[Content warning: mentions of childhood abuse]

 

 

For some, acknowledging their disorder’s origin is integral to recovery. This is often the case with disorders that stem from trauma.

I live with a disorder that is described as one of the most controversial – and stigmatised - of all psychiatric diagnoses. It is not only my disorder’s very existence that is supposedly controversial, but also its cause.

My disorder allows me to keep secrets from myself and from others - I can't tell others about what I don't know. And so, recovery relies upon reversing the code of secrecy through acknowledging the disorder’s traumatic origin.

The basics of Dissociative Identity Disorder (DID)

Dissociation is the psychological process in which the mind detaches itself from the self or the world, usually in moments of severe stress. DID is a dissociative disorder characterised by the presence of two of more distinct personality states which recurrently take control of one’s behaviour: influencing actions, thoughts, opinions, and functioning. Symptoms include amnesia, often in the form of “losing time”; depersonalisation, the experience of feeling detached from one’s body; and derealisation, which manifests as a sense of separation from the world. 

Dissociative experiences are common and are not necessarily symptomatic of a disorder, with examples including driving to a destination with little memory of the journey.

Research highlights childhood trauma and attachment difficulties as the two causal factors in developing DID. The trauma is chronic and severe, occurring in early childhood. This, combined with a child not receiving adequate support from a caregiver, increases the likelihood of a dissociative disorder developing. Abuse is often perpetrated by a caregiver and is sexual, emotional, or physical in nature.

The theory of structural dissociation posits that a child is not born with a unified personality, but rather different states for different needs such as happiness, anger, and hunger. These states unify by around the age of seven, creating a cohesive sense of self. If a child experiences the precipitating factors of severe repeated trauma and disorganised attachment, these states fail to integrate.

DID is both developmental and post-traumatic in nature, helping protect a child from the knowledge, thoughts, feelings, and emotions associated with the trauma. By dissociating, a child is able to compartmentalise the experiences, enabling them to endure what would ordinarily result in severe psychiatric breakdown 

Despite extensive research supporting the existence of this disorder and the role of trauma in developing it, many still doubt its existence. Although it has been called Dissociative Identity Disorder (DID) in the Diagnostic and Statistical Manuel of Mental Disorders (DSM) since 1994, most people know it as the outdated and stigmatising term "Multiple Personality Disorder". Some believe unethical therapists convince unsuspecting patients of a fictitious history of childhood sexual abuse - the patient unconsciously enacts symptoms of DID to please them. Such misinformation only adds to the disorder's stigma, making it exceedingly difficult for sufferers to get an accurate diagnosis to access appropriate treatment and support.

But that’s a conversation for another time. 

Reversing the code of secrecy

I suspect that the majority of people who have been abused were told, as young children, not to tell others about what was going on. Early life abuse instils a code of secrecy in a child before they even know what abuse is. This code of secrecy is reinforced through chronic abuse until the child no longer needs to be reminded not to tell. Abuse teaches children that the world is a scary place in which people who should love and protect you are also the ones to subject you to unspeakable horrors. 

If a person with DID is in appropriate therapy which, given the absence of UK NICE guidelines, follows a three-stage model of treatment by the International Society for the Study of Trauma and Dissociation (ISSTD), then their therapy will help them to process the cause of their disorder. This means hearing testimony from all parts of yourself, parts who may still think that they must abide by the “do not tell” principle. “Integrating traumatic memories refers to bringing together aspects of traumatic experience that have been previously dissociated from one another: memories and the sequence of the events, the associated affects, and the physiological and somatic representations of the experience”, says the ISSTD treatment guidelines.

The ISSTD guidelines assert that this integration of trauma “also means that the patient achieves an adult cognitive awareness and understanding of his or her role and that of others in the events. Work on loss, grief, and mourning may be profound in this stage as the patient grapples with the realization of the many losses that the traumatic past has caused (some of which might continue in the present)”. In this way, the amnesic barriers that reinforce secrecy are reduced.

Keeping secrets from myself 

My disorder allows me to keep secrets from myself and from others - I can't tell others about what I don't know. And so, recovery relies upon reversing the code of secrecy through acknowledging the disorder’s traumatic origin.   

Having myself – as in the part of my personality who writes this post – bear witness to the trauma that other parts have been through is part of my therapeutic journey.

Outside of the therapeutic realm, it is just as important for recovery that others acknowledge the traumagenic nature of DID. Disclosing abuse is one of the most terrifying things that someone can do and, for people with DID, a history of not being believed, listened to, or taken seriously by medical professionals, family members, friends, and teachers is common. Both their symptoms and their trauma history are dismissed, which serves to reinforce the feelings of self-blame that are typical in people who have experienced interpersonal complex trauma. 

To recover is to bear witness

Dissociated parts need a safe space in which they will not only be heard, but also believed unconditionally. Accepting that these parts are you - no matter how little they resemble the “you” who you know - reverses the psychological process of disowning experiences that is at the crux of dissociation. It means accepting that other parts of you exist on a neurological level, created as an adaptive response to hold experiences that were too painful for you to have in your consciousness. Dissociated parts serve a purpose, and recovery involves uncovering the nature of each one. 

What has traumatised a toddler part so severely that she can no longer speak? Why is there a carefree fifteen-year-old stuck in the year 2013? When was the part who smashes her head against the wall until her face is black and blue created? 

I must let them tell their stories. Ultimately, it's me telling my story. 

So – now do you understand why acknowledging the traumatic origin of my disorder is so important?

Denying the traumatic origin of DID denies those who live with it a recovery.  

 

 

Find out more about Mental Health Today's Teach Me Well campaign to better shape the mental health lessons coming to the national curriculum.

For more information about dissociative disorders, see Positive Outcomes for Dissociative Survivors