DISSOCIATIVE IDENTITY DISORDER IN A NUTSHELL
Glossary of Terms
Written by Shirley J. Davis
Alter- An alter is an ego state that has been separated from other ego states by amnesiac barriers which began to be formed in very early childhood. It is important to note that all humans have ego states, formed to handle different life situations. One may have an ego state that emerges at work, school, with parents and with friends that differ significantly in actions. When triggered by events similar to that for which an ego state is formed, that ego state will emerge to handle the situation. However, these “normal” ego states are capable of communicating, thus the person’s ego state does not “take over” in a way that amnesia for their actions result. When a young child is subjected to extreme and repeated trauma, their mind becomes overwhelmed by experiences they cannot understand or process. Thus, they form amnesiac barriers to protect themselves from remembering the events. Because of these walls, each ego state exists autonomously, having its own set of values and thoughts. When triggered by an emotion or event which is similar to that for which the ego state was formed, the ego state will take over and no memory of what has transpired will be retained by the other parts of the person’s mind.
Amygdala- The amygdala is part of the limbic system in the brain, the most primitive part of the human brain. The amygdala is responsible for the fight, flight or freeze response necessary to keep humans (and other mammals) from harm by allowing us to recognize dangerous situations immediately and ready our bodies for action. This part of our brain, when overstimulated over and over by early childhood trauma, may be partially responsible for some trauma victim’s hypervigilance. When imaged in person’s who have experienced severe and repeated early childhood trauma, it has been found to be smaller in volume showing that exposure to extremes of fear actually can cause brain changes.
Big- This a term people who live with dissociative identity disorder use to describe the adult members of their multiple system.
Body Memory- Memories aren’t only stored in the thinking part of the brain. Often memories of traumatic events are stored in the portions which control how humans relate to their bodies. A common example would be phantom pain. Sometimes when a person loses a limb in an accident they continue to feel pain as though that limb was still present. This is true of body memories as well. A person might have pain or sensations in the part of the body that was traumatized in childhood.
Co-Awareness- An important step towards gaining control of one’s life for a person living with DID is becoming co-aware. In this stage, all or most of the alters gain awareness of each other’s feelings, emotions, and memories.
Co-Conscious- Being able to be present in as many situations as possible is extremely important to the waking self in a multiple system. Becoming co-conscious means that whenever an alter emerges, the waking self is aware and awake and thus able to be in on any decisions and actions the emerged alter might make.
Complex Post-Traumatic Stress Disorder- Children who suffer chronic trauma such as abuse and a disruption in attachment to their caregivers, may develop Complex Post-Traumatic Stress Disorder. This developmental disorder leaves the child feeling terror, worthlessness and hopelessness. Below is only a partial list of the possible symptoms survivors may experience in adulthood:
• Inability to set up healthy boundaries
• Lack of trust
• Social isolation
• Difficulty perceiving and responding appropriately to other people’s emotional states
• Increased probability of developing serious medical problems
• Difficulty expressing wants and needs
• Impaired memory
• Problems with impulse control
• Aggressive behavior
• Sleep disturbances
• Fragmented and/or disconnected memories of life history
• Disturbed body image
• Low self-esteem
• Excessive shame
Co-Occurring Diagnosis- Often a person living with DID will have other disorders accompanying it such as borderline personality disorder or major depression.
Core- The central, sometimes original ego state of a multiple system.
Covert Switching- Changing from one alter to another without being noticed by people outside the person’s system.
Crisis- A mental health event which may lead to a dangerous situation such as suicide.
Depersonalization- A detachment within the self, regarding one’s mind or body, or being a detached observer of oneself. Subjects feel they have changed and that the world has become vague, dreamlike, less real, or lacking in significance. It can be a disturbing experience.
Derealization- A persistent or recurring feeling of being detached from one’s body or mental processes, like an outside observer of their life and/or a feeling of being detached from one’s surroundings.
Dissociative Identity Disorder- According to the Diagnostic and Statistical Manual, 5th Addition, (DSM-5) a person must meet the following criteria to be diagnosed with Dissociative Identity Disorder.
1. Two or more distinct identities or personality states are present, each with its own relatively enduring pattern of perceiving, relating to and thinking about the environment and self.
2. Amnesia must occur, defined as gaps in the recall of everyday events, important personal information and/or traumatic events.
3. The person must be distressed by the disorder or have trouble functioning in one or more major life areas because of the disorder.
4. The disturbance is not part of normal cultural or religious practices.
5. The symptoms are not due to the direct physiological effects of a substance (such as blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (such as complex partial seizures).
Dissociation- A mental process of disconnecting from one’s thoughts, feelings, memories or sense of identity.
Dry Wells- People who have no emotional support to give.
DSM-V- The bible of the psychiatric world produced by the American Psychiatric Association which outlines the different diagnostic criteria for mental conditions.
Eeyore Complex- A chronic depressed outlook on life where the person is always relating to others the negatives of their day to day life experiences.
False Memory Syndrome Foundation- A nonprofit organization founded in 1992 by Pamela and Peter Freyd, the FMFS purports to examine critically the concept of recovered memories, and supports the belief in false memory syndrome. They believe that recovered memories of childhood abuse are not true, but have been caused by faulty therapeutic methods. They have their own website at http://www.fmsf.org
False Memory Syndrome- Described as a condition in which a person’s identity and relationships are affected by memories that are factually inaccurate, but that they strongly believe. False memory syndrome is not a scientifically accepted or proven condition, nor is it found in the DSM-5.
Flashback- A reliving of an event of trauma as though the person were back in the time and place of the occurrence.
Fragment- A partial ego state, such as a nonverbal child.
Hippocampus- The hippocampus is involved in the storage of long-term memory, which includes all past knowledge and experiences. The hippocampus seems to play a major role in declarative memory, the type of memory involving things that can be purposely recalled, such as facts or events. The hippocampus also plays a role in learning and memory. Children and adults can develop amnesia to try and avoid remembering a traumatic event. This could be due to a decrease in the hippocampus which results in the shutting down of neurons or the dysfunction of neurons due to a decrease in volume. Multiple studies have been done with MRI imaging to substantiate that the hippocampal volume of adults who experienced chronic childhood trauma have decreased hippocampal volumes.
Integration- Integration is a highly controversial topic among people living with Dissociative Identity Disorder. In many cases, people have been misled by well-meaning professionals to believe that to integrate a person living with DID must pull together all alters into one cohesive personality with no divisions remaining between the person’s ego states. This, however, is not true. In this author’s opinion, such a cohesion between the alters in a person’s system cannot be achieved, anymore than a person who does not live with DID can separate their adult ego states to become a multiple. I believe that integration occurs when the ego states (alters) achieve their highest level of co-awareness, cooperation, and co-consciousness. I often give the example I shall relate below.
A multiple system is a lot like an orchestra. Every musician in the orchestra is a master of their instrument, however they do not cooperate or know of each other’s existence so the music they play sounds disjointed and chaotic. They need of a leader, a Maestro, to help them become aware of one another’s existence and abilities so that they can pull together to work in unison. Slowly, with a lot of practice, and by paying close attention to the Maestro, the musicians begin to play their parts in harmony with the others and the result is a beautiful melody of lovely music.
In the above analogy, the Maestro is leader of the alters, who is at first the therapist but after a while becomes the alter who is best suited to interact fulltime in the outside world. The orchestra members are the many alters in a multiple system, all playing their own music, unaware of the others and the chaos they cause. The result of the leadership of the Maestro, and the hard work of practicing together is integration.
Little- Child alters in the multiple system.
Losing Time- A person living with Dissociative Identity Disorder often will lose time when they are dissociated into another alter. Minutes, hours or even years can pass for the core without their knowledge. The result is confusion, disorientation, and fear.
MRI- Magnetic Resonance Imaging. It is a radiological test where a strong magnet is used to visualize soft tissues in the body. It is painless, but it can take a great deal of time to perform.
Multiple Personality Disorder- The old term for Dissociative Identity Disorder. Its name was changed in 1994
Personality- This term refers to individual differences in characteristic patterns of thinking, feeling and behaving which are attributed to an individual. Our personalities begin to be formed before birth, and continue to evolve until death. Humans have only one personality, so despite public opinion, the term “multiple personality” to describe someone living with dissociative identity disorder is incorrect.
Psychotherapy- Often referred to as “talk therapy”, this psychological tool consists of a client sitting with a mental health professional and working out through exploring personal insights, the problems they feel they need help with. This type of therapy can last from a few weeks to many years, depending on the diagnosis being dealt with. It is important to note that psychotherapy for dissociative identity disorder often takes multiple years to achieve enough recovery for the client to feel they have achieved a peaceful and fruitful stage in their life.
Relapse- Falling back into old patterns that one has determined to be negative to one’s health and happiness. In the case of DID, it can mean having an extended period of dissociation after a long period of stability. These relapses are usually brought on by extreme stress which the person has become overwhelmed by and is unable to cope.
Singleton- Anyone who does not experience the splitting (switching) which is the hallmark of dissociative identity disorder.
Splitting- Switching from one alter to another, it is also known as switching. Splitting is often out of the person living with DID’s control.
Stress- An occurrence which causes a person to feel a heightened sense of alertness. There is always stress in our lives, however some stress is toxic in that it overwhelms our abilities to cope and drives us to do things to cope we would not normally do. It is important to remember that even good stress, such as the birth of a child, can cause a dissociative episode.
Stress Hormones- Our brains have a mechanism to ready us to respond to any perceived threat and stress hormones are a key to this response. When a threat is perceived, the hypothalamus (an organ located in the brain) to send signals to other parts of the body including the pituitary gland, which is responsible for secreting adrenocorticotropic hormone (ACTH). This hormone then forces the adrenal glands to produce the hormone corticosteroid to increase the body’s readiness to flee, fight, or freeze to avoid or escape danger. These responses are automatic, and it is important to note that they are triggered by what the brain PERCEIVES as a threat, not necessarily the fact that a threat exists in the here and now. When young children are in severely traumatic situations repeatedly, their young bodies are subjected to being flooded with stress hormones continuously. As a result, their brains can become damaged in that the parts of the brain which regulate the fight or flight response are highly susceptible to being harmed by stress hormones which are never allowed to return to base line levels.
Survivor- A person who has lived into adulthood after experiencing childhood trauma.
Therapist- A highly trained mental health professional who offers hope and help to persons in need of someone to speak with to overcome an adversity in their life.
Trigger- A trigger is something that sets off a memory, flashback or dissociative event. Triggers are very personal as different things trigger different people. They can involve all five of the senses, and are very hard to avoid all the time.