A closer look at dissociative identity disorder

In another article I told you about dissociative disorders, and today we’re going to explore them a little further, specifically the one I find most interesting: dissociative identity disorder (DID). To understand this disorder, we need to start from the idea of vertical dissociation. And what is that?

• Horizontal dissociation is the kind that separates conscious from unconscious information. Examples include dissociative amnesia, derealisation and depersonalisation. In this type of dissociation the patient is less aware of their surroundings or of themselves.

• So-called vertical dissociation divides the conscious part into several states; that is, our (conscious) identity fragments into several identities (the critical one, the aggressive one, the caring one, the efficient one…). When talking about DID, this is the type of dissociation we need to bear in mind.

When we feel threatened, the immediate physiological response is fight or flight. However, if we can’t carry out either of these responses, our mind can come up with an alternative: splitting consciousness to escape mentally from the present moment. It’s as if your mind pressed the “off” button, disconnecting from the traumatic moment that’s taking place. If that traumatic moment happens repeatedly (sexual abuse, for example) at an early age, when few cognitive resources are available, this “disconnection” (dissociation) can become automatic, one more way of escaping moments experienced as stressful.

DID is associated with disorganised attachment in childhood. This means that the authority figure or figures (father, mother, grandparents…) are a source of both fear and comfort at the same time, which leaves the child feeling trapped because they can’t ask for help. As a result, a child who goes through traumatic situations and experiences disorganised attachment at home may split their identity into several incompatible identities (vertical dissociation) as a way of escaping their fears and anxieties. It’s important to bear in mind that we’re not talking about several identities per se, but rather a single one that has split into several. And each of these parts has its own memory, language, behaviours, expressions…

Many experts suggest that the younger the child at the time of the trauma and the more often it happens, the greater the fragmentation of the personality, that is, the more severe the DID the person will develop. However, there’s a wide range of possibilities in terms of the severity and symptoms of this disorder. Some of the most common symptoms are the ones I describe below:

• Dissociative crises
• Fixed ideas
• Auditory hallucinations
• Apathy
• Abulia (lack of will)
• Lack of emotions
• Partial or total anaesthesia (loss of sensation)
• Analgesia
• Loss of motor control
• Intrusive thoughts
• Actions outside voluntary control
• Loss of functions (voice, sight…)

In the articles on the symptoms of DID (part one and part two) we look more closely at the psychopathology of the disorder, explaining the symptoms and giving examples of the different cases in which they can occur and how.