Hi, I'm Dr. Tracy Marks a psychiatrist,
and I make mental health education videos.
I've gotten several questions on this topic
of dissociative identity disorder,
which used to be called multiple personality disorder.
What is it?
What does it look like?
And why does it happen?
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.
This is something that can happen as a result
of severe physical or sexual abuse.
It becomes a way to survive something that may not seem
like it's survivable.
So to get through it, you do it by dissociating.
Dissociation is a state of being disconnected
from your environment or yourself.
It's kind of like the opposite of being mindful,
when you're engrossed in the moment.
Here you're removed from the moment.
Some people feel as though they're looking
at themselves from outside of their body.
And some people feel as though they're
in a completely different place.
In that case, it's a total escape.
I talk about dissociative episodes in this video
on depersonalization and derealization.
This is a disorder that falls under the broad category
of dissociative disorders.
Dissociation in general
is a very protective coping mechanism.
Psychologically it's considered an immature,
or primitive defense mechanism
because it doesn't build resilience,
or help you adapt to life's difficulties.
Instead it allows you to escape the horrors
of a traumatic experience.
So for example, if you are being tortured
or sexually abused, you can use your mind to take you
to a different place,
and in the moment feel as if it's not happening to you.
This works well in the moment,
but it's not adaptive if you use this to deal
with other bad things later in life.
So what happens with dissociative identity disorder
is it interferes with your normal personality development.
As a child, you learn how to manage your emotions
from your caregivers and other important people
in your life like siblings and close relatives.
Some of how you respond to the world is in borne
part of your hard wiring,
but a good portion of it is molded
by your early experiences with those you see as caregivers.
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.
An example of this is a child who's visited in their bedroom
every night by a drunk or not drunk step parent.
How does a scared child handle being hurt
by an adult on a repeated basis?
One of the ways is to zone out and go to a different place.
Then when it's over,
you still have to process the pain of being violated.
So you compartmentalize that emotion and assign it
to someone or something else.
It's like having a hot potato in your hand
and giving it to someone else to hold.
Keep in mind with this scenario of repeated abuse
in the home, the child is continuing to have contact
with the abuser and other people who failed to protect you
in your mind also become abusers by proxy.
So how do you continue to function in a world
with so much danger around you?
You take on the identity of someone else who's very strong.
This helps in the short term, but in the longterm,
it keeps you from becoming a whole integrated person.
Now, the difference between this
and a multifaceted individual is the person without DID
sees themselves as being one person
with different aspects of their personality.
The person with DID doesn't take ownership of the facets.
The facets become their own entities
with no connection between them.
Here's an example to illustrate this difference.
When my son was young, probably around three or four,
he was doing something that I asked him
not to do several times and testing my patience.
I had not had a good day, and felt very overloaded with work
and home responsibilities, the working mom thing.
My son did something blatantly defiant.
I can't even remember what it was at this point.
All I remember was I was completely out of gas
at the end of the evening while my husband
was totally relaxed on the couch, watching television,
and tuning out my son's behavior.
I was not going to let my son get away with it.
And he must have read the expression on my face
because as I turned to grab him to move him away
from whatever it was,
he had already started in motion, and my arm hit his arm,
and he slid in his socks across the wood floor,
and into the wall, lost his balance and fell to the floor.
It felt like the whole thing happened in slow motion.
The three of us sat there for a few seconds staring.
My husband broke the silence and said,
- Now I know what my coworker means by crazy mama.
- So from that point on,
it became this thing that you better watch
what you do so you don't bring out crazy mama.
And by the way, my son wasn't hurt.
In fact, he fell with some drama like basketball players
do when they're trying to show a foul.
So with this example,
I'm showing you how I recognize that in general,
I'm pretty reserved with my reactions,
especially if I think that what I say,
or do will hurt someone's feelings.
But if I don't have the mental reserve
to exercise that kind of control,
I can lose it and become crazy mama.
But crazy mama is not a separate person.
I accept that it's a more aggressive, angry part
of my personality.
With the DID these separate entities
experience life independent of each other.
And there may be very little shared memory between them.
So with DID people can have gaps in memory
where they can't account for chunks of time.
This often causes a lot of distress
that you can't remember ordinary events
like driving to the store.
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.
With both of these disorders,
you can have dissociative experiences,
but people with borderline personality
usually remember their actions and behaviors
when they experienced different emotions,
and can see those emotions as belonging to them.
With DID you don't accept the emotions as yours.
It's part of a whole different self identity.
Sometimes the self identity can be experienced
as a voice in your head.
And this can lead people to believe that you have
a psychotic illness like schizophrenia.
If you take an antipsychotic medication,
the voices don't go away.
They may lessen in volume, or can seem harder to understand,
but they're still present.
And this can make you appear to be treatment resistant.
Also, depending on how you report your problems.
If you say you have five people living inside of you,
some clinicians may take that to mean
that you're delusional.
So because of these biases against this illness
as being something that isn't real,
or should be part of another illness
DID is often underdiagnosed.
The treatment for DID is trauma focused psychotherapy.
It's recommended to proceed in three stages.
The first is stabilizing your symptoms,
and focusing on safety.
Because of the traumatic experiences,
and the psychologically immature way
that your mind handled it,
there's often a lot of fear and anxiety.
Parts of you are the scared, helpless child.
So during this stage, you learn grounding exercises
that remind you that when you face certain situations,
you are safe.
You weren't safe back then, but you are safe today.
The second stage focuses on processing the trauma
by recalling details and grieving certain aspects of it.
You don't wanna move too fast to the stage
until you get a better handle on managing
your dissociation symptoms and other symptoms
that can come along with this,
like fear and desire for self harm.
In the third stage, you integrate
the dissociated self states.
You have to come to understand what role
each self state played in coping with your experiences.
What did those identities protect you from?
What emotions and behaviors were you avoiding,
and not taking responsibility for?
This kind of therapy is a lot of hard work.
So it's a big commitment and you really have
to be motivated to face it and stick with it.
You need to see a therapist who's trained in trauma work,
and says that they have the experience
working with people with dissociative disorders.
This is probably not going to be your psychiatrist.
This is not a standard therapy
taught in psychiatry residency.
You need a specific interest
in this with additional training.
If you have this problem,
you can still have other disorders like depression,
or anxiety for which you may need
to see a psychiatrist for medication,
but medication does not resolve
this fragmented personality issue.
That really requires a professional to help you move
through the stages of recovery.
For more information
on depersonalization derealization disorder
take a look at this video.
See you next time.