[Tw: Abuse] What is Dissociative Identity Disorder [DID]?
Good day all!
This is an informative post highlighting the basics of Dissociative Identity Disorder (DID), or previous known as Multiple Personality Disorder (MPD) which was later renamed to DID to accurately represent the disorder. It is a Dissociative Disorder and not a Personality Disorder. (Source: DSM-5)
This entire post is handwritten by myself, supported with sources, please do not copy and paste this elsewhere.
The Theory of Structural Dissociation
A child before the ages of 6 to 9, starts off with separate ego states (e.g. feeding, bonding/attachment, playing, etc.) which in a healthy and ideal childhood will merge and become one usually around puberty. This is where most people refer to as "finding oneself". However if the child experiences inescapable and long term trauma, this disrupts the unification process and the separate states of the brain fail to merge into a single self identity and the separate parts develop its own identity. These parts of identity are also referred to as "alters" (short for alternate identity), "parts", or "identities". It is imperative not to label them as "personalities" as it's not a mere personality but an entire identity by itself. The parts may have different names, age, gender, role within the body (collectively known as the "system"), body language, preferences, belief systems, voice, etc. Thereafter in life, any future trauma or stress may lead to a new split off of a part/alter as the brain has already learnt to cope with stress this way. Some parts/alters may also merge/fuse, depending on many different factors.
Amnesia in Dissociative Identity Disorder (DID)
DID is a mechanism by the brain made to survive the prolonged and horrific trauma. In DID, the brain may have parts that hold trauma (also known as "trauma holders") and these trauma, its accompanying memories, its emotions, may or may not be accessible to other parts. It is believed that this is done by the brain so as to preserve normal daily functioning by the parts that are capable of day to day life, also known as Apparently Normal Parts (ANP). The other type of parts e.g. trauma holders, persecutors, etc. are known as Emotional Parts (EP).
Amnesia in DID varies from system to system. These are also known as "Amnesia Barriers". The barriers seek to protect the ANP(s) from the trauma the EP(s) hold. One of the ways amnesia can manifest in day to day life in the individual with DID is when an part assumes executive control of the body while the other parts are completely switched out (also known as "blackout switches"). The part that is at the front (assuming executive control and consciousness) may do things that the other parts may not be aware of due to lack of access to the front consciousness. There are also grey-out switches which will be far more common than blackout switches where a part not actively in executive control may be in co-consciousness with the part that is fronting and may remember parts of what happened during the period.
DID Part/Alter Roles
There are a few known system roles in a DID system they are the following, but not limited to:
1) Host - the part/alter assigned by the brain to take on day to day matters and/or the one(s) who front the most
2) Protector - the part/alter assigned by the brain to protect the system as a whole. There can be emotional protectors, physical protectors, sexual protectors, etc. depending on the specific system.
3) Persecutors - best explained as a misguided protector. They usually intend to protect the system but may have toxic ways to go about them. Often times, persecutors who are gradually guided through therapy and/or support/help turn out to be one of the best protectors around.
4) Little - the part/alter with a mental age of between 0 to 12. Littles ARE children. It doesn't matter what the body age is. They should be treated as with any other child.
5) Gatekeeper - two types of gatekeepers; memory gatekeeper / fronting gatekeeper. The memory gatekeeper controls access to memories among parts/alters. The fronting gatekeeper controls access to the front among parts/alters.
6) Caretaker - the most common kind of caretaker are the parts/alters that may be in charge of looking after the littles, preparing meals, etc.
7) Introjects - Introject parts/alters are ones that may resemble real world or non-real world people. A known type of introject are abuser introjects where this specific part/alter mimics the actual abuser of the system in the past to recreate the entire scene again. Whether or not introjects are based off abusers, ALL PARTS/ALTERS are equally valid and must be treated with respect.
This list is non-exhaustive. Each part/alter is performs a role in the system and is there for a reason.
NO MAIN/ORIGINAL/CORE ALTER
Based off the Theory of Structural Dissociation, there is no 'main'/'original'/'core' part/alter. It didn't form in the first place, hence DID existed in the brain. Every alter has equal right to use the body and are all equally valid.
Prognosis of DID
To be determined by the client, facilitated by the therapist but in many cases either functional multiplicity (also called integration) where parts/alters learn to work together as a team, with reduced amnesia barriers and well controlled switches (fronting), or for a smaller part of the DID community, final fusion. This is where all parts/alters become one. There are also cases where partial fusion is chosen to reduce the number of parts/alters in the system or for other reasons. Fusion is where two or more parts/alters join together, thereby combining their current memories, skill sets, etc. and may identify with a new name moving on.
Written by S.J.W.
Dip. Counselling Skills
Sources:
International Society for the Study of Trauma and Dissociation (2011): Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, Journal of Trauma & Dissociation, 12:2, 115-187
The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization" by Onno van der Hart, Ellert Nijenhuis, and Kathy Steele.
American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.)
@SJW614
I think that this is a very good, informative article, and you are quite well-researched. I just wanted to point out something I learned from a clinical psychologist as a psychology major in undergrad. He said that the main reason DID was renamed was due to a shift in thinking from mental health professionals that DID was not really distinct personalities but rather alters or parts of an overall identity, since each alter often has a dominant mood/feeling state (and also corresponding names, ages, and perhaps shifts in voice and presentation of appearance), and they placed a stronger focus on treatment and therapy which tried to integrate and develop a connection between the alters.
This is very similar to what you said, but a slightly different idea, and I just wanted to put it out there. This doesn't mean you're necessarily wrong though; I find it interesting that mental health professionals don't necessarily agree on how to conceptualize some disorders, and some even argue that DID doesn't actually exist. I personally believe DID exists, but is just very rare--which is probably why some mental health professionals don't believe in it since they've just never worked with those patients before.
@PeacePink Thank you, I'm glad you appreciated my post. I'd like to state that the prevalence for DID is about 1.5% globally (Source: DSM-5, pg. 294), while the prevalence for people with red hair is 1-2% globally (Source: Healthline.com, BBC.com) and 1-2% for people of European origin (Source: www.ncbi.nlm.nih.gov, PMID: 31792316). So it isn't "that" rare. It's not common, yes. But not entirely rare either. That is to say that around 1 out of 100 people has DID. But it is not too easy to diagnose as most DID cases are covert and not overt, hence clinicians may misdiagnose it as something else.