D.I.D. Treatment: Is integration the goal?

We’ve all heard the metaphor: take a ceramic bowl, and smash it into the ground. Look at all of the glossy pieces, spread out on the ground. Apologize.

Will that bowl ever be the same again?

We all know it won’t. At best, the pieces can be glued back together to closely approximate the original form of the bowl, but there will always be thin seams that criss-cross its surface, little cracks and bubbles where the glue has dried.

D.I.D. forms as a protective mechanism to inescapable trauma that afflicts a person before the age of 8. It is not an organic disease process, but instead a developmental adaptation that allows the brain to survive circumstances that would otherwise be unsurvivable.

Every person’s personality has “parts”. Most people are familiar with the concept that people behave differently in different circumstances. At work, you behave differently than you do at home or at a party. However, in a typically developed personality, these parts work together seamlessly with no communication breakdown between them, and the person understands themselves to be a single multi-faceted person. In D.I.D., these parts create barriers between themselves so that they can individually hold memories and emotions that would be too overwhelming to survive were they stored together. The same parts that exist in a typically developed personality create barriers around themselves so that the “core” personality can function in day-to-day life without the destructive symptoms related to their traumas. They can trust their caregivers and form attachments with them because the memories that would be destructive to forming attachment bonds are stored in a part of their personality they don’t have easy, seamless access to. As time goes on, these barriers between parts are reinforced and the parts develop separately, in accordance with the aspects of their life that they individually hold.

There are many protective mechanisms the brain tries and considers before it resorts to this level of dissociation. This is because dissociation to the level of creating separate and self-sustaining “alters” is fairly disruptive to adult life. It is also permanent. Like the broken bowl that cannot be made seamlessly whole, once a person’s personality has split in this way there is no meaningful way to re-form it into what it would have been had it never split.

At one point, integration was the goal of D.I.D. treatment. What professionals now know is that integration is generally not possible and efforts to integrate a dissociated personality cause, in the long run, more chaos than they alleviate. Very rarely does a person with D.I.D. achieve a “true” integration; more commonly, they are successful only in shutting down internal communication so that they are unaware of the presence of parts. These parts will often then act out against the core personality and cause an increase of symptoms.

As a person with D.I.D., attempting to integrate my dissociated personality parts into one cohesive personality is akin to telling someone that the person they are at work is the only true version of who they are and if they are ever a different “version” of themselves, that is a pathology and should be treated as such. Attempts at integration actually make me weaker as a whole because they ignore and shut down parts of my personality that I would still have, albeit with easier access, were I typically developed.

D.I.D. is not exactly an illness. It certainly is not an illness in the same way that bipolar disorder or major depression are. In illnesses such as bipolar disorder or major depression, there is a physical difference in the structural workings of the brain as compared to a “healthy” brain. Like physical illnesses originating in other parts of the body, a regimen of medication can help correct the physical imbalances present, and talk therapy focused on symptom management and managing relapses takes care of the rest. D.I.D. is not a physical, structural pathology originating in the brain; it is a developmental adaptation in the personality formation process. It is actually a healthy, adaptive response to severe and inescapable trauma.

Treatment of D.I.D. is focused around treating symptoms (anxiety, insomnia) and comorbidities (depression, bipolar) with medications, and using long-term talk therapy to increase communication between dissociated personality parts. It is also focused around relieving symptoms of PTSD in the dissociated parts individually. Through this process, though the patient will always probably have dissociated personality parts, they are able to collectively function in society and live a life that feels positive and purposeful.

It feels strange to me to say that I am “diagnosed” as having D.I.D., because, even though that it the correct term, it feels wrong to say that the dissociated parts of my personality are akin to illnesses, something I can be “diagnosed” with. My alters are people in and of themselves and it feels wrong to me to compare them with disease processes. They had a job — to save my life, and our collective life — and they did it well. They continue to have jobs that function into adulthood. They are not, inherently and of themselves, the problem. The problem is the lack of communication between all of us and the symptoms of PTSD that manifest in parts that hold severe and unhealed trauma.

But the parts themselves? Not intrinsically a problem.

“But I don’t see you switch.”

When I first tell people that I have D.I.D., they usually give me a really long look, like they’re trying to look inside my eyes to try to see if they see anyone unfamiliar in there, and then they say some variation of, “Yeah, I don’t really see it.”

Sometimes, people will ask, “Have I met any of them?”

The answer to that question is, invariably, yes. Almost everyone in my life has met some version of me that is not truly me, and almost no one knows it.

This, understandably, spooks people. But the reality is that it’s not spooky at all.

Dissociation and the splitting off of a core personality into parts or alters is, at its core, a protective and adaptive response. It allows different parts to hold different memories and experiences that would be fatally overwhelming to a person were they stored in one unified consciousness. The child with D.I.D. is able to survive an unsurvivable environment because of this advanced compartmentalization. They are able to function in their everyday world without the pain of those traumas, because it was not truly them who bore the brunt of the experiences.

As a child with D.I.D. grows into an adult and enters a safe and stable environment, these parts become no longer adaptive because the situation which they adapted to endure has changed. This is often when a diagnosis is obtained and true healing, for all of the parts, can begin.

I have 11 personalities co-existing inside my body, including my own. Most were formed in adolescence and childhood. Only one appeared after the age of 18. By the age of 22, my personality system as I know it today was complete. The D.I.D. diagnosis I obtained this summer did not create any parts that were not already present and functioning; it only drew my attention to them. Once my attention was on these parts, I was able to ask them questions about themselves, and they identified themselves to me by name. But even before this identification, they existed, and they functioned in my day-to-day life without my knowledge.

If you think about it, having different alters come out and identify themselves by name as separate from the “host” personality is the absolute opposite of an adaptive response. In the work of healing, these parts must identify themselves as separate and work through the traumas they hold individually. In the work of doing the job they were created to do, however, it is absolutely not adaptive for them to identify as separate. In fact, even when there is no external danger, identifying as separate and individual personality parts can create external danger. This is why, outside of the therapy room, all of my alters answer to my name and generally behave in ways that lead people to believe that they are simply different facets of a well-rounded personality, instead of well-rounded personalities themselves.

“Switches” look different for every person with D.I.D., but mine personally are very subtle. Sometimes I don’t even notice until I realize that I have been receded into the back of my brain for quite some time, watching a force outside myself operate the machine of my body. I switch mid-conversation very often, and it usually appears completely seamless, even to me. If I do have a “harder” switch, the only visual tell is that I become very still and have a soft gaze focused somewhere around the midpoint oft the horizon. I may jump or shudder a tiny amount when a new personality takes over or when my personality regains control. But you would have to be watching very carefully to see that.

Some parts of mine, specifically younger parts who hold more severe trauma, have more obvious behavioral tells. They are often mostly mute, seek places to hide where they feel safe, and put on specific clothing because it feels safest and least triggering. They may appear to be irrationally angry or afraid. However, because they are so skittish, not many people in my life see these parts unless they are very close to me.

My older parts have a few distinct mannerisms, vocal inflections etc., that may lead to people being able to recognize them independently of me, but only if they have extensive knowledge not only of me as a person but of my parts as persons individually. Generally, only my therapist and people who I have met in D.I.D.-focused treatment programs have this kind of knowledge.

On occasion, people will tell me “not to switch”. I think their intent with this is to minimize disruptions to our relationship that could be caused by some Hollywood-inspired type of dissociative drama. The reality is, if I had that much control over my switching, the D.I.D. would be less of an issue. The absolute best I can offer them in terms of “not switching” is that I will try my best to be as much Katelyn as I am in my day-to-day life, which is really about a 40/40/20 split of Katelyn/Clara/Brutus. At worst, being told not to switch actually intensifies the switching and makes it more disruptive, because the parts read that as them not being safe in the situation and, having been well trained in responding to unsafe situations, react accordingly.

D.I.D. switching is not inherently dangerous. It is often not noticeable to the outside observer. It is just an everyday fact of living with D.I.D. and is not something to fear.

Lots of D.I.D. patients wonder privately if they are faking or exaggerating some aspect of their dissociation. The proof I offer myself personally when these doubts set in is that my alters exist whether or not anyone externally sees them. If I was faking or exaggerating my symptoms I’d be doing a pretty horrible job of it. My internal experience is much more fragmented and chaotic than what the external world sees of me.

No, you don’t see it, but that doesn’t mean it’s not there.

“My Head is Loud Today”

Imagine you are in a room filled with, say, twenty other people. They are all having conversations in groups of 3 or 4. No one is using their inside voice, which is unfortunate because you are all a) inside, and b) inside a very small room with impressive acoustics. You are in the dead center of the room and you are trying to make a phone call. Also, your cell connection is not great, and people in the room keep coming up to you at random and asking questions. At least one person is crying and at least two people are playing songs off of their phones, also not at an inside volume.

Imagine you are trying to herd 7-8 kittens out of a small room, and also there is someone following behind you and trying to hold a conversation as you try to scoop up kittens and remove them while blocking the already-removed kittens from returning into the room.

Imagine you accidentally took an Ambien at 7am and you have to do your full regular day while trying not to let anyone know that you accidentally took an Ambien at 7am.

When I say “my head is loud today”, this is what I mean. You, the lovely person who is trying their best to interact with me in a meaningful matter, are the person on the other end of that staticky phone call. You are the inquisitive soul asking me questions while I am trying to focus on Operation Kitten Relocation. You are the person that I am trying my best not to let know that I am trying to do a Tuesday while under the influence of a powerful prescription sleep medication.

Be patient.