One of the most perplexing mental health illnesses is Dissociative Identity Disorder. This disorder is best recognized as multiple personality disorder, a disorder that came to the public’s attention through movies such as “The Three Faces of Eve” and “Sybil”. Estimates vary, but only about 1% of the general population and anywhere from 5 to 15% of the psychiatric community suffers from multiple personality.
There has always been controversy surrounding this diagnosis. Does the personality (alter) represent a delusion or something real? Multiple personality is also something that has no objective criteria to observe, so the diagnosis seems very subjective. Some people believe that it is all made up and is produced by a therapist and an overly suggestible client.
For those who suffer from DID, the disorder, real or delusional, wrecks havoc in their lives. Getting up in the morning and deciding what to wear is a difficult time because each alter may have his/her own opinion about what to wear. The choice of foods at meal time can be quite problematic as well. In fact, any situation requiring a decision or choice can be quite trying as one tries to sift through all the opinions heard in one’s head.
Just how did this splitting come about?
Some people theorize that extremely traumatic events in which the child has difficulty dealing with can cause splitting. By dissociating when this event occurs, the child psychologically separates from the event to such an extent that they may not have direct recall as to what happened. As the child continues to use this ingenious method of escape, this defensive coping strategy becomes habituated and they begin to use it whenever they feel threatened. It now does not have to be triggered by an abusive or life-threatening situation. Over time the repetitive nature of the dissociation may result in separate parts of self that take on identities all their own.
What happens in therapy?
Integration is usually the goal. Some multiple personalities fear this goal. this is because the internal dynamics change when integration of an alter occurs and it becomes almost disorienting. Leaving everything the same feels comfortable and the person may feel like the alter is “done away with” or is lost. This is not the case. As skills training helps the multiple personality learn ways to deal with situations without involving the alter, the function the alter fulfills is no longer there. This aspect of the person’s personality becomes a part of them, rather than the feared loss. Working through the trauma that caused each split is also an issue that is addressed in therapy.
Therapy is not a quick fix. It is outside the boundaries of most insurance plans, because therapy usually is measured in years and not weeks or months. Integration and emotional health is attainable and this hope for emotional stability is what sustains many through the lengthy therapy.
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Author. Evelyn Wenzel, LCSW, CAP