5. Therapists further develop and “reify” (regard them as real or concrete) the self-states. Quite the opposite, therapists try to create an “inner communication and cooperation among self-states,” Brand said. They teach patients to manage their feelings, impulses and memories. This is especially important because a person switches self-states when they’re faced with overwhelming memories or feelings such as fear and anger.
Therapists help patients integrate their states, which is a process that happens over time. Unlike movies and media depict, integration isn’t “a big dramatic event,” Brand said. Instead eventually, the differences among states diminish, and the person is better able to handle strong feelings and memories without switching self-states and retreating from reality.
6. Only people with DID dissociate. People dissociate in response to trauma or other overwhelming situations such as intense pain or anxiety. So individuals with other disorders such as anxiety disorders and PTSD also dissociate. (In about six months a journal that specializes in depression and anxiety will focus its entire issue on dissociation.)
Researchers in other fields, specifically PTSD, are starting to reanalyze their data and categorize individuals into high dissociatives and low dissociatives. They’re learning that people who are high dissociatives often have a slower or poorer response to treatment. This shows that much more research is needed to learn how to better treat dissociative individuals, Brand said.
Also, brain studies have shown that high dissociatives exhibit different brain activity than low dissociatives. A 2010 review in The American Journal of Psychiatry concluded that people who have the dissociative subtype of PTSD “tend to have less activation in the emotional centers of the brain while recalling their traumas and while dissociating than do people with classic PTSD.”
7. Hypnosis is used to access or explore hidden memories. Some therapists used to believe that hypnosis could help clients retrieve accurate memories (like memories of abuse). Now, compelling research has shown that “experiences recalled under hypnosis can feel very true,” even though the person never experienced these events, Brand said. She added that all the reputable professional associations that provide training in hypnosis “educated therapists that they should never use hypnosis to try and facilitate recall of memory.” So if a therapist says they use hypnosis to explore memories, Brand underscored the importance of obtaining information about their trauma training.
Well-trained therapists use hypnosis only to manage common symptoms such as anxiety and chronic pain. People with DID tend to struggle with insomnia, and hypnosis improves sleep. It also “helps contain PTSD flashbacks,” and provides “distance from and control over traumatic, intrusive memories,” Brand said. People with DID often experience severe migraines, which may be “correlated with internal conflict amongst personality states.” For instance, one self-state may want to commit suicide while the others don’t.
Chronic health problems are common among people with DID. The underlying reason may be stress. The ACE studies have found a link between “adverse childhood events (ACE)” like parents’ substance abuse and divorce, as well as childhood abuse, and various psychological and medical problems.
Brand uses hypnosis in her sessions, which she describes as “facilitating a positive change in state of consciousness.” Many people with DID are actually highly hypnotizable, she said. To hypnotize a client, Brand simply says: “I want you to breathe slowly and deeply and imagine being in a safe place.”
An Example DID Case
So what does DID look like? According to Brand, picture a middle-aged woman who’s been in the mental health system for about 10 years. She comes into therapy seeking help for her self-destructive behaviors. She cuts herself, has made several suicide attempts and struggles with a disabling depression. She never mentions having DID. (Most people with DID don’t realize they have it, or if they do, they keep it hidden because they don’t want to be seen as “crazy.”)
But she’s aware that she “loses” gaps of time and has a bad memory. During sessions with her therapist, she spaces out. Often the therapist has to call her name to bring her back to the present. People have occasionally mentioned her out-of-character behavior. For instance, even though she rarely drinks, she’s been told that at times, she drinks a lot of alcohol. She realizes that this must be true because she’s felt hungover before but couldn’t remember having a single drink. “However, she admits only to herself that she cannot recall what she did for several hours on the nights before the hangovers. She tries not to think about these unexplained, frightening experiences.”
She also experiences PTSD-like symptoms. She recalls being choked and sometimes coughs profusely and feels like she can’t catch her breath. Or she gags when brushing her teeth. She struggles with a poor body image, low self-esteem and a number of chronic health problems, including fibromyalgia and migraines.
(Keep in mind this example contains generalizations.)
Regardless of the controversy, dissociative identity disorder is a real disorder that disrupts people’s lives. But there is hope and help. If you’re struggling with DID, check out this list of therapists from the International Society for the Study of Trauma and Dissociation.
You can learn more about DID from the International Society for The Study of Trauma and Dissociation. A highly regarded expert on the disorder, Richard P. Kluft, M.D., talks about DID and the TV series “United States of Tara” in this video.