Understanding Dissociation and When It Becomes Problematic
We’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.