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ELI5 - How exactly does Dissociative Identity Disorder work?
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Like how does your brain have so many different identities (or “alters,” I’ve seen used on certain websites) that don’t remember what happened when the other identities were in control? How does the brain have such different mannerisms and ways of thinking for the different alters? How does DID even form in the brain?
I’ve tried to look this up, but every time I do it takes me to all these medical websites that have the most complicated explanations.
Top Comment: First and foremost, know that DID is probably the most poorly represented psychological disorder in movies and television. It's usually overdramatized, glamorized, and usually written from a place of needing a convenient plot device rather than a place of genuine understanding. So forget what you've seen on the screen. To understand DID, you first have to understand the concept of dissociation. I'm simplifying here, but at its core, dissociation is a coping mechanism for trauma, whereby the conscious mind decouples from feelings it can't handle as a form of self-protection. Like a psychological circuit breaker. It can range from a mild emotional detachment to a complete decoupling from reality. Dissociation can happen at the time of trauma, or it can happen after the fact. Trauma leaves behind a complex cocktail of emotions that can come in overwhelming waves, and sometimes all the mind can do to withstand it is to detach. Often when someone dissociates, it doesn't look like anything. The person can "space out", develop a flat affect, move about on autopilot, or write a really long post on Reddit. Their memory of the time spent dissociating can be partial, or missing entirely. Some of this memory loss comes from the lack of awareness that comes with the detachment (you don't remember what you don't notice, or your fight-or-flight brain disregards as unimportant), and some of it comes from repression. The mind puts those memories behind the same psychological barriers as the trauma. DID is an extreme form of dissociation, specifically affecting victims of childhood trauma. It develops over time, and is often exacerbated by underdeveloped coping strategies and/or mismanaged care. In order to deal with the core trauma, and the recurring triggers, the mind not only detaches from these stresses, but also compartmentalizes them into more manageable segments, and develops a caretaker persona for those feelings. In the absence of a clear understanding of how to address overwhelming feelings, the person constructs someone to handle them instead. The person is often not even aware this is happening as it's happening, because it's usually happening unconsciously, and during dissociative episodes. When a person's alter takes over, that's them dissociating. But instead of "spacing out", they're allowing a constructed identity to manage the situation and/or their internal emotions. Becoming someone else is not only an extremely effective form of detachment, but adopting a persona also gives the mind something else to focus on. But it's important to remember that they're all the same person. They don't have different sets of memories in different sections of the brain, so much as some memories are repressed as a byproduct of the dissociation. With the right therapy and/or medication, a lot of these memories can eventually be recovered by the primary. Source: Grew up with someone who had DID, and had a lot of therapy for PTSD myself.
Dissociative Identity Disorder
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I’ve seen more clients lately coming to intake stating that they think they have DID.
Recently I’ve encountered: the appearance of twitching between stated changes in personalities, dropping things during stated changes, staring off into space and then suddenly becoming present again, presenting as asking questions with one personality, receiving an answer back. Then relaying the answer to me.
Have ya’ll noticed an uptick in clients stating they think they have DID?
Top Comment: honestly I fucking love these patients. Not a therapist but psych np here. I let them tell me their whole “lore” and I accept it without pushback or skepticism. Let it all spill out baby. And after 2-3 sessions, the lore and different personalities usually just... quietly go by the wayside. And we get down to business with med and therapy goals. I’ve learned so much with this kind of situation is the fact that they’ve been invalidated their whole lives. It’s almost a challenge at first “will this provider listen and accept me or will they judge and dismiss me?!” And so by being a receptive listener, they start feeling more security and we get into the ptsd and social anxiety or whatever else. I don’t really care if people get their ideas from social media. Its all contagious, whether it’s online or not. Let somebody develop their sense of self that makes sense to them and then we can move forward with the treatment for whatever else is brewing in that brain before the Instagram diagnosis made sense
Can I have a normal life with dissociative identity disorder (DID)? Do you take/recommend meds?
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To keep it short, I am pretty sure I have dissociative indemnity disorder (DID) and am starting to use IFS as therapy.
My parts come out intensely with emotions and thoughts, and sometimes a voice out of my mouth, body movements and facial expressions. I am aware the entire time and am observing.
I was prescribed low dose zoloft and no diagnosis yet besides acute stress disorder but my doctor doesn’t know everything I’m going through yet since it recently started.
Please tell me about how you life a “normal” life with these parts? How did it take to get that point and are you on medicine?
I’m scared of an antipsychotic blocking these parts and thus the healing process. But I’m also freaked out and am considering meds.
Top Comment: For starters, yes you can live a “normal” life with DID. For us, we go to school, hold a regular job, have loved ones, friends, and family. We put a lot of effort into working as a team. We take antidepressants, but also regularly exercise and try to eat healthy. Unfortunately, there remains a lot of stigma, so we’re pretty choosy in who we tell. There isn’t any medication to treat DID. You can treat comorbid conditions that present alongside it, such as depression or anxiety; but for dissociation treatment you’ll want psychotherapy. I understand the fear with antipsychotics, they come with major side effect profiles, and they’ve been reported to stifle in-system communication. That being said, anecdotally I’ve heard systems can reestablish a connection after an adjustment period. If you have concerns about medication, please talk with your prescriber.
I am diagnosed with Dissociative Identity Disorder. AMA.
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You've probably heard of it as Multiple Personality Disorder. I've dealt with this since as long as I can remember.
I'd really like to clear a lot of things up with mental illness as it is a large part of my life. It seems the media enjoys making it a lot of things it's not, which causes confusion. So, AMA. :) I can't tell you the mechanics of it really, I'm not a doctor. But I can tell you anything about my personal experience with it. :) For those of you who don't know what DID is, here's a wiki link for a quick reference... http://en.wikipedia.org/wiki/Dissociative_identity_disorder I'd also love to hear from anyone one else diagnosed with DID. I felt really alone for a long time and it'd be nice to meet someone who has dealt with it as well. Yeah, this is a throwaway account. I guess I just don't want my family to feel bad, as they were not very supportive in this and I'm going to be honest about it.
Edit: Why the downvotes? If it's not that interesting, I'm fine with that... But just wondering if there are other reasons? I know there's controversy about whether or not this is real, so maybe it's that? Someone want to shed some light on that? I'm also obviously not karma whoring. This is a throwaway account... So just curious. lol
Top Comment: I have been diagnosed with DID! I have had symptoms since 13. Because of abuse when I was young, I have virtually no memories of my life before 13. Do your parts talk to each other? I run a forum for all psych disorders and people tell me how their parts can talk to each other. Mine don't, though, I just totally black out and have no communication whatsoever between parts (except for a single alter who knows she's an alter, but she comes out like once a year).
Question- What signs you realize you had a dissociative disorder/are a system?
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I've been getting a lot of info from my two friends who both have dissociative disorders but not full-blown DID and between what they've told me and things my therapist has told me I'm starting to question if I have a dissociative disorder and if I should bring it up in therapy.
I do neurofeedback therapy once a week and my therapist was really surprised I wasn't much more visibly anxious until she looked at my brainwaves first session and told me I'm basically functioning by dissociating a lot the vast majority of the time. My memory is extremely shoddy, especially if I've switched functions for the day (ex. At work vs. When I get home and see friends vs. When I see family). I describe myself as having different "modes" for functioning. I may be in "caretaker" mode when dealing with animals at my job or caring for a sick person, "child" mode when feeling especially safe or if triggered in a specific manner, "organizer/planner" mode, "rage" mode, etc. And I sometimes get stuck in these modes outside their appropriate contexts. Sometimes I can't activate them when I need them too. I often find myself holding conflicting opinions on the same subject or viewing myself differently depending on what "mode" I'm in at the time. I might respond differently to similar situations depending on current mode (ex. Caretaker is exceedingly patient even when legitimately hurt but rage mode me is unsympathetic and easily angered by small things- caretaker will respond to being bitten by a dog at work calmly and quietly but rager will get insulted and angry). I dont quite know how to describe it, but its more than just a mood. Its closer to like a framework i get into and cant gurantee i can willingly put down. My mind feels fragmented and has since I was about 14. I don't think I have full-blown DID because I'm very aware this is happening, most other people dont seem to have noticed (a couple have), and I don't often have complete dissociative blackouts longer than 20mins, but I do very often have to logically build a timeline (this must have happened after that bc I was doing xyz after that) and "look for clues" to piece details of my memory together. I took the dissociative symptoms Inventory and scored within range for a dissociative disorder.
I hope this all makes enough sense and I apologize for the long post, but do these experiences match up?
Top Comment: with the symptoms you described, i’d definitely see about getting tested by a dissociative disorder specialist specifically (unfortunately not a lot of therapists or psychiatrists are well educated in DID). i’m diagnosed with DID and experience the same symptoms you do, including the ones you think disqualify you from having “full blown DID”. it’s a lot more common than you think for people with DID to be aware and to not have full black outs. it’s also very possible to have severe dissociation symptoms without the dissociative identity disorder. all that said, it’s worth getting tested. you won’t know until you do
Lost my petals, what happened, reddit?? (advice)
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Hello MTB world, this is my second day mountain biking, and thought I would try some progressive drops. I tried to keep my pedals flat (equal), but ended up losing them on this drop. Thankfully it was not as painful as it looks. It still does make me laugh to watch, though! Any advice? Let's hear it!
Top Comment: Are you a flower?
Diagnosing dissociative identity disorder
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So I'm a relatively new therapist though I've worked in mental health for a long time. One thing that I realized is that I'm uncomfortable with the DID diagnosis. It's the only diagnosis I'm uncomfortable making myself. I understand that it exists, and I don't doubt that. But how can I tell the difference between an actual case of DID in someone versus general dissociative-like coping mechanisms? Especially in young people (like 14-20ish).
I ask this because I have encountered this three times now where clients will say "oh I have other people in me" or "I black out and become a different person". And I have no idea what to tell them. I don't want to invalidate their lived experiences but at the same time DID seems like it's not the right call. They usually come to me with this after having Googled what is going on and already have come to the conclusion that's what it is.
Has anyone experienced this sort of issue? Does anyone happen to have experience themselves with DID? I will also talk with the office clinical supervisor during our next meeting.
Top Comment: I would start by trying to get clarification of what these experiences are like. The DES can help parse it out a bit?
How to tell if you actually have alters or if you are just faking it?
Main Post: How to tell if you actually have alters or if you are just faking it?
Top Comment: Hey there! This is probably going to be a very long essay of a comment so strap in (and preemptive apologies, lol, this is a pretty nuanced topic). Generally when people worry about faking DID/OSDD-1/P-DID, they can either worry they’re directly faking it (factitious disorder or malingering), are worried about mistaking another disorder for it, or are worried about imitative/sociogenic DID. I’ll try to cover all three of those here, in that order. To start with: factitious disorder or malingering. Both of these are easy to cover as there’s actually a pretty length set of descriptions in the DSM 5 TR’s DID entry, under the ‘differential diagnosis’ list (this list will come in handy later for the second in my list of three). Factitious disorder is a condition where someone either pretends to be sick or deliberately makes themselves sick, generally for attention. This usually has roots in trauma - perhaps they had neglectful parents who only paid attention to them while they were sick, or perhaps they were a ‘glass child’ with a sick relative who got all the attention and they got none, etc. Basically, if one does have factitious disorder, it’s not just ‘faker disorder’ - it means they have serious underlying issues that also should be addressed in therapy. Here is the description of how factitious disorder typically manifests with DID (I know this is r/OSDD , but OSDD-1’s DSM 5 entry is... one whole sentence, lol, so you usually have to refer to DID’s entry - they are extremely similar conditions, after all): Individuals who feign dissociative identity disorder usually do not report the subtle symptoms of intrusion characteristic of the disorder; instead they tend to overreport media-based symptoms of the disorder, such as dramatic dissociative amnesia and melodramatic switching behaviors, while underreporting less-publicized comorbid symptoms, such as depression. Individuals who feign dissociative identity disorder tend to be relatively undisturbed by or may even seem to enjoy "having" the disorder, or may ask clinicians to "find" traumatic memories. In contrast, most individuals with genuine dissociative identity disorder are ashamed of and overwhelmed by their symptoms, deny the diagnosis, underreport their symptoms, and display minimization and avoidance of their trauma history. Malingering is when someone fakes a disorder for some kind of gain - perhaps financially, or to excuse their actions (in the case of them being in trouble with a partner, or perhaps they commited a crime, etc) Here is what the entry says for DID and malingering: Individuals who feign the symptoms of dissociative identity disorder usually create limited, stereotyped alternate identities, with feigned amnesia related only to the events for which gain is sought, with apparent switching behaviors and amnesia only displayed while being observed. They may present an "all-good" identity and an "all-bad" identity in hopes of gaining exculpation for a crime. Okay, now that those are covered, the next one is ‘am I mistaking the symptoms of something else for DID/OSDD-1/P-DID.’ This one is... difficult to answer on your own. You really ought to consult a professional in general with these disorders, but especially in this case. DID is a notoriously covert condition that is difficult for even professionals to spot at times, let alone a layperson who doesn’t have the same training and education that a good professional would have. ISSTD’s treatment guidelines for treating adults with DID: Instead of showing visibly distinct alternate identities, the typical DID patient presents a polysymptomatic mixture of dissociative and posttraumatic stress disorder (PTSD) symptoms that are embedded in a matrix of ostensibly non-trauma-related symptoms (e.g., depression, panic attacks, substance abuse, somatoform symptoms, eating-disordered symptoms). The prominence of these latter, highly familiar symptoms often leads clinicians to diagnose only these comorbid conditions. As a result, DID has a pretty lengthy list of potential differential diagnoses that a professional usually has to rule out in some form or another during the diagnostic process. I’ll go ahead and list it below (from the same DSM 5 TR pdf I linked above): Dissociative amnesia, Depersonalization/derealization disorder, Major depressive disorder, Bipolar disorders, Posttraumstic stress disorder, Schizophrenia and other psychotic disorders, Substance/medication-induced disorders, Personality disorders, Posttraumatic amnesia due to brain injury, Functional neurological symptom disorder (conversion disorder), and Factitious disorder and malingering My best advice to you on this front is to seek a professional’s help whenever possible for you (I understand that may not always be immediately accessible). The last thing I mentioned: Imitative/sociogenic DID. If this in particular is what you’re worried about, then I have some specific advice for you. If you’re in online communities relating to DID/OSDD-1/P-DID, or follow accounts on social media related to it, or consume any other content relating to it, and you’re worried about imitative DID, then my advice is to disconnect from these communities, unfollow (or mute) these accounts, and stop consuming dissociative disorder related content for a few weeks/maybe even a couple of months. That may sound intensely difficult to you, especially if you have friends in these spaces, but it’s important for you to disconnect from anything relating to system stuff if you suspect you have imitative DID. By stepping back from it for long enough, it will help you get a clearer image on whether or not your symptoms are sociogenic in nature or not. If they persist even after stepping back for a few months, then that’s something to take note of. If it is imitative DID, it’s likely to stop after a certain point if you quit engaging in content or communities related to it. It’s also important to remember that these spaces can also cause a type of imitative DID symptoms in people who do actually end up having DID - as in, a lot of them can be quite unhealthy and promote practices that could cause someone with DID to misinterpret their own symptoms (I.e, mistaking maladaptive daydreams for actual dissociated parts). To cap all of this off: my biggest piece of advice to you (and anyone else with similar concerns) is to seek out a professional whenever possible for you. With how complex and covert dissociative disorders can be, it’s near impossible to properly sort this out on your own. And you’ll need a good therapist eventually anyways if you do have it.