DID MYTHS AND MISCONCEPTIONS
Dissociative Identity Disorder is by far one of the least understood mental illnesses out there. It is enshrouded in misinformation, outdated coursework (for students and practicing clinicians alike), and a seemingly unending barrage of defamation attempts. The latter sounds ridiculous, but probably shouldn't come as too much of a surprise once you consider that DID is caused by longterm, recurrent trauma in childhood - most often abuse. There is ample motivation for entire organizations to want to squash its credibility or deny its existence, particularly when some of the founders of such organizations were accused of child sexual misconduct themselves. But, that is NO excuse. In fact, it's a massive reason why we exist at all and why we are so passionate about getting solid, credible information out there to everyone.
There will be no shortage of information here on what DID is not, coupled with clarifications on what it is, but let's at least provide a brief summary for those of you unfamiliar so that you can better follow along. DID is a dissociative trauma disorder in which a survivor has undergone longterm, repeated trauma in early childhood. This trauma, combined with other factors, results in a rather dramatic interruption of psychological development -- particularly as it pertains to identity. Through a process known as dissociation, this thwarted development results in "differentiated self-states" (also known as alters/parts) who may each think, act, and feel considerably different from one another. These parts of the mind - who may have their own name, age and personality - are able to take executive control of the body, leaving the survivor without any awareness for the time they were gone. These amnesic gaps in memory can be for just a few moments, a few days, or even entire chunks of one's childhood. The alters in a DID mind exist to help the survivor cope with deeply painful and unconscionable trauma, holding it outside their awareness to the best of their ability. However, often once the survivor begins to find safety and/or enter adulthood, this once supremely creative and protective mechanism can turn into a maladaptive trait causing real life consequences. Additionally, all of these experiences can be, and often are, happening alongside the symptoms of PTSD (eg. flashbacks, nightmares, hypervigilance, insomnia, etc), as well as symptoms of other co-occurring disorders commonly seen in trauma survivors.
So, now that you know a bit more about the basics of DID, LETS GO DEBUNK SOME MYTHS! Since this is a lengthy one, we divided them into three parts: myths the general public tends to believe, misconceptions that even those familiar with the condition still hold onto, annnnnd then some of the truly bonkers ;) Let's do this!
Part One: The General Public
✘ Myth: DID is very rare.
Not even close. Its yearly prevalence rate (~1.5%) is actually more common than young women with bulimia and even on par with well-known conditions like OCD. While it is very hard to gather statistics on a community of trauma survivors built on secrecy; who can be afraid to receive such a stigmatizing diagnosis, have or have had therapists untrained to recognize their condition, are riddled with amnesia (leading many to be unaware anything is even "wrong”), and whose self-preservation often includes intense denial of trauma — it's still inarguable that DID is anything but rare. It is a major mental health issue.
[Update: More studies on the prevalence of DID: x, x, x, x, x, x ]
✘ Myth: People with DID are dangerous, villainous killers or have alters who do extreme harm.
Contrary to popular belief, survivors with DID are no more dangerous than those with any other mental health condition or the general public. The crime rate, violent use of weapons, domestic disturbances, etc. are no greater than (and often less than) the general population. In fact, due to survivors' prolonged exposure to trauma and violence, it is far more common for those with DID to be re-victimized, on the receiving end of violence and/or abuse, than to perpetrate it. Many even take very staunch stances on pacifism after a lifetime of aggression and pain.
✘ Myth: DID isn’t real. It’s a condition created by therapists / exaggerated BPD / attention-seeking / actually HPD and compulsive lying / etc.
Research begs to differ. DID has distinct markers that separate it from all other disorders already in the DSM and it’s conclusive that DID results from longterm childhood trauma - nothing else. It’s the only condition that has such pronounced amnesic gaps ("missing time"), differentiated personality states, as well as exposure to extensive trauma; it did not just materialize from thin air or without solid precedent. Iatrogenic cases (“therapist created”) do not present the same as authentic DID and can be distinguished, just as malingerers and factitious presentations can be separated. (For more information on those: here.) More very valuable research here on DID validity: ✓, ✓, ✓, ✓, ✓.
As for the idea of it being “just attention-seeking”: It should be observed that ALL disorders, even physical illnesses, have groups of individuals who will pretend to have them. DID, however, has no higher rates of this than other conditions, and there is even a specific set of criteria that clinicians can use to confidently determine if someone is feigning the condition. But, primarily, there are far easier, more believable, more profitable, and more "rewarding" conditions to fake for attention (or to garner sympathy) than DID. DID is a condition riddled with stigma, vitriol, and people from all corners of the world eager to call you a liar, say it's not real, or (even if they do believe you) hurl a bunch of insults at you just for the complex trauma you've been through. This is not what most are looking for when it comes to cultivating sympathy or attention. While some do try, many tire very quickly once they realize how many small quirks and minor details about their alters they must be able to recall and maintain seamlessly, and most are not trained actors to manage this. Furthermore, there are even greater hurdles to clear for anyone trying to seek treatment or therapy for DID (as opposed to just claiming it in their personal lives or online) - so most do not.
We do not disbelieve the outright existence of eating disorders, cancer, or OCD merely because some people fake having them, do we? (...even though the rates of malingering or factitious disorders for those conditions are higher.) Why should DID be any different?
✘ Myth: If you have DID, you can’t know you have it. You don’t know about your alters or what happened to you.
While it is a common trait for host parts of a DID system to initially have no awareness of their trauma, or the inside chatterings of their mind, self-awareness is possible at any age. Once starting therapy, receiving a diagnosis, or becoming familiar with the condition, the entire path to healing relies on gaining access to all of that information, as well as establishing communication with parts inside. But, even without therapy, some can be aware of a few traumatic experiences, be able to recognize the signs of switching, or learn about themselves through old journal entries, photos, their wardrobe, reading old letters they don’t recall writing, and more.
✘ Myth: Switches in DID will be dramatic, obvious, detectable, or involving parts who want to wear different clothes/makeup, etc. / “If you really had DID, everyone would know it.”
*buzzer noise* False. Only a very, very small percentage of the DID population has an overt presentation of their alters or switches (5-6%). While some hints of detection can be seen amongst friends and therapists, most changes are passable as completely normal human behavior. DID is a disorder structured around concealment. Dramatic switches or changes in one's behavior or physical appearance would attract far too much attention, which could be dangerous for the survivor. Alters learn how to blend in, and many who do have considerably different personality traits, mannerisms, accents, etc., often try their VERY best to mirror the host's presentation.
For some, in the presence of loved ones or others “in the know”, some of these acts of concealment can fall away and their alters may feel more free to express themselves individually - but it still won’t be anything like what you’ve seen on TV. Child alters, however, are sometimes the most distinct when fronting in survivors who are very "adult". They've even been know to win over some the most stern of DID-doubters. But! This is one of the primary reasons that DID systems tend to keep these parts away from the front at all costs, especially in public settings. As for the act of switching itself, it can often look like an inconspicuous fluttering of the eyelids, a little muscle twitch or facial tic, or some other small movement of the body that looks like anyone repositioning themselves (or, y’know, just breathing). Switches can be detected if paying very close attention and while being aware of the condition, but it’s very, very rare for strangers or acquaintances to recognize one themselves. They’d sooner assume something else entirely.
✘ Myth: DID is a disorder of “multiple personalities”, and that is what's "wrong" with the person afflicted or is what makes it an illness.
Having separate identities is merely the byproduct of something greater, not the sole disorder. The real dysfunction lies in the complex trauma and the countless effects it had on the child’s mind and their neurology -- including flashbacks, nightmares, hypervigilance, dissociative amnesia ('losing time'), depersonalization/derealization, emotion dysregulation, somatic symptoms, and heightened vulnerability to a long list of other medical and mental health disorders. Most of the healing from DID revolves around the processing of traumatic memories and sifting through the layers and layers of pain, sadness, anger, betrayal, grief and trauma that each alter holds. Yes, therapy does also address the very unique, distinct challenges of having alters -- from how to get along with one another and work cohesively, to keeping the body safe when individual parts are struggling with self-harm, to how to keep child parts from popping forward whenever you pass the toy section at a store -- but DID is ultimately a trauma disorder, NOT a disorder of personality.
✘ Myth: DID happens because the mind is so traumatized that it splits into tons of alters. The mind just shatters into pieces under all the pressure of trauma.
This was a long-believed model for DID, and one still held by many therapists today who have not updated themselves with the current understanding of dissociation and identity development. The Theory of Structural Dissociation states that DID results from a failure to integrate into one identity, NOT a whole that breaks, shatters or splits. We have a more detailed (but also very “layman-friendly”) explanation here: You Did Not Shatter.
✘ Myth: DID can develop at any age.
DID only develops in early childhood, no later. Current research suggests before the ages of 6-9 (while other papers list even as early as age 4). Prolonged, repeated trauma later in life (particularly that which is at the sole control of another person, or breaks down a person’s psyche and self-perception) may result in Complex PTSD - which does have overlapping symptoms - but they will not develop DID.
It should be noted there are also other dissociative disorders, some that even mirror DID very closely (most notably OSDD and its subtypes), and age may be a very slight influencing factor in the lessened alter differentiation and/or amnesia experienced there. However, most with those presentations were quite young for their trauma as well. There are also many reasons that one may present more as an OSDD-type system instead of a DID system, but they’re a conversation for another day! Understanding DID is tough enough for most! Still, many of these myths will also apply to many of the symptoms, systems and experiences of OSDD survivors, too.
✘ Myth: Survivors with DID can just switch on demand if needed for a task or if someone simply asks for them.
Plainly put, this is just not possible. Sure, for some there are absolutely moments where they can call upon specific alters for certain tasks, but there are no guarantees or absolutes (and, for any number of reasons). When it comes to outsiders trying to call upon parts, this could range anywhere from "sometimes possible" (particularly in therapy or in extremely safe relationships where that boundary has been established beforehand), to "hit-or-miss" (dependent on the person, their intent, the state of things inside, being triggered forward but not actually wanting to be there, and so forth), to "never" (it’s either completely inappropriate and uncalled for, it's unsafe, they have a highly protective reason for staying inside, they can’t even hear you, they don't know how to come forward on their own, or some other very important reason). Survivors with DID are not a magic trick.
NOTE: DO NOT TRY TO CALL PARTS FORWARD UNLESS YOU ARE A TRAINED PROFESSIONAL OR HAVE THE SYSTEM’S IMPLICIT PERMISSION TO DO SO IN NECESSARY SITUATIONS.
To not obey this is a serious violation of psychological and emotional boundaries.
✘ Myth: Communication with alters happens by seeing them outside of you and talking with them just like regular people -- a hallucination. (We can thank The United States of Tara for this one.)
Nope, not so much. While there are exceptions, this is a very rare, inefficient, and an extremely conspicuous means of communication. It also relies on a visual hallucination, which is typically a psychotic symptom that most with DID do not have. However, it IS a possibility, and some do experience this; but it's mainly the result of extreme dissociation combined with mental visualization that feels incredibly real on the outside (as opposed to a true external hallucination of an alter).
For most survivors with DID, "seeing" and speaking to their alters happens internally - inside the mind - often including a landscape called an "internal world". Communication may happen through passively-influenced thoughts, face-to-face (in each other's respective bodies, via the internal world), or through “voice” communication heard in the mind. This is why DID diagnoses can get so commonly mixed up with schizophrenia; these discussions and differently 'voiced' thoughts can seem like “hearing voices”, particularly if you don't know what an auditory hallucination would sound like or have better language to describe your experience. But, in DID, these voices and conversations are not actual auditory hallucinations (again, barring very rare exception). They are more like very “loud” versions of one’s own thoughts (versus, say, hearing the radio or a tea cup talking, or voices of those whom you know do NOT belong to you or share your life story). Alter communication is very much a part of you and stems from somewhere in your conscious mind - even if the thoughts, ideas, and tones are considerably different from your own inner monologue.
Other frequent means of communication are things like: journaling, art, post-it notes, non-dominant hand writing, pictures; and, now more commonly, things like online blogging, social media, voice recordings, videos, and more.
✘ Myth: Parts in a DID system are all just variations of the host at different traumatized ages of their life.
Nope. Parts can be any age, gender, or personality type. They can have entirely different outlooks on the world, faiths, sexual orientations, political views, etc. Many are even associated with no specific trauma at all but still have a very important and necessary role inside the mind. Alters are NOT merely “frozen” or “stunted” aspects of the host, marked by when a trauma took place. (Not to mention that trauma 'took place' every single day, for a lot of years, for a lot of people). This can be the case for some - and their parts’ names may even all be similar or variations of the survivor’s name - but even they typically show great variation from what the survivor was actually like at those ages.
Personality differentiation is a hallmark of the condition. Without it, it's not DID.
✘ Myth: Because 'x' person lied about having DID, they’re probably all lying.
Generalizations have never gotten us anywhere in life. Do some people lie about having DID? Yep. Do some ignorantly use it as a crutch to try and excuse bad behavior? Sure do. Does that mean the millions who are struggling every day just to go on after an entire childhood of trauma -- who are fighting an uphill battle of perseverance to overcome sky-high suicide rates, while warring against heartless stigma and lack of access to basic care -- they're just all lying? No, no annnd no. Does it instead make the people who lied the ones we should be shaming? ..the terrible jerks who appropriated someone else’s suffering for their own gain? Definitely.
✘ Myth: People with DID will inevitably cheat on you/be unfaithful because their parts will just go be with someone else.
I know it’s hard for many to believe, but everyone is different. What one person does, their system does, or television leads you to believe is inevitable will not apply to everyone. Many exist in highly exclusive, monogamous relationships and are instead the ones living in fear of being cheated on, becoming inadequate, burdensome, or dissatisfactory to their partners; and, too often, they are the ones who are left. DID survivors tend to be more concerned with simply finding a healthy, non-abusive, communicative relationship than to "go wild" with the "promiscuous alters" (but more on them later). Flippantly suggesting otherwise is degrading.
✘ Myth: You can treat DID with medication.
There are zero medications to treat DID. There are, however, medications that can be helpful in managing some of the symptoms of PTSD or other comorbid conditions. Medications to calm extreme anxiety, alleviate depression, lessen nightmares, stabilize mood, help with compulsions, quell severe insomnia, etc. can all be helpful at various points in a survivor’s treatment. But nothing exists to help the symptoms associated with DID, and many can even make them much worse. Be extremely wary of anyone suggesting they can help with your dissociative symptoms or switching through a medication or infusion regimen. They are most likely misinformed, but may also be lying to you or seeking to cause you harm.
✘ Myth: Integration is a “must”, or is everyone’s goal in therapy.
Callback to our theme: everyone is different. Complete integration into a single, individualized identity - also known as final fusion - is the goal for some. But it is not, and does not have to be, for everyone. It is possible to achieve full healing by processing memories, establishing communication across the whole mind, lowering dissociative barriers, and increasing aptitude by everyone working toward a common goal - all without experiencing the fusion of any parts at all. Some may choose to integrate a few alters or aspects of self with one another or themselves - or "downsize" - but still leave a small system to go about their lives. Others may begin the process, discover it’s truly not for them, and separate again - either spontaneously or with intention. There are many, many reasons why someone may choose any of the above. But becoming singular is NOT a must, and anyone insisting that it is or refuses to accept your decision to remain distinct identities, does not have your best interests in mind and heart.
✘ Myth: Folks with DID are incapable of being successful or living normal lives. They’re dependent on the system and just cycle in and out of hospitals unable to do things for themselves.
Absolutely false. While success is defined differently by everyone, there are survivors with DID doing extraordinary things - all at varying levels of function, system size, memory integration, and therapeutic care as they’re doing them, We have folks who are CEOs of million dollar companies, professional athletes, high-ranking members of government, leaders of prestigious non-profits, as well as trauma surgeons, lawyers, military servicemen, professional actors, entrepreneurs, college professors, and even therapists — all with dissociative identity disorder. We know many with PhDs, masters degrees, small businesses, and brilliant technology patents. For some, their DID helped them succeed, with different system members able to take on separate tasks, memorize notes, rotate sleep schedules, or offer new creative solutions;. Others found it an obstacle, but more because of how they were treated or inhibited by those around them. While some found success after reaching a place of more complete stability, others were still in therapy twice a week, wrestling with difficult flashbacks and alter switches, but still excelled nonetheless and were content with their choice to do so at that time.
But, more importantly, success isn’t required, nor necessary for anyone with DID. And there is nothing wrong nor shameful about requiring assistance or needing hospitalization. For many, after a life of such severe, chronic, and painful trauma; followed by a litany of symptoms, stigma, treatment, disbelief, and endless barriers to accessing the same life everyone else was awarded — a boring life is the goal. That is the success. No adventure, no high-stakes, no demands, no chaos. Just peace. Just average. A mundane, quiet, unremarkable life, in harmony with their communities and mind, can be the richest reward for so many. But, what each individual person wants for their life, or has fought tirelessly hard for, says nothing about what the broader collective of DID survivors are, or should be, capable of. Having DID is not what will influence a survivor’s success, lack of safety, support and resources is.
