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50 Treatment Issues for Dissociative Identity Disorder

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“I have DID.  How long will it take for someone with Dissociative Identity Disorder to feel better?”

 

As a clinical therapist, I hear that question frequently.  It’s a reasonable question.  I certainly understand that when dissociative trauma survivors are deeply hurting and struggling in their life, they want to feel better as quickly as possible.

However, the clinical treatment for someone with Dissociative Identity Disorder (DID / MPD) is long term.  Some research has said that the treatment can be completed within two or three years, but in my clinical experience, that is far from the truth.

dissociative identity disorder 1
dissociative identity disorder 1 (Photo credit: hunnnterrr)

Dissociative Identity Disorder is a result of long-term, chronic, severe, sadistic child abuse. 

As children, these survivors witnessed and experienced a myriad of heinous crimes.  They typically describe repeated consuming abuse by multiple perpetrators, and then were otherwise emotionally neglected, starving for comfort, consolation, or attention. They were left alone, even while very young, to process and contain their pain by themselves. 

For these children, the splitting process became their way of coping with emotional intensity, conflicts, huge distress, and intense pain that were otherwise far too difficult to manage on their own. 

They blocked off their pain, locked it away from themselves, and left it there.  Sitting, waiting, piling up for years.

dissociative identity disorder 2
dissociative identity disorder 2 (Photo credit: hunnnterrr)

When you understand how much pain and abuse has occurred in order to create the dissociative splits in the first place, it is no wonder that the healing process is also so very long. 

All areas of dissociative survivors’ lives are touched and profoundly changed or affected by the abuse.  It simply takes a very long time to address everything properly.

 

 

Some of the treatment issues for DID are:

 

  • Stabilization of the person – both internally and externally

  • Managing and eliminating self-injury and self-harm issues

  • Examining and obtaining current-day external safety from abuse

  • Internal system safety

  • Developing effective internal communication

  • Calming internal noise and chaos

  • Working specifically with child parts

  • Working specifically with adult parts

  • Working specifically with teenage parts

  • Learning about the other system parts

  • Working with internal perpetrator introjects

  • Creating emotional separation from external perpetrators

  • Working with triggers

  • Correcting cognitive distortions

  • Addressing gender confusion, male vs. female issues

  • Processing emotions

  • Body image issues

  • Reducing time loss, memory loss, amnesia

  • Time confusion, time distortion

  • Trauma processing – memory work

  • Body memories and kinesthetic issues

  • Understanding re-enactments and trauma bonds

  • Healing sexual abuse issues

  • Healing physical abuse issues

  • Healing emotional abuse issues

  • Healing ritualized abuse issues

  • Healing exploitation, pornography, prostitution, sex slavery issues

  • Managing family, marital, parenting issues

  • Addressing addictions

  • Managing eating disorders

  • Household management issues – improving daily functioning

  • Relationship issues and teaching social skills

  • Understanding the effects of trauma on the brain

  • Improving self-independence and self-reliance

  • Improving self esteem issues

  • Leaving disability and regaining employment

  • Depression and medication management

  • Bipolar disorder and medication management

  • Anxiety / Panic and medication management

  • Post-traumatic stress issues (PTSD)

  • Reducing phobias

  • Social anxiety and social isolation

  • Safely eliminating suicidal ideation and suicidal behaviors

  • Homicidal ideation and anger management

  • Exploring spiritual confusion

  • Philosophical issues

  • Detachment and separation issues

  • Treating sleep disorders

  • Treating medical complications and physical harm resulting from the abuse

  • Reaching integration, blended states, or effective system team work

 

Watch this VIDEO made by Kathy.   This large tree becomes a perfect metaphor for describing the complications of the healing process for most dissociative trauma survivors.

 

That’s a tremendous amount of work. 

And most of these issues surface again and again and again, requiring in-depth attention on a regular basis for years of time.  Even so, genuine healing from severe trauma can happen.  It does happen.  I’ve seen it happen.  I know without a doubt that healing from unresolved trauma is absolutely possible.

However, emotional healing on such a wide scale just does not happen fast.  Forcing the issues or pretending to be “done” sooner than realistically possible is not helpful.

Simply put, years of severe injuries will require years of intense healing.

It takes as long as it takes.

 

Do you need specialized help?

Please remember, if you need any personal assistance with any these 50 Treatment Issues, there are two qualified trauma therapists here at Discussing Dissociation.  You can get help if you need it.

Consider:

A Phone Consultation with Kathy

An Email Consultation with Laura 

 

DID experts with years of work with trauma and dissociation can be extremely helpful for you.  Individual consultations for you, for your therapist, for you with your therapist are available.

Please contact the Client Care Team if you have further questions.

 

 

I wish you the best in your healing journey, all 50 steps of the way….

 

Warmly,

Kathy

 

Copyright © 2008-2018 Kathy Broady MSW and Discussing Dissociation

 

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dissociative identity disorder

Dissociative Identity Disorder (Photo credit: genelin1211)

 

 

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Comments

  1. Thank you for this article. I have been in therapy for 12 years and, although I am doing so much better than I was, I am still struggling. Almost everything in this list of issues applies to me, so it was so comforting to read because I often get down on myself for the length of time I have been in recovery.

    Reply

    • Hi None,

      Well, personally I do not think that integration is a universal goal at all. From what I have read, integration was the goal of DID therapy some time ago but that is not the current thinking. I certainly do not intend to integrate. Both Kathy and Laura (our experts here on DID) do not support the idea of integration. Do a search on the DD website (search function in the right-hand sidebar) on “integration” to find links to the following blog articles that maybe helpful to you:

      Integration: A Requirement for DID Therapy – Or Not?
      Integration – A New Category and Nine Quick Opinions
      The Big Questions Answered by Laura, the DID Email Consultant

      Here you will get Kathy and Laura’s perspective on this issue as well as what folks in the community here think about integration.

      ME+WE
      02/25/2018

      Reply

    • Hi. Having integrated I can say that integration was not my goal originally but it happened gradually as I got more control over my recovery meaning I developed skills to deal with my trauma. I wonder if it’s called a ‘disorder’ does that not say that there’s a problem?? I wouldn’t change a thing. Being present 24/7 has both good and bad but I feel so free and happy most of the time. Memories still come up but without my parts, I now see them as an adult and it’s definitely in the past and I don’t have parts getting upset reliving it. It’s horrible but much easier to deal with as an integrated person

      Reply

      • Hi Annie,

        Thank you for sharing your experience with us. I have tons of questions, but I’ll withhold them all and ask just a few.

        You say you didn’t start out with integration as a goal, but that it happened as a result of your working on trauma. Was it your decision or your parts decision to integrate? How did you know when they had integrated?

        Just a couple of questions. I hope you don’t mind.

        Thanks!
        MultipleMe
        11/24/18

        Reply

  3. I had an idea for maybe another one.
    maybe handling inside people with disabilities or challenges.
    like inside kids that are selectively mute, or have austm, things like that.
    i have austism, and most people dont know how to deal with me.
    i dont get very many chances to talk.

    Reply

  4. Oh, my….just re-read this….somehow I didn’t see last time that there was a “homicidal ideation” issue…..you just spoke out loud all of my teen years…….I was “numb” all through my teen years…..always made the honor roll in school….but felt very disconnected from everything and spent hours and hours just walking as much as I could to try to lessen the energy from the “volcano of rage” I felt inside….but had no idea why it was there….or what it would take for it to completely explode……

    I know I had the “suicidal ideation” issue…..but couldn’t understand why I kept feeling this intense internal rage at my father…..he didn’t put us in the hospital….so I couldn’t figure out why I was so angry at him…..but it came out over and over in nightmares and “daydreams”…..me lashing out at him with one goal……..just figured something was either “very bad” or “seriously wrong” with me……now I see that it is an actual “issue” with DID……..oh, my…….

    Reply

  5. This is good. I found present day probs of everyday life makes it too hard to deal with past things.

    Reply

  6. A great list! Really appreciate so much of your work, Kathy!
    I was reading a book for practitioners about DID and came across the statement that, beneath most or all DID systems is a narcissistic personality structure … I was wondering whether this is another ‘treatment issue’? As in, presumably once so far along in working with the DID system, the narcissistic structure comes to light?
    I’m wondering how people with DID navigate this? It was a total surprise and nasty shock for most of my system to read that info about narcissism, and we are now wondering how it can be wise to work through everything, create better internal communication, etc and holistic integration if the outcome will be a person who treats other badly, compared to now where we tend to consider other external people a lot, treat others well, and have lots of empathy (first time ever ever to question therapy work).
    I couldn’t find anything on your site about this, so I’m interested to find out your perspective…

    Reply

    • Hi Aurora,

      Early on in my research on “what is happening to me” I came across the idea of DID systems as a narcissistic personality structure as well. I rather freaked because the idea of being a narcissist really shocked, depressed and saddened me. I certainly did not see myself that way and was actually physically ill at the thought (particularly since a couple of my abusers were narcissists).

      As I explored a little deeper, I think that what was being said was that our alters have a rather singular and narcissistic personality structure because they have a limited scope in reason, dimension, role and purpose. In other words, they are not a fully developed personality in and of themselves (i.e., our true personality is an amalgam of all of the dimensions of our alters and our host). Because of the more limited perspective, understanding and role of our alters, they have a sense of self that is “alter-specific” centered and strive to ensure that their view is seen as dominant, unshakable, the only perspective needed, etc. to the point of rejecting or not recognizing other alters at times. There is also an element of preservation involved as well. So, it is not that DID folks are narcissists but that our alters function in a way that can be seen as a narcissistic in their understanding, presentation and preservation of themselves.

      I may be WAY off base here but that was my take on it. I do hope that I am on the right track because I sure would be devastated to be told that I have a narcissistic personality. Kathy is super busy right now I am thinking but maybe she will give her take on this question.

      ME+WE
      12/01/18

      Reply

  7. Does anybody know any studies done on the effects of drugs and alcohol with D.I.D
    For instance if I am under the influence another roommate can take over. I say yes . My care team say no. its one body. My debate is we all are in control of our different thought and emotion dislikes and likes. One of us will get sick and not the other. Lori and Jessie had a broken foot but not the rest of us. We sleep at different times so the physical body doesn’t get the same amount of sleep as we do . We use the bathroom at different time . I hope someone understands what I’m trying to say. We are so individual. Lori can’t drink it puts her over the edge emotionally it’s almost like a wire come lose in her brain. She will go into anxiety mode and OCD mode. I can drink and or use cannabis And it’s a different effect for me . I’m relaxed having fun .
    Does anybody else agree with me that like everything else can you fix this individually . And or if you know of a study

    Reply

    • Hi Sissy,

      I do not know of any studies. I can only speak to my experience. Yes, everyone in my system is different when it comes to the things that you describe. So, some of my folks have different allergies, eye sight issues, gastro-intestinal problems, sleep patterns, likes/dislikes with things like foods, alcohol consumption, etc. The thing is, everyone in my system shares a body so, if something goes wrong with my body (like the cold that I have now) or I put things in my body (like alcohol, foods, etc.) then potentially every one of my insiders may be affected (or maybe not). But, someone will. And, as long as at least one of my insiders is affected, then the team (my whole system) is asked to get on board to help them.

      I tend to have general system guidelines to not indulge in activities/things that could be upsetting to another insider. The thing is, I am not in control of when my insiders come out. So I just never know if I start out with one person who is okay with whatever it is that I am doing but may get triggered into another. It is not a matter of stifling the activities of insiders but sharing mutual responsibility to the system as a whole. Some things just have to be off limits entirely (because they would seriously hurt one or more of my insiders) while others are negotiated (certain parameters drawn up so everyone feels safe and is not harmed). It is tricky sometimes because wants and needs can conflict. But, I try and stress with my insiders that they want others to respect the guidelines meant to help them so they need to respect the guidelines draw up for the others. It is mutual respect and help as a team.

      So, for example, my one insider likes to drink alcohol. She can drink a lot and it does not affect her at all. However, if my little ones come out they are left being very, very sick, frightened and confused. I do not tell her not to drink but not to drink as much. Then, I also try and have my little ones in a safe place so they do not come out. But, that takes a lot of organization and cooperation.

      I hope that this made some sense Sissy. Maybe others will jump with some other thoughts on this topic. I would like to know about any studies as well.

      ME+WE
      12/12/18

      Reply

  8. Appreciate this list. Homicidal ideation struck a chord, because previously I had a year of feeling homicidal, and also a year of feeling suicidal, and I had no other way of dealing with it at the time except being a strong person and not losing control of myself, suffering through it and making sure that neither myself or anyone else was hurt.
    Fortunately I am a strong person.
    I suspect from what I have seen there are multiples who have been created with a weak front personality to prevent them healing, specifically so that facing and healing their trauma is too much for them.

    The main thing I want to say is about the conceptual language of therapists.
    My personal experience contains aspects of bio-energy, the energy body and wounding hacking and resculpting of same, demonology, genetics, metaphysics, psychic experiences, criminology and manipulation both physical and energetic, hierarchical and organised cult criminality, and the harvesting of energy, souls, hearts, and soul fragments.

    If Kathy was my therapist, I would understand her psychological conceptual language, but would she understand mine?
    With a therapist who practices mental and behavioural reprogramming there would be little chance of meaningful communication.
    I would understand the faith of a Christian therapist, but consider it unethical.
    A scientific materialist would call me delusional, and the feeling would be mutual.

    I have seen many reports of clients having to train their therapists. I suspect the client still has to pay in this case, which is wrong.

    I hope more therapists will learn to extend their conceptual language, as Kathy has learnt from her patients, in order to understand their life experiences and what they are dealing with.

    As a visual metaphor, if patient and therapist cannot communicate conceptually,
    it’s like a dog talking to a goose.

    Reply

  9. Kathy
    I Just watch Room on Netflix with Brie Larson Jacob Tremblay and Joan Allen. It a 2015 film about a 5 year old boy experience the outsider world for the first time after escaping from captivity.
    It’s made me think about the ones I keep in rooms in our inside world with nothing but a stuff animal a bed and a blanket.
    I have always thought I was doing the best thing so this shell could Survivor and look normal on the outside world. Now I’m not so sure . These poor kids are alone with the pain that was cause to them. Maybe it’s time they start to experience the real world to.
    This is Scary has hell . Can the body handle this happening or will it be on over loaded.

    Feeling a lot of anxiety just thinking about it . I can almost hear you saying. Yes yes yes and Yes! this is right . But take one step at a time work with Belinda and don’t do it on your own.
    You can delete any part of the comment you want. It my be good though for others to watch this movie.
    Missy
    P.s when is that new podcast of your going to be out? Or did I miss it

    Reply

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