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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 still 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.

It's only later, beyond twelve-months and four years of age, where the same circumstances recur, and the child gains what is required to manufacture two "dissociated" and "distinct personality states." (Lanius et al., 2014), (Giuseppe et al., 2014), (Courtois et al., 2012), (Vermetten et al., 2007), (van der Hart et al., 2006) (If a child is older before "punishment" recurs the result will probably be a Personality Disorder.) The two distinct states that are created define dissociative identity disorder, and separate it 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 a chaotic, and complex functioning of interacting and reacting episodes of painful experience. 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 that they settle into the mental disorder that was already determined (due to environmental factors) before the process took place. Completion of dissociative identity disorder is prior to age four, and the result is the creation of two contrasting types of "dissociated personality states:" "distinct states" and "less than distinct states," which define themselves through behavior, maturity, intensity of phobic reactions and emotion. The states protect an exposed child from the horror of unprocessed trauma. (Lanius et al., 2014), (van der Hart et al., 2006) See structural dissociation for more.

Personality states: distinct
Distinct states determine adult-like mentality and daily life actions and reactions that the conscious mind cannot help but be consumed with. The other "type" of state, a less than distinct state, can influence the distinct states 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 unprocessed trauma, which would result in disquieting the mind. 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 that is "out," (in control of consciousness) is trapped in the present, repelling anything from consciousness that disturbs that reality; it's like having a "coat of armour" protecting it from anything it does not face daily in life. It is unable to acknowledge anything that fails to make sense and will convince itself whatever caused it to experience confusion never happened. Distinct states in other disorders, never replicate this seamless ignorance. (Lanius 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 as the DSM-5 calls them) are child-like, basic and lack elaboration found in distinct states. The states are saturated in "remembered abuse," neglect, abandonment and affectivity, and visceral reactions of a painful childhood play-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," so able to maintain an "opposite stance" from distinct states; less than distinct states in dissociative identity disorder stay inside (subconscious) unless they are "face-to-face" with a perceived threat from their childhood. However, they can influence the state that is out, from within, so no matter if they are "in or out," vehement expression causes them to destroy personal relationships as they express the temperament and posture of a severely traumatized child, who as an adult, have the power, strength and position foreign to a 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; a fact verified now many times by fMRI scans. (Schlumpf et al., 2014) What is happening and what is experienced differ, however. While individuals with OSDD can host the entirety of their many personality states in consciousness at the same time, (Schlumpf et al., 2014) individuals with dissociative identity disorder can only feel like they do. In dissociative identity disorder, when a state in the subconscious finally gets a distinct state that is out to recognize it, the state is surprised. It had probably been attempting the action for ages, with no result. When it gets a response it might be clumsy as it attempts interaction. It is able to distort the individuals face, and make body parts move, but it's all performed from within the subconscious mind. That same state, a year later, is well practiced and so communication is easier leading to the misthought that more than one state is actually in consciousness. (Lanius et al., 2014)

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 less than distinct states are forever active, and, in-fact, 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 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 (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 (due to the phobia between them) 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.

Dissociative amnesia
Not paying attention and so not recalling is normal and is not a function of dissociation, however 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 this disorder, they differ from other trauma caused disorders, 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 year old, his young friends showed up at the door and asked him to go fishing, but his father came to the door and ran the boys friends off, and then beat his son. Now Paul is an adult his fishing buddies show up unexpectedly at his door at 7:00 am, and his pregnant wife explained to them that she needs her husband at home to carry items from the house and garage into the yard for a sale that begins in 2 hours. Paul wanted to go fishing, but supported his wives statement and his friends left. He becomes agitated and emotional, and then is wrought with feelings of anger and fear, and he has no idea why. A tornado effect is building as less than distinct states are reacting to that childhood event when he was eight. Which state or states were beat on that day in childhood are irrelevant because many states have shared the trauma experience inside, and they are acting out with a growing vengeance causing the distinct state in control of Paul's consciousness to become overwhelmed and Paul expresses the rage toward his confused wife. See symptoms for more.

Dissociative boundary
Each dissociated state in the disorders that have them (PTSD, BPD, OSDD, DID), have a dissociative boundary that is exclusive to the mental disorder it belongs to. Each has their own neurological makeup that defines their excitability, transpiration, absorption, reactibility, critical mass and depth. In this way the 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. All states belonging to these illness are phobic of each other, with the distinct states reaches a level so high that they cannot accept other states exist. Less that distinct states are far 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 other less than distinct states. (Lanius et al., 2014), (Vermetten et al., 2007), (van der Hart et al., 2006) See dissociative boundaries for more.

Symptoms
The affects of dissociative identity disorder are hidden from the afflicted, so the direct symptoms rarely bring individuals with this disorder to therapy. Instead, they make their way to counselors for problems they are aware of including eating disorders, anxiety, and relationship problems. ( Giuseppe et al., 2014), (Courtois et al., 2012) When integration finally becomes substantial, dissociative symptoms can be noticed. Phobia between the states has decreased and the dissociative boundaries are less intense. At this point a distinct state will be able to accept the problem and can finally work to solve it.  The first thing they usually acknowledge is affects by less than distinct states. They may begin to acknowledge their flashbacks, seizures, nightmares, emotions, and other states taking partial control. They will eventually make attempts to communicate with inner inner states. All this had happened in the past too, but it was ignored due to phobia and the intensity of dissociative boundaries.  All this work is just the initial stage of integration. The individual still have a long process to work through before they are healed. See symptoms for more.

 
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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, other specified dissociative disorder (OSDD), and unspecified dissociative disorder.

Mental disorders listed under the category of Trauma Stressor-Related Disorders include: reactive attachment disorder (RAD), disinhibited social engagement disorder, posttraumatic stress disorder (PTSD), and acute stress disorder (ASD). (DSM-5, 2013)

For more see the
Trauma and Dissociation wiki


 

 

Structural dissociation of the personality

 

Posttraumatic stress disorder
It is the less than distinct states that have PTSD-like symptoms, but its only when a distinct state has advanced in integration to a point where it can acknowledge them that they are expressed as a symptom by the individual. If they symptoms are actually posttraumatic stress disorder, in addition to dissociative identity disorder, it makes little sense because a less than distinct state cannot have a lesser disorder and still exist with the behavior it does. Lanius et al. lean in favor of saying that individuals with dissociative identity disorder do not have PTSD, but do have like-symptoms.  The distinct states are absent of any symptoms that are related to PTSD.   (Lanius et al., 2014)

Personality Disorders
While it's clear that some serial killers have suffered from dissociative identity disorder, it's not clear that they also are inflicted with a Personality Disorder.  At the time of structural dissociation a child's fate is already written and it was dictated by their upbringing.  The etiology for the Personality Disorders and Dissociative Disorders are vastly different, with the earlier experience belonging to the Dissociative Disorders.  If a child has adequate care during infancy, they will not suffer dissociative identity disorder, however every other disorder associated with structural dissociation (PTSD, BPD, OSDD) is still possible.   Research has not narrowed down a specific time line for the Personality Disorders, but common sense says that the individuals with these have adequate care during their infancy, and later suffer the abuse that causes their disorder.  If this is the case then it's not possible for an individual to have both dissociative identity disorder and a Personality Disorder, but they certainly could have PTSD, BPD, OSDD and  also a Personality Disorder.  (Lanius et al., 2014)  Individuals with DID can have both distinct and less than distinct states that imitate the behavior that dictates a Personality Disorder; in fact, a distinct state can act like it has any illness including blindness, and deafness.  (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. (ISSTD, 2011) (Howell, 2011, p. 57), (van der Kolk, 2014)

Integration
Dissociated states cannot escape their fate - ever; their only way out is to no longer exist, which is only possible through moving active trauma - to memory, and starting a whirlwind of activity that can lead to an individual with a normally "integrated mind." While other mental disorders also experience less than distinct states, their versions are far less elaborate, distinct and phobic, resulting in profusely different behavior. See integration for more.

Prognosis
An infant who's 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 parts that make up the personality. Think of the pieces of an intricate puzzle as normal ego states and whoever is attempting to put the puzzle together cannot get the pieces to fit because they are damaged, and so the puzzle remains, not broken, split or fractured, but damaged 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.

Child abuse and dissociative identity disorder
Dissociated states exist in PTSD, BPD, OSDD and DID, and in every mental disorder their phobic reactions,  decisive dissociative boundaries, chemistry, neurology, physical make-up vastly differ. The most complex of these disorders, dissociative identity disorder, faces disturbing and complicated difficulties that are vastly misunderstood.  This page has explained or will explain many of them so they will not be repeated here, but keep in mind those differences when contemplating the following.  Dissociative identity disorder, unlike the three other disorders mention is not always a function of childhood abuse, or at least that's the most common thought.  This however might be incorrect thinking, as Lanius et al., points out in their 2014 book: Neurobiology and Treatment of Traumatic Dissociation: Towards an Embodied Self.  (Lanius et al., 2014) Their reasoning goes as follows.  If an infant is well taken care of in their first year of life then dissociative identity disorder will not occur.  If we accept that the trauma during that year is due to hospitalization, a caregiver with mental health or emotional problems then what accounts for the recurring trauma in a second developmental stage of life.  (Lanius et al., 2014) It would be hard to fathom that anything but purposeful abuse could consume two different developmental  stages, but still some researchers insist this is the case.  (Frewen and R. Lanius, 2014)   

Dissociative Identity Disorder


 

DSM-5 categorized Dissociative Disorders involve two complex versions, and each has an etiology based on complex trauma.

Dissociative identity disorder consists of two distinct states and two or more less than distinct states. The distinct states experience true psychological amnesia, while the less than distinct states are limited to dissociative amnesia.

Other specified dissociative disorder has only one distinct state, but has two or more less than distinct states. The states are associated with dissociative amnesia.

The DSM-5 describes dissociative identity disorder as a disturbance in the normal integrative function of memory, identity and self
with true amnesia, which of course only exist st between distinct personality states.

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.

 

"The massive damage to an afflicted individual in childhood, as a whole, changes their very essence in ways that are not innate to the human animal. They become ill as they undergo more neurological damage than the human mind can tolerate, and in doing so react by modifying the structure of their personality through the process of structural dissociation." ~Mary C. Elizabeth
 
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