Symptoms of dissociative identity disorder (part 2)

Here’s the second part on the symptoms of dissociative identity disorder (DID).

Bodily symptoms of dissociation

As for bodily symptoms, paralysis, convulsions and psychogenic non-epileptic seizures are the best known in DID. Auditory hallucinations are also common.

Intrusions

Intrusions can take the form of ego-dystonic thoughts (as in obsessive-compulsive disorder), voices (children’s voices, threatening voices, voices arguing with each other…) or a feeling of being controlled by an external force that seems to make you do things you don’t want to do. All of these can be present in DID and reflect alterations in, or confusion about, one’s own identity (I talked about this in part one). One of the differences often pointed out between dissociative voices and those found in schizophrenia is that the former usually appear in childhood. This is a guideline, not a definitive criterion: telling them apart requires a careful assessment of the symptoms as a whole.

Emotional regulation and belief systems

In our childhood attachment relationships we establish our emotional regulation mechanisms and our core beliefs about our own identity (who I am). I’ve already written in another article about the disorganised attachment that people with DID have usually experienced. If a child doesn’t have a healthy attachment figure, the likelihood of later identity problems and difficulties regulating emotions increases. Generally, people with DID reject emotions related to vulnerability and attachment because of their disorganised attachment in childhood. They perceive any emotion linked to attachment as dangerous. Many also reject certain positive emotions such as joy, affection or warmth because they are unfamiliar with them and may interpret them as a possible threat. Guilt and shame are also emotions that shut them down.

As we discussed in part one, patients with DID often have trouble recognising their own and other people’s emotions, because they weren’t able to fully develop what we call mentalisation. What’s that? It’s the ability to understand our own and other people’s behaviour in terms of mental states (thoughts, emotions, wishes, intentions), which includes realising that other people have a mind of their own, different from mine. Mentalisation develops through healthy attachment in childhood. If a person hasn’t had a healthy relationship with their main caregiver, it’s hard for them to have developed an adequate level of mentalisation.

Core beliefs are formed in childhood, through our experiences and upbringing. In DID, fragmentation is high, which means there may be different personalities functioning independently, and core beliefs or schemas can be very different for each of them. For example, there may be one very introverted, shy personality while another is the life and soul of the party; or one well-meaning personality while another is extremely aggressive.

In any case, the symptoms mentioned are not exclusive to DID. They can be part of other dissociative disorders, or even of other psychological disorders of a different nature. That’s why assessing a possible case of DID has to be thorough and pay close attention to whether these symptoms are related to a serious traumatic event in childhood, as this can be key to reaching a correct diagnosis.