What to Know About the History and Treatment of Dissociative Identity Disorder

From the true story recounted in “Sybil,” which describes the fictionalized experience of a young woman with 16 personalities, to the psychological thriller “Split,” which narrates the fight for survival for three girls against a man wielding 23 personalities, the film and television industry finds characters with “multiple personalities” intriguing and captivating to audiences, but how much deeper does the psychological condition go than just the surface Hollywood scratches?

The first documented account of a person possessing “multiple personalities,” now known as dissociative identity disorder (DID), was written about a 20-year-old German woman who began speaking perfect French and spoke German with a French accent in 1791. She had memory of everything she did while she was the “French Woman;” however, she denied all knowledge of the “French Woman” while carrying the personality of the German.

Many studies on dissociative identity disorder were done in the time between 1880 and 1920, with 67% of known cases being reported and documented. Following this time, reported cases slowed down greatly due to increased diagnoses of schizophrenia.

The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM), defines dissociative identity disorder as “the presence of two or more distinct personality states or an experience of possession. The overtness or covertness of these personality states, however, varies as a function of psychological motivation, current level of stress, culture, internal conflicts and dynamics, and emotional resilience (Kluft 1991).”

The identity of the dominant or “primary” personality appears most often in a person with DID, but can also branch off into “alternate” personalities. The subpersonalities develop separate and distinct sets of memories, thoughts and cognitive function, as well as more broad characteristics such as race, age, and family history, similar to the famous case of Sybil Dorsett as described by Ronald J. Comer in “Fundamentals of Abnormal Psychology” (Comer, 182-83).

Sybil’s case has been described fictionally in the novel and movie “Sybil” but is based on the real case of Shirley Ardell Mason. Shirley developed 16 different personalities — all of which she was unaware of — giving her the ability to cope with the extensive emotional trauma that was caused by early childhood abuse. Shirley’s case was extremely important and vital for the acceptance and understanding of the reality of DID. Her case presented psychologists with a standard measure with which to diagnose and evaluate other individuals exhibiting similar symptoms.

In Shirley’s case, her personalities differed on many levels. It is common for subpersonalities to have different abilities, like one being able to drive, speak a foreign language or play a musical instrument, while others are not capable. In addition to these, each personality may differ on food preferences, friends, literature and handwriting. Psychologists have discovered that each personality may also have psychological differences, such as differing nervous system activity, allergies and blood pressure levels (Comer, 183).

According to the National Alliance on Mental Illness (NAMI), symptoms of dissociative identity disorder conventionally begin development as a result from a traumatic event in a child’s or adult’s life, such as physical, sexual or emotional abuse, as well as military combat, as a way to cope and keep the memories under control and at bay.

It is estimated that around 2% of the population experiences dissociative disorders of some form, with women being more likely than men to be diagnosed. Nearly half of all adults in the United States experience at least one derealization or depersonalization episode in their lifetimes, but only 2% meet the full criteria for chronic episodes of the disorder.

What separates the severe form of dissociation from everyday dissociation, like typical daydreaming, is the brain’s neurological response to excessive experiences with traumatic stimuli. Because most cases of DID are linked to early childhood abuse, experienced at age nine or before, many individuals find comfort in dissociating from their dominant personality, and instead, allowing subpersonalities take control (Lev-Wiesel, 372). As Deborah Haddock stated, “If an individual is traumatized in early childhood and the experience is so overwhelming that he is unable to process it, the child may dissociate to survive.” (Haddock, 28.)

People living with DID tend to switch personalities when a psychosocial threat is perceived. Switching from one personality to the next can allow a distressed subpersonality, or “alter,” to retreat, while another alter, one who is more easily able and competent to handle the situation comes out (Kluft).

Individuals with DID may also deal with a condition called dissociative fugue. According to Ronald Comer, author of “Fundamentals of Abnormal Psychology,” “People with dissociative fugue not only forget their personal identities and details of their past lives, but also flee to an entirely different location.” Some individuals with dissociative fugue travel short distances. They may be gone briefly — a matter of hours or days — and end suddenly, or the person may travel far from home, change their name and establish a new identity, build new relationships, and even display new personality characteristics (Comer, 180).

One of the most famous cases of dissociative fugue is that of Cheryl Ann Barnes, a 17-year-old high school student who disappeared from her Florida home and was found one month later in a New York City hospital listed as Jane Doe (Comer, 180).

Similarly to dissociative amnesia, described by Comer as “a disorder in which people are unable to recall important information, usually of an upsetting nature, about their lives,” in cases of dissociative identity disorder, people may experience unexplained, non-epileptic seizures, paralysis or sensory loss (Comer, 178).

The DSM describes how the dissociative amnesia of individuals with dissociative identity disorder manifests in three primary ways: “as 1) gaps in remote memory of personal life events (e.g., periods of childhood or adolescence; some important life events, such as the death of a grandparent, getting married, giving birth); 2) lapses in dependable memory (e.g., of what happened today, of well-learned skills such as how to do their job, use a computer, read, drive); and 3) discovery of evidence of their everyday actions and tasks that they do not recollect doing (e.g., finding unexplained objects in their shopping bags or among their possessions; finding perplexing writings or drawings that they must have created; discovering injuries; “coming to” in the midst of doing something.)”

Risks attributed to DID are very prevalent. As stated in the DSM-4, “Over 70% of outpatients with dissociative identity disorder have attempted suicide. Assessment of suicide risk may be complicated when the presenting identity does not feel suicidal and is unaware that other dissociated identities do.”

Dr. Gary Peterson, a psychiatrist in Chapel Hill, North Carolina, outlines five of the primary dissociative symptoms presented in DID patients in his book “Guidelines for the Evaluation and Treatment of Dissociative Symptoms in Children and Adolescents.” First, he mentions an individual having inconsistent consciousness and fluctuating attention, such as trance-like states or “blackouts.” Second, Peterson describes people living with DID having constant forgetfulness and fluctuations in the ability to recollect information. Third, he describes them having extreme fluctuation in moods and behavior. He continues saying in his fourth symptom that patients have a “belief in alternate selves or imaginary friends…may reflect disorganization in the development of a cohesive self.” Lastly, he states that depersonalization and derealization can cause a person to have a sense of dissociation from their normal sensation, emotions, and perceptions (Peterson, 2). The model Dr. Peterson demonstrates and lays out contributes to a credible DID diagnosis in patients.

Dr. Peterson additionally outlines a four-part model depicting treatment options for DID. He focuses on integrating the subpersonalities of a patient with their dominant personality. Firstly, the therapist should assist the patient in awareness of the differences between their dominant personality’s perceptions and behaviors versus those of their subpersonalities. Peterson thoroughly defines the importance of the ability to confront basic conflicts.

Secondly, a person’s dissociation is a form of defense and putting up a wall, preventing them from facing their problems head-on, so it is important for them to recognize and confront the “conflicts between internal voices, imaginary friends, or conflicting identities” (Peterson, 8). The therapist should, once a conflict is acknowledged, provide solutions to the need for a “dissociative escape.”

Next, the importance of confronting past traumatic and negative memories is vital to take a step toward integrating personalities. Peterson describes that talking about the reasons dissociation may occur within a person to the patient themselves can assist the patient in dealing with the negative events tied in with dissociation.

Lastly, Peterson recommends self-monitoring, as well as making friends and family of the patient aware of warning signs, giving them the ability to step in when dissociation may occur. This can help the dominant personality remain present in distressing situations, instead of dissociating and switching (Peterson, 8-9).

There are many other forms of treatment options for individuals living with DID. Cognitive behavioral therapy (CBT) includes therapy incorporating communication within the subpersonalities and dominant, helping patients find coping strategies rather than dissociating when found in conflicting situations. Dialectical behavior therapy (DBT) is a therapy emphasizing on individual psychotherapy, as well as group skills classes given to help people learn new skills and strategies to develop the knowledge that their lives are worth living. Eye movement desensitization and reprocessing (EMDR) is a psychotherapy that focuses on enabling people to heal from symptoms and emotional distress resulting from negative and traumatic experiences.

Dissociative identity disorder heavily prevents individuals who struggle with it from having a “normal,” happy life. Constant episodes of derealization, dissociation and switching personalities keeps those with DID from recalling past events and building relationships with others. Risks attributed to this disorder may hold back people from ever fully recovering. Dissociative identity disorder is a condition that everyone should be aware of to help those living with it gain their lives back.

Sources:
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th ed., text revision, 1994.

American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed., 2013, p. 216-17.

Comer, Ronald J. Fundamentals of Abnormal Psychology. 6th ed., Worth Publishers, 2011, pp. 176-90.

Haddock, Deborah B. The Dissociative Identity Disorder Sourcebook. 1 ed., McGraw-Hill Education, 2001, p. 28-30.

Kluft, Richard P. “Dealing with Alters: A Pragmatic Clinical Perspective.” Psychiatric Clinics of North America, vol. 29, no. 1, Mar. 2006, Accessed 17 Nov. 2018.

Lev-Wiesel, Rachel. Dissociative identity disorder as reflected in drawings of sexually abused survivors. Journal of the Arts in Psychotherapy, 2005, p. 372.

Peterson, Gary. Guidelines for the Evaluation and Treatment of Dissociative Symptoms in Children and Adolescents. 2003, pp. 1-10.