Frequently Asked Questions

The Short Answer

Unless you are an experienced professional who treats DID/OSDD patients and has spent time with the potential system in session, YOU CAN’T.

The Longer Answer

Do people fake dissociative disorders online? Yes. Is it our (or your) job to weed them out? No.

There is a lot of misinformation about these disorders, but it’s not our job to censor it or call anyone out. Instead, we take the high road and provide information and our life stories to combat it.

If you'd like to read the full position of the cafe on this topic, read this blog post on Fake-Claiming, Invalidating, and Self-Diagnosis. The TL;DR version is no one here is a medical professional who can either confirm or deny someone's diagnosis.

No. This is where you get into the distinction between personalities and identities. To start with, in implying that DID is the same as having a different personality for different situations/scenarios in life, you’re entirely discounting the amnesia aspect of the disorder. A massive aspect of this disorder is that alters are separated by amnesiac barriers, keeping them separate and distinct from one another. Many more aspects are getting overlooked (particularly trauma), but amnesia is the main aspect that gets massively forgotten in this comparison. This idea of plurality, connected to being a different person in different scenarios, would connect much more to Internal Family Systems (IFS). This therapy model is used for anyone in the world to give names to the different parts of themselves to understand how their different ‘parts’ communicate and work with or against each other to understand themselves better. Is that an okay way to view yourselves, and is it okay for someone to view themselves potentially in a plural way because they employ IFS in their daily life? Yes. Do they have a disorder connected to plurality? Do they have DID? No. Amnesia is what makes DID; shifting your personality based on your circumstance is something almost everyone does.

If you haven’t spoken with the person experiencing the flashback on how they prefer to be assisted, it is best to err on the side of caution. Trying to help, regardless of intent, can often cause more harm than good. Stay calm, and don’t ask too many questions. They are probably in too much of a crisis to answer them. Instead, step aside and give them space, but stay nearby. Let them know you’re there if they need anything, but then start using your phone or something so they don’t feel like they’re being watched. Be there if they choose to reach out, but leave the person alone if they are in no immediate danger.

Please, DON’T touch the person experiencing the flashback unless they have made it clear that it’s okay. A hug or a hand on the shoulder may seem like a comforting gesture, but the person is in sensory overload, and it may make things much worse.

There will never be a one-size-fits-all answer to this type of question. Not only is every system different, but every alter within a system is different. There’s no consistent answer that will always be correct. In general, though, it’s best to err on the side of caution and give them space unless explicitly asked to do otherwise.

Consult your friendly neighborhood Dissociative Dictionary.

Systems and individual alters will have their preferences, so asking what pronouns they’d like you to use is always good. How things generally work, though, is that the entire system is plural – it is multiple alters, and therefore, you would refer to them collectively with plural pronouns (they/them). However, when referring to an individual alter, you’re referring to a single person (he/him, she/her, etc.). This can become a little blurry with non-binary alters who may use singular they/them pronouns. When in doubt, ask.

The main thing is not to be a jerk. If you feel the person fronting doesn’t want you asking about who they are, refrain from referring to them using pronouns, or use the pronouns for the host, who they may be masking as. If an alter tells you their pronouns, though, respect them.

This is a common question. You might default to asking who is fronting to try to be a good ally – thinking that knowing whom you’re talking to helps validate that alter as an individual. And for some alters in some situations, it might. However, the consensus answer to this question is that no, you should not ask who is fronting until you have established with a system that it makes them feel validated and they want it from you.

If a system is not specifically talking about DID/OSDD they are often naturally masking, even if the ally doesn’t know it. Even if they’re out to you as being a system, masking is a natural defense mechanism that systems have built up throughout their lives. For many alters, it’s a more comfortable, easy, and safe feeling than unmasking. When someone asks who is fronting, it can feel very unsafe. Having your disorder called out like that can feel incredibly jarring and frightening. Remember that DID exists to be hidden! Having it brought into the light outside of the system’s own control can create panic. Additionally, if the alter who was fronting wanted to continue masking, you’ve now put them in the uncomfortable position of feeling like they need to lie to you that they’re not themselves.

For these reasons as well as others, don’t ask this question until you’ve established whether the system is okay with it. Even if one alter loudly proclaims their presence every time they’re out, that doesn’t mean the system as a whole has agreed to give you that kind of information whenever you ask.

(If you’re having a conversation where who is fronting is highly relevant, or the conversation is surrounding their disorder already, it may be a more appropriate time to ask who is fronting, but only if you’ve established it’s okay first. Respect the system’s boundaries.)

No. Most systems cannot control their switches. See this Wiki article for longer explanations.

Yes. DID forms in childhood, so everyone with DID had it as a child. That said, DID often goes undetected by the person who has it until adulthood.

DID can be treated, but it's a lifelong disorder. That being said, there are many healing paths to take with DID, and many people with DID can live very functional and happy lives. See The Different Healing Goals for Systems

Yes. Alters can be any age or gender. The mind created alters during trauma when the brain desperately tries to think of what the body needs to survive. Maybe the body was a 9-year-old girl, but the brain thought a 30-year-old man could survive what they were experiencing at the time. Now that 9-year-old girl’s body has a 30-year-old male alter.

Some alters can communicate with each other; some cannot. This can be worked on over time, and therapy can be a great tool to assist with this communication. Some alters will communicate auditorially (hearing voices), some will speak out loud, some will write notes to one another, some will journal, some will share memories, some will communicate through loved ones. There are many ways alters find to communicate with one another. See DID/OSDD Survival Guide (System Communication Techniques) for more information.

No. However, part of what DID does is cover trauma memories with amnesia. Not remembering you have trauma is fairly common for people with DID, especially early in their journeys. DID can not form, however, without repeated trauma before the age of about 7-9 years old.

No. Generally, the answer to any question that starts with “Do all systems” will be "no." There is no "one size fits all." Systems are created in a child's mind, and they’re not following any rulebook. Some systems have inner worlds; some don’t; some work to build inner worlds in therapy, and some have inner worlds that only some alters can access. There is no hard and fast rule that all systems experience inner worlds.

You’re not going to like this answer, but don’t. While it can be okay to write about a character with DID if they happen to be in your story, their having DID should not be the focus of the story. That is not your story to tell.

To put this into perspective, let’s imagine a white writer decides they want to write about the experience of what it’s like to be black in America. They want to do that as ethically as possible and ask many questions to ensure they’re doing it right. Is that okay? No. As a white person, they should not be writing about someone else’s experience like that. They’ll never fully understand what it means to be black in America.

That said, would it be wrong for them to write a black character into their story? Of course not. Could there be moments where issues of race come up where they consult people to ensure they’re handling it ethically? Yes. But the entire point of the book shouldn’t be to tell someone else’s story.

If we replace that example with DID, this makes more sense, right? DID is fascinating to many people, and they want to write about it. Their hearts are in the right place – they see the media misrepresent us and want to do it right. However, it’s not their story to tell. Plenty of systems are capable of writing and creating their own art. Boost our voices and support our projects, but don’t try to be our voice. Sure, you can write a character who happens to have DID, but please DO NOT write about someone’s lived experience with DID. Unless you have the disorder, you’ll never fully understand. Recognizing that is the sign of a true ally.

The general understanding is that if a disorder is something that comes from life experience (PTSD, etc.), singular alters can have that disorder without other alters having it. However, if the disorder comes from birth/genetics (autism, etc.), that will affect every alter in the system. That being said, it’s important to recognize that every alter might manage that disorder differently, and the disorder might present completely differently. One alter’s ADHD symptoms might seem much more ‘extreme’ from the outside than another’s, simply due to how they feel about it and how they manage it.

Similar things can apply to allergies, diseases, accommodation needs (things like glasses, wheelchairs, canes), and more.

The person you know will likely have a fairly steady memory of daily things, but you may notice severe amnesia if they switch. Amnesia may also come up in smaller things or things that have to do with trauma – but is the person you know going to randomly completely forget who you are? Almost certainly not. Just be prepared for them to switch, for someone else in their system not to know you, and to recognize that they’re not the same.

DID can be treated, but it's a lifelong disorder. That being said, there are many healing paths to take with DID, and many people with DID can live very functional and happy lives. See The Different Healing Goals for Systems

You must have a therapist who is trauma-informed if you are going to therapy to process trauma. Processing trauma is something that needs to be done delicately and at the correct pace for the patient. If it is rushed, it can cause harm, so therapists need to be careful and well-trained. Rushing trauma processing can be very harmful, and this is not just something for the therapist to keep in mind but something for you – the client - to do as well.

It can be easy to get frustrated as the client and feel like you’re not making enough progress. Maybe you feel like you’re not doing ‘good enough,’ your therapist isn’t working hard enough for or with you, you’re upset because therapy costs money and you want to be seeing results, or maybe you simply want to be better. It could be a combination of these factors or something unique to your situation. Checking in about these possibilities is never a bad idea – talking to your therapist about these concerns can be good. Sit down and talk about how you feel you’re not making the progress you want. They might see more progress than you do and be able to reflect that, or they might be able to adjust your treatment approach. However, trying to push yourself to ‘get to the hard stuff fast’ isn’t a healthy approach to therapy.

No. Generally, the answer to any question that starts with “Do all systems” will be "no." There is no "one size fits all." Systems are created in a child's mind, and they’re not following any rulebook. Some systems have inner worlds; some don’t; some work to build inner worlds in therapy, and some have inner worlds that only some alters can access. There is no hard and fast rule that all systems experience inner worlds.

Measuring progress is a very important part of therapy and can be easily forgotten. Without actively measuring your progress, it can be easy at times to feel like you’ve plateaued or like you’re being vulnerable, spending money, and doing a lot of emotional labor for nothing. In reality, you are likely making a lot of progress; you simply aren’t tracking it, so setting up a system to do so is important. Here are some ways you can do this:

Set goals: Setting goals with your therapist can help you know what you are trying to achieve. Goals should be specific, measurable, achievable, and relevant. This will not only help you but also assist your therapist. As you progress, you and your therapist can check in on where you’re at along the way regarding your goals.

Feedback from your therapist: Ask your therapist for feedback. It’s okay to ask them questions – it might feel scary or like it’s something you’re ‘not supposed to do’ – but why? You’re paying them to help you – you should be able to ask them, in their professionally trained opinion, where they think you’re at and how you’ve progressed with their assistance. If they think you haven’t made enough progress, maybe other techniques need to be used, and this conversation could be a good starting point to begin moving towards more productive treatment for you. Ultimately, the goal is for you to get the treatment that will work best for you. Ask questions and ask for feedback.

Assess the frequency and intensity of symptoms: Clients can assess the frequency and intensity of their symptoms. For example, if a client was experiencing daily flashbacks before therapy, but 6 months in is only having two flashbacks a week, that’s significant progress.

Journaling: Keeping a journal can help track your progress in therapy. Write down your thoughts, feelings, and behaviors, and reflect on them to see how far you’ve come and how patterns change over time.

This is written from the perspective of someone living in the US. The situation in your country may differ.

Therapy costs can vary widely based on different factors (i.e., the therapist's credentials, the type of therapy, insurance, etc). We’ll go over a few different things to look into & different ways of paying that will often be offered by therapists in your area:

Out-of-Pocket: If you choose to pay without insurance, therapy can range often from $50-250+ per session.

Insurance: Many health plans will cover mental health services. Check with your insurance policy to see if therapy is covered, your copay and deductible, and if it only covers a certain amount of sessions/year.

Sliding Scale: Many therapists will offer sliding scale fees. This means they will adjust their rate based on your income, making therapy more affordable for lower-income people.

Community Clinics/Nonprofits/Universities: Some organizations will offer lower-cost or free therapy services.

Employee Assistance Programs (EAPs): Your workplace may grant you access to a certain number of free therapy sessions.

Online Therapy Platforms: Online therapy often has different pricing structures, which can be more affordable than in-person therapy.

Having a therapist betray your trust in such a vulnerable situation is an awful thing. If this has happened to you, I am sorry. It’s very important, however, to not allow this to shut you off from professional help or to associate what one therapist did with what all therapists will be like.

It’s okay if it takes a long time for you to open up to a new therapist, and it’s okay if it takes a long time to trust them. When you begin working together, you can tell them (if you’re comfortable) that you’ve had a bad therapist/client relationship before that’s caused you to mistrust therapists and that it may take some extra time to open up and trust them. Any good therapist will be understanding and respectful of that. Give yourself time to heal, but don’t give yourself so much time that you allow that to turn into fear of returning to the work. Do virtual sessions if those are easier for you, and give yourself time – just don’t let one bad therapist take away from you a massively valuable resource in your healing journey.

There are many reasons that your friends are not a replacement for therapy. Not only is putting that burden on your friends unfair to them – your friends are not your therapists. No matter how much they swear up and down, they want to be there for you and don’t mind; they are not equipped to give certain advice. They oftentimes may not only steer you down the wrong path or worsen your mentality surrounding a situation, but their mental health may be negatively impacted by trying to act in a counselor-type role when they’re not equipped to do so.

A therapist is not only removed from the situation but also trained on how to help you and take care of themselves simultaneously. It’s an ethical way to be able to talk about intense things and to vent about your life on a regular and lengthy basis – with your friends, it is not appropriate and can cause serious damage both mentally and to those friendships.

Additionally, you don’t need to worry about your therapist's feelings in a therapist-client relationship. Obviously, they’re still a person, and you can’t disregard that, but they’re there to help you with your problems, and they have signed up (and are being paid) to help you with difficult things – you don’t have to worry about being a “downer.” You also don’t have to censor or self-edit your speech because you don’t want to hurt their feelings or out of concern of being judged. Therapists are trained to be understanding, and chances are they’ve heard 10000x worse.

With friends, you often might get advice for the short term (and therefore gain short-term relief and gratification), but with therapists, you can chart a path of plans for how to work towards long-term goals, and therefore making much more significant progress and a much more significant and positive impact in your life.

Complex PTSD (CPTSD) is a diagnosis in the ICD-11. However, it is a relatively new diagnosis to be recognized officially and does not appear in the DSM-5. This often causes confusion about whether or not it is an official diagnosis or more of a generally accepted term amongst the community. It is, however, a real diagnosis.

There is no medication for DID. However, there are medication options for co-morbidities that are common with DID.

Please know that it’s a normal experience to go through a few therapists to find the right fit for you, and don’t get discouraged. Finding the right therapist for you can be a process, and it’s okay to take your time to find the right match for you.

Like any other professional relationship, the therapeutic relationship depends on a good fit between the therapist and the client. You need to feel comfortable and safe with your therapist to open up and work through your challenges and the things you wish to process with them. Sometimes, finding the right therapist you can connect with takes a few tries.

It’s very important to remember that finding the right therapist doesn’t reflect you or your ability to navigate therapy. Therapists are trained to work with various clients, but the first or first few therapists you see may not be the right fit for you. It’s very important to remember that therapy is a collaboration, and it’s okay to communicate your needs and preferences to your therapist and let them know if you need something from them that you’re not getting.

Don’t be afraid to ask questions or express concerns during the initial consultation or first few sessions. This can help the therapist to know if you’re a good match for one another. Trusting your gut and paying attention to your feelings during and after each session is also very important.

Remember that therapy can be very valuable and transformative to your life. Additionally, when working with a therapist, there are bound to be uncomfortable things you’re speaking about, so there is a degree to which you want to push yourself out of your comfort zone. So long as you don’t feel red flags that seem potentially harmful, try to stick with your therapist for at least a handful of sessions to see how things pan out because sometimes pushing through discomfort is necessary. If you have truly given a therapist your best shot, however, and you simply aren’t meshing, it’s okay to accept that a therapist isn’t the right match for you and decide to find a different therapist.

Keep trying, and don’t give up hope – you will find the right therapist!

This answer reflects the situation in the United States.

A psychiatrist is a medical doctor who can prescribe medication.

Psychologists typically hold doctorates; however, they do not attend medical school and are not medical doctors. Instead, they study human thought and behavior.

Both psychiatrists and psychologists can diagnose disorders and provide counseling and therapy; however, only a psychiatrist can prescribe medication.

PTSD comes from witnessing or experiencing a singular traumatic event. This could be something like a car crash, a natural disaster, a sexual assault, a wartime atrocity, or a violent act.

CPTSD comes from long-term repeated trauma. CPTSD often develops in those who have been abused by someone who was in a caregiver or protector role, often developing in children. Examples include survivors of ongoing childhood sexual assault by a relative or caregiver and survivors of human trafficking. Other long-term traumas that can result in CPTSD include (but aren’t limited to) childhood neglect, ongoing/long-term physical, sexual, or emotional abuse, living in an area of war, or being a prisoner of war.

This answer reflects the situation in the United States.

A therapist is a licensed counselor. They help clients treat mental health symptoms and work through managing their stress, relationships, daily and lifelong mental health issues, processing, and more.

A psychiatrist is a medical doctor who can diagnose and prescribe medication for mental health disorders.

Often, patients will work with both a therapist and a psychiatrist on a team (they’ll meet separately generally, but there should be communication between the two), with their therapist meetings happening more regularly. In contrast, they will meet with their psychiatrist more infrequently for medication check-ins and prescriptions, diagnosis meetings, and more.