Keywords: Dissociative identity disorder, personality, identity, adverse childhood experiences, alters, core identity, host identity, depersonalization, derealization, psychotherapy.
Introduction.
Three Persons In One Person? What is dissociative identity disorder? How does dissociative identity disorder come about? What are alters in DID? How does a person with dissociative identity disorder act? Let us look at the brain of the person with DID. Can DID be treated?
The way some people behave, one will think that they are possessed by evil spirits. At one point in history, people suffering from Dissociative Identity Disorder (DID) were said to be possessed by evil spirit. When science had not advanced to the point it is now, there was no way anyone could explain certain behaviours. How could someone explain in those days why a man will call himself the devil and behave like one? Why will a grownup woman start to talk and behave like a little girl? What could make someone believe that he is a dog and begin to bark and behave like one? And in between all these strange behaviours, such people still have times of normal behaviours.
With the advent of modern science, these mysteries became unraveled and we began to understand that such people had DID. Let us see how three persons can live in one person.
What is dissociative identity disorder (DID)?
Dissociative identity disorder is a mental illness, whereby the person suffering from it, has two or more personalities or identities. It can be like three persons in one person. These different personalities or identities will control the person at different times. Also the different personalities come with different names, thinking patterns, behaviours, moods, memories, personal history, likes and dislikes. And the different personalities have independent initiatives. They can also come as different genders, voice tones, etc. But the person’s main identity, is the one most people know him or her with before the illness started. It is called the core or host personality.
The old names for DID was multiple personalities or split personality. But today these two nomenclatures have been dropped.
Dissociative identity disorder starts in childhood, usually before the age of 6 or 10 years and continues into adulthood. If untreated it lasts a life time. Sometimes, these personalities can be up to 100 or more and they help the person to cope with life stressors. But this is a wrong coping method. So under stress, the child displaces that unbearable hurt into an imaginary person or persons. This helps to reduce the stress from the child’s real self. Despite all this, the core or host person is still distressed by the condition.
Some people believe that DID is a form of Post Traumatic Stress Disorder which occurs in childhood. This is because the child’s brain can not cope effectively with trauma or stress.
How does dissociative identity disorder come about?
Dissociative identity disorder is brought about by severe stressors which usually come about during childhood. Research papers have it that 90% to 99% of cases of DID are due to childhood stressors.
It is actually a psychological response to interpersonal and environmental stressors that occur in childhood. The severe recurrent stressors happen during the sensitive brain developing period, which is the childhood stage.
These severe stressors include Adverse Childhood Experiences (ACEs), natural disasters, terrorism, wars, accidents, bullying, etc. These ACEs include physical abuse and neglect, emotional abuse and neglect and sexual abuse. Other ACEs are parental divorce, separation, death of parent(s), parental incarceration, parental mental illness, parental substance abuse and community violence. In disorganized attachment and where the behaviours of parent are threatening and not predictable, DID can occur.
Severe painful medical or surgical procedures in childhood, can also be a risk factor for DID. Also being forced into cultism in childhood or being trafficked as a child, can bring it about.
So when someone is faced with any of these severe stressors, he or she will dissociate self from the happenings. The child removes himself or herself from the hurt by transferring the hurt to an imaginary person. It is known that children can easily do magical thinking and fantasying. So by transferring this hurt to a fantasy person the child can continue life without remembering the hurts.
What actually happens in DID is that the stressors affect the brain, causing lack of connection in thinking process, memory, etc. But it should be known that not everyone subjected to these stressors develop DID. It is linked to genetic inheritance.
What are alters in DID?
In DID, there exist different identities or personalities in the person suffering from it. The person’s usual personality is the core or host personality, while the other personalities are known as alters. It is like a host and two alters will be equal to three persons in one person.
These alters can present with different speech, mannerism, gender, etc., as already written earlier. They can also have different allergies, handedness, and one may need to wear glasses while the host personality does not.
Alter may even claim to be from a different ethnic group from the host. Some alters can present as animals. For example, though the host personality is human, one alter can believe that it is an animal, like a dog. And the more alters, the varied the demands and behaviours.
When changing from host personality to alter, or from one alter to another, it does what is called switch. Each switch is usually not dramatic. It just blend into the normal environment that strangers may not know that there is a change of behavior. But before relatives who know the host behavior well, they are able to recognize the switch.
Note that it is not very possible for one to bring up an alter at will, it comes up during stressful moments. Sometimes, the host may not be aware of the alter and vise verse. But with some people, they are aware of each other and may even communicate with each other using internal communication.
How does a person with dissociative identity disorder act?
In DID, there is actually disconnect between the person’s thoughts, feelings, actions and identity. And the symptoms differ in different people.
When the host personality wants to switch to alter, it may take seconds, minutes or days to complete the switch. For some people they have symptoms during the switch. These symptoms vary from one person to another and include dizziness, weakness, zooming out or trance state, etc. Some people describe the alters as being in darkness or in a deep hole.
Memory issues:
One of the symptoms in DID is problem in remembering or memory. This is the reason it is known as a dissociative disorder. So such a person may have variations in memory or fluctuations in memory about events that brought the illness about or other events. They also have problems with remembering personal information, like their names, age, etc. Even recent discussions are not adequately remembered.
Usually, emotionally charged information are very easily forgotten. And because of this memory gaps, the person feels that time is lost. For example, an alter may last minutes or hours or even days. After each alter, the host may not remember the alter period and to this host, it is time lost. Sometimes, these memory loss may span the entire childhood period. Some people can remember the events that occur during alters, but it will be sketchy, while other cannot.
Out of body experience:
The person feels that he or she is not the one present or existing in that point in time. And the environment seems strange. These are called being depersonalization and derealization, respectively.
Behavioural issues:
People suffering from DID have confusion about who they really are. They are not sure of their identity and what they really want out of life.
It has been mentioned earlier that each alter comes with its own behavioural pattern. An alter can be seen doing things the host doesn’t do in normal circumstances, like smoking, etc. Also an alter in a grown woman, may present like speaking with a baby voice. This is called a child alter. Using the three persons in one person sample, a normal 30 year old woman is the host personality. Then she has one child alter and another alter that smokes.
An alter may even be violent against its self, and may want to kill itself. But the alter is unaware that killing itself means killing the host. Take for example, in the three persons in one person, if one alter is suicidal, it will kill the host.
A child may believe that he or she is possessed by a demon and start to behave intimidatingly. Such a child may call himself Lucifer or the devil.
An alter may present the picture of being disabled. Thus a normal host identity, may present as a blind or dumb alter. Even an alter can be very seductive and excessively sexual without remembering having sexual intercourses. But can feel irritation in the private part as if she had sex.
Co-occuring mental health issues:
Persons suffering from DID may also have other accompanying mental health issues. These include depression, anxiety, sleep problems, deliberate self harm or suicide, compulsions, substance abuse, etc.
Let us look at the brain of the person with DID.
In DID, certain areas of their brain are smaller in size, especially areas concerned with awareness, memory and emotions. These brain areas include the frontal lobe, hippocampus, amygdala, etc. In general, the brain is small in size. This reduction in brain areas are due to cortisol, a toxic chemical, produced during the abuse and neglect in childhood. Cortisol can also rise during other stressor in childhood.
The white matter in certain areas of the brain are thicker in persons with DID than in those without DID. This is actually what brings about the different mannerisms seen in DID, like the different handedness or skills in alters.
There is also a problem at the brain parietal lobe. This area is not just small in size, but it is also over stimulated. And this is what brings about the depersonalization, ie. the out of body experience.
Can dissociative personality disorder be treated?
Social support:
A strong support system from family and friends is very important for people suffering from DID. Family members and friends should know about the condition. And the person suffering from the disorder, should be able to open up to their support system. He or she should let them know what is happening and allowing them to get the help he or she needs.
For the family members they should be well in the know about DID. They should be ready to go into therapy with the suffering person.
For friends and family members, they should be very supportive during the alter phases. They should do all in their power to remain calm during the times of switch. Be empathic and find out from them how best you can help. Avoid putting them into stressful situations.
Help the person avoid substances of abuse and encourage them to be compliant with medications and instructions from professionals.
The individual:
Someone with DID, should use of mindfulness ie. being able to bring the thoughts to the present and handling it. Such a person should be physically active during the day and exercise can help.
Then eating good diets by eliminating processed foods and reducing the intake of sugar will be helpful. And getting adequate sleep is very important.
Avoiding situations and things that can bring up the switch, is necessary in the treatment of DID.
Use positive coping strategies when faced with stressors. Then being ready to accept treatment and being compliant to treatment modalities is imperative.
Consulting with professionals:
The mainstay of treatment in DID is psychotherapy, known as talk therapy. There are different types that will be administered to the patient. And this talk therapy comes from a clinical psychologist.
When there are other mental illness co-occurring with DID, then the psychiatrist will be consulted. There is no cure for DID, rather it can be managed.
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