This post is part of a series of guest posts on GPS by the graduate students in my Psychopathology course. As part of their work for the course, each student had to demonstrate mastery of the skill of “Educating the Public about Mental Health.” To that end, each student has to prepare three 1,000ish word posts on a particular class of mental disorders, with one of those focusing on changes made from the DSM-IV to the DSM-5.
Can Dissociative Identify Disorder be Entertaining? by Kelley R. Bailey
Have you ever watched the TV series The United States of Tara? Maybe you’ve seen the movie Sybil or The Three Faces of Eve? The common theme in all of these is the portrayal of dissociative identity disorder (DID), formerly and popularly known as multiple personality disorder (MPD). The media’s characterization of DID helps to foster the confusion surrounding those who suffer from this disorder. The most recent example, The United States of Tara, presents a woman married with children as the subject. She has several alternate personalities and transitions into different ones when she’s stressed out. One alter is a wild teenager, another a beer drinking Vietnam vet. Other personalities or alters include a prim housewife, therapist, and a little girl named Chicken. The alters are depicted in such a way to make the audience like and sympathize with Tara and all her personalities. The series has you believing her kids have an interesting cool mom and her husband is lucky to have such a diverse wife. Although entertaining, such a portrayal could not be farther from the truth for those who suffer from dissociative identity disorder. Most live in a state of stress, not in a fun loving family which allows them to transition from one personality to the next with glee and abandon.
The cases of DID portrayed in the media rarely resemble real life cases. Movies like The Three Faces of Eve or Sybil are dramatized and simplified for the audience. Understanding the features of DID is complicated and, although it is dramatic, the features are seldom similar to these movies. What makes DID difficult to conceptualize is the multifaceted aspects of the disease. Most individuals suffering from dissociative identity disorder have a covert and subtle display of symptoms and generally have been diagnosed with a number of other disorders such as bipolar, PTSD, assorted personality disorders, and/or varying anxiety disorders. For example, dissociation is common for those who suffer from PTSD, so the symptoms of DID may go unnoticed for years. People afflicted with DID often have borderline personality disorder too, which is categorized by unstable relationships, unstable sense of self, and efforts to avoid abandonment among other symptoms. Confusingly, these are some of the common indicators of DID as well. Couple this with anxiety, depression, and PTSD, and it is easy to see how a person with “multiple personalities” can go unnoticed.
So, then, what exactly is DID? Dissociative Identity Disorder is when a person dissociates from the real world by becoming someone other than their original self. In simple terms, it is when a person has at least two distinct different personalities (and often more). Often the alters are unaware of each other as each single personality takes control of the person at different times. Each personality has it’s own individual self image, name, identity, and experiences separate from the other alters. Each alter will have it’s own particular voice, posture, way of speaking, acting, and relating to others.
The dissociation appears to serve as a defensive mechanism used to cope with extreme stress. It is a way of protecting the person from severe physical and emotional trauma that has happened to the individual, usually as a child. This allows the person to separate or compartmentalize specific thoughts or memories from their normal consciousness.
Those with DID often have experienced repeated severe sexual and/or physical abuse. Thus, it is apparent why many also suffer from Post-traumatic Stress Disorder (PTSD), which is characterized by re-experiencing the traumatic event(s) and avoidance behaviors, among many other symptoms. All of this makes it difficult to treat the disorder, including trying to separate out what problems are due to which symptoms.
Treatment generally takes years and involves the process of what is called integration. This is when the therapist works with the patient to integrate or make known all the personalities to the original person. By integrating the personalities, the individual has a more cohesive grip on their world and their reality. Integration has been shown to diminish certain symptoms such as feeling like their experiences or thoughts are not their own, being controlled by something outside of him/herself, hearing voices, depression, borderline symptoms, extrasensory perceptions, number of amnesia episodes, and others. It is noted that the decreases were attributed to the treatment process combined with integration and not just integration alone. Symptoms can be reduced and coping skills developed, but no one is ever ‘cured‘ from DID.
It often takes a considerable amount of time for a person suffering from dissociative identity disorder to realize what is happening to them and this comes about by engaging in therapy. The person is left wondering where they’ve been, what happened, what was said and to whom. When they do get a diagnosis and begin to understand what is happening the fight is on to integrate the personalities into a whole so amnesia or fugue is not happening all the time and this generally is met with resistance from one of the alters.
DID is not easily explained nor is it easily understood. Each person has their own unique experiences, trauma, alters, symptoms, and manner of presenting those symptoms. Perhaps the voice of one who lives with the disorder describes it best. One blogger who reportedly suffers from DID wrote:
It [DID] is primarily a metaphysical experience. This is not hard science. We’re talking about the unplumbed depths of psyche, we’re talking about stored and repressed experiences, we’re talking about instant and specific regressions to pieces of past locked in their perfect moment of timeless reality. We are talking about things that often can’t be measured or quantified. In essence, the entire experience is unprecedented, each and every time, with each and every person to live it. Whatever realizations I have about my own inner landscape, they will probably never apply to anyone else’s.