In the first blog in this series we set out our full aims and what we hope this series might do to destigmatise some commonly misunderstood and misrepresented experiences of mental-ill health and mental disorders, you can read that here.
In this blog we discuss: dissociative disorders, why they still hold stigma today, why they are frequently misunderstood, what they are, ‘mythbust’ some common misconceptions and what we can all do to help fight stigma.
Types of dissociative disorders
Coming from the word ‘dissociation’, dissociative disorders are varied and as with many other experiences of mental-ill health sit on a spectrum that is diverse and unique for each person who experiences it.
What is dissociation?
An experience of dissociation is often as a result of how the mind and body responds to overwhelming stress, this could be due to a traumatic event like a physical attack, abuse or loss.
Everyone experiences dissociation uniquely but some common symptoms of dissociation and the kinds of dissociation are:
- feeling ‘outside’ of your body and the place you’re in.
- feeling as though the world around you seems ‘fake’ or ‘unreal’ (called derealisation).
- feeling as though you aren’t real, or feeling unsure of who you are or a ‘de-centred’ sense of self (called depersonalisation or ‘identity confusion’)
- finally, losing time and memories (dissociative amnesia).
Mood disorders such as major depressive disorder and bipolar disorder can involve dissociative episodes, dissociative episodes also often interact with psychosis, especially in relation to depersonalisation and the idea of a ‘de-centred’ sense of self.
When a person experiences frequent dissociation and is severe enough to impact their daily life a person might be diagnosed with a dissociative disorder.
Dissociative identity disorder (DID)
Previously called ‘multiple personality disorder’, DID is a complex condition which usually involves all types of dissociation listed above. With DID, the experience of identity confusion is heightened to what some call, ‘identity alteration’. This is often what people associate with the idea of ‘switching’ identities or what people used to call, personalities, (hence the old name) and is why you may see some people with DID talking about their ‘alters’ in reference to their altered states or identities.
The experience of identity alteration can look and feel like:
- noticeable/felt/severe changes in your identity.
- feeling as though different parts of you are in control at certain times.
- different identities may have different genders, ages, ways of thinking and seeing the world.
- experiencing a conflict in how you remember past events due to these identities.
- experiencing amnesia between when one part of your identity is in control and when another is.
It is important to emphasise here that the current understanding of DID has moved past the previous notions of ‘personality’ or ‘split personality’. Now, the understanding is closer to how we understand people in general, through a framework of ‘parts’ as you might see in therapies such as Internal Family Systems (IFS), where all parts or ‘identities’, as in DID, are part of a whole person or personality.
All people experience feeling like different versions of themselves in different situations, however people who do not experience the identity alteration in DID always have a sense of their ‘central’ sense of self, even if it may be hard to connect with at times.
With DID, this central sense of self, that can act as a director or mediator to these other parts is not present, though people with DID might experience one identity that feels the closest to what we understand as ‘you’, or a sense of self; this might be referred to as the ‘main identity’ or ‘host identity’.
- See also: 'Fighting stigma: what is psychosis?'
- See also: 'I display symptoms that can be scary, bizarre, or unpalatable: why I felt excluded from WMHD'
- See also: 'Denying the traumatic origin of Dissociative Identity Disorder denies those who live with it a recovery'
There are many misconceptions about DID, namely that those with the disorder are inherently more likely to commit violent crime. As we discussed in our blog, ‘Fighting stigma: what is psychosis?’, DID too, as it has been represented in popular media, especially in films such as M. Night Shyamalan’s Split, has long been associated with violence, ‘insanity’ and volatility.
We spoke to Chloe, who has a diagnosis of DID about how these representations affected her feelings towards her own diagnosis:
“The first time I was assessed and diagnosed with DID was just one month after Split's release in cinemas. In the run up to my diagnostic assessment I was haunted by posters declaring, "KEVIN HAS 23 DISTINCT PERSONALITIES. THE 24TH IS ABOUT TO BE UNLEASHED.”
“I knew that a DID diagnosis was on the cards and seeing these posters at every bus stop did nothing to quell the disquietude rising inside of me. If anything, having this popular trope revived in front of my eyes made me all the more adamant that I didn't have DID. I so badly hoped that my assessment would concur that I was experiencing a different mental health condition. This is not to say that other conditions aren't stigmatised, but this level of stigmatisation in popular culture was something I didn't want to face.”
Depersonalisation and derealisation disorder
This is when a person experiences regular and intense depersonalisation or derealisation, enough to impact their ability to fully experience and live their life, but doesn’t experience the same kind of identity alteration to the extent as seen in DID.
Other specified dissociative disorder (OSDD) and unspecified dissociative disorder (UDD)
When you experience some range of dissociative symptoms severely enough for them to not be explained by another diagnosis (such as depression) but are not specific enough to fit into DID, depersonalisation or derealisation disorder you might receive one of the above diagnoses. This may also be diagnosed alongside trauma disorders such as complex post-traumatic stress disorder (CPTSD).
Why do people develop dissociative disorders?
Dissociation as a symptom and as a disorder can be best understood through the lens of trauma. Dissociation as a symptom of a traumatic event is a natural way for our brains to protect our psyche and sense of self from things that are hard or difficult to process: such as violence.
The point at which this natural reaction to trauma can become a dissociative disorder is when the perceived danger or trauma is over, but the dissociation continues, especially when any of the previously mentioned types of dissociation are the immediate reaction of the mind to protect the person from what might be a common experience (aka conflict with a partner) and not a traumatic event.
When a person experiences complex and sustained trauma at a young age, when our sense of self is not fully developed, a person becomes more susceptible to developing a dissociative disorder. Examples of this kind of trauma could be childhood sexual abuse (CSA), neglect, physical abuse and emotional abuse.
After experiencing such severe trauma, where dissociating was the only way to survive that trauma, dissociation might become the coping strategy you defer to in any stressful situation.
A mixture of talking therapies such as psychotherapy, medication that allows the person to stabilise their mood such as antidepressants, and medication that allows a person to feel less distress in relation to the more severe symptoms, such as antipsychotics as well as specialist trauma therapies that might allow traumatic memories to be reprocessed such as dissociative disorder EMDR can all help someone with a dissociative disorder function at a more manageable level in their daily life.
As with many disorders that are stigmatised, if you manage to receive a diagnosis and access therapy (though this can be particularly difficult with dissociative disorders such as DID), life can be quite manageable and importantly, enjoyable.
Why the stigma?
As previously mentioned, depictions in film and TV such as those in Split have been historically very harmful to our understanding of DID, which is arguably the most commonly known of dissociative disorders. Other films such as Identity (2003), and even, as Chloe pointed out to us in our discussion, going back to The Strange Case if Dr Jekyll and Mr Hyde (1886), has solidified the idea of people with DID and dissociative disorders as being not only dangerous, but often, beyond help.
Many people with DID in films and TV either die, succumb to one of their more violent alters or are incarcerated. The message this sends to society and to those who are suspecting they might have a dissociative disorder like DID, or have already been diagnosed is that they are untreatable, a ‘lost cause’ and that they are destined to violence.
A paper in the Harvard Review of Psychiatry picked apart six myths about DID, leaving no stone unturned and stated that the cost of the myths and ignorance about DID result in higher rates of ‘suicidal and self-destructive behaviour’ and that those with the diagnosis ‘experience significant disability, and often require expensive and restrictive treatments’.
Unfortunately, culturally pervasive myths about DID and dissociative disorders can very easily seep into how the disorder is viewed and treat within psychiatry and psychology. In order to fully understand the broad range of experiences throughout dissociative disorders and to find treatment plans that get to the heart of those experiences and what they’re rooted in (as we discussed, most often trauma), we must first dismantle these myths, misconceptions and damaging representations present in popular media.
To end, Chloe articulated more of her experience in interacting with services during her journey to diagnosis and then when eventually receiving one, how it helped her:
“Being passed from pillar to post and being dismissed as being "too complex" are problems those of us with DID face inevitably at some point in our interactions with services. For a group of people who have all experienced chronic childhood trauma, being treated this way often bolsters messages from childhood abusers - we're mad, we're bad, no one will ever believe us.”
“A diagnosis of DID gave me a framework to better understand myself and my other parts, encouraging me to let them a little bit closer rather than banish them out of my consciousness."
To read more about dissociation and dissociative disorders and the diagnoses associated with it you can find further information through Mind, here. If you or a person you know is experiencing dissociative symptoms it is important you make contact with a GP so that they can get the help they need.