Dissociative Identity Disorder or Multiple Personality Disorder, as we once called it, is one of the most misunderstood mental illnesses in the entire field of psychiatry. It is one of those mental illnesses that have been sensationalized and exaggerated by movie industries, leading many people to get the wrong idea about what it truly is.
I’m sure you’ve heard people throw around the phrase “multiple personalities” more than once or twice. Laypeople often use the term to describe anything from bipolar-type behaviours to general mood instability, but what does it mean in the clinical sense?
What is Dissociative Identity Disorder?
Dissociative Identity Disorder (DID) is a disorder that develops due to a combination of factors, including childhood trauma. It presents as severe mental dissociation — a disconnect between a person’s thoughts, memories, feelings, and sense of identity. It usually develops in childhood as a coping mechanism to severe trauma.
In DID, a person has two or more alternative personalities (alters, for short) that could have different ages, genders, accents, hobbies, skills, abilities, and even disabilities. Researchers have reported a case of a person who had a few alters that were blind while the other alters weren’t. Also, one alter doesn’t have access to all the memories of another alter, so one alter’s memory of life can be completely different from another alter’s memory of life, even though they are in the same body. Because the alter in charge of the body (or the alter that is fronting) can change regularly, some cultures consider the illness synonymous with being possessed.
What Does it Mean to Dissociate?
The name of the disorder changed from Multiple Personality Disorder to Dissociative Identity Disorder in 1994. The change was to show that the primary symptom of the disorder is dissociation. It is the symptom that brings about all the other symptoms. Dissociation is the general disconnection between one’s thoughts, feelings, memories, and/or sense of identity. You know how sometimes you arrive at a destination, and you don’t remember walking there? That’s minor dissociation. It is what happens when a person ‘zones out’ and disconnects from their internal and/or external environment for a while. Negligible dissociation occurs to everyone, and it’s completely normal.
Dissociation as a Coping Mechanism
You’ve probably heard some rape victims talk about feeling detached from their bodies when the trauma occurred or feeling like it was happening to someone else. That’s an example of how the brain sometimes naturally uses dissociation as a means of coping with severe trauma.
It is a survival mechanism, enabling the victim to mentally escape their suffering since they cannot physically escape.
The longer the trauma persists, the more the victim dissociates to deal with it. This goes on until, at some point, the victim begins to dissociate even in the absence of real danger. It is almost as if the brain starts assuming that the individual is in a somewhat perpetual state of being traumatized. To the victim, dissociation gradually becomes their automatic response to any stressor, and thus, a dissociative disorder ensues.
Continuously using dissociation as a means of coping with stress or triggers is doubly insidious. On the one hand, it affects a person’s interpersonal relationships and their general ability to function. On the other hand, it prevents a person from fully processing the trauma they experienced and healing from it.
When Trauma Breaks the Child
All dissociative disorders aren’t created equal. Dissociative Identity Disorder, in particular, is not just a disconnect from one’s mental state or thought processes. It’s a split in one’s identity.
You may be wondering, “How does dissociation somehow lead to identity splitting?” It all lies in how important a person’s childhood is to their mental development. The current most prevalent theory about how this happens is the theory of structural dissociation.
It states that no one was born with an integrated personality — a complete, interconnected sense of self spanning different aspects of our being. A child has separate basic states of mind or ego states for each basic need they have. As the child develops, around age 5 to 9, these states of mind integrate to form a sense of self — an identity.
When a child experiences consistent trauma and frequently dissociates to deal with it, that process is interrupted. As a form of dissociation, a child may imagine themselves as someone they think would be unaffected by the trauma. Perhaps, someone they perceive as powerful. An ego state then forms around that so that each time the trauma occurs, they dissociate into what they perceive as a persona that would not be affected by that pain. This enables them to escape.
As time goes on, other alters emerge to deal with other stressors in the child’s life. Dissociating becomes their stable coping mechanism. These alters formed are so distinct and separate from each other and serve different functions that cannot be interlinked. Because of this, it is impossible for the alters to merge into one, so a single stable sense of self is never formed.
In that way, the trauma irreparably breaks the child apart.
Dissociation and other Trauma-Related Disorders.
Last time, I discussed PTSD and how trauma changes the brain. PTSD, as well, has an element of dissociation associated with it. Dissociation is shared among all trauma-related disorders, from borderline personality disorder to PTSD to complex PTSD (CPTSD) to other specified dissociative disorders (OSDD). Of course, this has everything to do with the fact that dissociation is one of our natural responses to trauma.
In PTSD, dissociation explains why a person might have little to no memory of the event. This phenomenon is called dissociative amnesia. It could also explain the very vivid flashbacks — memories that have not been fully processed because they’re not accessible to the person’s current mental state. Some people with PTSD remember their trauma well and only have vivid flashbacks when they encounter a trigger. This is because those vivid memories are compartmentalized somewhere, ‘blocked out.’ This is very typical of dissociation.
The dissociation in PTSD and other trauma-related disorders is not as severe and definitive as that in DID, but it’s still worth noting.
Dissociative Identity Disorder over the years has come to be understood as the growing of different personalities even though that’s not really what it is. It is also neither fake nor a result of demonic possession. It’s a split in identity, a direct result of how trauma can severely wreck a mind. Although rare, more people need to acknowledge it as it is to melt the stigma surrounding it.