Dissociative Identity Disorder: Treatment Perspective - Part 7

How does DID disrupt lives? The chronicity of a DID diagnosis, would normally determine the gravity of its interference in the normal lifestyle of the patient. The level of DID severity is measured by several psychiatric and psychological instruments in an initial diagnostic intake interview, that would also assess the client’s Global Assessment of Functioning. Hence, the treatment regime would invariably focus on alleviating the disruptive nature of the disorder, inclusive of the threat of a suicide attempt, if present. Here are a few stories of patients’ experiences of their disorder.

Catherine is a food technologist and a team leader in her department in a multinational corporation. The high stress level in her division meant that from time-to-time she would dissociate at work. There would be periods at her workplace she has no memory recall. This is an additional level of stress for her as teamwork is essential. When she gets home, she is mentally exhausted, and further dissociates herself by fugue trips during the early hours of the morning without her husband’s knowledge. (Fugues are periods when a person wanders away from home with no memory of who she is, and do not remember how they got there). On one occasion, one of her dissociated parts was planning a fugue suicide trip: by bringing an overdose of her medicine with her in the car. Thankfully, she woke-up from her fugue in time, after driving to her destination, in a remote part of Singapore.

Any disagreements between husband and wife or any major unforeseen family news would trigger Jane’s dissociative state. At times she would faint while she was shopping or marketing and would remain unconscious for 15 minutes or so. At times longer. She would also suddenly sit-up in bed at around midnight and berate her husband for his past indiscretions and mistakes. Occasionally, she would physically attack him. All her dissociative incidents remain outside of her conscious memory system.

Jonathan, in his 20s, would be watching television and when a violent scene was screened, he would dissociate. One of his alters would take over and be watching the rest of the TV programme. None of his family members were aware of these changeovers, but when they questioned him after the show on different incidents in the movie, he cannot recall viewing them. Similarly, this would recur when he was reading a story with brutal episodes or a description of savagery in the newspapers. To discuss any event with violent scenarios with Jonathan would become a frustrating affair for anyone.

Amanda would be discussing a class topic with friends at her college when a loud noise nearby or someone quarrelling in the distance would suddenly cause her to dissociate. When her friends call out to her as she walks away from her group, she does not hear them. It’s as though the part that surfaces do not recognize her friends. These episodes happen so regularly that Amanda’s friends had taken for granted that she was habitually in a rush to get somewhere rather than be talking with them.

Janet would be sitting quietly, with her husband next to her, in church, during a Sunday service. While preaching, the pastor raised his voice excitedly to make a point in his sermon over the microphone, Janet immediately dissociated. She screamed at the top of her voice followed by uncontrollable weeping, disrupting the service. This happened numerous times, and on each occasion, she would be led away from the service by a staff. After she had time to regain her composure and back to her normal self, she couldn’t recall her screams and tears nor what triggered her dissociation. But after each occasion, her reactions to her pastor’s occasional loud pronouncements deeply embarrassed her and her husband.

​The occurrence of individual triggers affect DID patients in numerous ways, and their regularity and severity in disabling normal thinking and memory processes would depend on whether the person is co-conscious or not with their respective alters or dissociative parts. When co-consciousness exists, a level of control can be learnt. Inversely, without co-consciousness with surfacing parts can be frustrating, and certainly disorientating and demeaning to one’s self-confidence and self-efficacy.