Understanding Dissociative Identity Disorder (DID) and its Trauma-Informed Treatment

This episode by Dr. Tracey Marks delves into Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder, explaining it as a failure to form a total, integrated personality, resulting in "different pieces of one personality." It primarily develops as a protective coping mechanism in response to severe, repeated physical or sexual abuse, allowing individuals to dissociate from overwhelming trauma. Dissociation, described as being disconnected from oneself or one's environment, is a primitive defense mechanism that, while effective in the moment of trauma, hinders the development of resilience and adaptive coping skills for later life challenges.

The podcast details how early experiences of extreme fear and neglect disrupt normal personality development, leading a child to compartmentalize painful emotions and adopt alternate identities to survive perceived ongoing danger. A key distinction is drawn between DID and a multifaceted individual: while the latter recognizes different aspects within a single self, a person with DID experiences these facets as distinct entities with little shared memory or ownership, leading to significant memory gaps for chunks of time. This fragmentation often causes distress and can be misconstrued as other conditions.

Dr. Marks addresses the controversy surrounding DID, noting that some clinicians doubt its existence, often misdiagnosing it as Borderline Personality Disorder (BPD) or Post-Traumatic Stress Disorder (PTSD). She clarifies that while BPD and PTSD can involve dissociative experiences, individuals with DID do not accept the emotions or actions of their alternate identities as their own. Furthermore, the experience of self-identities as "voices in the head" can lead to misdiagnosis as a psychotic illness like schizophrenia, despite antipsychotic medications being ineffective in resolving these voices, contributing to underdiagnosis due to clinical biases.

The recommended treatment for DID is trauma-focused psychotherapy, structured in three stages. The first stage focuses on symptom stabilization and safety, teaching grounding exercises to manage fear and anxiety. The second stage involves processing the trauma by recalling details and grieving, emphasizing that this should only proceed once dissociation symptoms are better managed. The final stage aims for the integration of dissociated self-states, requiring the individual to understand the protective role each identity played and to take responsibility for previously avoided emotions and behaviors. This intensive therapy requires a significant commitment and a therapist specifically trained in trauma work and dissociative disorders, as medication primarily addresses co-occurring conditions like depression or anxiety, rather than the core personality fragmentation.

Dissociative identity disorder develops when a person fails to form a total personality that integrates all aspects of yourself and your emotions.

So instead of having multiple personalities, you have different pieces of one personality.

Dissociation is a state of being disconnected from your environment or yourself.

Psychologically it's considered an immature, or primitive defense mechanism because it doesn't build resilience, or help you adapt to life's difficulties.

If during that process, you are exposed to extremes of fear and neglect, the train goes off the rails because you don't have the maturity to know how to process that kind of pain.

The person with DID doesn't take ownership of the facets. The facets become their own entities with no connection between them.

With the DID these separate entities experience life independent of each other. And there may be very little shared memory between them.

There's still controversy around this diagnosis. Some people don't believe it really exists, and is a manifestation of other illnesses like borderline personality disorder, or post traumatic stress disorder.

The treatment for DID is trauma focused psychotherapy.

Medication does not resolve this fragmented personality issue.