There are many different ways of describing people’s multiplicity outside of the language of ‘disorder’. Pluralism, multiplicity, fragmented selves and internal collectives are some. People who live with DID may refer to their identities in many different creative ways: parts, aspects, flatmates, personalities, internals – those are just some. People form beautiful ways of describing what they may call ‘systems’, ‘committees’, internal worlds. Finding out the language and way that works for your internal collective is important, and special to you.
How the clinician determines if you have DID (diagnosis)
DID can be difficult to diagnose, as any signs and symptoms identified during routine mental health assessments (e.g. for depression, anxiety, insomnia, self-harming, hearing voices) are common to other mental health problems. A standard assessment will therefore often not identify a dissociative disorder.
It is therefore useful to work with a clinician who specialises in this experience. It’s important you take the time to talk with your doctor and help them understand what you or your loved one is experiencing.
Your doctor will help you find the right mental health professional to diagnose the experience you have, then they will work alongside you to help you feel more in control and live the life you choose.
Treatment of DID can involve a number of aspects, each of which can be tailored to your individual needs. It’s important you choose a mental health professional with experience in treating dissociative conditions.
The goals in therapy may include integrating different personalities into one cohesive personality. It may also be that your different personalities remain in your life but you find better ways to relate to them, so they don’t cause you distress. Certainly, therapy will help you to process any trauma you are carrying. Treatment options include:
Due to the trauma that people with DID have often experienced, building a trusting relationship with a therapist is essential. A strong therapeutic relationship includes a safe environment and appropriate boundaries. The therapist should have a good understanding of personality and know how to teach stress management and work through traumatic and dissociated material.
Useful types of therapy may include sensorimotor and somatic psychotherapy, to address the physical disconnect from the body in trauma, and the body’s flashbacks to trauma. Trauma-focused cognitive behavioural therapy (TF-CBT) may help process trauma and challenge unhelpful core beliefs. Dialectical behavioural therapy (DBT) may provide useful skills for managing intense emotions and tolerating distress as trauma is being processed.
It may take a long time, often years, for you or your loved one and a trusted therapist to cover all the agreed goals for treatment. That is expected and beneficial. As you work through therapy, you can expect your life to improve bit by bit along the way.
All types of therapy/counselling should be provided in a manner that is respectful to you and in which you feel comfortable and free to ask questions. It should be consistent with and incorporate your cultural beliefs and practices.
It can be difficult to find a therapist where you feel understood and that you can work with successfully. This is a process. Many people go through a period of time with several different diagnoses before they find one that makes sense and helps you move forward. Don’t give up, ask around and keep trying!
There are no specific medications to help DID, but your doctor may prescribe medication to help with other issues you may be experiencing, such as not being able to sleep, anxiety or depression. If you are prescribed medication, you are entitled to know:
- the names of the medicines
- what symptoms they are supposed to treat
- how long it will be before they take effect
- how long you will have to take them for and what their side effects (short- and long-term) are
- what the process of stopping medication might look like.
Withdrawing from the medicine (i.e. stopping taking them) can have complex effects. Make sure you talk this through thoroughly with your doctor and are aware of supports that are available.
Even if you are breastfeeding, medication might be an option. It is best to discuss with your health provider what might be on offer for you.
The term complementary therapy is generally used to indicate therapies and treatments that differ from conventional western medicine and that may be used to complement and support it. Certain complementary therapies may enhance your life and help you to maintain wellbeing.
In general, mindfulness, yoga, exercise, relaxation, massage, mirimiri and aromatherapy have all been shown to have some effect in alleviating mental distress.
I moved from trying to conform, to sitting with the discomfort of not being like other people, to actually celebrating and being proud of our difference. This has been a core part of moving towards wellbeing. As long as we tried to conform, we always felt lacking… I think it is most important that people know that life gets better, that identities can work together and craft beautiful lives. It is hard work, but it is possible. Don’t believe the myths; write your own story
What has helped me? Accepting that our way of being was understandable in the context of our life, even if it was not understandable to people generally. That our way of being didn’t equal disorder, rather strength and a desire for life. And that actually being able to see the world through multiple lenses meant we were able to see different worldviews and have different skills.
Thanks to Jenni Beckett, clinical psychologist, and members of the Thriving Madly peer support network in Christchurch for reviewing this content. Date last reviewed: September, 2022.
Thanks also to Sutherland Self-Help Trust for making the 2022 updates possible.