"The past is not
dead. It's not even the past." cit. William
The most serious and pathological form
of dissociation is the Dissociative Identity
Disorder (DID, former called the Multiple
Personality Disorder (MPD).
As seen above, dissociating is something
which can happen to anyone: it is something
like creating or experiencing a distance
from oneself (a
reality outside oneself, a reality at
a distance) and sometimes one has suppressed
certain experiences from his or her own
Someone with a DID/MPD on the other
hand, creates or experiences a distance
within him or herself, dissociates
in him or her self, cause
of the fragmentation of the personality
or identity and has amnesia for
all or some split-off personality parts
(also called alters).
A Dissociative Identity Disorder (MPD) is
a disorder originating from an evolutionary
survival strategy. With regard to extreme
traumas, it develops in the early stages of
The D.I.D. is found at the end of the dissociative
spectrum and is distinguished by many forms
of dissociation. It involves at least two
different identities or personality states,
also called alters.
The basis of every (also normal) identity
or personality is memory.
D.I.D. demonstrates a (more or less) loss
of memory and changes in identity. The normal
integrated functions of identity, memory and/or
consciousness are broken. This means that
DID patients often have difficulties in remembering
(or cannot remember) important personal experiences
from their own life history.
Personal (traumatic) experiences, with their
connected behaviours, are stored and carried
out by different personality parts. At the
same time, the main person (or host) may not
necessarily be aware of those experiences
or behaviours. Because D.I.D. has different
identities or personality states one can speak
of a fragmented personality.
Although the term “personality state”
(or “part”) is probably more
accurate, I will use the term 'alter' here,
simply because it is shorter.
While undergoing a trauma, the original
person hides, in a manner of speaking, in
the mind to escape the life-threatening
situation of that moment. (see: neurological
consequences of psychotrauma)
Subconsciously, an alter is created then
who can handle the traumatic event and can
cope better with it. This alter, in fact,
lives through the traumatic event about
which the original person (later) can remember
It can also happen that this “new”
alter takes over from the original person
for a shorter or longer period, sometimes
(but not always) with other specific character
traits such as being more extroverted or
introverted, more fearful or fearless, and
so on. During the period that this new alter
exists, he or she experiences new things
in life and develops new skills, talents
and behaviours. Mostly, however, these are
attached to the defence skills used while
undergoing the experienced trauma.
Often (but not always) alters have their
own names and sometimes different gender
identities or preferences from those of
the original person. It can also happen
that alters are animals, because an animal
is somehow safer or stronger than a human,
especially when he or she had to undergo
an 'inhuman' traumatic experience. In addition,
alters can have completely different physical
conditions. Thus, in people with D.I.D.
it can happen that one is sick with fever
and another is not;, eye measurements show
different results from one day to the next;
blood pressure measurements show significant
differences, and so on. Incidentally, such
differences can be extremely puzzling to
DID/MPD as shown in popular movies and
media probably give laymen the impression
that the different alters should be distinguished
easily, but this is rarely the case. Someone
with a D.I.D. did not only learn in life
how to hide his/her own existence (playing
dead), but also how to hide the differences
between alters as part of the survival strategy.
It is not difficult to understand what would
happen with a victim, when perpetrator(s)
would notice that a person to whom their
aggression or sadism is directed, is actually
not there at all. So although subconsciously,
patients with DID are often remarkably capable
of hiding the alters or where the pain and
When pointing out the whole of an alter-structure,
often the term 'system' is used.
are alters who deal with daily functioning
like work, housekeeping, etc., and those
are normally not aware of the underlying
traumas of other alters within the system.
Highly functioning alters are sometimes
called 'host' but a better description is
so called A.N.P.'s (Apparent Normal Personality).
They are somehow kept away from the traumatic
content(s) in the system and therefore also
completely or partly amnesiac with regard
to traumas. And mostly these are alters
who are afraid to loose control, are very
rational and/or superficial emotionally.
It is believed that A.N.P.'s are phobic
with regard to the traumatic memory or memories
and, accordingly, to the alter who experienced
it. So in most cases the A.N.P. is functioning
more or less apart from the others in the
There can also occur (often more) alters
who lived through the traumas and are more
hidden in the system. These are called E.P.'s
(Emotional Personality). It often seems
as if those alters are stuck in the traumatic
event (as if time has stood still), complete
with the feelings and defenses of the traumatic
event of that moment. In these alters one
can often see: freezing, flight and fight
etc. and among them one finds the more or
less well known little children personality
The more extreme and ongoing the traumatic
history was, the more extreme or complex
the dissociative disorder usually is. An
A.N.P. can alternate with E.P. (primary
structural dissociation = PTSD). Or it happens
that one or more E.P.'s are split but not
the A.N.P. (secondary structural dissociation
= complex PTSD, B.P., DDNOS).
Or the A.N.P. is also split into different
parts and sometimes some of the E.P.'s are
extremely well hidden and sheltered behind
another E.P. or A.N.P. (tertiary structural
dissociation = complex D.I.D.). (v.d.Hart;
Someone with a D.I.D. also often shows
signs of other disorders in the dissociative
spectrum. (see: dissociative
In relation to DID one often hears the notorious
term, "hearing voices".
People with schizophrenia and psychosis
often say that they hear voices which come
from outside and which sometimes give them
This is rarely or never the case with people
diagnosed as D.I.D. These patients are well
aware that the voices they hear are coming
from inside the system.
What is meant here is voices like “strangers”
in the head. (“Strangers” in
this case are the alters).
These voices are very distinct from the
thoughts belonging to the person (-part)
who is present at the time.
or alter changes.
The changing between alters is called
It can happen to someone with a D.I.D.,
and often to their own terror and revulsion,
that he/she can in reality hear an inner
alter speaking and taking over.
The shock probably has something to do with
the threat of the A.N.P. losing control
and being so frightened of that, that he/she
cannot even hear this alter voice while
other people in her/his environment can.
This A.N.P. will often react with: "I
didn't say that at all!", and then
suspicion and insecurity regarding the outside
world will often increase in the A.N.P.
The same happens when an inner alter executes
one or more actions in the outside world
without the knowledge of the A.N.P.
Internally it also can be a sign for the
A.N.P. that someone is threatening to take
over (the daily functioning) or that he/she
apparently is not functioning well. In regard
to that, often the A.N.P. reacts with more
intense concentration and fierce attempts
to keep control.
So one can imagine that, when this goes
back and forth, this A.N.P. gets very tired
or exhausted in the end. Therefore one can
often see extreme fatigue phenomena in someone
who is dissociating a great deal.
A layman could think: “Why bother,
let the other alter come forward”,
but unfortunately it doesn't work that way.
First, because it has become a way of lifetime
coping. And second, other alters usually
have a different preoccupation, lifestyle,
etc., so that a conflict arises with regard
to functioning within society. For instance
it can mean that one cannot do the job that
one has been used to doing for years; one
doesn't know how to handle things, doesn't
know people or certain skills anymore; not
to mention E.P.'s who are preoccupied with
their trauma's. Often in a safe therapy
setting and with an empathic therapist may
they come forward.
There are alters (mostly A.N.P.'s) who are
well aware of reality 'now', often automatically
coming forward and alternating with the
other A.N.P., with or without his/her knowledge
or being noticed in the outside world.
often happens that someone with DID has
to endure so called 'triggers'. A 'trigger'
can be a smell, sound or image which brings
a partial or whole traumatic experience
into memory. As mentioned above, an A.N.P.
will react fearfully to this and with evasion.
But the urge of the E.P.'s traumatic memory
can be so strong that one gets flashbacks,
nightmares, panic attacks, eating problems,
relationality problems (where none were
before), depressions and so on. In short
the whole range of symptoms as seen in multiple
dissociation. (see dissociative spectrum
Also, feelings can arise such as not fitting
in one’s body anymore; one feels too
big or, for instance, certain limbs like
arms and legs feel as small as if they belong
to a toddler or 10-year old, while the rest
of the body seems of normal length. It sometimes
also can happen that one is easily lost,
finding oneself back in strange and unfamiliar
In contrast with normal memories, these
kinds of traumatic memories have, in fact,
always been stored in a separate box, where
nothing could get in or out, and in some
cases are so detailed that it seems as if
they just happened or one is still in the
middle of them.
Especially when the patient feels safe and
is an adult, partial or whole memories of
former traumatic experiences (E.P.) can arise
in the consciousness of the A.N.P.('s) or
sometimes called hosts. With the guidance
of a psychiatrist or therapist who is familiar
with trauma treatment these traumas can be
worked through. Unfortunately, it is often
a long road with many pitfalls, for the patient
as well as the therapist.
Whether one can work on and process the traumatic
content(s) in therapy also depends on the
will and strength of the patient and the circumstances
in which he/she is living.
Sometimes it can be better or preferable to
stabilize the patient first. That is, one
first learns to deal with daily problems and
one’s dissociative phenomenon.
The eventual result of therapy will depend
on the severity of the traumatic history,
the complexity of dissociation, the circumstances
in which the patient lives and the quality
of the therapist.
In any case, and in the end, it is possible
to cope with DID in a more healthy way or
to be healed under the guidance of a skilful
and empathic therapist.
It should be obvious that it can be devastating
for the patient if the therapist treats
DID as having little importance, shows little
interest, gives a wrong diagnosis, or when
a patient chooses a vague alternative therapy.
In origin, D.I.D. is a survival strategy
and dissociating happens subconsciously.
Often people who claim they have D.I.D.
frequently and in public switch easily among
the different alters. However, publicly
displaying the alters seems more like copy
cat behaviour than a survival strategy,
and serious doubt about the authenticity
of the disorder is warranted. Often in such
cases appalling numbers of alters are also
mentioned. D.I.D. is a disorder which is
often imitated in order to get attention.
There are a lot of misdiagnosis
and in the past a lot of people with DID
got the diagnosis, schizofrenia. Nowadays
it is often 'borderline'.
F.i. because the therapist doesn't
believe in the existence of DID/MPD;
thinks that DID and BPD are on the
same continuum (despite several studies
and research which proves otherwise)
or the therapist finds it too difficult
or the problems too complicated and
makes it borderline.
Depersonalization - Derealization
can be a dissociative symptom
by many personality disorders. Some researchers
and therapists think that DID and BPD
are on one continuum. But this is in contradiction
with the opinion of a lot of DID patients
who experience several differences between
someone with BPD. Differences between
the two are also experienced in DID support
groups. Besides that it is a wellknown
fact that a DID is often faked, sometimes
unconsciously. This can happen when patients
think that having egostates is the same
as having alters. However only between
alters (from the word; alter
~ change, changing) there is amnesia and
having egostates is normal.
A lot of DID patients f.i., can get the
diagnose BPD cause of automutilation.
But the latter is seen in a lot of personality
disorders. Besides that, patients with
BPD do have an egostructure, which is
fragmented in a DID. And there are more
For example; ego states are not dissociatied
alters and alters are no moodswings and
dissociation is a different process than
repression. In genuine cases of DID there
is fear (or phobia) and embarrasment about
having other personalities. "In
contrast, those individuals who show up
on TV talk shows, touting their “diagnosis,”
raise the most suspicion of having ulterior
motives, such as a craving for attention
and money, to be seen by others as “special”
and different". Raymond Lloyd Richmond,
D.I.D. has many features which can manifest
themselves in different ways and differently
in each patient. One could say that D.I.D.
is a personality disorder which above all
is caused by extreme human (mis)treatment.
This can include or be exacerbated by silencing,
denials (and therefore denial of identity
and existence), life threats, extreme and/or
sadistic violence, humiliation, accusations
of madness and fantasy, and so on. If children
who undergo such traumatic events were allowed
to speak out and be treated with understanding,
fragmentation or identity splitting (D.I.D.)
would probably never occur.