Once referred to as multiple personality disorder, dissociative identity disorder (DID) is a serious mental health condition.
DID is associated with long-term exposure to trauma, often chronic traumatic experiences during early childhood. It is often misunderstood and portrayed incorrectly in popular media.
Dissociation—or disconnection from one’s sense of self or environment—can be a response to trauma. It can happen during a single-incident, traumatic event (e.g., an assault, a natural disaster, or a motor vehicle accident), or during ongoing trauma (e.g., wartime; chronic childhood abuse).
The person experiencing the trauma is so emotionally overwhelmed that they cope by dissociating—they “shut off” from what’s happened and categorise the experience. Dissociating allows a person to distance themselves from the trauma they experienced.
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What Is Dissociative Identity Disorder?
Dissociative identity disorder—a type of dissociative disorder—most often develops during early childhood in kids who are experiencing long-term trauma. This typically involves emotional, physical, and/or sexual abuse; neglect, and highly unpredictable interactions with caregivers.
Some children in such circumstances can develop DID by compartmentalising their ongoing, traumatic experiences and then displacing them onto other aspects of themself. By doing so, they can distance themselves psychologically from pain.
To an extent, dissociation permits the child to move through life without constant reminders of distressing events.
So, how might a child start dissociating to cope with trauma?
Dr. Melissa Kaufman states, “During early development, children possess a wonderful capacity for magical thinking. For example, some kids believe that Superman is real and that someday they will be able to fly, too.”
”Some kids may displace their own thoughts or feelings onto a personified stuffed animal or onto a personified imaginary companion: ‘I’m not worried about my first day of kindergarten, but Fluffy is!’ All of these things are completely appropriate developmentally during early childhood.”
Since a young child doesn’t know it is impossible to “turn into a different person,” such displacement of thoughts or feelings can also become a coping mechanism for children who suffer from repeated trauma.
For example, a child who experiences ongoing sexual abuse can think, “It’s too overwhelming to feel such fear. It’s too dangerous to feel such anger. It’s too real to know what is happening to my body. That’s not me. That’s someone else.”
”By doing this,” adds Kaufman, “They displace overwhelming thoughts, feelings, and memories onto different, personified aspects of self and separate from their painful circumstances. This ‘not me’ experience is the cornerstone of DID.”
Importantly, DID often allows children to maintain attachments, creativity, and the capacity for humour and reflection under extremely difficult circumstances.
However, as dissociation continues into adulthood, when the danger no longer exists, it can interfere with—or even prevent—recovery from trauma.
Dissociative Identity Disorder Is Treatable
The overarching goal of DID treatment is to maintain stability, rather than moving quickly into focusing on processing trauma.
In contrast to PTSD stemming from a single event that happened in adulthood, DID is associated with repeated traumatic events during critical developmental periods in early childhood.
Because of this, typical treatments for PTSD, such as a time-limited course of prolonged exposure or eye movement desensitisation and reprocessing (EMDR), are not the standard of care for DID.
DID is best treated with a three-phase approach that focuses on safety and stability, processing traumatic events, and eventually being able to live without dissociating. Any phase of the process can take several years, and often the phases overlap.
In addition to symptoms of PTSD and dissociation, individuals with DID often need treatment for co-occurring issues. These include depression, suicidality, self-harm behaviours, disordered eating, and body image distortions.
Phase 1
The first step in treatment aims to reinforce the safety of the person with DID, with a focus on more serious symptoms like self-harm or suicidal ideation.
In treatment, a licensed mental health expert helps the person with DID replace any harmful coping techniques they use with healthier options. At the same time in treatment, the clinician works with the patient to identify the PTSD symptoms they may be experiencing.
They also start the process of teaching ways to understand that dissociated identity states represent important feelings, thoughts, and memories that, while very difficult to accept, are part of an entire self.
Phase 2
The second step focuses on identifying, addressing, and working through traumatic memories.
Doing this under clinical care helps the patient build distress tolerance and manage reactions to traumatic memories in a safe environment. Doing so with the help of a mental health professional is key to avoid re-traumatization.
As symptoms of PTSD and co-occurring issues stabilise, DID patients begin to integrate compartmentalised experiences.
They understand that painful thoughts, emotions, and memories they mentally packed away as children—however difficult they may be—really belong to them. They learn to connect their life experiences to their sense of self. They felt as though they had a whole and coherent narrative of their own life.
Phase 3
Last, DID patients learned to live their lives now without relying on dissociative defences to cope. As new and different coping methods are used successfully, they will probably experience greater confidence, increased self-awareness, stronger self-regulation skills, and more emotional stability.
Treatment must also address individuals’ struggles to feel safe in close relationships and in the world. People with DID often view themselves as damaged, somehow at fault for the abuse sustained during childhood, and unworthy of care.
Because of this, the development of a trusting alliance, safety and symptom management during treatment takes time. Trauma-focused work must be paced gradually.