It Takes an Inner Village to Survive Dissociate Identity Disorder and Complex, Traumatic, Stress-Ind
In the 21st century, dissociative identity disorder is one of the most controversial DSM-V diagnosis, especially in comparison to diagnoses like anxiety, depression, schizophrenia, even somatic and sleep disorders. When I worked on my Masters’ degree at Edinboro University and internship at St. Vincent Hospital, it was the end of the 20th century. My abnormal psychology professor lectured on the dissociative disorders, claiming that if we drew a line down the medical and psychological community, there are an equal number of people on one side of the fence that believe DID (then called multiple personality disorder) is a “real” disorder while the other side of the fence see it as all fabricated, all “in their heads” (for an example of this type of conversation, please listen to the discussion by Drs. Bethany Brand and Paul McHugh). It was enough to get my attention and I studied this diagnosis for my Masters’ thesis. Myths continue into the 21st century about DID, including that it is actually schizophrenia, schizoffective disorder, or a psychotic representation of bipolar disorder. And movies continue to support myths and falsehoods surrounding this diagnosis, the most recent of movies being Split (2016).
What are the actual facts? Dissociative Identity Disorder pertains to an individual who develops different identities or parts as a result of a severe trauma that began in the early childhood years that continue in varied formats for their childhood and teen years. It may be due to physical abuse, mental abuse, or sexual abuse, but the psyche attempts to survive by compartmentalizing thoughts, emotions, and memories in separate “boxes” or areas of the brain. If one did not have DID, then all thoughts, memories, and emotions would be stored in the format of people who are diagnosed with complex posttraumatic stress disorder (CPTSD). This is why I studied this disorder, but I’ll comment on this again at the end of my blog.
Organizations like the International Society for the Study of Trauma and Dissociation (https://www.isst-d.org) and professionals like Bessel van der Kolk, M.D. and Peter Levin, Ph.D. are just a few examples of those whose mission is to get the right information into the world about trauma and dissociation. Revolutionary research is underway at McLean Hospital, a Harvard Medical School Affiliate, to map the identities with fMRI scans. One of their successful case studies was featured in her own recent docu-series, The Many Faces of Jane, giving a 21st century look at what DID truly is. Past criticism on the validity of the diagnosis from case studies featured in the case study/movie The Three Faces of Eve or biographies like Suffer the Child by Judith Spencer and When Rabbit Howls: The Troops for Trudi Chase, but provide insights into the ethical treatment of DID patients. They also add to the sense of vagueness in the mind of the mental health professionals (therapists to psychiatrists) who provide the direct care and guidance in patient’s recovery. Previous treatment recommendations suggested that full integration of the separate pieces of identify is the only way to recover, which may leave professionals overwhelmed as to what full integration looks like. Because of this confusion, some professionals withdraw from treating DID patients or refer out to other professionals. Today’s research shows that inner communication between identities, known as co-consciousness, is also an appropriate recovery option and is achieved in three phases of treatment. The first two phases of teaching coping skills and processing the trauma is within most mental health professionals’ training for CPTSD. Going the extra distance to refresh their training in CPTSD and dissociation is a valuable next step in patient care for many mental health professionals who work with members of this population.
Approximately 1% of the general population has been diagnosed with DID. Critics would say this statistic is over-inflated. Proponents would say this is an underrepresented percentage based on misdiagnosis as mentioned earlier in this blog. The International Society for the Study of Trauma and Dissociation state that while 1% of the population has been diagnosed with DID, up to 10% of the population do report significant dissociative experiences.
Over 7% of the general population have admitted to experiencing several of the symptoms of the disorder and 1/3 of these people have had several out of body experiences before in their lifetime. To interpret this statistic, one must realize that the majority of the population dissociates throughout the week with their imagination/daydreams. This is a normal, problem-solving and entertainment mechanism built into our brains. Out of body experiences are defined as the dissociative experience of observing yourself from an external perspective as though your mind had left and was observing your body. When we reference DID, this natural mechanism to dissociate, paired with severe, repetitive, and extended trauma-experience can create the potential for DID. The Dissociative Experiences Scale-II (DES-II) by Eve Bernstein Carlson, Ph.D. & Frank W. Putnam, M.D. The DES-II scale measures abnormal dissociative experiences based on 4 main factors of dissociation: Ego Integrity, Depersonalization/Derealization, Amnesia, Absorption/Imagination. These 28 questions, in a elf-administered test, allows clinicians and patients to increase chances of accurate diagnosis.
So what is the reader’s takeaway? As part of being human, we have the capacity for creativity. We were also educated to understand the dynamic of nature vs nurture and survival of the fittest. For today’s researchers, the skeptics, the mental health professionals, and all who are involved in the ethical care of these patients, consider this question. What if the extreme representation of these two ideas (creativity and survival) is that for the few who are unfortunate enough to experience severe trauma at a young age are able to, unconsciously, compartmentalize trauma to create a village to help them survive the horrors they experienced? This would be the ultimate survival of the fittest, ultimate creativity, having their own village that keeps them alive. It takes a village to raise a child is a popular paradigm in our culture. It will also take a village of ethical professionals to support the village of the DID patient.
For more information about best practices in the assessment and treatment of DID, please visit https://www.isst-d.org/