Dissociative Identity Disorder (DID)
Page Two
Over the course of treatment, Julie eventually identified 13 different alter personalities. Julie's experience is not uncommon for individuals with DID. Most people with DID have more than one alter, and some have reported up to 200 alter personalities! Usually, some of the alter personalities know about other alters, but only one alter (known in the psychology literature as the Internal Self Helper) knows about all the other alter personalities. This was true for Julie. She had some alters that knew about others, but only one knew about all the other alter personalities.
Though effective at protecting the child in the immediacy of a traumatic and emotionally horrible situation, dissociation obviously creates a false understanding of the world that generally crumbles years later as the brokenness and stresses of life continue into adulthood. Even after the abuse is over and the child is separated from the threatening situation, the dissociation and lack of communication between the personality states continues. Ultimately, individuals with DID often seek counseling, not for the DID itself but because of depression, memory loss, confusion, or distress over forgetting particular interactions with people. For Julie, it was feelings of sadness and abandonment after the loss of a meaningful adult relationship that initially brought her into counseling.
Causes
As you read this, you may be thinking of others you know who were terribly abused in their childhood years but never have had any symptoms of dissociation. Not every abused child becomes dissociative, just as not every smoker develops lung cancer. It appears there are five critical aspects, all of which must be in place, for DID to occur.
First, there must be severe trauma that is terribly upsetting to the child, typically in the form of repeated abuse. In fact, over 80 percent of people diagnosed with DID report experiences of childhood abuse, most often incestuous sexual abuse. With continued child abuse a pervasive distrust and a deep sense of shame emerges in the child. The memories and feelings surrounding the physical and sexual abuse that Julie experienced as a young child were the basis for her dissociation.
Second, there must be inadequate supports and comforts in the child's environment. Many children cope well with horrific childhood trauma because they have comforting and caring adults in their lives. The presence of support and care can be extremely meaningful to the wounded child, and it can also prevent more serious problems later on. In many abusive families, one parent may be actively abusive while the other parent is more supportive. For Julie, both parents were overtly physically and sexually abusive, thus destroying her ability to trust anyone or develop supportive relationships with adults of either gender. This lack of support from other adults in the middle of a traumatic home situation made Julie more vulnerable to DID.
 For Julie, both parents were overtly
physically and sexually abusive, thus
destroying her ability to trust anyone
or develop supportive relationships
with adults of either gender.
Third, this trauma must occur at a critical stage in the child's development. Most adults with DID were abused between the ages of three and five years, which suggests this is a critical developmental age when the child's traumatic experience can lead to a rigid compartmentalizing of certain memories and feelings.
Fourth, there must be some sort of experience later in life that evokes emotions that have been hidden in a split off personality state. For example, perhaps the DID adult is in a marriage relationship with a spouse who has some characteristics similar to an abusive parent. Being with the spouse evokes some of the old emotions—emotions that have been tucked away because they were too painful to tolerate. As these emotions are repeatedly evoked, despite efforts to suppress them, they are eventually manifested in the form of an alter personality. The loss of a relationship in Julie's adult life, and the abandonment and fear she felt with that loss, led to the emergence of the little girl alter personality of "Chris."
Fifth, there appears to be some personal disposition or propensity that makes some people more likely to dissociate than others. Just as some people are born with greater musical aptitude than others, some are born with a tendency to protect themselves by dissociation. When all of these factors occur in the same person, then DID is likely to result.
Prevalence
Dissociation and DID are not new phenomena. In fact, dissociation can be documented in Egyptian mythology as far back as 400 B.C. Clinical and popular interest in dissociation and DID has been on the rise for the past 20-30 years. However, clinical and popular interest in another area, false and repressed memories, has also been on the rise.
Because the treatment of DID involves bringing out memories that have been long split off from consciousness, it can be very difficult to differentiate between repressed memories that have been recovered and false memories that have been created in the context of a counseling relationship. Because of questions, fears and lawsuits regarding false and repressed memories, much is at stake in correctly diagnosing DID. Some counselors are so fearful of misdiagnosing DID and inadvertently causing their clients to create false memories that they actually avoid the diagnosis.
Assuming dissociation and DID are real phenomena, how frequently does DID occur? The nature of the disorder makes it difficult to know. Estimates vary widely, from 1 in 50 to 1 in 10,000 among North Americans. In one survey of 500 Christian counselors and 100 psychologists (not necessarily Christian), only two percent of the clients being seen were diagnosed with DID. Keep in mind that the overall prevalence of any psychological disorder will be much lower among the general population than among those seeking help for psychological problems. In sum, it appears that DID is rare.
Despite the fact that DID is rare, many people are familiar with it through representations in popular culture. DID has been popularized and sensationalized through movies like Sybil, The Three Faces of Eve, and Me, Myself and Irene. Unfortunately, DID is frequently confused in the media with the much more common psychotic disorder known as schizophrenia. For example, a recent film's central character suffered from DID, yet he was referred to as "schizo" in the movie.
 Continued on Page Three
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