We continue on a review of the symptomatology of dissociative identity disorder. Pseudonyms have been used for names.

​On several occasions, Wendy’s friends had encountered her, either in her college or at church, and had called her by name as they passed each other, but she would look right past them, not responding at all. When they had mentioned these incidents to her, she could not recall them and denied that she was ever present at that location, at the time.  Wendy has vague memories of a part of her that possessed an extraordinary creative ability, that had won her several artistic awards. Sometimes, she would be surprised how she had won a prize, or who did those drawings. She hears voices talking among themselves in her head, but assumed that it was all part of a normal thinking process with everyone. 

June had suicidal ideation. Once a month, in the early hours of the morning, while in a fugue state, she would drive her husband’s car out of the garage, for a couple of hours. Her husband, never discovered her absences.  She would ‘wake up’ and find herself at deserted spots, with all her medication next to her and a bottle of water. Shocked and crying,  she wandered how she got there and why she had brought her medicine with her.  It is not uncommon that during periods of unusual stress, a suicidal alter would take control and initiate an attempted suicide. 

Angie had been suffering from anorexia nervosa for several years. During a counselling session, an alter surfaced. She was fully aware that a part of her personality state had come out, beyond her control. It was the alter’s unexpected first appearance, and it distressed Angie. This was followed by an orientation of her dissociative state, and a further exploration of how it related to her eating disorder.

Alice just wanted to talk! All outward appearances indicated that she is a normal person. However, she had a niggling sensation that at times she cannot recall where she had been to or what she had done. No one had noticed her ‘forgetful’ memory. During her second interview, as we were chit-chatting about her early teen years, she suddenly stumbled over her words, and was seized with a fear that was abnormal. Her eyes looked past me, and when I enquired what was happening to her, she froze. She tried getting off her chair, but was unable to do so; seemingly riveted to the armchair. Within a minute or two, she was back to her normal self. But she had no memory of what took place earlier.

Hilary would be playing ‘hide and seek’ in a counselling session whenever a specific person’s name was mentioned. It appears that the name would trigger an alter to come forward, and she would dash behind a chair or sofa in fear. She’s not co-conscious with this particular personality state. 

“I have full control over Joy, and I get her to do anything I want. I know that Joy is a Christian now, but I am a Buddhist. I have no problems over her religion. I beat her husband because he called me a demon whenever I surface.” This may be typical of the language used by a violent personality state. To  surreptitiously conclude that such an alter is demonic, would be a huge mistake.  A demonic entity can be exorcised, but an alter cannot be cast out as it is part of the person’s memory system! There are other distinguishing differences between light and darkness in a dissociative person. I shall share more of that in another blog post.

In the mental health profession, the diagnostic criterion for each disorder is clearly defined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). This is to provide practitioners with a reliable guide for diagnostic judgments to some of the most complex cases in the cognitive, behavioral and emotional realm. Usually, an introductory interview with the client may tentatively surface some of these criteria, but in most cases, these explorative sessions will likely lead toward more detailed investigative procedures for diagnostic clarity, followed by an appropriate treatment strategy. 

​In this article, due to privacy issues, I shall only review some of the symptomatology as interviews and treatment unfolded with a few of my previous clientele. Pseudonyms have been used for names.

The commencement of my first identified case of dissociative identity disorder (DID) was rather uneventful as the client’s initial presenting issues were constant occurrences of violent partner relational tensions and recurrent fainting spells. She was on medication for schizophrenia, an anxiety disorder, depression, insomnia, high blood pressure, and diabetes. At the second session, this 60+ years old lady suddenly induced a trance state that alerted my immediate suspicion as to how involved the case was going to be. Conversations with that personality state tended to be in the third person, while the individual had no memory of what had transpired after being brought back to consciousness. This meant that the person was not co-conscious with at least the first alter that surfaced. Eventually, she had over 20 alters. 

In another case, the young lady, Jane, had been in supportive treatment for over two years for schizophrenia and an anxiety disorder.  In one of these sessions, she lowered her head, and with her hand, reassembled her hair to cover her face. Then, one of her alters instantaneously surfaced, speaking in a childlike voice, and calling herself by a different name. She announced that she had been observing the treatment sessions all this time and is now ready to trust me. Jane had no recollection of this conversation with her alter when she came out of her trance state.

The young man seated before me was polite, and apparently, self-controlled. It was an initial interview for his dysthymia treatment, a persistent depressive disorder. We were exploring his childhood background, and I casually requested some information on his relationship with his father. He looked sideways, tilted his head to one side, and immediately jumped out of his chair, screamed at me, waving his arms threateningly. Taken aback, I sought to calm him. John had no memory of the altercation. 

S​he was in her mid-thirties, referred by her aunt, with whom she was staying with. She noticed that her niece, Mary, would be sitting by herself staring into the air for hours at a stretch. Once or twice a week, after midnight, she got into her aunt’s car and drove around for an hour or two. On a couple of occasions, her aunt caught Mary returning to the house after her driving trips, walking right past her, ignoring her, despite her name being called. Mary had no recollection of her fugue state; nor where she had driven to or for how long she was away from the house.  A dissociative fugue is a temporary state where a person has amnesia and ends up walking or travelling to an unexpected place. People with this symptom can't remember who they are or details about their past.