Understanding Dissociation and When It Becomes Problematic

Blank-faced woman holding mask of faceWe’ve all had moments where we felt completely spaced out. What is normal, and when do instances of mental escape become a cause for concern? Dissociation, or the feeling of being disconnected or separated from oneself, is a common experience, especially as a means for coping with or escaping from stressful situations.

I like to explain dissociation on a continuum. At one end there is “normal” dissociation, the kind we all do at times. A popular example to describe simple and typical dissociation is driving your car on autopilot and not really paying attention to the road ahead, yet managing to safely make it to your destination. Another example is when you are completely absorbed in a movie until the person next to you reaches for the popcorn and your awareness snaps back to the present moment. These moments of “escape” happen occasionally and are a normal part of the human experience.

A little further down the spectrum is the type of dissociation used as a defense mechanism to cope with stressful situations or feelings of being completely overwhelmed. People will sometimes describe themselves as detached, “out of it,” or even as if they are watching themselves from an out-of-body perspective.

At the other end of the spectrum is a mental health diagnosis called dissociative identity disorder (DID). Previously known as multiple personality disorder, this condition involves dissociation so extensive that it results in a complete split, or compartmentalization, of memories and experiences that ultimately become separate and distinct personalities. Different personalities are often referred to as “alters,” while the main identity is typically called the “host” personality. Together, the various personalities make up a system that initially served to help an individual cope with experiences of extreme and repeated trauma, often including severe sexual or physical abuse at a young age.

‘Alters’ and Dissociative Identity

DID is often difficult to comprehend, and the multiple personalities within a person with this diagnosis are sometimes hard to recognize or believe until a personality shift is witnessed within the person. Each personality serves some type of purpose for the host person. For example, one alter may be the “playful one,” while another is the “protector” or “helper.” Each alter has his or her own interpretation of events and, often, only certain alters will remember the details of the trauma that occurred.

Different alters typically have their own names and distinct traits. They may speak in different accents and tones, display different mannerisms and body postures, and dress differently from one another. They each have their own idea of how they look, and sometimes it’s vastly different from the host person’s actual appearance.

A person with DID often has alters of different genders than the host person’s true gender, and they may have personalities who are “stuck” at younger ages than the host personality’s actual age. For example, an adult experiencing DID might have an alter personality who is 5 years old and is interested in coloring or playing with dolls. Each alter may have a unique set of talents and hobbies, and some may even speak different languages.

DID After Surviving Trauma

While DID is initially a coping mechanism the brain employs to allow a person to survive extreme trauma, it can lead to difficulties as the host person grows up and tries to interact in a world where this level of dissociation is not widely understood. Individuals with DID are often misperceived and sometimes called liars because the stories or actions of different alters don’t add up.

Although the trauma may have ended, the barriers in the mind remain and can lead to confusion for the individual, who may also experience co-occurring symptoms of depression, anxiety, and posttraumatic stress. Sometimes, certain alters may develop self-destructive patterns, such as drinking excessively, behaving recklessly, and engaging in actions to sabotage the host personality’s efforts to stay healthy. Some alters may have suicidal thoughts or attempts.

A person experiencing DID who ends up in the hospital may often be misdiagnosed since hospital staff may only see a snapshot of the system and issues. Incorrect diagnoses often include major depressive episode, bipolar, substance abuse, and schizophrenia.

The following indicators are often displayed by individuals who experience DID:

  • Gaps when recalling daily events
  • Repeated mentions of losing time or blacking out
  • Wearing clothing they don’t remember purchasing
  • Finding themselves somewhere with no knowledge of how they got there
  • Finding notes or drawings they don’t remember creating
  • Not remembering conversations, events, or experiences with others

How Dissociative Identity Disorder Is Treated

Treatment for DID involves long-term, consistent therapy to break down the “walls” in the mind. This involves gaining an understanding of each alter and processing their various experiences, including those that involve the original trauma. Consistent treatment can sometimes be difficult because certain alters may be resistant or skeptical Some people with DID fear the loss that may occur from “curing” them of their personalities. Rather than getting rid of each personality, the goal is to assimilate the positive and functional aspects of each alter in a way that helps the person feel more balanced and less chaotic.of help. Also, dealing with arising crises within individual personalities may delay the course of trauma treatment. A good rapport between the person in therapy and therapist is essential.

The goal of treatment is often referred to as “integration,” which involves bringing together the fragmented and compartmentalized parts of the person’s memory. Some people with DID fear the loss that may occur from “curing” them of their personalities. Rather than getting rid of each personality, the goal is to assimilate the positive and functional aspects of each alter in a way that helps the person feel more balanced and less chaotic.

While DID can be a complicated and frustrating condition for individuals who live with it, it is important to remember that dissociation is a natural mechanism of the brain and can work as an extraordinary process for ultimately surviving horrific experiences.

© Copyright 2015 GoodTherapy.org. All rights reserved. Permission to publish granted by Megan MacCutcheon, LPC, therapist in Vienna, Virginia

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by GoodTherapy.org. Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

  • 25 comments
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  • addie

    December 3rd, 2015 at 10:28 AM

    Why am I not the person who can let go of my problems? I just can’t seem to forget about them, they are always with me

  • Liz

    December 4th, 2015 at 8:44 AM

    I also have the disorder, unfortunately the memories will always exist. The ultimate goal is to reprocess the memories to remove them as a trigger. Have you ever looked into EMDR?? Its the best way to help with the reprocessing and integrating the splits in personality! Best of luck!!

  • Tom Dorrance LICSW

    December 9th, 2015 at 5:41 AM

    Hi Adie,
    You have my compassion for how hard it is for you.
    You might want to look into IFS (Internal Family Systems Therapy ) ON THE selfleadership.org website. I am a practitioner. I find it to be effective and user friendly when practiced by a IFS-trained therapist.
    Warmly,
    Tom

  • Megan MacCutcheon, LPC

    Megan MacCutcheon, LPC

    December 3rd, 2015 at 12:59 PM

    Addie –We often ruminate about problems until we are able to effectively process or reframe them. If the problems are regarding traumatic, I can tell you that trauma treatment often involves talking about the stressful experiences over and over, in different ways, in order for the brain to process and ultimately move past the experience. Even for people who don’t experience severe trauma, it can be difficult to let go of issues, often because we engage in what is called “negative self-talk” – Your thoughts or that voice in the back of your mind may constantly be dwelling on the negative aspect to things, making it hard to find peace. Working with a therapist who practices Cognitive Behavioral Therapy can help you find ways to effectively process the problems so they are not getting in the way of leading a happy life.

  • Ginger

    December 4th, 2015 at 8:46 AM

    Sometimes I can feel different whereas though I look in the mirror and see a total stranger. I touch my face peer into the mirror do not not recognize a thing my eyes aren’t mine. I speak different sometimes I am Asian, Latin, African, from the Islands. I am an writer an artist, I believe its the creative and higher wave link

  • Kristin

    December 4th, 2015 at 9:42 AM

    I was traumatized as a child for 5 years by my stepfather. I have been to several different therapists and have even tried the therapy with the beeps? I can’t remember what it was called. I found out a year and a half ago that I have DID. I’m reaching out because it’s getting bad again. I thought I had it under control but one of them sabotaged a relationship with someone I’ve waited years to be with abs now they are trying to convince me that I’m worthless and that the world is better off without me. I’ve been keeping exhaustingly busy to not be alone with myself. I’m fighting the thoughts but I’m scared that they’ll win this time. I don’t know anyone else with this. I’m afraid of being misdiagnosed. I don’t know who to turn to.

  • The GoodTherapy.org Team

    The GoodTherapy.org Team

    December 4th, 2015 at 10:32 AM

    Dear Kristin,

    We are very sorry to hear about your difficult experience. If you are looking to find another therapist that may be a better fit for you, please feel free to return to our homepage, http://www.goodtherapy.org/, and enter your zip code into the search field to find therapists in your area. If you’re looking for a counselor that practices a specific type of therapy, or who deals with specific concerns, you can complete an advanced search by clicking here: http://www.goodtherapy.org/advanced-search.html

    Once you enter your information, you’ll be directed to a list of therapists and counselors who meet your criteria. From this list you can click to view our members’ full profiles and contact the therapists themselves for more information. You are also welcome to call us for assistance finding a therapist. We are in the office Monday through Friday from 8:00 a.m. to 4:00 p.m. Pacific Time; our phone number is 888-563-2112 ext. 1.

    We also wanted to provide you with some links to resources that may be relevant to you at this time. If you feel you are in crisis, please visit http://www.goodtherapy.org/in-crisis.html

    Wishing you the very best,

    The GoodTherapy.org Team

  • Kristin

    December 4th, 2015 at 6:31 PM

    Thank you so much for the links. I just feel so lost right now

  • Megan MacCutcheon, LPC

    Megan MacCutcheon, LPC

    December 5th, 2015 at 7:08 AM

    Kristin – I want to add that DID treatment is long-term work and one of the most important factors in whether treatment is effective is having a good rapport with your therapist. So don’t be afraid to shop around – You may need to meet with a few different therapists until you find somebody you really connect with. You want to work with somebody who understands trauma & DID – A lot of professionals still don’t really believe in or understand the diagnoses because it’s one of those “have to see it to believe it” things sometimes.

    There are also some good books out there that may help you better understand and feel less alone with your diagnosis: The Body Keeps the Score by Bessel van der Kolk is a great one and Breaking Free is a memoir of Herschel Walker, a famous football player diagnosed with DID.

    Good luck!!

  • Stacey

    December 18th, 2015 at 8:25 PM

    Nurse here (not mental health nurse) – maybe schizophrenia would be something to be considered due to symptoms of hearing voices and the voices are trying to tell her to do something, and it seems the voices would be hard to just ignore

  • alex

    December 4th, 2015 at 10:16 AM

    I do not get this at all, how someone can dissociate from their true identities in such a way that they do not even recognize who they really are anymore?

  • D

    December 4th, 2015 at 9:22 PM

    It is true… My wife deals with them, ages around 2 to 98 male and female. Some are very mean and cause her to hit herself, some have threatened me and our family saying another one has put a hit out on us. She hates them and does not want to leave house when episodes are going on, she has had 30 in one day and we count around 15 at any time, they do recycle and new ones arrive. Most have a handicap or are disfigured. She has been dealing with this for 2 years now.

  • L kumar

    August 16th, 2016 at 11:55 AM

    I am still trying to get rid of it by being more into reality and not in denial.it occurs as a result of chronic stress in a normal individual (other factors like PTSD are also cause).

  • Linda

    December 4th, 2015 at 11:48 AM

    I have DID from abuse I am lucky I have integrated mine with help from a fantastic psychologist it took along time and hard work, but I couldn’t carry on as one of my alters destructed everything good I had x

  • Robert

    December 4th, 2015 at 7:25 PM

    I do it agree that periods of concentration and absorption are mild forms of dissociation. Dissociation refers to the phenomenon of separating from the self. Absorption and concentration involve separation, not from the self, but from outer reality.

  • Judy

    December 4th, 2015 at 11:43 PM

    Have DID. Diagnosed when hosts birth children molested. Triggers. Therapy good but therapist retired. Five of us left. Isolated and estranged from family/friends. Lonely. Soooo hard to trust. Inner world only safe place. We are freaks

  • mae

    December 5th, 2015 at 7:22 AM

    I am definitely the person who zones out. Not that I am not paying attention, but I guess that I am overly paying attention and so I zone out on everything else.

  • Mike B.

    December 5th, 2015 at 1:12 PM

    This is great to hear pretty much explains what I’ve got. I grew up as a self minded individual and being German Italian and Cherokee I got 3 different ways in me lol I have pretty much been dealing with my own thoughts “breaking down the walls” and making humor of my different personalities but as I learned what is called my host is dominant and always on point to make sure my alters stay on the same page. Like I have a calling in me to live in the wild but by weighing my pros and cons I can just take walks lol. Its rough does cause anxiety but that’s when I try comming up with enough sleep and energy to exercise kinda sorta figuring this out and how to explain it to help others and myself cope better. Thank you

  • Rosy

    December 6th, 2015 at 12:48 AM

    What does DID look like in children and how do you go about getting a diagnosis? I am working with a 9 year old boy and i am concern that he may have DID

  • Megan MacCutcheon, LPC

    Megan MacCutcheon, LPC

    December 6th, 2015 at 6:34 PM

    Hi Rosy – You can Google “Dissociative Experiences Scale” and look at the questions. Although the scale is for adults, reading over the questions can give you a better idea of what to listen for or things to ask the client.

    The International Society for the Study of Trauma & Dissociation also has some good information regarding dissociative behavior in kids (with a recommended reading list at the end) on their Child & Adolescent FAQ page, at this link: isst-d.org/default.asp?contentID=100

    Hope these help!

  • Ardeth

    December 7th, 2015 at 8:53 AM

    so this is a real thing? I really didn’t know that

  • David

    December 11th, 2015 at 12:15 PM

    Hello all, DID has been apart of my life as long as I can remember. I am an 8th degree Black Belt and retired martial arts teacher. How to communicate something so prevalent in our lives. First Kristen I hope you read this… You are not worthless and the one life would be better without is the person trying to convince you are. Dealing with DID can lend to the worst choices in mates as we will take who will have us. Try to see the beauty of who you are and realize that if you where in a wheel-chair your affliction would be noticeable. Being that mental disorders are internal those who have a selfish interest in your life ie. what you do for them cannot look beyond their own needs. Yours will seldom be included as your needs to communicate with one who truly loves you is not seen by the selfish observer of your actions. DID is the thief and the choice of love interest in your life is part of the self deception that you can do no better, this is just my life, what do I do where do I go and I have no other options. That sweet Kristin is one of the greatest self deceptions that prevents or slows our progress. I say ours because you are not alone. None of you are. I too am afflicted and use simple methods to keep myself in check. I would be glad to share that with anyone who cares to know them. Know that I have never meet any of you I truly care for you as I care for the daily roller=coaster that is the life of the mentally afflicted. I am by no means cured of these… on the contrary I am only now seeking help. I am however a 40 year practitioner of martial arts and know the path out is connectivity with those who can truly understand each other. Communication is key and good listeners and understanding one for the other and a long term communication done in such a fashion. There is light through the forest for those who truly wish to see. I know of a path that is a holding pattern that is capable of keeping self loathing or destructive behavior at bay. Any who wish to create an ongoing communique feel free to email me and who knows where the path may lead. Can a man who has lost his legs walk again? With the correct action… absolutely YES. Can those with crippling mental disorders live a life without all the negative DID symptoms? With the correct action… absolutely YES. One day we may be helping others as we have ourselves. Thank You for your time and have a great day. with all my heart and love…

  • gabrela

    January 1st, 2016 at 9:34 AM

    It is mentioned here that therapy should be a long term therapy. May someone tell how long, estimated in months or years? And if this affection is really treatable through therapy or only can be ameliorated ?
    I am in Therapy for 2 years and a half, with conversion and dissociation diagnosis, caused, shortly, by emotional neglect and psychical abandon trauma, under gestalt approach , with a great therapist. Even we have had a very good connection and resonate each other in particular closely way since the very beginning, the progress was slowly mainly due to my resistance to this closely human contact, which was difficult to stay with and accept as being real. I was completely skeptical about my potential to raise myself to the therapy(st) expectations, and still now we both agreed that progresses are noticeable, I am completely obsessed that for me therapy should be forever.

    I am struggling with two forces: overwhelmed of guilty for my less performance due to long therapy period, and after all don’t want to lose therapy relationship.

    Now we agreed less frequency for overcoming termination, and feel disappointed about leaving forced by this guiltiness, and without feel recovered.

  • Megan MacCutcheon, LPC

    Megan MacCutcheon, LPC

    January 5th, 2016 at 3:36 PM

    Gabrela,

    It’s hard to give a good estimate on how long therapy will take because, with dissociation diagnoses, it really depends on so many factors, including each individual, the length of time they’ve been struggling with the disorder, how extensive their dissociation is, how many alters they have, their resistance to change, their skepticism of help, the resources they have available and other obstacles that may get in the way of treatment.

    But I would definitely say more in the years versus months range. I once read a statistic (don’t remember where or how accurate it is) that it takes on average seven years to really get a handle on and integrate dissociative parts. This number is kind of arbitrary since, again, it depends on so many things…But it helps me to conceptualize that by “long-term” I mean several years, at least.

    Of course the consistency of therapy with a dedicated focus on working through DID symptoms is important. Consistency and focus can sometimes be a challenge for people with DID. I’ve had clients who sometimes disappear for months or longer and others who have so many other day-to-day struggles or interpersonal conflicts to discuss, that the specific work towards integration sometimes gets put on the backburner. It’s a lot of pieces to juggle and I think there are ebbs and flows along the way in therapy—so I hope you can cut yourself some slack, let go of the guilt, and have realistic expectations for yourself. It sounds like you’ve made some good progress and are motivated to continue on that path.

    To answer your question about whether dissociative identity disorder is treatable or just ameliorated—The fact that your mind used dissociation to deal with trauma is something that cannot be taken away; however, through therapy, you can process the events that occurred and find new ways to manage stress in the future, so you no longer need to dissociate as a way to cope.

    Regarding therapy ending – Clients often ask me when they will be “done” or can “graduate” from therapy. And my answers is whenever they decide to stop coming…And even then, they may decide to come back again down the line.

    We are all works in progress, and for some people therapy is a snippet of their life while for others it can be a life-long part of their journey. I have some clients who came in to process a specific issues, for example a break-up or some specific stressor, but who, years later, continue to come to therapy because they’ve found that, even when things are going well, they like having a place to vent, check-in, unwind or process the events in their weeks. Some clients will taper back to “infrequent check-in” appointments when things are going relatively well.

    While therapy is often a means to solving a problem, there doesn’t need to be an ongoing problem for it to continue to be useful. But at the same time, if therapy or the relationship with a therapist becomes too much of a crutch, that is another issue to work through and tapering back or terminating with that particular therapist may be in your best interest.

    Some therapists may not work from a long-term perspective and may encourage you to move on after a certain goal is met or once they feel they can no longer be helpful to you. If that is the case and you still feel that you would benefit from therapy, I encourage you to find a new therapist with whom you can continue your work. While you may not need as intensive or frequent sessions, there is nothing wrong with continuing therapy for as long as you feel it is a support or benefit to your life. You may have some new insights and goals from working with another therapist. But certainly should not end therapy altogether if you feel it would still be helpful.

    I hope this helps!

  • gabrela

    January 10th, 2016 at 7:13 AM

    Dear Megan, thank you for such an advised and detailed answer. There is more than I expected, I appreciate your interest a lot. If I knew about years terms from the very beginning, it would was a huge problem less.(Im kind of perfectionist and performance obsessed) Got the ideea, to focus on my own interests and my benefit. What I have to do now is Just to move from what seems to be a dependency, to what really is more to be done , and when I will be ready to leave therapy well, make to happens in a beautiful way. Still not know how to do this exactly, but already have another perspective. Hope to find the correct path.
    Thank you so much,

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