I’m Melissa, and I’m part of a system of alternate identities. We were diagnosed with Dissociative Identity disorder by two psychologists, or by our psychiatrist as having alternate identities as a comorbid with Complex-PTSD.
Whether it be for themselves, a loved one, or a therapeutic client, some might be looking for answers regarding the signs, symptoms and treatment of DID, otherwise known as multiple personality disorder. In the interest of providing a bit of an outline as to what can lead to a diagnosis, we are making this episode about where our own story matches the criteria, as well as aligns with leading research.
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Melissa: I have alternate personalities.
Skittle: It’s really funny!
Melissa: But, what if none of this is real?
(Imitation of therapist) How do you feel?
SpitFire: Can she just get out of my face?
Melissa: What if I’m not real?
For the first time in our life, my system has access to the appropriate treatment for our appropriate diagnosis. We finally know what is happening, and we now own the chance for change, for wellness, through long-term therapy for Dissociative Identity Disorder.
The criteria in the Diagnostic Statistical Manual, AKA, the DSM-5, describes DID as at least two distinct identity states who have their own perceptions of the world, or of themselves. It describes amnesia for past traumatic events, or for recent events. It cannot be due to substance abuse, or to cultural differences in view of demon possession, and it must cause a degree of emotional distress.
As true as the points are in the DSM, it leaves many relevant signs and symptoms on the sidelines that have been thoroughly described in several research studies on DID and on those diagnosed with it. The DSM focuses on apparent and outward symptoms, like switching, but there is far more to this dissociative state.
There are many accurate signs and symptoms that are well described and outlined by Paul F. Dell, who created the MID, as in M-I-D assessment scale, or the Multi-Dimensional Inventory of Dissociation.
I read and re-read several articles by Paul F. Dell. His defining of the dissociative experience is so relatable. The details are so interesting, and the number of them far outweigh what the basic knowledge presented in most literature.
Most information online is somewhat of a regurgitation of a few general points. They entirely miss the mark when it comes to the broader signs that are applicable to a high percentage of those with DID or OSDD. (Otherwise Specified Dissociative Disorder)
In order to present the more subtle, overlooked, and perhaps invisible signs, I’m going to present how they apply to my system, or to my experience.
You’ll hear the introductions to each sign or symptom with a thick and near ridiculous emphasis in order to add a kind of subheading in this audio. I may find myself snickering at myself along this episode as a consequence. I could avoid layering an accent on the symptoms by editing in some sound effects, but then there would be nothing to giggle at, so bare with me.
A major highlighted point in diagnosis is full or partial amnesia of events. Those with DID might find evidence of lost time, such as finding objects they clearly purchased, losing things, or finding drawings or journal entries they made but can’t remember.
In my situation, I’ve encountered people who claimed to know me, but I didn’t know them. I’ve received packages in the mail that I had no memory of ordering, but the transactions were in my accounts. I’ve blanked out of entire conversations where the people in the room were then gone and the results of our discussion were left behind for me to find.
Many times, those with DID will not realize that they have these memory gaps. There may be many small moments that are in a sense, blipped out of awareness, but it can become habitual to brush off the signs of these blanks as quirks or normal forgetfulness.
In many instances, the switching to an alternate identity is not forgotten. It’s really more like watching a scene unfold through your shared eyes, but you’re in the backseat of the mind while hearing what a Headmate is saying, and even feeling your own feelings, while simultaneously feeling those of the alter that is fronting.
Before I was accepting of my Headmates, I very much feared them. I sensed them to be a virus to exterminate. I felt like, when they took over, and I was aware of it, this was comparable to screaming in a soundproof booth. No one could hear me scream because the words that came out were not mine. I grew terrified that an alter would take over and I would spend my life as a prisoner behind my eyes; helplessly watching.
I realized later though, that a protective mechanism of the mind would not harm me in that way. All Headmates in a system serve a purpose. I served mine as well. We need each other.
*Conversion Disorder Symptoms*
Feeling different symptoms related to conversion disorder is another sign of a dissociative disorder.
Conversion is when there are physical symptoms that can not be explained medically. They are considered to be the result of the conversion of emotion to symptoms that can be felt in the body.
A common series of questions when evaluated for DID are about migraines, stomach upset, severe and chronic fatigue, and more.
I find that a truly fascinating element to conversion is the link it has with Dissociative Identity Disorder. If you scrounge through PubMed or articles, or of the American Psychiatric Association, then you find little tid-bits that make so much sense; like puzzle pieces fitting together.
Repeated trauma releases a flood of glucocorticoids, which has been found to lead to neurobiological differences in the brain, such as a shrunken hippocampus, and an amygdala that is approximately 20% smaller than the average. If you take this link between the brains of those in the study who were diagnosed with DID, and to studies of commonalities in those with conversion symptoms, you find a shrunken amygdala within both disorders.
But then, riddle me this… What are the side-effects of a small amygdala? A little PubMed research magic later, and I come across references to slower blood-brain flow. Oh? And what does this lead to? Slow blood circulation can lead to symptoms such as severe fatigue, migraines, and the interesting thing, even gastro-intestinal issues… because food is then digested far slower, which leads to stomach upset.
The John Q in me finds this fascinating, but as do I. It explains so much.
Moving on from that point of interest leads us to, *Trance states*
Those who dissociate strongly find themselves staring off into emptiness that leaves a kind of blank-look on their face.
When this happens to me, I’m not looking at where my eyes are pointing. I’m more-so in some form of void where I may not feel time advance, or things may feel like a blur in my mind. In this state, I am not looking in front of me; I am looking into nowhere.
We’ve been caught more times that I can count where those around us were trying to see what we were fixing. We’ve come out of trance states where friends, family, or general onlookers were looking in confusion at the ceiling, the wall, the sky, or wherever the direction we were facing seemed to lead. These moments tend to be awkward, as often people ask us what we are staring at. We tend to be in such a daze that our words come out as more of a dislocated mumble.
While this sounds like a reference to a tattoo or a belly piercing, the meaning can be a dissociative response to sensing a Headmate. This is the alter-alien sense of the self, such as of our body, our thoughts, or our urges, where it feels like they belong to someone else.
I’ve found myself saying things like, “It’s like someone else is speaking through my mouth.” I might state, “I’m not the one who did that,” or “I feel their anger, but it’s not mine,” or “Someone wants to laugh and jump, but I’m trying not to let them.”
If we run those thoughts through a spell-check, then even the program refuses to understand relating the possibility of mixing “I feel,” with “their anger.” A red line under the word “their” indicates that one cannot “feel” the anger of another.
As foreign of a concept as it can seem, we can sense each others wants, needs, feelings, impulses, or even thoughts.
This is not to be mistaken with psychotic auditory hallucinations. These, unlike with schizophrenia, are heard inside the mind, rather than it sounding like they are coming from outside of ones-self.
It’s common to hear children crying or laughing inside our head. We can hear distinct voices of men, women, or children, arguing, or having generic conversations with each other.
With schizophrenia, the voices do not converse together. With DID, they very much can, and do, as long as they are aware of one another.
I hear my Headmates often. It tends to be when my mind is blank; like in a meditative state, or very fatigued. I hear ruckus, like hustling about while they talk, laugh, make jokes or passive conversation, and sometimes engage in heated arguments.
I catch little windows in our dissociative walls. It seems that it’s not usually intentional on their part for me to hear them. It’s more of a sound leak through the window panes.
While it’s not as common to see a Headmate as it is to hear them, it’s not entirely rare. Sharing their own images to one another within what we might call “The Headspace,” isn’t unusual. It’s also possible to see them in front of us, very much like a hallucination, but this is a “dissociation.”
Maggie, one of my very positive Headmates once stood still in our Headspace, where it was just her, with nothing around her, like she was deliberately showing herself to me. This is how I know what she looks like, with her long, wavy, wild red hair. I’m very fond of the fact that she chose to do this, as I very much wished for a connection.
I’ve also seen two Headmates in front of me, quite unexpectedly, but rather serenely, from my perspective. I was entirely calm at seeing them; even interested and in a sort of peace-state.
To describe the scene, there was a blonde baby sitting on the floor who looked to be possibly a year and a half of age. She looked up beside her to a woman with pixie short, platinum blonde hair, who stood tall and thin. The woman looked startled at recognizing that I could see them, then hurriedly picked up the baby, and they sort of… vanished…
I’ve tried to figure out what caused this, as it did not seem to be the choice of the woman that I saw. Something of a theory is that I was seeing through the eyes of a Headmate within the Headspace who was seeing what I was presented with.
This lengthy word refers to feeling detached from ones-self, like feeling as though we do not exist.
In my case, I often felt that I was not real. I was simply a consciousness floating through the world without a body. On a several occasions, I needed to remind myself sternly that I was real, and to stomp my feet to ground myself as I walked so as to not lay down on the sidewalk and give up. I thought, “Why keep walking if I don’t exist? What’s the point?”
It often felt like when I spoke, my voice wasn’t real. I needed to push myself to finish sentences because, “Why bother speaking when my voice is as unreal as i am? What’s the point?”
This fancy lingo indicates a distorted perception of the world around us, like the world is either unreal, or that it shifts and appears different.
In my case, when I feel derealized, I’m often also depersonalized… and certainly confused.
The world shrinks, or changes in front of me. I might be on the subway track after a difficult day, then as we approach the end of the route, I feel progressively lost and wondering if I’m on the right train. I couldn’t recognize my surroundings despite that this was my habitual route home.
When rising from my seat, it felt like the world was sideways. When walking to the bus, it seemed like everything was in a kind of cloudy haze. Once on the bus, I wondered if this was really a bus. It seemed far too small to be a bus; like the walls were close together, and more like a very large car.
Luckily, I found my way home, despite uncertainly of whether I was even in my own city, or if I had become irreparably lost.
*Awareness of the presence of other identities*
This awareness is what I hinted at earlier in this episode where we are aware of what our Headmates do, say, think, or feel.
The concept that the activity of alters or the switches between identities is always forgotten is distant from the truth. Many who do have amnesia barriers also experience co-conscious switches. With OSDD, the host is always aware, to at least a point, when a Headmate takes over.
There can be uncertainty about who we are, or who we identify as, or what we believe ourselves to be.
If I’m sensing the passive influence of the IQ of Headmate John Q, or the hyperactive and heightened amplitude of young Exclamation Mark, then I may be confused as to who is feeling what. I may mistake their feelings or wants as mine, because I can feel them.
It can be an art to un-salad our minds so that I recognize what I personally want, think, and feel, while they experience their own co-occurring track; like trains running side by side.
Experiencing flashbacks is the re-living of a traumatic moment of the past, which can be auditory, visual, sensory, or even tactile.
This is not an uncommon symptom of Post Traumatic Stress Disorder, but as DID is the highest on the PTSD spectrum, it is incredibly common to re-experience trauma, as though it were happening in the moment.
This is described as unintentional or disowned utterances.
We often have brief switches where one of my Headmates comes forward for only a word or sentence, or sometimes merely a facial expression. I refer to these as micro-switches. I realize when this happens and feel detached from identifying with what was said because it belonged to another part of our dissociated whole.
*Temporary loss of well rehearsed knowledge or skills*
One Headmate might have an ability that the others don’t. This can lead to moments where those with DID will know how to do something with ease, while other times, the answers or skills are a struggle, or complete mystery.
My skill would be human connection and relating through emotion. I connect deeply with language and with how to weave it into an artistic representation.
If John Q is at the front, while he may be adept with facts and research, or intellectual debate, he knows little on relating to people, or to himself in order to connect with others.
It was like we had to re-learn friendship, communication, or connecting with caring about relationships at all. During a longer period of John Q on the surface, we were writing a conference speech. The chunk of perhaps 10 minutes of the text that he input was entirely unusable. It was purely factual and dry of emotion. It was more like an educational course than a way to reach the audience in a personable way.
We had asked our therapist from at that time to teach us to communicate again. We sent an email in French that translates to basically, “The re-structuring of the capacity for communication.”
On the flip-side, if I’m at the front and John Q is not, I do not have the capacity to explain the linguistic nuances of an inductive inference…
To recap these points of signs and symptoms, there are far more subtle indications than are generally taught, or known about.
Most indicators are invisible to perception of those around us and go more-so behind the scenes, so to speak. You won’t see or detect when there’s chatter between Headmates. It’s far more subtle than most imagine, which is likely why these dissociative signs are missed, or dismissed as quirks.
So, what’s the treatment for Dissociative Identity Disorder?
There are no medications for Dissociation. The only treatment for DID is long-term psychotherapy. This consists of either two or three therapeutic stages.
The first is to develop coping skills for facing PSTD symptoms, strong emotions, or destructive behaviour. There needs to be a tolerance for heightened feelings or traumatic memories.
The second stage is to face our past trauma and learn to work through it so that it doesn’t have such a strong impact or hold on us. We can then move forward from such experiences and be more connected as a system.
For some, the process stops there. As opposed to previously, when the concept of functional multiplicity and remaining as a system was not accepted, this option is now often left open. We can decide if we move onto step three, which is integration to a unified self.
We may start off the first step determined to reach the end of the third, but then changing our minds to stop at step two in acceptance of multiplicity. Or, a system might begin with the conviction that they will never integrate, but find themselves at ease and welcoming it.
Integration is not always possible. For those that it is, regardless of what a system chooses for themselves, the options should be clear and properly explained so that their informed decision is one to be worked toward and accepted.