https://thepsychpractice.com/plog/dissociative-identity-disorder

 Co-author: Belinda Sng Qi Rong

Happy mid-week everyone! As we launch into a short working week, let us spend some time on understanding a complicated yet interesting diagnosis that is often portrayed in the media. These characters are often portrayed as having violent tendencies, a vulnerable side that requires protecting, and lapses in their memory. Can you guess which disorder it is? Cos’ we’d have difficulties guessing which just on the basis of this general cluster of behaviours. 

Mental health conditions is a common topic portrayed in television shows these days, which greatly helps in raising awareness on these topics that seemed to be a taboo in the past. When it comes to Dissociative Identity Disorder (DID), previously known as multiple personality disorder, many of us may first associate it with the violent kidnapper in the movie Split, or the infamous campus rapist Billy Milligan from various media publications. Unfortunately, the awareness raised on this condition is often coupled with the reinforcement of stereotypes of the disorder. Serial killers, kidnappers, and psychopaths are often the first things that come to mind when DID is brought into the picture - a result of what is commonly portrayed in the media. I’d bet this is the first time many of you have heard about such a disorder, because it happens so rarely in the community and occur mostly in individuals who had suffered severe psychological trauma! Because it is so rare, it’s no wonder that the scientific community is also split about the validity of the diagnosis, to the extent that some have called it a form of psychosis or paranoid delusion. 

In fact, individuals with DID are more likely to have been victims of crime rather than persecutors. According to the Dissociative Identity Research Organisation (2018), DID is formed in childhood due to repeated trauma in early childhood (before age 10) before the personality is fully integrated. To block out unpleasant memories, the brain creates amnesia walls as an extreme form of defence mechanism. This results in a fragmented ‘personality’, or what is known as ‘alters’. In DID, alters are created unconsciously as a way for the brain to cope with trauma. Typically, it has characteristics deemed desirable to keep one safe. Each alter holds a different memory, role and meaning within the system. These alters can have different ages, gender, names and perceived appearance. Each alter could also have different preferences and outlooks on life. Interestingly, researchers have found that these differences extend way beyond the mental states, presenting in observable biological responses such as heart rate, blood pressure, brain activity and even health conditions such as vision and diabetes. In short, alters can be thought of as any completely functioning individual separate from other alters within the system. 

The system is made up of the host and all alters that are created. It is important to note that every system is unique, and not every system would have all types of alters mentioned below. There are also several more alters that we did not cover in the list. 

Types of alters (fragmented states of the mind)

• 6Host, apparently normal parts (ANP). The host of the system has control of the body most of the time, managing daily activities. Hosts usually do not hold trauma memories and are unaware of the existence of other alters. A common misconception is that the ‘host’ is the ‘original child’ - this is not necessarily true, and we will explain why later on in this article. 
• 1Child. Also known as littles, child alters may be created to hold traumatic memories from childhood at the point of the abuse, or without traumatic memories or experiences - as a way of compensating for the loss of a happy childhood the individual should have had. 
• 7Protector. These alters help with managing unpleasant emotions such as anger, fear, and shame. They keep the system safe by dealing with perceived threats, or abuse. 
• 9?2/4Caretaker. Often the nurturing figure within the system, caretakers are responsible for caring for other alters, especially child alters and others who are more vulnerable within the system. 
• 3Gatekeeper. This alter may have general access to all traumatic memories held by the system, and is able to control which alter takes control of the body in certain situations, as well as which alters have access to certain spaces within the inner world. As such, gatekeepers often have witnessed most of the trauma that the system has been subjected to. They may present as emotionless in order to cope with the trauma. 
• 5/7 Persecutors. Unlike movie exaggerations, persecutors rarely engage in external antisocial behaviours that go against the law. Rather, the anger is channelled inwards through self-hatred, causing hurt to other alters. They may purposefully harm the body or other alters to hinder the system’s progress in healing. Ironically, this is their way of protecting the system from getting hurt in future abuse. 
• 8 Non-human alters. Animals, ghosts, fairytale creatures (fictives), or inanimate objects like machines. Although rare, these alters may be created when the child feels overwhelmed by a traumatic experience and the mind believes that they would be able to survive if they were something else that represents strength or bravery - something that the child wishes to possess to survive the abuse. 
• 9/10Dead alters. Ghost alters are created when the child or individual believes that they have died from the abusive experience. 
• Sexual alter. Created to handle memories of sexual abuse or rape, keeping these memories away from other alters within the system. 
• Fragments. Fragments are alters that are not yet fully developed. They exist to hold a single traumatic memory or emotion.  

Individuals with DID do not get to choose their alters’ appearance, name, gender, age, or species. Alters are created for the purpose of survival and coping with trauma. Each alter holds different memories and roles within the system - depending on what the system needs to cope or survive. While some alters are fully aware that they are alters, others (such as the host) may have completely no idea. Although it may seem too bizarre to be true, we have to remember that DID is formed to help the individual deal with psychological trauma. Thus, for the host to be in control and carry out daily tasks, oftentimes, it can be unaware of their past trauma and the existence of the disorder itself. 

Now, you might be wondering, in a shared body with many alters, who is the ‘original’ child? Picture a broken glass, which is the original piece? Every alter within the system is a valid part of the ‘original child’. While there may be some systems that have an ‘original child’ alter (known as the ‘core’ alter), it does not make the other alters any less valid. 

Living with DID 

Imagine living together with your colleagues at work or classmates at school - some of which you're closer to, some you just can’t seem to get along with. Now, how about sharing a body with them and that all decisions made (regardless of who made them) affects the quality of your life. Be it physical health, the person’s looks, or finances, every decision made by anyone would impact the system as a whole. Similarly, when alters in a system make a decision, it affects the life of the entire system. Below are some common daily challenges that people with DID face on a regular basis.

• Dissociative amnesia. The most common challenge that comes with DID is the loss of memory. Keeping track of time is a common challenge faced by alters within a system. Alters usually do not have access to memories of happenings when they are not in control of the body. It can thus be a challenge to keep up with what the body is going through at any point of time.  
• Control of the body. Alters are also not granted equal access to the body, which means that while one alter may be in control of the body for the bulk of the day, other alters may not even get a chance to be out for days at end. Unlike the portrayals in certain movies, one cannot choose to ‘summon’ a specific alter whenever they wish to escape a situation. Rather, most of the time alters do not get to choose when they want to be out. Imagine ordering your favourite dishes for dinner only to realise another alter has fronted and several days have passed since then. 
• Choice of clothing. Alters may identify as different genders from the physical body and have a preference for different styles. At times, alters who come into control may find themselves in an outfit that they do not feel comfortable in. They may thus take action to feel more comfortable for themselves. For example, male alters in a biologically female body may not feel comfortable having long hair like the body does, and goes to get a haircut. On the other hand, female alters in a biologically male body may opt to wear a wig to feel more comfortable in the body. 
• Finances. Sharing a body also means sharing a bank account. One alter could be saving money to get something they need only to have the money used by another alter to get something else of their own. 
• Positive triggers. Positive triggers are objects or situations that tend to pull a specific alter to the front. Toys are a common positive trigger for child alters.  
• Caring for the body. Every alter has to work together to ensure that the body gets adequate sleep, water, and food. Moreover, there is a shared responsibility to keep the body safe from harm (self and others), as well as to steer away from meeting trouble with the law. 

Individuals with dissociative identity disorder are highly likely to also have other comorbid mental health conditions such as post-traumatic stress disorder, depression, anxiety, or eating disorders. Before we end off, we would like to reiterate that DID is a mental health condition that develops due to trauma. Dissociation is a form of “playing dead”, which only happens when the fight, flight, and freeze response fails to keep us safe. Recovery from DID does not necessarily mean integrating all existing alters into a full personality once again, but rather, establishing clear communication and boundaries where all alters can manage or  function as a whole. 

We hope you find this article helpful in giving you a brief understanding of the complexity of DID. As we may only have known this condition through media portrayal, we hope to have provided some clarity and cleared up misconceptions that you may have about the condition. Given the right treatment, people living with DID can lead a full functioning life.