Symptoms of dissociative identity disorder

Dissociative identity disorder is a mental disease with symptoms which are hidden from not only from the world, but from the afflicted individual. (Lanius et al., 2014) Children with the burden are rarely in an environment in which they are able to express their distress, if they even realize it. More often than not, young ones with dissociative identity disorder think everyone is like them.

Here is how one woman, who distinctly remembers her childhood explains it. See personality statesto learn about the different states that exist in dissociative identity disorder.

Distinct state (DS1): Time made no sense, as did my life in general. The only thing I ever did was sit in my room with my ear to the wall and listen. I was so lonely I wanted to die. As soon as the door would open, I would be scared and then gone. This was my life and the same scenario repeated many times.

Less than distinct state (LDSa): I would only be out when Mother was in my bedroom, and I moved slowly because I knew if I did not she would fly into a rage and beat me. My only thoughts were how to not get beat.

Less than distinct state (LDSb): I was only out to be beat by Mother, but I was very good at playing dead so she would stop. My only function was to survive a beating by her.

Distinct state (DS2): I would go with Mother and my siblings on trips to Grandma’s house, but as soon as Mother would become angry I was scared and then was gone. Later I would be at my Grandma’s house, and people talked about things I did that I could not recall.

Less than distinct state (LDSc): I would be in the car with Mother while she screamed at me and called me a stupid idiot.

Distinct state (DS3): I would be in my room hiding under the bed, in the farthest corner, unwilling to touch my bed because it was a place where I was hurt. When Father walked through the door and I heard his voice I was gone.

Less than distinct state (LDSd): I would only be out when Father would hang me from the ceiling and punish me. The pain and fear was something I could deal with, but I hated it.

Distinct state (DS4): I would go to church with Father and it was scary. People there did not like me because I was dirty, and smelly.

Less than distinct state (LDSe): I would be out in church when Father would make me “pay tribute” to the pedophiles there.

This is the way of life for a child with dissociative identity disorder. The distinct state will be out when the child feels safe, and when threatened, a less than distinct state instantly takes over. (Giuseppe et al., 2014) In adulthood distinct states are out in environments that are “safe,’ which for most adults is all the time, but for a child it can be rare.

Somatic illness
Although somatic illness is a disorder unto itself, it is also a symptom of dissociative identity disorder. It is wild in its spectrum of presentation, but the illness is isolated within personality states. If all states have an illness, then the individual has it and it is not somatic. (van der Kolk, 2014) For instance, if the individual is normally blind, but one state is not, then the problem is somatic. Somatic illness comes in many forms, but common examples include: deafness, change in vision, back pain, chest pain, limbs absent of any feeling, dirt in the eyes, knee pain, and digit and joint pain. Somatic illness can also “pretend” it is a disease. (van der Kolk, 2014) Individuals with dissociative identity disorder can have states who acts as if they have ulcers, migraines, GERD, skin disorders, tics, digestion problems, overt signs of distress that have no cause and so on. The good news is that upon integration of states somatic illness goes away, but the reality is that full integration (unification) of states in those afflicted with dissociative identity disorder is far from a reality for many, if not most. Integrating from dissociative identity disorder is difficult for all, and impossible for some. Some will spend their entire life trying and never make it.Personality Disorders and PTSD 
Different states within the personality system can, and often do have introjected behavior of “bad” people from their childhood, and they can project learned behavior of those with Personality Disorders, however they cannot actually have a Personality Disorder, and at the same time have a Dissociative Disorder. They also cannot have PTSD and a Dissociative Disorder, but the Dissociative Disorders do have PTSD-like symptoms. (Lanius et al., 2014)

Dissociative boundaries
As a child, dissociative boundaries are developing, and although they function well enough in childhood that there is amnesia between the states, the boundaries become more intense as the individual ages. (Lanius et al., 2014)Beyond childhood is when most with dissociative identity disorder “discover” their illness, even though they have had symptoms all their life. Their dissociative boundaries are so invasive they are not “allowed” to experience them, until a great deal of integration work has been done. (Giuseppe et al., 2014) See our page on dissociative boundaries for more.

Symptoms of dissociative identity disorder 
When symptoms finally do become evident to the afflicted they are as follows: confusion, lack of awareness of overall actions, trance, switching between states, feeling of alien possession, true amnesia between distinct states, dissociative amnesia associated with less than distinct states, derealization, depersonalization, voices heard from “inside,” non-epileptic pseudoseizures, flashbacks, anxiety, depression, overt emotions in response to perceived abandonment, insecurity, emotional overwhelming in personal relationships, eating disorders, substance abuse, somatic illness. Self harm is possible, but not likely because complete switching would occur when threat was eminent, however self harm is common in other specified dissociative disorder.

Psychological amnesia: true amnesia and dissociative amnesia 
Amnesia is the most identified symptom of dissociative identity disorder, but understanding psychological amnesia is important if this symptom is to be used to distinguish OSDD from dissociative identity disorder.

Less than distinct states are only associated with dissociative amnesia. They do “loose time,” but this is not the type of amnesia that defines dissociative identity disorder; true amnesia which is only present between two distinct states is. True amnesia only occurs in dissociative identity disorder. A distinct state is never child-like. It is an adult-like state that goes about the day doing daily tasks. (Lanius et al., 2014)

Switching between distinct states is not in response to a trigger. For instance, a distinct state is washing the dishes, but then the individuals children walk through the front door, and in response she switches to another distinct state that is capable of dealing with the children. There will be true amnesia between those two distinct states.

If a distinct state is washing dishes, and her Father walks through the door, and it’s unexpected because he has not been part of her daily life for years, then that will trigger a less than distinct state to take over. There will be amnesia between the distinct and less than distinct state, but it will be dissociative amnesia. (Lanius et al., 2014)

To put it simply the only disorder with true amnesia is dissociative identity disorder, and true amnesia only exists between distinct states. Dissociative amnesia is present between either two less than distinct states or a distinct state and a less than distinct state, but this occurs in other disorders as well as dissociative identity disorder such as PTSD, dissociative forms of borderline personality disorder, and the Dissociative Disorders: OSDD and dissociative identity disorder. (Nijenhuis., 2011)
Psychological amnesia responds to integration
As integration moves forward both distinct and less than distinct states will share more memory. This does not change the criteria for diagnosis, and dissociative identity disorder, certainly does not become “like” OSDD. Failure of a distinct state to retain childhood memory is not true amnesia. The loss of time between less than distinct states and between a distinct state and less than distinct states is also not true amnesia; it is dissociative amnesia. The only amnesia that matters for diagnosis of dissociative identity disorder is true amnesia, and that will remain between distinct states until an individual is at a stage of integration where diagnosis would no longer be sought.(Lanius et al., 2014)