Does DID/MPD exist as a clinical condition, or is DID/MPD “just an extreme example of what we all do every day.”?

Is this an “either/or” question or do these really say the same thing?

These thoughts and words come from a post that Annenco sent me – a post from someone who attempts to explore and resolve the concept of DID/MPD in 400 words or less. Hers is a kinder, gentler stereotype – tempering the concept into something everyone can more easily reject.

For those who are unfamiliar with DID/MPD, walk with us. You’ve practically accepted us already. Really.

DID/MPD is not an orphan diagnosis. DID/MPD is part of the “Dissociative Spectrum” – a continuum of dissociation starting with the most benign – “Highway hypnosis – missing your exit” through the most severe – “variations of DID/MPD.”

I think if this entire continuum were more familiar to people, uninformed beliefs and statements would be less prevalent. I believe It is simply lack of information that causes these misunderstandings – not intentional maliciousness or discrimination.

Those of us with various levels of dissociation up and through severe DID/MPD understand this, as we are familiar with (and living within) the spectrum.

We’d like others to understand it as well. Trust me that you already accept most of the continuum. Extending that to the other end isn’t hard.

Really.

The Dissociative Spectrum Revealed (at a high level)

Let me show the Dissociative Spectrum here for reference, from RealMentalHealth.com. Head over there to see a clearer version.

Let’s quickly review the six items listed on the dissociative scale, as it is the basis for my thoughts in her post.

a) Normal dissociation - the oft-quoted “highway hypnosis” example where you get lost in your thoughts and miss your exit.

b) Dissociative amnesia/fugue – blocking out painful memories. Repressing partially or totally. Sometimes ending up in difference places without realizing how you got there. Flashbacks, trancing out.

c) PTSD - more severe flashbacks, amnesia, triggers. Cycling between vivid flashbacks and memories to emotional numbing and avoidance. (Post Traumatic Stress Disorder)

d) DDNOS – Best understood as less well defined personality states than DID; amnesia may not be pervasive. Feeling like you are looking at yourself from outside your body. (Dissociative Disorder Not Otherwise Specified)

e) DID -Existence of 2 or more personality states. Caused by repeated trauma that overwhelms an individual, especially a child. To escape the trauma the child/individual may pretend it is happening to someone else. For many reasons – horrible actions, emotional and physical threats against themselves or family members.

Over time, a child begins reacting, almost like a reflex, to protect themselves…and the “pretending” and “going away” become more solidified. The amnesia of one part to the horror carried by another part solidifies the boundaries between these personality states. Then when these “states” are active, the experiences, likes, friends, and memories become associated with each. And then we have DID. (Dissociative Identity Disorder)

f) Poly-fragmented DID – DID with a much larger number of personality states, likely caused by sadistic/ritualistic abuse by multiple perpetrators over time. (RealMentalHealth)

As an aside (within an aside), it is important to note that a LARGE MAJORITY of DID (and probably ALL of poly-DID) does not happen instantaneously. The trauma(s) that launch the initial dissociation and amnesia are the seeds, but DID is most commonly caused by repeated triggers and trauma. In a majority of cases, it forms over time. Actively, but subconsciously. Because the amnesia to encapsulate the events isn’t a static event. The encapsulation must be actively maintained over time.

AND – DID and Poly-DID are the most “extreme” cases, but let’s recognize that it is PART of the continuum rather than some dangling participle with no connection to reality.

This is fundamentally what most people do not understand. Continuum, not outlier.

<!!! And remember that word “extreme” for later. There might be a quiz>.

Back to the misconceptions

The writer of the post in question (I am including no links to her blog as my discussion is related to the topic as a general misconception rather than a discussion against her post and thoughts specifically) presents several examples that fall along the Dissociation Spectrum.

These examples are escalating steps that she relays are “normal.”

a) The highway hypnosis example – missing your exit.
b) Amnesia. Partially or totally repressing memories caused by trauma or “events…that are too distressing.”
c) “[W] e switch off (dissociate) ourselves from the feelings attached to the distressing thoughts …”
d) “…[S]o we can view them almost as if it happened to somebody else.”

Hmmmm. I agree.

Implicit understanding and “sort of” acceptance of the Dissociative Spectrum

There seem to be three groups of people on this earth. On one end are those who think DID is bullshit. On the diametrically opposite end are those who either have DID or know someone who has DID.

In the middle is everyone else. People who are open-minded but not really interested enough to express an opinion either way. Those who believe it might be true perhaps after some reading or studying abnormal psych. Those who’ve read/seen the stereotypes and rejected them as too outlandish…but who feel a lingering sense of emotional believability. Who really do believe that DID is possible.

Boy, I wish this were a bell curve, but sadly it is not.

<But if we count not only those with DID, but the number of different personalities within them, we could represent a larger piece of the pie, eh? >

Although this writer places herself with the non-believers, I think she is actually in the middle group. It’s just that her logic and her belief system prevent her from accepting what she might already suspect.

Compare the four “normally accepted” examples she gives above with the six milestones on the dissociative scale. She presents a 1-to-1 match from normal dissociation (a) through DDNOS (d).

Let me clarify – I am so psyched that she accepts the first 4/6ths of the scale and gives examples, but ohhh, don’t reject the last 2/6ths!

<Yes, we know how to reduce fractions. But it’s more illustrative this way.>

Maybe it’s all in the definitions. Here are her thoughts:

“Personally I do not believe in the existence of this condition as a clinical entity.” … “[M]y personal belief is that DID/MPD is just an extreme example of what we all do every day.”

An “extreme example.” I would argue that she is correct in her assessment. Looking at the spectrum, DID certainly is the extreme.

Extreme is defined as:

“Of the greatest possible degree or extent or intensity; e.g., “extreme cold.” (WordNet (r) 1.7)

Far beyond a norm in quantity or amount or degree; to an utmost degree; “an extreme example.” (WordNet (r) 1.7)

The best of worst; most urgent; greatest; highest; immoderate; excessive; most violent; as, an extreme case; (Webster’s Revised Unabridged Dictionary (1913)

She has it right. DID is the extreme. She recognizes it as the extreme.

But is it what we do every day?

…for most folks, probably not.
…for some of us, yes.

If the overwhelming trauma she lists were to be repeated over time, would that then constitute “every day”?

I really think she has the glimmer of belief but is not able to tie “extreme example of what we do every day” to DID. It’s like she just needs a little mental nudge to take that final step along the continuum she has already defined and accepted.

Another misconception about fixed and fluid personalities

The writer uses, as support for her argument, the notion that DID “presupposes that our personality is fixed and immutable, when in fact we are constantly changing and growing and evolving.”

Yes, I agree for the most part. However, this “argument” for DID is false and irrelevant.

*I* have grown and learned from my experiences, and changed over time. Some other parts of me have as well. We are not “fixed” in time, and DID does not REQUIRE a fixing in time.

However, there are some parts or personality states that are fixed in time. Having not grown or evolved. Some of those carrying the trauma, having locked it (and themselves) away in an attempt to maintain the amnesia and protect the rest. For them there has been no growth; very little connection to the outside world other than sourcing flashbacks and triggers.

Let me provide a personal example, even though I am always hesitant about sharing details.

I am a party of about 11. A few of me have grown over time. Gained experience, evolved based on successes, failures and “normal” life. I have three or four who have been/are locked in time. One has been with me, influencing me without growing much – locked in a set of behaviors related to triggers from my first trauma. One has recently rejoined me and is slowly “coming up to speed” … having been partially locked in time. One I know is a tightly knotted keeper of lashing anger wrapped around another holding most memories of another trauma. Quite a collection of growth, little growth, no growth, etc.

<A veritable cornucopia of relative evolution!>

And one particularly interesting situation, I have one special someone <careful…> who has evolved over time based on normal experiences during her time in front, but since I started all this therapy and recognized more what was happening inside me, that part has grown in a different way – understanding how her actions and words have hurt other people. She and I are helping her to recognize and temper this.

So, in this case, it is a different kind of growth – a dual growth if you will. Perhaps even more complicated than the “normal” evolving this writer asserts.

<Not just linear growth, but bifurcating growth as well!>

While this writer’s arguments are not valid, I am happy that she has given me the opportunity to consider this aspect. I hadn’t thought much on it before, but its use as an argument against DID is thought-provoking.

Breakdown in understanding

I don’t mean to hammer this writer – I am simply using her post as an example of how I think people misinterpret DID because they are not familiar with the Dissociative Spectrum. And because stereotypes are passively accepted as fact.

After what we have covered here, this becomes apparent at the end of her post:

“When we drive our car on a familiar road, we’re not consciously concentrating on every bend, line, tree or lamp post. We know the road, so we’re probably thinking about what to have for dinner, or the conversation we had with our friend on the phone last night, or any number of things. But it’s not ‘another person’ doing the driving.”

This is where it all breaks down. DID is not highway hypnosis. These two are on opposite ends of the spectrum. One cannot be used as a denial of the other.

I am sad because this convoluted logic hurts us. She seems reasonable. Perceptive enough to believe if exposed to the right information. But the lack of understanding causes her (and many many others) to draw conclusions that are simply not true. And because she seems reasonable and not rabid, it makes her conclusions all the more believable to the average person in that middle group of open-minded.

References

Turkus JA. (1992). “Spectrum of Dissociative Disorders” RealMentalHealth.com accessed on August 24, 2008 from http://www.realmentalhealth.com/dissociative_disorders/spectrum.asp