Dear Ms. DID: Does Altercide, suicide of an alter, kill the entire system?

We know the definition – taking your own life. Some of us understand this terrible state of mind and the internal war accompanying the decision.

This is not an essay on suicide prevention, but an exploration into its relationship to DID.

So I wondered, are those with DID more prone to suicide? If so, why?

I have read that some alters within a system may be suicidal. Are these alters capable of making the decision for the entire system? Would the system let them?

So, it is possible that one alter can “commit suicide” while leaving the others intact? Is killing another alter considered homicide?

And if so, are these alters aware that their suicide/homicide will affect the entire system?

Interesting questions.

First, some stats

Some good solid references exist for both descriptive and quantitative statistics.

The Merck Manual provides a nice overview of the disorder. As expected, the outcomes are all over the board. [1]

Dissociative identity disorder is chronic and potentially disabling or fatal, although many with the disorder function very well and lead creative and productive lives. People with this disorder are prone to injuring themselves. They may engage in self-mutilation. Many attempt suicide.

Patient with DID generally have co-morbid conditions (other medical baggage along with the primary DX) such as orderline personality disorder, somatization disorder, major depression, and PTSD. The disorder is associated with “high incidence of suicide attempts” and these patients attempt suicide more frequently than other psychiatric patients. [2][3]

More on stats. Since a large percentage of those with DID also meet the criteria for PTSD, these statistics are relevant. PTSD increases the likelihood of a suicide attempt by 6 times – the highest for any anxiety disorder and about equal to that with Major Depressive Disorder. Degree of suicide risks is dose dependent – it increases with number of abuse events and additional types of abuse. [ISSD Guidelines]

The insurance industry has already recognized and perhaps responded, reporting,

The DID psychiatric population is a complex group with mental disorders that place them in a group likely to use maximum disability benefits and who would pose increased life underwriting risk. In addition, the literature indicates a high excess risk for early mortality and excess health care expenses compared to the normal population. [4]

Sigh. Perhaps another reason to continue receiving your benefits under the PTSD diagnosis code rather than adding the DID code. So far, that it was I do. And after I see my meds doc, who was the one to formally diagnose me with DID, I do not submit his bills as claims. This is legal; I just choose not to use my benefits for a diagnosis that may cost me a lot more financially, and perhaps professionally, in the long run.

Ross and Norton (1989) noted “suicidality as a presenting symptom in nearly 70% of 100 cases of MPD reported to them by 92 clinicians throughout North America.” [5] Sar and Ross report that 61% and 72% of the patients attempted suicide. I am unable to access Ross’s entire article, but it attempts to identify the differences between those with DID who have attempted suicide, as compared to those who have not. [5][6]

Fetkewicz et al., (2000) reported that

MPD group more patients attempted suicide after being diagnosed than before and they made more separate attempts at suicide than before. [7]

However, the sample size for this research was small (N=12) and the authors are from the False Memory Syndrome Foundation, (Philadelphia, PA). While I have nothing but sympathy for the patients and families who are devastated by false memories, I must raise a yellow flag when the research is potentially biased in this way.

Why do individuals with DID want to commit suicide? Kluft (1992) reported several motivations

Vindictiveness, the overwhelming impact of flashbacks that could not be distinguished from reality, inner warfare among the alters, anticipated object loss, guilt in connection with a parent’s death, and pain and hopelessness associated with abandonment.

53% reported suicide attempts internally – one alter against another. [8]

Okay, let’s summarize. Suicide and self-injurious behavior (which is not covered in detail here), is very prevalent in the DID population in general, and as compared to other psychiatic conditions.

Let’s take this a bit further.

Who inside this system is self-destructive and why?

This high incidence of suicide attempts is an important reason that the first phase of DID treatment is stabilization, which includes safety.

I think it’s important for us to consider any differences in suicidal thoughts when DID is factored in. After all, are the suicidal thoughts shared by all in a multiple system, or just one or a few?

I’ve read that often multiples have one or more self-destructive alters, although until now I haven’t seen anything more than lists of “types” of alters. Inter-alter communications could be an important consideration. These “bad” alters may manifest aggression or represent the abuser. They may be in place to “punish” the individual for revealing “secret” information. Conflict may arise if alters have different “loyalties” which must be understood. Reasons must be respected in order to work towards common goals. [9]

FaithAllen presented an interesting article called How to Integrate Self-Destructive Dissociative Identity Disorder (DID) Alter Parts, reports that when a self-distructive alter is triggrered or comes out, that you may feel overcome with urges that are very strong, and may be impossible to resist. Even if you did not feel self-destructive before this time. [10]

She and others stress that healing involves talking about the trauma, and letting down the barriers among selves. This can naturally be triggering, and some of these self-descructive parts may have been dormant for years. This can explain why perhaps an occasional thought or background thoughts of self-injury or suicide may suddenly become much stronger as trauma work continues.

I like FaithAllen’s reasoning better than the “gentleman’s” implication above that increases in suicide after DX are due to false repressed memories and the aftermath of learning they may not be real.

Altercide – Integration as Killing off the Selves

Integration is sometimes explained as removing the splits to create a single whole. This idea of integrating self-destructive alters reminds me of one interpretation of Integration – that of removing the alters until the individual with DID becomes a single personality.

Is this one mechanism of alter-integration “alter-homicide”? To coin a phrase, “Altercide”?

Removal of most selves, leaving only one? Perhaps just the birthchild. or the one who is most often center.

Is this murder, this idea of killing a self? Is it the humane way to remove a destructing or suicidal alter? If we, as individuals with DID, “kill” off a part, is that murder or suicide?

My selves scream out in protest. <Me? Kill me? I protected you for years!>

The closest I have experienced internally are the small occasional floating of ideas that someone besides me should be center. But that isn’t death, just perhaps a democratic vote, or at worst a coup attempt.

On first glance, it seems perhaps logical to just kill off the “bad” alters that may want to initiate suicide (or homicide against the host or another alter). FaithAllen asserts that the self-destructive alters are actually acting out of caring and love. Perhaps an explanation being that non-suicide initiated self-injury helps an individual regain the ability to feel, escaping the pain and numbness of severe dissociation. Again, this may be more applicable for alter-initiated self-injury (again, not today’s discussion), but not for alter-initiated death.

Dealing with self-destructive alters

So what do we do about these self-destructive alters? Instead of altercide as a mechanism of healing, a recommendation appears to be understanding the trauma and the destructive alter’s role in that pain. What role the alter played in the initial trauma or it’s aftermath. To reach out to that part of yourself and understand the role, process the pain, and reintegrate.

While integration is usually a goal in therapy, one of the minimum recommendations is awareness, cooperation and full communication among the alters.

However, figuring out how to get that is a real challenge.

Where is this User’s Manual for this process?

FaithAllen provides several recommendations on integrating a self-destructive alter, a primary recommendation being that you find a therapist skilled dealing with those who have been severely abused. She also provides many realistic and thoughtful suggestions that I have never seen elsewhere – recommendations that acknowledge that sometimes the urge is too great not to cut. And in these situations, we should try to be co-conscious with the self-destructive alter in an attempt to minimize the damage. Sometimes there is nothing you can do except be aware of what is happening, attempt to minimize it, and get help if the damage requires medical attention. Thank you, FaithAllen, for acknowledging this practically and nonjudgmentally.

In more extreme situations when the alter causes violent and/or out-of-control behavior, both hypnosis and restraint sessions have been used to allow interaction with an aggressive alter to understand that alter’s role in the system. While it may seem extreme, Young reported a 96% benefit from restraint therapy that included therapeutic abreaction, alliance with violent alter, and connection with alter not otherwise available. [11]

Bottom line

I simply don’t have one. I did this research to explore the sudden rise in violence against myself, and my own recent thoughts of suicide. Information-gatherer that I am, this digging helps me to understand how my thoughts and experiences line up with what is considered “normal” (again, that somewhat comforting word) in this area of extreme mental turbulence and despair.

References

[1] The Merck Manuals: Online Medical Library. (2003). Dissociative Identity Disorder, accessed from http://www.merck.com/mmhe/sec07/ch106/ch106d.html

[2] Dissociative identity Disorder Treatment, Cause, Symptoms, Medication, accessed from http://www.depression-guide.com/disorder-dissociative-identity.htm

[3] Waseeme M. (2007). Child Abuse & Neglect: Dissociative Identity Disorder, Medicine from WebMD. Nov 28, 2007, accessed from http://www.emedicine.com/ped/topic2651.htm

[4] Galbraith PM, Neubauer PJ. (2000). Underwriting considerations for dissociative disorders.
J Insur Med. 2000;32(2):71-8. Review.

[5] Ross CA, Norton GR. (1989). Suicide and parasuicide in multiple personality disorder.
Psychiatry. 1989 Aug;52(3):365-71.

[6] Sar V., et. al. (2004). Childhood Trauma, Dissociation, and Psychiatric Comorbidity in Patients With Conversion Disorder, Am J Psychiatry 161:2271-2276, December 2004, accessed online here.

[7] Fetkewicz J, Sharma V, Merskey H. (2000). A note on suicidal deterioration with recovered memory treatment. J Affect Disord. 2000 May;58(2):155-9.

[8] Kluft, R. P. (1995). Six completed suicides in dissociative identity disorder patients: Clinical observations, Dissociation, 8(2), 104-111.

[9] Pratt A. (2000). DID/MPD: Working Within the Multiple System:online conference transcript. Heathyplace.com, accessed from http://www.healthyplace.com/Communities/Personality_Disorders/Site/transcripts/multiple_system.htm

[10] Allen F. (). How to Integrate Self-Destructive Dissociative Identity Disorder (DID) Alter Parts. eHow, http://www.ehow.com/how_2178196_identity-disorder-did-alter-parts.html

[11] Young et al., (1991). Restraints in the treatment of dissociate disorders: a follow-up of twenty patients. Dissociation, Vol N No 22, June 1991.

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4 Comments»

  Tigerweave wrote @

The idea of killing off or in any other way getting rid of an alter that is “negative” is er… actually just the same old same old. “Let’s dissociate from this part of me so I am not experiencing it.”

Actually I don’t think it is possible to kill an alter, though I can’t say I have tried it, I am sure if it was in any way possible I would have done it 😉 (And then no doubt lived to regret it)

And… the biggest and most important point to me about all this is: that “alter” is ME. It is ME that is hurting and destructive and trapped in the past and trapped by the actions of the perpetrators.

How could I leave a part of me (“killing” it off) in such agony and consider myself healed? Wouldn’t I simply be doing to it what the perpetrators did to it/me so long ago?

Keep writing!

  emilylonelygirl wrote @

Tigerweave,

Yes, you are right on track with me. It seems “killing the bad alter” is a common theme with those do don’t have DID and don’t understand. I’ve no argument with them – this is an incredibly complicated and “taboo” topic – I just try to have patience. And share information.

Like you, *I* am also an alter, but the one most often center lately. Emily is the birth child and we are working to make her more center. To give her her voice back. There are perhaps only 2 or 3 within me WITHOUT the pain, and they are all splits/alters. So, the stereotype isn’t universal, as you pointed out too.

So yes, altercide is not an option. But an interesting digression for me as I explored the idea of suicide within the realm of DID.

Thanks for writing!

  3v3ng3la wrote @

Hey Sister
I’m very sorry if i come as insensitive for it is not my intention.
With Love
3V3NG3LA

[The content of this long comment is addressed as a separate post here.]

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