Questions from Allies
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, they do. Is it our (or your) job to weed them out? No.
There's a lot of misinformation out there about these disorders, but it's not our job to censor 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. First of all, when you imply that DID is the same as having a different personality for different situations or scenarios in life, you're completely ignoring the amnesia aspect of the disorder. A massive aspect of the disorder is that alters are separated by amnesiac barriers that keep them separate and distinct from each other. Many other aspects are overlooked (especially trauma), but amnesia is the main aspect that is massively forgotten in this comparison.
This idea of plurality, related to being a different person in different scenarios, would be much more related to Internal Family Systems (IFS). This therapy model can be used for anyone in the world to name the different parts of themselves to understand how their different "parts" communicate and work with or against each other to better understand themselves. Is this an okay way to see yourself, and is it okay for someone to potentially see themselves in a plural way because they use IFS in their daily life? Yes. Do they have a disorder related to plurality? Do they have DID? No. Amnesia is what makes DID; shifting your personality based on your circumstances is something almost everyone does.
If you haven't talked with the person experiencing the flashback about how they prefer to be helped, it's best to err on the side of caution. Trying to help, regardless of your intentions, can often do 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 close. 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 approach you, but leave them alone if they are not in immediate danger.
Please, DO NOT 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 experiencing sensory overload and it can make things much worse.
There will never be a one-size-fits-all answer to this kind of question. Not only is every system different, but every alter within a system is different. There is no single answer that will always be correct. In general, though, it's best to err on the side of caution and give them space unless specifically asked to do otherwise.
Consult your friendly neighborhood Dissociative Dictionary.
Systems and individual alters have their preferences, so it's always good to ask what pronouns they want you to use. The way things generally work, though, is that the whole system is plural - it is multiple alters, and so you would refer to them collectively with plural pronouns (they/them). However, when you refer to a single alter, you're referring to a single person (he/him, she/her, etc.). This can get a little fuzzy 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 get the feeling that the person fronting doesn't want you to ask who they are, refrain from referring to them by pronouns, or use the pronouns for the host they may be masquerading as. However, if an alter tells you their pronouns, respect them.
This is a common question. You might default to asking who's fronting to try to be a good ally - thinking that knowing who 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 masking naturally, even if the ally doesn't know it. Even if they're out to you as a system, masking is a natural defense mechanism that systems have built up throughout their lives. For many alters, it's a more comfortable, easier, and safer feeling than unmasking. When someone asks who is masking, it can feel very unsafe. Having your disorder called out in this way can feel incredibly jarring and frightening. Remember that DID exists to be hidden! Having it brought into the light outside of the system's control can cause panic. In addition, if the alter who was fronting wanted to continue masking, you've now put them in the uncomfortable position of having to lie to you that they're not themselves.
For these and other reasons, don't ask this question until you've determined that the system is okay with it. Even if an alter loudly announces his presence every time he's 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's fronting is highly relevant, or the conversation is already about their disorder, it may be a more appropriate time to ask who's fronting, but only if you've first established that it's okay. Respect the boundaries of the system.)
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. However, DID often goes undetected by the person who has it until adulthood.
DID can be treated, but it's a lifelong condition. However, there are many ways to heal from DID, and many people with DID can live very functional and happy lives. See The Different Healing Goals for Systems
Yes. Alters can be of any age or gender. The mind creates alters during trauma when the brain is desperately trying to figure out 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 she was experiencing. 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 help with this communication. Some alters will communicate auditorily (hearing voices), some will speak out loud, some will write notes to each other, some will keep journals, some will share memories, and some will communicate through loved ones. There are many ways that alters find to communicate with each other. See DID/OSDD Survival Guide (System Communication Techniques) for more information.
No. However, part of what DID does is cover up trauma memories with amnesia. Not remembering a trauma is quite common for people with DID, especially early in their journey. However, DID cannot form without repeated trauma before the age of about 7-9 years.
No. Generally, the answer to any question that starts with "Do all systems" is "no". There is no "one size fits all". Systems are created in a child's mind and don't follow a set of rules. 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 may 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 in perspective, let's say a white writer decides he wants to write about the experience of being black in America. They want to do it as ethically as possible, and they ask a lot of questions to make sure they're doing it right. Is that okay? No. As a white person, you should not be writing about someone else's experience like that. You'll never fully understand what it means to be black in America.
But would it be wrong for them to include a black character in their story? Of course not. Could there be moments where issues of race come up where you consult people to make sure you're handling it ethically? Yes. But the whole point of the book shouldn't be to tell someone else's story.
If we replace that example with DID, it makes more sense, right? DID is fascinating to a lot of people and they want to write about it. Their hearts are in the right place - they see the media misrepresenting us and want to get it right. But it's not their story to tell. Many systems are capable of writing and creating their own art. Elevate 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 it. Recognizing that is the mark of a true ally.
The general understanding is that if a disorder is something that comes from life experience (PTSD, etc.), then singular alters can have that disorder without other alters having it. However, if the disorder comes from birth or genetics (autism, etc.), it will affect every alter in the system. However, it's important to recognize that each alter may handle the disorder differently, and the disorder may manifest itself completely differently. One alter's ADHD symptoms may seem much more "extreme" from the outside than another's, simply because of how they feel about it and how they deal with it.
Similar things can apply to allergies, diseases, accommodation needs (things like glasses, wheelchairs, canes), and more.
The person you know will probably have a fairly stable memory for everyday things, but you may notice severe amnesia when they switch. Amnesia may also occur for minor things or things related to trauma - but will the person you know randomly forget who you are? Almost certainly not. Just be prepared for them to switch, for someone else in their system to not know you, and to realize that they're not the same.
Questions from Dissociative Folk
DID can be treated, but it's a lifelong condition. However, there are many ways to heal from DID, and many people with DID can live very functional and happy lives. See The Different Healing Goals for Systems
You need to 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 right pace for the patient. If it is rushed, it can be harmful, so therapists need to be careful and well trained. Rushing trauma work can be very harmful, and this is something not only for the therapist to be aware of, but also for you - the client - to keep in mind as well.
As a client, it can be easy to get frustrated and feel like you're not making enough progress. Maybe you feel like you're not doing "well enough," maybe your therapist isn't working hard enough for or with you, maybe you're upset because therapy costs money and you want to see results, or maybe you just want to get better. It could be a combination of these or something unique to your situation. It is never a bad idea to think about these possibilities - it can be good to talk to your therapist about these concerns. Sit down and talk about how you feel you're not making the progress you want. They may see more progress than you do and be able to reflect that, or they may 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" is "no". There is no "one size fits all". Systems are created in a child's mind and don't follow a set of rules. 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. If you're not actively measuring your progress, it can be easy at times to feel like you've plateaued or that you're being vulnerable, spending money, and doing a lot of emotional labor for nothing. In reality, you're probably making a lot of progress; you're just not tracking it, so it's important to set up a system for doing so. Here are some ways to do this:
Set Goals: Setting goals with your therapist can help you know what you are trying to accomplish. Goals should be specific, measurable, attainable, and relevant. This will help you as well as your therapist. As you progress, you and your therapist can check in to see where you're at with your goals.
Feedback from your therapist: Ask your therapist for feedback. It's okay to ask them questions - it may feel scary or like 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 are and how you've progressed with their help. If they don't think you've made enough progress, perhaps other techniques need to be used, and this conversation could be a good starting point for a more productive treatment for you. Ultimately, the goal is for you to get the treatment that works best for you. Ask questions and get feedback.
Assess frequency and intensity of symptoms: Clients can rate the frequency and intensity of their symptoms. For example, if a client was experiencing daily flashbacks before therapy, but is experiencing only two flashbacks a week after 6 months, that's significant progress.
Journaling: Keeping a journal can help you 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 United States. The situation in your country may be different.
The cost of therapy can vary widely based on a number of factors (i.e., the therapist's credentials, the type of therapy, insurance, etc.). We'll go over a few different things to look for and different payment options that are often offered by therapists in your area:
Out-of-Pocket: If you choose to pay without insurance, therapy can often range from $50-250+ per session.
Insurance: Many health insurance plans cover mental health services. Check with your plan to see if therapy is covered, what your co-pay and deductible will be, and if you are limited to a certain number of sessions per year.
Sliding Scale: Many therapists offer sliding scale fees. This means that they will adjust their rate based on your income, making therapy more affordable for people with lower incomes.
Community Clinics/Nonprofits/Universities: Some organizations offer low-cost or free therapy services.
Employee Assistance Programs (EAPs): Your workplace may give you access to a certain number of free therapy sessions.
Online Therapy Platforms: Online therapy often has different pricing structures that can be more affordable than in-person therapy.
Having a therapist betray your trust in such a vulnerable situation is a terrible thing. If this has happened to you, we are sorry. It's very important, however, that you don't let this dissuade you from seeking professional help, or associate what one therapist did with what all therapists will be like.
It's okay if it takes you a long time to open up to a new therapist, and it's okay if it takes you a long time to trust them. When you start working together, you can tell them (if you feel comfortable doing so) that you've had a bad therapist-client relationship before that caused you to distrust therapists, and that it may take you some time to open up and trust them. Any good therapist will understand and respect this. Give yourself time to heal, but don't give yourself so much time that it turns into fear of returning to the work. Do virtual sessions if they're easier for you, and give yourself time - just don't let a bad therapist take away a massively valuable resource in your healing journey.
There are many reasons why your friends are not a substitute for therapy. Not only is it unfair to put this burden on your friends, but your friends are not your therapists. No matter how much they swear up and down that they want to be there for you and don't mind, they are not equipped to give certain advice. Not only can they often lead you down the wrong path or worsen your mentality about a situation, but their mental health can be negatively affected 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 to help you while taking care of themselves. It's an ethical way to talk about intense things and vent about your life on a regular and lengthy basis - with your friends it's not appropriate and can cause serious damage both mentally and to those friendships.
Also, in a therapist-client relationship, you don't have to worry about your therapist's feelings. Of course, they're still a person, and you can't ignore that, but they're there to help you with your problems, and they signed up (and get 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 what you say because you don't want to hurt their feelings or because you're worried about being judged. Therapists are trained to be understanding, and chances are they've heard 10000 times worse.
With friends, you may often get short-term advice (and thus short-term relief and gratification), but with therapists, you can chart a path of plans for how to work toward long-term goals, and thus make much more significant progress and a much more significant and positive impact on your life.
Complex PTSD (cPTSD) is a diagnosis in the ICD-11. However, it is a relatively new diagnosis to be officially recognized and does not appear in the DSM-5. This often leads to confusion as to whether it is an official diagnosis or more of a commonly accepted term in the community. However, it is a real diagnosis.
There are no medications for DID. However, there are medication options for comorbidities that are common in DID.
Please know that it is a normal experience to go through several therapists before finding the right one 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 fit.
Like any other professional relationship, the therapeutic relationship depends on a good fit between therapist and client. You need to feel comfortable and safe with your therapist in order to open up and work through your challenges and the things you want to work through with them. Sometimes it takes a few tries to find the right therapist with whom you can connect.
It's very important to remember that finding the right therapist is not a reflection of you or your ability to navigate therapy. Therapists are trained to work with a wide variety of clients, and 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 to 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 the first few sessions. This can help the therapist know if you're a good match. It is also important to trust your gut and pay attention to your feelings during and after each session.
Remember that therapy can be very valuable and transformative in your life. Also, when you work with a therapist, there are bound to be uncomfortable things that you'll talk about, so there is a degree to which you'll want to push yourself out of your comfort zone. As long as you don't feel any red flags that seem potentially harmful, try to stick with your therapist for at least a handful of sessions to see how things go, because sometimes pushing through discomfort is necessary. However, if you've really given a therapist your best shot and you just aren't clicking, it's okay to accept that a therapist isn't right for you and decide to find someone else.
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 results from witnessing or experiencing a single traumatic event. This could be something like a car accident, a natural disaster, a sexual assault, a wartime atrocity, or an act of violence.
CPTSD results from long-term, repeated trauma. CPTSD often develops in those who have been abused by someone in a caregiving or protective role, often 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 lead to CPTSD include (but aren't limited to) childhood neglect, ongoing/long-term physical, sexual, or emotional abuse, living in a war zone, or being a prisoner of war.
This answer reflects the situation in the United States.
A therapist is a licensed professional counselor. They help clients treat mental health symptoms and work on 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 will generally meet separately, but there should be communication between the two), with their therapist meetings occurring more regularly. In contrast, they will meet less frequently with their psychiatrist for medication reviews and prescriptions, diagnostic meetings, and more.
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