by anonymous, reprinted with permission.
What are Signs of Dissociative Identity Disorder?
Or, how do I know if I have it?
I am going to take a crack at answering this question as a clinician with over 25 years of experience working in the mental health field. I am going to speak to this question from over 10 years of working with many forms of complex trauma directly. This is a long post to read, sorry, but DID is also a very complex form of trauma to explain, so bear with me.
To answer this question accurately it is important for people to know that trauma studies is a fairly recently evolving field. Trauma which people often think of as Post-Traumatic Stress Disorder is really not just this diagnosis but rather is seen by many clinicians on a spectrum. This is to say, there are minor symptoms of trauma, and very severe and complex symptoms of trauma of which dissociative identity disorder is the most severe underneath schizophrenia that has been induced by trauma.
Before I answer this question of, “what are the signs of dissociative identity disorder” very directly? Let us define trauma. Trauma is a single past event, or series of past events that continues to affect an individual’s behavior negatively for a long time after the event has passed. This is to say, that even if a person told themselves mentally that they had gotten past the specific event, there would still be certain negative behavior patterns that would continue to manifest as a result of the original experience. Addictions are a good example of this.
Truly if you had dissociative identity disorder, the chances that you would know it are very small. The signs and symptoms of dissociative identity disorder generally look like other kinds of disorders to therapists. When a therapist/clinician does an assessment they usually do not know how to screen for DID so often someone with DID looks like they have symptoms of either Borderline Personality Disorder (which is the most common misdiagnosis given by clinicians for those with DID), Post-Traumatic Stress Disorder, or Bipolar disorder.
The majority of clients that I see who could demonstrate over time that they have dissociative identity disorder usually do not come in for help for this problem specifically, but rather they come into my office seeking help for severe panic attacks, nightmares, depersonalization, and most specifically, the one sign that differentiates DID from all other disorders, time loss. So clients report that they have long periods of their day where they feel as if they are in a deep dream, or sometimes they do not even remember where they were for long periods.
If you believe you have dissociative identity disorder ask yourself the following questions:
1) Do you have difficulty controlling your emotions?
2) Do you ever feel angry and you don’t know why?
3) Do you have frequent Panic Attacks?
4) Do you have any physical ticks that you do when you get anxious?
5) Have you ever cut on yourself to get rid of emotional pain?
6) Do you take intense risks? Does the risk-taking ever involve sexual behavior?
7) Have you ever been diagnosed with ADHD/ADD?
8) Have you ever experienced Time Loss?
9) Have you ever had the feeling that you are not real or that other people in your life are not experiencing what is real?
10) Do you have nightmares? How often?
11) Do you ever experience a memory that is so strong it seems to swallow you, and you have to fight to keep yourself really in the present moment?
12) Have you ever felt that there is something really wrong with you as though you are fundamentally flawed?
13) Do you ever feel like you are totally alone? That you know one really understands you?
If you found that you have answered yes to at least eight of these questions, then you have posttraumatic stress disorder. If in addition to eight yes answers, you have answered yes to question 8 and question 9 then there is a very high probability that you have dissociative identity disorder. These questions are based upon the research of the world’s foremost expert on trauma, Dr. Bessel Van Der Kolk (The Body Keeps the Score, 2014). You could also say that anyone with dissociative identity disorder also has posttraumatic stress disorder.
If after answering the questions you feel that you might have Dissociative Identity Disorder, then you would need to also consider the following symptoms that I list below.
What follows below are the signs and symptoms of Dissociative Identity Disorder as defined in the Diagnostic and Statistical Manual of Mental Illness (DSM 5, 2015). I want to say that no person or psychologist can meet someone and accurately know everything about that person’s behavior in one to two hours, that is absurd. It takes time to really know someone; so when I work with clients I will assess over time for these symptoms, as there is no way that all of the following symptoms will manifest in one or two sessions. It takes many sessions over time to responsibly and accurately verify that an individual has such a serious level of trauma.
Dissociative Identity Disorder (300.14)
1) There is a disruption of identity characterized by two or more distinct personality states. This usually happens unconsciously. The disruption identity involves marked discontinuity in sense of self and sense of agency accompanied by related alterations in the persons affect, behavior, consciousness, memory, perception, cognition, and/or sensorimotor functioning.
When working with a client it is important that the clinician try to show the client the truth of this in a very simple way; The signs and symptoms that have been observed are recorded in a session after obtaining a written consent, so that both the client and I can hear and bear witness to alterations in disruptions and identity.
2) The client experiences reoccurring gaps in their recall of specific events, important personal information, and some traumatic events that are inconsistent with ordinary forgetting.
3) The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
4) The disturbance is not a normal part of a broadly accepted cultural or religious practice for the client.
5) The symptoms are not attributable to the physiological effects of a substance; the client has no history of blackouts or drug and alcohol abuse or other medical conditions such as; for example, head trauma or complex partial seizures.
Client manifests criterion A symptoms related to discontinuities of experience that are currently affecting the individuals functioning. Alters appear mostly in the context of intimate relationships, with family, with children, with friends.
Client manifests criterion B dissociative amnesia in three primary ways:
- demonstrates and reports gaps in remote memory of personal life events
- demonstrates and reports lapses and dependable memory
- demonstrates and has reported the discovery of evidence of their everyday actions and tasks that they do not recall are doing, I. E. Finding unexplained lists, objects, writings.
Dissociative amnesia is defined in the DSM 5, as an inability to recall important autobiographical information, usually of the traumatic or stressful nature, that is inconsistent with ordinary forgetting. It is important to note, that dissociative amnesia most often consists of localized or selective amnesia for a specific event or events; or generalized amnesia for identity and life history. A person who has dissociative amnesia also experiences significant distress or impairment in social occupational or other important areas of functioning. This diagnosis would only be true if the person was not using substances or had a neurological or serious medical condition, such as complex seizures, or traumatic brain injury that could better explain it.
A responsible clinician will of course, have assessed already for symptoms of bipolar disorder, major depressive disorder, psychotic disorder, and substance use disorder, as again, it takes time for both the client and the counselor to become conscious of this complex trauma.
I have worked nearly the entire gamut possible in the mental health field including state hospitals, federal prison, adolescent treatment, and adult inpatient and outpatient treatment. I started my career as a psychiatric nurse, worked many years in the field of addictions including; drugs, alcohol, gambling and sexual addiction, finally coming to work in private practice and as a workshop leader in helping people resolve traumatic reactions. I have a lot of compassion for those who struggle with trauma, nightmares, excessive worries, anxiety and panic attacks because I struggled myself with early childhood trauma and was able to work through it with the help of others.
I have found that the majority of people who struggle with addictions or dependency issues also have some had some form of traumatic experience whether or not they are fully conscious of it. And that is just the thing, just as the other writer on this forum says, Princess Leia Lucas, “because if you have it, you will probably have little or no conscious knowledge of it, and that’s exactly what saved your life “. So this is precisely what makes this particular disorder so controversial. The nature of this particular disorder is to use unconsciousness as a defense mechanism. It is to split your consciousness apart in order to cope with your trauma. In fact the DSM 5 does state, “that most individuals with non-possession form dissociative identity disorder do not overtly display their discontinuity of identity for long periods of time; only a small minority present a clinical attention with observable alternation of identities. When alternate personality states are not directly observed, the disorder can be identified by two clusters of symptoms: 1) sudden alterations or discontinuities in sense of self and sense of agency and 2) recurrent dissociative amnesias” (p.292). Putting this more simply, it is extremely rare that anyone would come into a therapist’s office manifesting symptoms like in the movie Sybil. It is almost as rare that anyone would manifest symptoms in the way we see Dissociative Identity Disorder portrayed in Hollywood movies.
I would like to finish with an example to explain what I just said above. Imagine that you are a six-year-old and every Sunday you spend with your grandfather who you love and have been spending time with as far back as you can remember. Every Sunday you go with your grandfather to the zoo. And you both have a great time at the zoo, it is your weekly ritual. Imagine also that it is part of this weekly ritual that grandpa has sex with you for a few hours after you come home from the zoo each week. Because just the thought of this action is so horrific, you may feel inside of you the resistance to even want to read further or imagine this. This is understandable. So if you were a six-year-old child you would not want to experience every Sunday the horror of your loving grandfather suddenly turning into a monster. There is a way to NOT experience this. The way is, that while he is starting his sexual ritual with you, you begin to imagine that you are somewhere else. You begin to imagine that you ARE someone else. That you are someone else in another place where this is not happening. You go away from your body and your mind into a kind of dream state similar to meditation that you create and reinforce week after week making it stronger and more believable. You may even begin to experiment with creating new sub personalities that are stronger and more powerful. But you build your imagination to the level of the most professional actor. Only… in this circumstance you forget that you’re an actor and you believe that you ARE the character. In fact you need to become lost in the character to survive the abuse. Eventually, you become lost in the character to the point that you no longer remember who you really are. You no longer recall your true nature.
It is the rediscovery of this true nature that is part of the process of recovery from trauma. It is awakening from the dream because you begin to realize that it was never just a dream but a nightmare that you had learned to live within. And now you realize that you no longer have to live within the nightmare. You deserve to have freedom from anxiety. You deserve to have serenity and be present for the experience of love.