Information about Dissociative Identity Disorder (Multiple Personality Disorder) and living with the condition.

Laura Astorian, Ph. D.

Laura has thirteen years invested in the public school system where she teaches psychology and history.  She is an on-line hockey writer since 2007, both for Thrashing the Blues which she manages, network blogs (Bloguin’s Puck Drunk Love and SB Nation’s SB Nation Atlanta, SB Nation St. Louis, Birdwatchers Anonymous, and St. Louis Game Time), and a featured contributor on the Yahoo! Sports blog Puck Daddy.

Laura currently holds a Doctorate in History Education degree from Kennesaw State University.

A  D. I. D. Presentation

The DID Presentation you are about to view was created by Laura Astorian, Ph.D. for a High School AP Psychology course. This is a fictionalized account of having a psychological ailment. For questions about this blog project or its content please email the teacher, Laura Astorian: laura.astorian@cobbk12.org

Originally Published on May 9, 2015, and used with the permission of Laura Astorian, Ph.D

Dissociative Identity Disorder by Laura Astorian, Ph.D

Dissociative Identity Disorder Slide Narrative
1. DISSOCIATIVE IDENTITY DISORDER (DID)  Multiple personality disorder  Most extreme dissociative disorder  Contains elements of: Depersonalization  Derealization Amnesia Identity confusion  Identity alteration Diagnostic criteria: Switching between 2+ distinct personality states (alters)  Recurrent dissociative (amnesiac) boundaries between alters Symptoms clinically significant cause of distress/dysfunction & not due to imaginative play, religious practices, culture, substance use, or another condition

2. DISPELLING MYTHS AND MISCONCEPTIONS NOT schizophrenia, bipolar disorder, or borderline personality disorder  Affects 0.1-1.5% of population Worldwide phenomena Only overt/florid in 5-6% of cases  Traumagenic- caused by repeated or long-term childhood trauma Not sociocognitive/iatrogenic  Must form before ages 6-9 Individuals with DID can be co-conscious (aware of alters and capable of using body at same time as one or more alters)

3. SYMPTOMS  Depersonalized/ego-dystonic, unpredictable, uncontrollable actions and speech  Internal voices or streams of thought not owned by individual Intruding depersonalized/ego-dystonic emotions, sensations, thoughts, urges  Perceptions, memories, skills, preferences changing between sets Depersonalization; seeing body as different age, sex, race, build; not recognizing self in mirror  Disconnection from name, physical attributes, history, memories Amnesia Finding unfamiliar possessions, art, writing Being called unknown name by familiar stranger  Being confronted about unremembered actions Dissociative fugue/unremembered travel Inability to recall past, especially traumatic history Flashbacks of traumatic events (may or may not be re-repressed once done)

4. PREVALENCE  0.1-1.5%  Some estimates high as 3-5%, others low as 0.01%  6-10% of inpatients Gender disparity: Some studies say 1:9 M:F, others say equal  Equal for children and adolescents diagnosed Disparity may be due to males with disorder not entering therapy or entering prison system instead  Has been found in India; the Netherlands; China; the United Kingdom; Belgium; Russia; Norway; Israel; Germany; Canada; South Africa; Australia; Puerto Rico; Japan; Switzerland; Turkey; Scotland; Spain; Argentina; Sweden; New Zealand; Brazil; Finland; Taiwan; Singapore; Slovakia  Present in other countries as possession-form

5. ALTERS  Differentiated/dissociated self states  Structural dissociation: emotional/apparently normal parts  Have unique perception as self as individual Can take recurrent control of body with some degree of recurrent amnesia  Can have different: Natures and characters Ways of perceiving and reacting to the world Affect and expressiveness Internal perceptions of appearances, ages, genders, species  Preferences, sexualities, opinions, desires, needs, memories Knowledge, skills, abilities, sensory-motor functioning Reactions to stress, allergens, medications Psychological or physiological disorders  True alters only present in DID or OSDD-1

6. TYPES OF ALTERS  Core/original  First alter within system/body  Host/fronter(s) Handles some or most aspects of daily life  Protectors Protects body, system, other alters, host, core Persecutors  Harms body, system, other alters, host, core to retain control, avoid future or worsening of abuse, express internalized negative messages or feelings  Introjects Based off of outside people (fictional, historical, family, abusers) Memory holders Usually hold memories of trauma but can also hold happy/innocent memories  Gatekeepers Control switching or access to certain areas inside, memories, other alters Internal self-helper Holds knowledge about system, other alters, trauma, history, internal workings  Fragment Not fully differentiated alters; hold single or simple emotions, memories, actions or reactions, purpose

7. SWITCHING AND PASSIVE INFLUENCE  Switching  Change in alter(s) in control of body/fronting  Consensual (wanted by both alters), forced (wanted by one alter), or triggered (caused by alter better suited to handle stimuli being forced to front)  Can involve co-fronting (2+ alters using body at same time), co-consciousness (2+ alters aware of outside world at same time), black out (1+ alters no longer aware of outside world), or time loss (1+ alters no longer aware of passing of time)  Can be slow, quick, or uncontrollably rapid Can involve blending (temporary merging of alters) Passive influence Intrusive thoughts, feelings, emotions, opinions, preferences, urges, actions Changes in skills, abilities, memories, emotional range

8. ETIOLOGY AND DEVELOPMENT  Long-term childhood trauma often combined with disorganized attachment  90% – childhood abuse and neglect 10% – medical/surgical procedures, war, human trafficking, terrorism  Forms before ages 6-9 Either splitting of self due to denial of trauma or failure to integrate due to trauma (theory of structural dissociation)

9. STRUCTURAL DISSOCIATION  Theory of formation of dissociative disorders  All children born as collection of ego states Most naturally integrate into one stable self  Trauma disrupts this integration PTSD: one central self state with trauma- associated ego state separate (1 ANP+1 EP)  C-PTSD/BPD/OSDD: one central self state with multiple trauma associated ego states separate (1 ANP+EPs) DID: many self-states, some associated with trauma and some with daily life (ANPs+EPs)

10. CO-MORBID CONDITIONS  DID often associated with:  Posttraumatic stress disorder  Depressive and bipolar disorders  Anxiety disorders Personality disorders  Somatic symptom and related disorders Feeding and eating disorders  Substance-related disorders Obsessive-compulsive disorder Sleep disorders Self-injury

11. TREATMENT  Therapy  Talk and behavioral therapies (CBT/DBT)  Art, music, and play therapy Eye movement desensitization and reprocessing  Family therapy Medication for co-morbid conditions Hypnotherapy NOT appropriate for treating DID  Risk of memory contamination, creation of new alters or strengthening of existing alters, flooding with memories  Integration or cooperation Integration: fusion of two or more alters into one Choice of individual/system; many therapists no longer push or even advise integration.

12. PERSONAL EXPERIENCES: ALTERS We are many within one. I am not them, nor they me, yet we share one body, one mind, one life.

13. PERSONAL EXPERIENCES: IDENTITY CONFUSION Who am I? What age am I? What’s my sexuality? Is this really me? What do I feel? Why am I doing this?

14. PERSONAL EXPERIENCES: DEPERSONALIZATION That can’t be me. These aren’t my hands, my legs, my face. I don’t recognize this person. I don’t feel their emotions or understand their thoughts. Why is my body crying?

15. PERSONAL EXPERIENCES: DEREALIZATION Nothing is real. This is all staged. I have no past nor future. This moment does not matter.

16. PERSONAL EXPERIENCES: INTRUSIONS I feel like someone is hovering at the edge of my awareness, and I can feel their terror overtaking me. I’m detached from it; I don’t understand it and can’t name its cause. I have the urge to hide somewhere, but I know that that’s silly, and I can ignore it.

17. PERSONAL EXPERIENCES: CO- CONSCIOUSNESS My body moves, and I can’t control it. Words come out of my mouth that aren’t mine. I know what’s happening; I can feel her behind me, and she can feel me. If I try, I can communicate with her through a cacophony of thoughts, images, and mental sensations.

18. PERSONAL EXPERIENCES: AMNESIA I don’t remember my childhood. I don’t remember last week. When I try to remember, I feel pressure in my head as if my consciousness is limited by a glass cage. I’m not sure that I mind. What I do know of my past is too painful for me to face.

19. PERSONAL EXPERIENCES: FLASHBACKS I feel sick. Every muscle in my body is tense and prepared to fight. I know that I’m safe; I know that. But I feel his hands on my body, and I have to resist the urge to gag. I’m not a child anymore, but I feel small and helpless. I can almost hear his voice in my ears, taunting me. There are no words for this. I won’t remember this. I’d rather die.

No corrections have been made this narrative and slides have been kept in its original to protect the work of the author and creator.  If you want a copy of this information please see LinkedIn.  Thank you for your cooperation

Thank you Dr. Laura Astorian for the use of the D. I. D presentation and for your investment into tomorrow’s generation