Integration Dissociative Identity Disorder

Mindfulness is acting with a purpose and focus that leads to awareness of mental processes. Both mental and emotional changes can be created through mindfulness, leading to physical changes in the brain. We can literally manipulate our neural pathways and stimulate growth in the brain, and if performed correctly these changes can heal damage due to unprocessed trauma. It’s important to understand that without mindful work needed change will not occur, but with it we can perform almost magical changes in the mind.

Think of integration like putting a puzzle together that can’t be solved without taking the pieces of life experience that led to dissociation, and fitting them together where events must be reassociated with one another. Trauma belonging to the different senses and various emotions are fed through the hippocampus to the cerebral cortex where they become integrated. In this way they move from the unconscious to the conscious mind or in other words, from dissociated to associated. There are integrative milestone that have been given labels such as coconsciousness, coparticipation, copresence, and so on, but these natural paths through the integrative process.

To put it simply, unification (also called fusion) is the way the normal, untraumatized and undissociated mind works. In dissociative identity disorder, at least, the states do not “integrate” on at a time. All the states must go through the process of integration. Participation is needed from all states in phase II to get to the point where unprocessed trauma can be organized in such a way, by the brain, that it can be picked up and processed into actual memory. States do not “merge” one by one. As unprocessed memory is shared, states can become more comfortable with one another however.

Three phases of integration
The most common aspects of any three phase treatment plan involves establishing safety, stabilization, dissociative symptom reduction, and working with and integrating traumatic memories. Identity integration and rehabilitation consume the final phase. The phases do overlap, perhaps due to some parts of the personality lagging behind others, but the main focus will normally fall on one phase at a time. The states are in turmoil during this process as they fight to find their way through the rapid changes that occur – which might take years for the individual as a whole, but inside they are unstabling and forceful, and so integration must go at a pace that is tolerable for them. Many individuals never leave phase I, but phase II is the healing phase. This must be faced if the person is to ever heal from their mental disorder.

Phase I – Overcoming the phobia of dissociative parts
This first phase involves internal feelings of empathy for all parts of the personality, as well as developing cooperation, understanding and acceptance that all parts together make up the one personality of an individual.  This sounds easy, but in reality a great deal of energy is spent dealing with external triggers and inner conflict between parts. The ISSTD guidelines stress this is the phase to “minimize behaviors that are dangerous to an individual or others in their lives, as well as poor thinking that makes the individual vulnerable to re victimization by others. Other behavior that is addressed is relationships, eating disorders, violence, aggression, and risk-taking. Intervention directed at individual parts involves challenging maladaptive thinking and behavior. Parts that identify with the abuser can be particularly difficult to manage. Ultimately overcoming the phobia of dissociative parts should obtaining the experience of all parts feeling oneness. The entire process moves toward decreasing structural dissociation and prompting the individual to understand that all the parts make up the whole. (van der Hart, 2006)

Phase II – Overcoming the phobia of unprocessed trauma 

This phase requires the individual re-experience trauma in some form and share them throughout the system. To proceed the individual with structural dissociation must overcoming the fear of trauma and integrate the bulk of them. The work in this phase also involves overcoming attachment issues to people in the past and present. Once trauma is processed and shared among the parts of the personality there is still work to be done. This sharing of unprocessed trauma is called synthesis.

  • Synthesis is when a traumatic experience is shared across all parts in their system.
  • Realization occurs once synthesis is successful, and it needs to be followed with a full awareness that one has experienced the trauma, and that the trauma is indeed in the past. Thus the individual gives the traumatizing event a place in his or her personal autobiography.
  • Personification follows by allowing the realization that the trauma belongs to the individual. Strong emotions are experienced in this phase while traumatic material is emerging. It’s affects come in the form of shame, horror, terror, rage, helplessness, confusion, anger and grief.
  • Narrative begins. Through this work an individual can transform their trauma into a comprehensible and coherent narrative, rendering dissociation unnecessary. This work is still not sufficient for unification. During this phase the individual will move spontaneously back and forth from phase II to phase I. (van der Hart, 2006)

Phase III – Integration (unification) of the personality and overcoming the phobias of normal life
In the first two phases the individual has learned to overcome the phobia of other parts in the system, phobia of the unprocessed trauma and has accepted they were abused as a child. Phase III involves going beyond the integration of trauma memories by more fully sharing them with all parts of the personality. Expect painful grieving, relinquishment of long-held beliefs, and a struggle to adapt to new ways. The individual will learn to spread emotions across all parts of the personality in order to deal with the onslaught of emotion that they will experience in this phase such as shame, horror, terror, rage, helplessness, confusion, anger, and grief. Trauma manifestations can occur for up to 27 months after unification is secure(ISSTD, 2011), but the goal of having a normal, non-dissociated mind will come eventually. During this phase the individual will move spontaneously back and forth from phase II to phase III with new trauma material emerging at the same time the individual is doing phase III work. Upon unification the individual generally keeps the skills and attributes of the various dissociated parts of the personality. (van der Hart, 2006)