Dissociative identity disorder: the multiple voices of Psychology This article was published in the ATP Today magazine Connie Batt Lower Sixth
likely that they will be able to integrate it into their autobiographical narrative if they do not have the words to describe it or anyone willing to listen and care for them. Therefore, traumatic events become dissociated.
Dissociative identity disorder (DID), previously known as multiple personality disorder, is characterised by a fragmentation of identity. The personality of the one person is comprised of many ‘parts’ or ‘alters’ that are not functioning together in a smooth, coordinated and flexible way; the single person does not have a unitary single sense of self, put perceives themselves to be multiple. DID reflects a failure to integrate various aspects of identity, memory and consciousness into a single multidimensional self. People diagnosed with DID may experience feeling like a stranger to themselves or feeling as if there are different people within their mind. This can cause them to feel uncertain about their identity. This disruption in identity involves a change in sense of self which causes a shift in behaviour, consciousness, memory, perception, cognition and motor function. Some people experience amnesia, so they do not remember what has happened when another alter has been in control. This can cause frequent gaps in memories of personal history, for example people, locations and events. Individuals may report hearing voices and trains of thought over which they have no control. Others experience a sense of physical change; their bodies suddenly feel different, such as the body of a small child or someone big and muscular. Alters each have their own names, ages, genders, voices, histories and mannerisms. Each alter perceives the environment and self differently. Some people feel that they have one ‘main’ part of their identity that feels most like ‘you’; this is referred to as the host identity and may be the alter that presents to others most frequently.
Some people with DID prefer to refer to themselves as “we” as it better represents their identity. Particular identities may emerge in specific circumstances and become the driver of the mind; they gain control of the mind and body, however the individual experiencing this may not have control as to when different alters decide to take over. Dissociation is a defence mechanism that helps people cope during trauma. This can become a dissociative disorder if the environment is no longer traumatic but the individual acts as if it still is; the dissociation needed to protect themselves suggests that the individual has not been able to process past traumatic events. People who develop DID frequently report having experienced physical, sexual or emotional abuse and/or severe neglect during childhood. Brand, Classen, Lanius et al found that amongst their patients with dissociative disorders, 86% reported a history of sexual abuse and 79% a history of physical abuse. Taking into account the amnesia between different alters, these percentages could be even higher if they had been able to recall the trauma. In childhood, the brain and personality are still developing which means any trauma experienced can have a long-term effect. DID is intimately associated with attachment, and attachment patterns are formed from a young age, providing a template for the rest of life. If children do not feel supported to cope with difficult emotions and situations, they are more likely to use dissociation as a way of dealing with trauma. It is less
The psychodynamic approach would suggest that DID could be caused by childhood experiences. This implies that trauma at a young age will significantly influence an individual’s adult life. The ego protects itself using defence mechanisms. In the case of trauma, such as physical abuse, the trauma would be repressed into the unconscious, and effectively forgotten. However, the thoughts of our unconscious can be expressed in dreams. People with DID may have post-traumatic symptoms such as nightmares, flashbacks or startle responses. Freud would suggest that dream analysis therapy could be used to decode the manifest content of the nightmare into the latent meaning, the therapist would have to reverse the dream work processes. The cognitive approach would highlight the internal mental processes of the different alters. Each alter perceives the world differently which would lead cognitive psychologists to research perception, memory, language and attention of the different alters. However, it is very difficult to investigate internal mental processes. Wundt, a pioneer experimental psychologist, advocated an adapted form of ‘scientific’ introspection to isolate and identify the constituent parts of consciousness to try and infer what is occurring inside an individual’s head.
Dissociation is a defence mechanism that helps people cope during trauma.
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The biological approach may suggest that people are more likely to develop DID if the individual has close biological relatives who also have the disorder. They would argue that genetics may play a role in inheriting the disorder. They may suggest that the disorder could be caused by neurotransmitters and prescribe antidepressants or anti-anxiety drugs to help control the psychological symptoms.
