, and ONLY if, an alter is dangerously our of control and only until the proper therapist can be found. It does not make alters disappear, but will calm anyone. It is dangerous used in this manner and should only be used if lives are in jeopardy.

Schizophrenic hallucinations are generally vague and unconnected with the senses. Meaning they are visual, or they are auditory, seldom both. Occasionally other senses are involved but they just don't seem to mesh as in real life.

The alters of someone with D.I.D. can be seen, heard, smelled, even touched by the person with the diagnosis. They are as complete to the host as the people you know in your life. They may even be younger or older than the host, they may be male or female, they may have knowledge that is very different than the knowledge of the host. There may be family systems within the alters (i.e. alters may be siblings, spouses, even families with children).

Alters may not be recognized by the professional who tries to help. Alters may speak in their own voice, a voice very different from the host, but only if they trust you. If the alter doesn't trust you, he/she may speak through the host person in the hosts voice. This can fool you into thinking the host is involved and fully knowledgeable of what is happening. They may not be aware at all but may be “dis-associating”.

Trust them if they don't remember the event. People with D.I.D. are often known as “chronic liars” because they dissociate and honestly don't remember. If they know they are D.I.D. and have had some therapy, they may be able to investigate and find the alter who is responsible. If they are not yet diagnosed and do not understand what has happened, they may become defensive. It is quite possible they'll think you're accusing them of lying, as everyone else has in their past, and they will not handle it well. If they've never been diagnosed this may be a key sign that they are D.I.D. If this is the case, you may find it advisable to wait until you've found an experienced therapist to talk to about this. This is the time to confer with someone more experienced and make a referral. Even if you're a mental health professional, if you're inexperienced with D.I.D., then work side by side with an experienced professional. Depending where you work and your exact job description, you may only be expected to recognize and refer, and of course, not make things worse. Always remain the friend or helper, but do not expect to be the primary therapist unless you're sure you know what you are doing.

Always remember that the primary mission of any alter is to protect the host. They were created for this purpose and will continue to do this whenever necessary. This is what can make someone with D.I.D. dangerous. Often the host is someone who, by nature, isn't capable of violence towards others. Pushing them can make them violent towards themselves. Suicide is a constant concern.

Another key sign that a person could have a dissociative disorder is the “loss of time”. The host may have no knowledge at all of entire months or years of their lives. Or, they may have just lost a few hours now and then. That time is set aside for the memories of the alter who was present, or “fronting”. It is not unusual for an alter to take control of their host and go their own way now and then.

Often alters will be children. They need what all children do, nurturing. Children alters may grow up quickly as they make progress in therapy.

Their are many psychiatrists in community mental health centers that will never accept the diagnosis of dissociative identity disorder, at least in my experience. They may have been trained to believe that D.I.D. is extremely rare and they can't possibly have one in their office. Plus, no one can recognize someone who is D.I.D. in a 15 min. office visit.

If someone is diagnosed D.I.D., and doesn't know anything about D.I.D., they may very likely not even know that they were ever abused. The alters experienced the abuse, not the host. At the time they were abused, they were far too young to handle it and survive.

Be fully prepared before you suggest the possibility that they were abused. Once you open Pandora's Box, there is not backing out. AND remember that the abuse may still be a part of the hosts life. If this is the case, you may cause them to be in even more danger. It is important to learn about the person's family and current living situation before upsetting the present.

An adult with dissociative identity disorder may be 1) never before diagnosed, 2) diagnosed but never in treatment, 3) misdiagnosed, 4) diagnosed and in treatment. Many undiagnosed D.I.D. function well for years without treatment if feeling safe. I know one female with D.I.D. who had a career and was happily married until her children were grown and out of the home. She was involved in a serious car accident which most likely triggered the reappearance of the alters. I knew another male with D.I.D. who was homeless, alcoholic and struggled to make it from one day to the next having received the diagnosis but told there was no treatment available. I know another who'd been misdiagnosed since the age of 4 when a pediatrician couldn't think of another reason why a 4 year old was still non-verbal except retardation. He was later diagnosed childhood schizophrenic when he started talking as he talked only to the alters that he could see.

One book I read, believe it or not, claimed that dissociative disorders were as common as all mood and anxiety disorders combined. (I think that has to include those daydreaming in boring classrooms around the world.) But at the same time, it is clear it is NOT a rare occurrence. Many with a dissociative disorder are better off in the dark, not having to deal with the trauma that their alters experienced. But when it interferes with the quality of their life or alters resurface later in adulthood, it needs to be dealt with in a humane and compassionate manner.