Dissociative identity disorder: clinical features and treatment approaches

Dissociative Identity Disorder

Dissociation is a disruption in the usually integrated functions of consciousness, memory, identity or perception of the environment (Diagnostic and Statistical Manual of Mental Disorders 1994 as qtd in Frey 1999). Dissociative disorders interfere with a person's general functioning, including social relationships and work. Through the mechanism of dissociation, the mind separates or compartmentalizes certain unpleasant or painful memories or thoughts from normal consciousness. These memories or thoughts are, however, not erased but can spontaneously resurface or be experienced again by objects or events in the environment that link to the memories. Dissociation depends on severity. Mind dissociation often occurs in most people because of some physical stressors, such as lack of sleep for some time, minor accidents, or getting over-engrossed in something, without detracting them from normal functioning. It is the moderate or severe forms that warrant genuine alarm, such as traumatic experiences of childhood abuse, combat, criminal attacks, brainwashing, hostage situations and disasters (Frey).

The human brain stores traumatic memories differently from normal memories (Frey 1999). Traumatic memories are dissociated or separated and can break into consciousness without warning and the person cannot control these memories. They do not combine with normal memories and, in time, these traumatic ones can change one's personality and develop dissociative identity disorder or multiple personality disorder. Dissociative identity disorder or DID has several levels of severity and begins suddenly. It is a new phenomenon in the U.S. and, as such, is often misdiagnosed. DID is considered the most severe form of all dissociative disorders. Causes of DID include an innate ability to dissociate easily, repeated and sever physical or sexual abuse in childhood, lack of supportive person who counteracts the abuse, and the influence of other relatives who already have the disorder or its symptoms. DID is most often linked to abuse in childhood, a time when memories are stored, retrieved and poorly understood or interpreted. The major symptoms are amnesia, depersonalization, de-realization, and identity disturbances. Amnesia represents gaps in a person's memory for long periods of time or because of traumatic events. In depersonalization, the person feels his or her body as unreal, changing, dissolving, being out of his or her body or watching a movie of himself or herself. De-realization leads the person to perceive the external environment as unreal, such as by seeing walls, buildings or other objects as changing in size, shape or color or perceiving other persons as machines or robots. A person with DID often experiences confusion about his or her identity or even assumes a new one. This identity disturbance grows out of a split of a person's entire personality traits or memories, which can occur when a stressful or traumatic experience triggers the resurfacing of these separated or dissociated parts. The person may act differently, respond to a different name or become confused with his or her surroundings (Frey).

DID normally begins in early childhood, around the age of 4 and more frequent in females than males at a 9:1 ratio (Gale Encyclopedia of Medicine 1998). If untreated, it tends to become a lifetime condition. Even complete cure is unlikely. Available statistics say that an individual with DID has an average of 15 identities, each identity developing in response to new situations. The person switches from one identity to another in adjusting to the new external or internal situation or memory and this change or switching is evident in the posture, facial expression, voice tone, speech pattern, mood or behavior (Gale Encyclopedia 1999).

Conventional treatment of DID includes psychotherapy, medications, and hypnosis (Frey 1999, Gale Encyclopedia 1998). DID is usually a chronic condition, which requires five or more years of recovery. Therapy may be individual or by group. It is long and difficult and the successful integration of the severed identities into one is also unlikely, as shown by the findings of a 1990 study of 20 DID patients of whom only 5 were successfully treated. One technique used is called "talking through" to one of the personalities in the person or to all of them as a group. Another is the recall the person's childhood memories, usually under hypnosis, which requires skill and caution, as the recovery of some memories can be so traumatic as to cause further or unexpected harm. Many psychologists, psychiatrists and memory experts doubt that memories of events before the age of three can be recovered (Gale Encyclopedia 1999).

A book, entitled "Shared Grace: Therapists and Clergy Working Together (Billich et al. 2000)," is the collaborative work of a Jewish minister, a Christian minister and a social worker on a woman plagued with DID from childhood abuses. By putting their skills together, the authors provided an approach at mental health, which combines psychological services with spiritual interventions. It introduced a spiritual dimension to their sessions while rendering services to patients or clients. The book also presented step-by-step practical suggestions for collaborative work between therapist and clergy. It focused on transforming the damaged and dysfunctional images of God, the importance of support systems within the religious community, the use of guided imagery, and the creation of healthy rituals and ceremonies (Bilich et al.).

DID is described as the ability to escape within oneself during a traumatic experience or event and the saving of painful memories as if they never occurred (Grace 2002). It not simply forgetting or repressing those memories but also actively pushing out of the memories into a separate, hidden and split-off unconscious space in the mind. If a child endures the condition of dissociation over a period of many years, separate mental states or entities can develop into individual "personalities," also called "insiders" or "alters." These insiders or alters carry specific memories and emotions but are not integrated to form a complete "self." They have different ways of dealing with other people and thus are completely different from the other alters or insiders. These insiders may or may not know about one another within the system (Grace).

Many persons with DID seek counseling or therapy without knowing their conditions but only because of their stresses, depression, mood swings, memory loss and confusion in adulthood (Grace 2002). Some of them even have a tendency towards self-persecution, self-sabotage, and even self-inflicted but outwardly directed violence. The complex nature of DID, its accompanying problems and the internal consequences of a lack of love in a small child, individual counseling or therapy in the hands of a genuine expert is of primary importance. Group counseling, on the other hand, will be threatening, frightening, ineffective and even damaging to the person. The preparation involves sufficient time for trust to gradually build between the person or client and the therapist and feel safe and confident in building a relationship and sharing himself or herself with the therapist (Grace).

Composed of a physical body and a non-physical body, a person's capacity towards severe abuse extends beyond the emotional and physical spheres (Grace 2002). His spiritual life can be messed up by the pain and confusion he experiences. He may feel angry with God or feel that God is angry with him, for allowing the abuse or pain. Or he may feel alienated from God and think that God can never accept, forgive or love him. He may also think that he is naturally bad and therefore hated by God as those who abused him made him feel. There are persons who profess a religion but carry this massive and very destructive conviction and conflict within them. There are those who have alters or insiders who identify themselves as Christians and alters or insiders who do not. Moreover, there are persons with DID who become subjects of exorcisms because of their alters or alternate personalities, described as "demonic." It is possible that one such person was deprived of the expression of normal reaction of anger as a child whose anger or rebellious part has been dissociated and created a personality that hates God or even reacts violently to the name of Christ. This condition does not mean that the part or alter is a demon but only a dissociated personality, which has been vastly damaged and is angry, disillusioned and confused. Considering the depths of the consequences of DID, what most likely accounts for trance states, amnesia, hearing voices, subjective perceptions of other identities, and different voices or handwriting styles is early childhood trauma (Grace).

The experienced Christian therapist will help the person or client with DID to go through his spiritual problems in a safe, non-judgmental but caring environment and allow him to openly discuss his questions concerning God (Grace 2002). The therapist will also help the client confront difficulties of trust and shame and help him build faith in and accept God. The process of healing DID is long and complex and has different results for different persons but healing is achievable. In some afflicted persons, insiders can become willing to "integrate" with the other insiders into the whole person or to remain separate but aware of the rest. Some Christian therapists say that with the healing power of God's love, many of these insiders moved out from the shame and pain in the afflicted person and entered into a true experience of God's love and acceptance.

Certain Christian communities offering support of this kind are guided by the Scriptures, specifically Isaiah 61, concerning their possessing of the Spirit of the Lord and being anointed (Grace 2002).

One group that provides assistance to persons suffering from DID is called the Christian Survivors Ministries (Grace 2002). It makes available an environment of love and acceptance where the afflicted survivors can and will not be rejected or feel ashamed and where they can feel aware of the value of their lives. It offers hope to those who feel hopeless. It encourages survivors to confront and actively and productively work through their problems. It encourages and enables survivors to allow God to work with them in safe ways to be healed. It encourages survivors to accept and live by the truths about themselves so that they can be set free from the abuses they have been subjected to. Its staff members provide accountability and support for one another in their growth in faith and in healing, sensitively establish friendship and genuine care to all member through supporting words and actions and encourage members to establish a supportive network of resources, including therapists, counselors and friends, who can exhibit accountable relationships and appropriate help lines and other support groups (Grace).

The Christian Survivors Prayer Team consists of members who provide a safe service for all its members (Grace 2002). Each of them is committed to work according to strict guidelines on confidentiality and sensitivity in dealing with other members. The leader seeks to embody the principles set out by the vision statement and the philosophy of care and to role model their interactions on the forum and their inter-relationships within. The leader commits to meet with other leaders regularly together and to maintain continuous dialogue among themselves. He will supply regular feedback and updates to the members, work closely with them and maintain a strong and mutually supportive group. The leader and his members totally support and embrace the vision statement and philosophy of care established. They will respect confidential information entrusted to them. They will be guided by the fundamental philosophies of love, care, faith, belief in God, Christianity, Scriptures, encouragement, support, friendship, healing, self-belief, gentleness, sensitivity and empowerment, which are demonstrative in the entire staff.

In support of one another, members of the communities of DID survivors will offer prayers for administrators, staff, prayer team members and forum members at least once a week (Grace 2002). They commit that all team members are valued, supported and keep a voice. They will attend regular prayer meetings and brainstorming sessions. They will participate and maintain regular forum prayer days and get involved in events aimed at fostering a stronger and more unified prayer focus. They commit to work closely together in order to maintain fundamental philosophies that represent Christian Survivors (Grace).

The smaller groups programme was introduced in the summer last year in response to the need for forming smaller "pockets" of members and for closer and easier friendships within CSM (Grace 2002). It has rapidly grown in the last full year. It is composed of 8-10 regular members of the communities of DID survivors, who pass 16 weeks of review from the time of application. They are committed to spend consistent and sufficient time with the group they are placed in, keep the confidentiality of the information they secure or are entrusted with, extend energetic support to other members of the group and form stable and strong friendships with them. These small groups are not "issue-driven," Their private forums are. Their goal is to forge strong and close friendships or relationships and they commit to care for other members through constant posting at these forums. They are encouraged to express what is going on in their lives for the insights and inspiration of other members who read their postings. In the meantime, the rest of the members who access these postings are expected to express support and understanding for the rest during regular meetings and at postings in forums (Grace).