Dissociative Identity Disorder (DID) is a mental health disorder that can result when there was severe child abuse and/or neglect. Colin A. Ross, M.D. is a specialist in the treatment of DID, see his book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality for more information. (G3.32)
The author provides an example script he developed for patients to describe what cognitive therapy is and how it might help them. The script begins with lines that suggest that our feelings are sometimes affected by what we think and that if that is true then changing how we think may be the best way to change how we feel. He describes cognitive therapy as a method for helping the patient to learn what not to do rather than focusing on teaching them what to do.(p 339, G3.32)
Incorrect beliefs can develop during childhood that may have been helpful to the child at the time but may cause problems later in life. The author discusses false assumptions commonly believed by DID patients and he describes a few cognitive therapy techniques which he found helpful for challenging the old beliefs and guiding the patients to new beliefs. Counseling strategies and false assumptions are discussed within the section titled Cognitive Restructuring Techniques. (pp 338-345, G3.32)
G3.9: Cognitive Restructuring Techniques for “false assumptions.”
The false assumptions are discussed in the book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality within the section titled Cognitive Restructuring Techniques (pp 338-345, G3.32) I found the ideas helpful and combined the false beliefs into a list, with notes summarized from my understanding of the text, words in italics are quotes from the text:
- “Different parts of the self are separate selves.” – Which can lead to the false belief that different parts of the self (alters) actually have different bodies and cognitive therapy may address the risk of one alter causing physical harm to the host (primary personality) by tackling the alters’ false belief that there are two or more separate bodies.
- “The victim is responsible for the abuse.” This false belief may occur during developmental stages in early childhood when the child believes that what happens in the world is caused by the child’s actions. Cognitive therapy can challenge the underlying belief that “I must be bad.”
- “The abuse happened because I am bad.” Children can’t just leave their caregivers and the need to love and feel love is also strong so it can be a common false assumption that whatever is happening is right and the child is wrong or deserving of the mistreatment. Cognitive therapy can discuss the differences between a child’s and an adult’s responsibilities in life and whether traumatic events are something other children could cause to occur or that they deserve instead of normal love and affection.
- “It is wrong to show anger.” Cognitive therapy can help teach what healthy anger is and how to control it. Underlying false beliefs can be challenged by asking: “Who says anger is bad? How do you know that?”
- “The primary personality can’t handle the memories.” Cognitive therapy can help the DID patient to recognize that as an adult the primary personality is older and may have more ability to cope with painful memories. (paraphrased from the book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality: Cognitive Restructuring Techniques, (pp 338-345, G3.32))
- The first and last of the assumptions listed above are more specific to DID in that amnesia is involved; the memory of the trauma is blocked from the primary personality. However a child in a trauma situation might also develop the last assumption about other people in their lives. They might feel a need to protect family or others from information that the child might fear is too disturbing in some way or had been told by someone else to keep secret.
- Less severe cases of childhood trauma may result in the child growing up believing false assumptions similar to those listed in number 2, 3, and 4 without the child also developing amnesiac memory blocks or feeling like there are parts of the self that are separate from each other.
Dissociation can be a normal coping strategy but in DID it can become disruptive for the adult even though it may have helped the child survive traumatic events. Cognitive therapy strategies can help the patient recognize that the beliefs they had developed as a child are not necessarily true at all or they are not true now that the child is really an adult. Initial recognition of false assumptions can help change old beliefs and related behaviors quickly, but it can also take months or years repeating the new beliefs to replace the old childhood beliefs.
G3.10: Therapy for Dissociative Disorders can be Effective & Cost Effective.
Information from the book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality regarding the cost effectiveness of therapy for DID found it to be very cost effective and could save years of ineffective therapy. Clinicians have reported stable integration in children with DID in as few as 5 to 10 office visits. The shortest reported integration for a child patient occurred in just one session and the longest treatment reportedly took 30 sessions over five months. The point is made however, that it wouldn’t be ethical to treat a child with DID while they are still experiencing abuse because the therapy would be taking away the child’s coping strategies. (p256, G3.32)
Adults with DID have been reported to have spent as long as twenty years in ineffective therapy before the diagnosis of DID was made. Twenty years of therapy can cost $500,000. Research that examined the treatment of fifteen women found that it took an average of 8.1 years in therapy before a diagnosis of DID was even made, at an average cost of $166,786.97 each. In comparison the average length of treatment once a diagnosis of DID was given was 2.6 years. (p257, G3.32) Two to five years of therapy before reaching integration is typical for patients with DID. (p257, G3.32)
The diagnosis of DID became controversial in the past as some practitioners over diagnosed and may have led some patients to false memories during sessions. However it is a real condition that is not very common.
- A narrative “dramatized” description of a patient with DID and her therapy is available in the book Jennifer and Her Selves. written by the patient’s psychotherapist: (G3.33)
- A patient with the condition shared her own story and “survival tips” for others with Dissociative Identity Disorder. At the time she wrote her book the condition was still called Multiple Personality Disorder. The next section includes more of Sandra J. Hocking and Company’s story in their book, Living With Your Selves: A Survival Manual for People With Multiple Personalities, (G3.34) . Sandra wrote the book along with some of her “alters“, the other sides of her personality that were formed at different stages of her childhood or adult life. More about her story and the difference between DID and schizophrenia will be included in the next post.
Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.
- G3.32: Colin A. Ross, M.D., Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality., Wiley; 2nd ed., Oct. 30, 1996, rossinst.com, (pp 256-257, 338-345, G3.32)
- G3.33: Gerald Schoenewolf, Jennifer and Her Selves. (Dell, 1992) http://www.amazon.com/Jennifer-Her-Selves-Gerald-Schoenewolf/dp/0440212871 (G3.34)
- G3.34: Sandra J. Hocking and Company, Living With Your Selves: A Survival Manual for People With Multiple Personalities, Launch Press, 1992, https://www.amazon.com/Living-Your-Selves-Survival-Personalities/dp/1877872067 (G3.34)