Trauma, abuse can lead to dissociative disorder

Abby’s closest friends urged her to see a psychotherapist.

“They say sometimes I’m like a whole different person,” this grad student in her 20s explained.

Abby dismissed their concerns, admitting she was “moody sometimes” but not to an extreme.

“Sure, I have ups and downs like everyone, but nothing out of the ordinary,” she insisted.

I questioned her about family, childhood, relationships, personality traits, etc. However, when I inquired about past emotional trauma, our interaction took a turn toward the surreal.

“That’s none of your business!” she erupted, her voice suddenly abrasive and menacing, with eyes like daggers.

Collecting myself while she quietly seethed, I apologized for being “intrusive” and reassured her I would not go there again. Slowly, the taut facial expression eased, as did her labored breathing, and then she closed her eyes.

When they reopened, she seemed her prior self, and then asked, “Now, where were we?”

She appeared only marginally aware of what had just transpired. So, when I cautiously shared my observations about her abrupt shift in comportment, she expressed disbelief.

“What do you mean? We’ve just been talking,” she replied. This was more than a dismissive “no big deal,” but actually reflected an absence of memory.

After further inquiry, I deemed Abby a probable case of “dissociative identity disorder” (DID), which is the updated term for “multiple personality disorder.” I say “probable” because this is a rare condition that some mental health types dismiss altogether.

Folks with DID do not have multiple personalities so much as a fragmented identity that manifests as two or more distinct personas or alter egos. And while some psychologists assert people with DID are simply highly suggestible, there are neural imaging studies indicating otherwise.

One compared the brain scans of clients exhibiting DID with those of actors simulating this condition, which yielded two vastly different measures of neural activity. For a challenged few, DID seems to be the real deal — a fractured sense of self that alternates between two or several personas that take turns activating certain brain functions, attitudes and behaviors.

Granted, most of us have “multiple personalities” in the form of different personas we inhabit (often called moodiness), but those with DID differ. When occupying one of their alter egos, they exhibit discernible changes in mannerisms, memories, moods and behavior not otherwise associated with their main identity.

Most people with DID endured severe childhood abuse, often physical and sexual, and have a high risk of suicide. My attempt to ask Abby about prior abuse summoned her alter ego. It wanted me to back off, which I did.

Psychotherapy is the primary treatment for DID, although medication may alleviate symptoms (depression, anxiety, etc.). While a chronic condition, closer reintegration of the various personas usually improves well-being over time.

All of us don different mental masks on occasion.

But people with DID put on different selves.

Philip Chard is a psychotherapist, author and trainer. Email Chard at outofmymind@philipchard.com or visit philipchard.com.