Dissociative Identity Disorder
Dissociative identity disorder (DID) maintains a misunderstood and misrepresented reputation, but the specifics of this disorder have been identified and well represented among the studious, even though the average layman fails to understand the full complexity of this inhumanly caused disorder. If the most basic of an infants' innate needs are dismissed, or worse, purposely defiled, then the baby has suffered the initial phase necessary to cause either a Personality Disorder or one of the two complex Dissociative Disorders: other specified dissociative disorder (OSDD) and dissociative identity disorder.
A second step is initiated when later, between twelve-months and four-years of age (perhaps longer, but certainly before five), similar circumstances recur, resulting in the two "dissociated" and "distinct personality states" that define dissociative identity disorder. (Lanius et al., 2014) (Giuseppe et al.,2014) (Vermetten et al., 2007) (van der Hart et al., 2006)
If a child is older before "punishment" recurs the result will not be dissociative identity disorder. (Lanius et al., 2014) The two distinct states that are created separate dissociative identity disorder from "other specified dissociative disorder" (OSDD). When two distinct states exist together, they hold true to the behavior of this disorder, as well as the actions and functions that define it. (Lanius et al., 2014) (Giuseppe et al., 2014) (van der Hart et al., 2006)
Dissociated personality states cannot be denied as they have in the past, since todays science verifies not only their existence, but their actions, behavior, separation, distinction and identity through the use of fMRI (Functional magnetic resonance imaging) scans of the human brain. (Schlumpf et al., 2014) See etiology for more.
The nature of unprocessed trauma
Trauma held in the mind is complex, with chaotic functions interacting and reacting in episodes of painful experience from past trauma. Trauma is destructive in this form and unsettling to any state it interacts with. It is loss of the greatest magnitude. You see, in this form, loss is experienced time and time again, but in many different ways. It's unbidden torture; relentless, painful and highly unbearable. (Lanius et al., 2014)
Structural dissociation of the personality
Structural dissociation is a response to "unprocessed trauma" that remodels the personality leaving an individual bound in such a way they settle into the mental disorder that was already determined when a child was isolated in a world of unyielding pain and terror, starting in infancy and either continuous or repeating before age four. In combination with earlier factors, and through the process of structural dissociation, two contrasting types of "dissociated personality states develop: "distinct states" and "less than distinct states," and each "type" defines themselves through behavior, maturity, intensity of phobic reactions and emotion. The states function in a confusing manner, as they work to protect an exposed child from the horror of unprocessed trauma. (Lanius et al., 2014) (Giuseppe et al., 2014) (van der Hart et al., 2006) See structural dissociation for more.
Personality states: distinct
Distinct states determine adult-like mentality as they perform daily life actions in response to reactions that the conscious mind can't help but be consumed with. The other kind of state, a less than distinct state, can influence the distinct state that is out, causing overwhelming confusion, excitability, intense fear, depression and dramatic swings in temperament and emotional instability. Distinct states defend themselves without thought, as reflexive efforts isolate them from the influence of the mind's holding of unprocessed trauma. There are distinct and less than distinct states in all disorders associated with structural dissociation (PTSD, BPD, OSDD, DID), but the states in each are unique unto themselves, and while all experience phobia, the distinct states in dissociative identity disorder are riddled with it. The distinct state in dissociative identity disorder that is "out," is trapped in the present, rabidly repelling anything from consciousness that disturbs its reality. It's like having a "coat of armour" protecting it from anything it does not face daily in life; unable to acknowledge all that fails to make sense. It will convince itself that whatever caused the confusion never happened. Distinct states in other disorders, never replicate this seamless ignorance. (Lanius et al., 2014) (Giuseppe et al., 2014) (Vermetten et al., 2007) (van der Hart et al., 2006) See personality states for more.
Personality states: less than distinct
Less than distinct states (discontinuities in sense of self and agency) are child-like, basic and lack elaboration found in distinct states. The states are saturated in "remembered abuse," neglect, abandonment, affectivity, and visceral reactions of a painful childhood played-out over and over again in their world of the subconscious, engulfing them in an unyielding wasteland of traumatic experience. These types of states are buffered from "outside distractions," therefore are able to maintain an "opposite stance" from distinct states; less than distinct states in dissociative identity disorder
stay in the subconscious (although they do push the boundaries of it) unless they are "face-to-face" with a perceived threat from their childhood. However, they can influence the "feelings" of the state that is out, so no matter if they are "in or out," vehement expression urges them to lash out and destroy personal relationships as they express the temperament and posture of a severely traumatized child, who as an adult, has the power, strength and position foreign to a child, especially an abused child.
(Lanius et al., 2014) (Vermetten et al., 2007) (van der Hart et al., 2006) See personality states for more.
One state only is ever conscious in dissociative identity disorder
One state only will ever have residence in the conscious mind of an individual with dissociative identity disorder, no matter what degree of integration they have accomplished. This is a a fact that has now been verified many times by fMRI scans. (Schlumpf et al., 2014) (Lanius et al., 2014)
Integration work begins when one distinct state recognizes another state's intrusion
less than distinct state
is finally recognized by a distinct state, and they interact in a way that the distinct state out is aware, then the first needed step to healing has been finally taken.
(Distinct states at this point, while in the subconscious, are not yet aware.) Interaction between the two very different states will be clumsy at first, but the state in the subconscious will distort the individuals face causing a smile, frown, funny or scary faces, and
make body parts move, as it desperately attempts communication. What communication takes place is dependant on what the distinct state can recognize. The affects of less than distinct states that dissociative boundaries hid in the past become prominent, and symptoms are felt that were "ignored," including flashbacks, seizures, alien-like movements, and heard voices.
In addition, the distinct state will begin to experience a bit of the intense fear of inner states, as well as their anxiety, and panicking. The distinct states will begin to notice somatic illness and "alien" pain, as well as derealization, depersonalization. (Lanius et al., 2014)
Coconsciousness in DID never means more than once state is conscious
Communication between distinct states that are in the conscious mind, and less than distinct states occupying the unconscious part of the mind, over time, can become efficient in a variety of communication skills, eventually leading to an altered experience in switching. Switching will eventually become elaborated as an "echo" is experienced by the state departing or entering consciousness, during which they "hear " what the conscious state is saying. This is not two states in the conscious mind at one time, but instead is a lessening of dissociative boundaries by the distinct states, so thoughts and verbal expressions during the process of switching between consciousness and the subconscious are known. (Lanius et al., 2014)
Individuals with OSDD will have an entirely different experience, as all their states can always be present in the conscious mind at one time. Dissociative identity disorder and OSDD are not experienced in the same way. They have differing etiology, presentation, actions, reactions and avenues of healing. They are distinctly different disorders.
To confuse them confuses the very essence of human bioneurology and psychoneurology.
Inner world of the subconscious
In the subconscious mind of individuals with dissociative identity disorder, distinct states lack "awareness," at least until substantial integration takes place, while the less than distinct states in dissociative identity disorder are forever active in the subconscious mind, and never sleep or get tired. Their "energy" is amazing as they interact with other states and build shared realities. See personality states for more.
True psychological amnesia only exists in DID
Psychological amnesia is either true or dissociative, and "true amnesia" is only experienced when there are two or more distinct states. (Lanius et al., 2014) The DSM-5 uses this fact to list criteria to diagnose dissociative identity disorder, since it is the only disorder associated with two or more distinct states.
(van der Hart et al., 2006) If a state that is mature and adult-like, and routinely attends to daily life tasks, switches with another state that behaves the same way, and the two states do not have knowledge of the switching then dissociative identity disorder is suspect. (van der Hart et al., 2006) Switching of less than distinct states (child-like) are not of importance to the diagnosis of dissociative identity disorder, since this is common place in OSDD. (Lanius et al., 2014) (van der Hart et al., 2006) See symptoms for more.
Not paying attention, and so not recalling is normal and is certainly not a function of dissociation. On the other hand, dissociative amnesia is not only a function of dissociation, but its behavior is close to the literal definition of dissociation. (Nijenhuis., 2011) When unprocessed trauma exists in the mind, daily life events cause reactions. Like most behaviors in dissociative identity disorder, they differ from other disorders that are associated with structural dissociation (PTSD, BPD, OSDD), because in dissociative identity disorder, one state only can occupy consciousness. (Lanius et al., 2014) (Nijenhuis., 2011) Here is an example of how this can happen in dissociative identity disorder.
When Paul was eight years old, his young friends showed up at the door and asked him to go fishing, but his father ran the boys friend's off, and then beat his son. Now Paul is an adult, and one day his fishing buddies show up unexpectedly at his door, and his pregnant wife explains to them that she needs her husband at home to carry items from the house and garage into the yard for a sale that has been advertised to begin in two-hours. Paul wants to go fishing, but he supports his wife and his friends leave. He notices he is agitated, and wrought with feelings of anger and fear, with no conscious explanation of why. A tornado effect is building as less than distinct states
are reacting to childhood events that interact with the beating his father gave him when he was eight. Which state or states were beat on that day in childhood are irrelevant, because many states have since shared that trauma experience inside, and they are acting together with a growing vengeance, causing the distinct state in control of Paul's consciousness to become overwhelmed. In turn, Paul expresses the rage toward his confused wife.
See symptoms for more.
Dissociated states exist in PTSD, BPD, OSDD, and dissociative identity disorder, but each has a dissociative boundary exclusive to the mental disorder it belongs. Neurological makeup defines the excitability, transpiration, absorption, reactibility, critical mass and depth of the states within each different mental disorder. In this way boundaries define innate action and inaction of states, defending (or not) them based on their limitations, and perceptions of what is "seen" as harmful. The most profound states of all belong to dissociative identity disorder, where all states are phobic of each other, with the distinct states so phobic they cannot accept other states even exist. Less that distinct states are less straightforward; they are selective about which states they are phobic of and which they are not, allowing them to usually communicate (in the subconscious) with at least some other less than distinct states.
(Lanius et al., 2014) (Vermetten et al., 2007) (van der Hart et al., 2006) See dissociative boundaries for more.
The affects of dissociative identity disorder are hidden from the afflicted, so direct symptoms rarely bring individuals to therapy. Instead, they make their way to counselors for problems they are aware of including eating disorders, anxiety, relationship problems and work related issues. (Giuseppe et al., 2014) (Courtois et al., 2012) When integration finally becomes substantial, dissociative symptoms are noticed. As part of the process, phobia between states decreases, dissociative boundaries abate, and all come together to allow the distinct state that is out to experience, finally, the disabling symptoms they were unable to recognize before. A distinct state will finally be able to accept the problem and can then work to solve it, but otherwise, the symptoms are hidden from the only part of the personality system that can initiate the integration process. See symptoms for more.
Child abuse and DID
Past thinking was that dissociative identity disorder was not always a function of childhood abuse. The authors of Neurobiology and Treatment of Traumatic Dissociation point out that this thinking is old. Their reasoning is that if an infant has adequate care in their first year of life, then dissociative identity disorder will not occur. For instance, if an infant were to be in a hospital for an entire year, and feel traumatized, alone and uncared for, it's unlikely that the same child would still feel that way after they were a year old.
By that time it would be obvious that the staff was caring for them. Hospitals, and orphanages of the past did leave children alone thinking that it would harm the child - parent relationship if workers gave the child much attention, but no more. Today, at least in the US, foster homes encourage relationships, and there are no longer any orphanages. Today hospital staffs freely give a child support, care and attention, and visitors are welcome. It would be hard to fathom anything in the US, in this day and age, other than purposeful abuse that could fully consume two different childhood developmental stages that are needed to cause dissociative identity disorder.
(Lanius et al., 2014) Child abuse is a human epidemic that is destroying the human race at a pace that far exeeds that any disease man-kind has ever been faced with. (van der Kolk, 2014)
Posttraumatic stress disorder-like symptoms
An individual with dissociative identity disorder does not also have PTSD, but they do have similar symptoms including exaggerated startle reflexes, flashbacks, derealization, depersonalization and they fluctuate between hypoarousal and hyperarousal.
(Lanius et al., 2014)
Individuals afflicted with DID do not also have a Personality Disorder
While it's been reported that serial killers, and other assorted "bad guys" have suffered from dissociative identity disorder, it's not accurate to say they are inflicted with a Personality Disorder and a Dissociative Disorder. An individual with dissociative identity disorder can certainly have states that have introjected behavior, and so unwittingly portray a Personality Disorder.
Keep in mind, that at the time structural dissociation takes place, a childs fate is already written, dictated by their upbringing.
Dissociative identity disorder is caused by an inability to fully integrate states, and that function is believed to take place prior to age four, and certainly by age five.
Personality Disorders occur after a child escapes structural dissociation. These children could be, and probably were, abused prior to age four, but it was not at the level that caused structural dissociation. A child then with associated states who continues to be abused can develop a Personality Disorder. However a child who has already succumbed to structural dissociation cannot.
In summary, individuals with dissociative identity disorder can portray a Personality Disorder, but they cannot actually have one. (Giuseppe et al., 2014) (Lanius et al., 2014) See symptoms for more.
Physiological and psychobiological measures
In the same way that a distinct state can portray behavior demonstrated by someone they were persistently exposed to in childhood, they can do the same with biological and physiological ailments, including visual acuity, medication response, allergies, food intolerance, plasma glucose levels in diabetic subjects, heart rate, blood pressure, galvanic skin response, muscle tension, immune function, electroencephalography patterns (EKG, ECC), functional magnetic resonance imaging (fMRI) activation, brain activation, regional blood flow, and taste preferences. This is most dramatically seen in states that are out and are completely blind or deaf, yet when other states are out they can see and hear perfectly well. (ISSTD, 2011) (Howell, 2011, p. 57) (van der Kolk, 2014)
Dissociated states cannot escape their fate - ever; their only way out is to no longer exist, which is only possible through moving active trauma (in the mind) to memory (in the brain), and starting a whirlwind of activity that can lead to an individual with a normally "integrated mind." While other mental disorders (PTSD, OSDD and sometimes BPD) also experience less than distinct states, their versions are far less elaborate, distinct and phobic, resulting in profusely different behavior. See integration for more.
An infant whose destiny is to succumb to dissociative identity disorder is so tortured psychologically that their being never was able to come together in a way that allowed linking of the states that make up the personality. Think of the pieces of an intricate puzzle as normal states, and the pieces are damaged and so won't fit. The puzzle remains, not broken, split or fractured, but "irregular" and so never put together. Dissociative identity disorder offers a deity of stumbling blocks that few ever do navigate, and so unfortunately many go to their graves never finding a way to overcome the mental disorder. See integration for more.
The DSM-5 categorizes dissociative identity disorder as a Dissociative Disorder
Dissociative identity disorder consists of two distinct states and two or more less than distinct states. When two distinct states exist, as it does in this mental disorder, then the individual experiences true psychological amnesia, while the less than distinct states are limited to dissociative amnesia. Dissociative identity disorder is a disturbance in the normal integrative function of memory, identity and self with the property of true amnesia, of which, only exists between distinct personality states, and this is what the DSM-5 describes.
DSM-5 Trauma Stressor-Related and Dissociative Disorders
Mental disorders listed under the category of Dissociative Disorders in the DSM-5 include: dissociative identity disorder (DID), dissociative amnesia (DA), depersonalization - derealization disorder (DEP), other specified dissociative disorder (OSDD), and unspecified dissociative disorder (UDD).
Mental disorders listed under the category of Trauma Stressor-Related Disorders include: reactive attachment disorder (RAD), disinhibited social engagement disorder (DSED), posttraumatic stress disorder (PTSD), and acute stress disorder (ASD). (DSM-5, 2013)
Misconceptions, personal bias, media sources, and various forms of denial have worked together to distort the presentation, epidemiology and etiology of dissociative identity disorder, a mental illness often associated with extreme and early child abuse and neglect, and the spread of misinformation has been going on for decades. To confuse dissociative identity disorder with any other disorder, such as other specified dissociative disorder, confuses the afflicted, and their therapists and slows the progress of research.