At Bridges, my group for people who experience significant dissociation and/or multiplicity, sometimes people express anxiety about their diagnosis. In fact, this area is surrounded by an intense anxiety that can make it very difficult for people to think clearly or feel okay about whatever is going on for them. Obviously we don’t diagnose each other or try to answer that question for anyone one way or the other, but to let people know they’re accepted and their experience counts whatever it turns out to be.
Some people develop serious mental health troubles, get referred to a psychologist or psychiatrist, and are quickly given an accurate diagnosis that fits their experience well. Some people have a much rockier path to working out what’s going on for them, and in the areas of dissociation and multiplicity, diagnostic uncertainty are pretty common. This can be really tough! Spending long periods of time struggling with diagnoses that don’t really fit, collecting many diagnoses, or having doctors trade them in for a new one every few months can be really confusing. For many people with a dissociative disorder, this is what happens. They may spend many years and receive many different diagnoses before a doctor identifies a dissociative condition.
If you have a psychologist, they can do certain tests where they ask you questions to determine if you experience a lot of dissociation. They may also be observing the kinds of changes in you that suggest multiplicity. Sometimes other parts will communicate with them directly and clear up the uncertainty. Books about DID generally list the obvious amnesia based indicators such as finding clothes and belongings you don’t recall purchasing that aren’t your taste, being approached by people who know you by another name, losing time, finding yourself in places and not being able to recall how you travelled there. If you don’t experience severe amnesia, it’s likely you won’t get these kinds of clues.
Dissociative Identity Disorder (DID) in particular is often treated as sensational, fundamentally different from any other mental illness or condition. There is considerable debate among professionals about how to identify and treat it, and whether the condition even exists. To be fair, every other mental illness in the DSM, and a few that aren’t, also have these kinds of debates. But the sensational way DID is often treated can mean that considering it as a diagnosis carries an extra anxiety. Many people who are diagnosed with DID feel incredibly anxious about this, afraid it may be true, and also afraid it may not be. So how can you know?
Firstly, by bringing the whole concern back down to earth. DID is not special, having it does not make you special, not having it does not make you special. Unlike a medical condition where x bacteria can be shown to cause y disease, the realm of mental health is far less clear. Dissociation occurs on a continuum from normal common experiences, right through to severe disruptive mental illness. Multiplicity likewise, is not black or white, you do or you don’t. Most multiples are actually diagnosed with Other Specified Dissociative Disorder (OSDD, formerly called Dissociative Disorder Not Otherwise Specified or DDNOS) as they don’t quite meet the rigid criteria for DID. Identity instability is a common symptom of several disorders, such as Borderline Personality Disorder, and Posttraumatic Stress Disorder. There is a continuum here also, from the usual human experience of being a person with different sides or parts, different facets to their personality, through to issues around identity instability, an uncertain or absent sense of self, distinct ego states especially related to strong emotion or trauma that can be suppressed or triggered, issues with being susceptible to engaging in expected roles, through to splitting of the personality into distinct parts that perceive themselves as separate and contain their own skills, needs, hopes and memories. This isn’t black and white, and if you’re struggling somewhere on this spectrum it can take a while to work out exactly where.
That’s okay! People with psychotic symptoms may be diagnosed with schizophrenia, then schizoaffective disorder, then psychotic depression. Because none of these conditions is treated in a really sensational manner, having the label change isn’t such a big deal. It should be that way for these issues too. In the end, the label doesn’t matter. What matters is finding a framework that makes sense for you and that helps you move in the right direction. If you’re feeling really anxious and uncertain, these questions may help clarify things a little for you.
- Do your symptoms/experiences take energy to sustain, or energy to suppress? What happens when you’re tired and worn out – do they get worse or better?
- Do your experiences predate therapy? For example, very different handwritings, hearing voices, a complex history of mental health problems that disappear and reappear, extensive amnesia.
- Does the framework of multiplicity make sense to you?
- Does it help? Is it reducing or increasing stress? (it’s okay if it’s doing both)
- What happens if you trial the idea that you’re not a multiple? Do members of your system fight to get your attention, or does the internal stress settle down? Do you function better or worse? Is there still things going on you can’t explain?
- Do any other frameworks fit your experiences? Identity instability rather than switching between parts, trauma related ego states? Do they fit better, worse, or as well as the idea of multiplicity?
- What do your ‘other parts’ think is going on? Do you agree or disagree?
The thing is, certain types of therapy, such as family systems therapy, parts therapy, schema therapy and so on can be useful for anyone at any place on this spectrum. The basics of trauma recovery (where appropriate) also remain the same. Issues like needing to feel safe, to build your self-awareness, learn more about how to take care of yourself and listen to yourself are also the same. The format may be a little different, but the underlying issues of developing a good, loving relationship with yourself, learning how to manage ambivalence, dealing with triggers and reactivity, reducing dissociation, calming intense distress, reconnecting to buried parts… they’re all the same. I think one of the reasons the condition of multiplicity does fascinate people is because it is just normal human functioning writ large. We can all relate to the themes, although not usually the extent of the divisions. Some (by no means all!) theories of personality are that all people function as a collective, with sub-personalities managing different life areas.
So, from these perspectives, nailing down the exact label becomes less important, it may not even change the focus of therapy or recovery. There are people who hear voices and have a psychotic diagnosis who find a multiplicity framework useful and consider their voices to be parts of themselves. They don’t switch or experience amnesia and their diagnosis remains the same, but a multiplicity framework is useful to them. I’ve also read of other people who are encouraged to view their experiences as multiplicity who feel pushed into that perspective without good cause, and determine that their situation is about abrupt mood changes rather than switching, for example.
The heart of this is that chronic denial can do terrible harm. Anxiety around accepting what is really going on for you can leave you refusing to listen to or look after yourself. It is helpful to find frameworks that fit and work, and hanging onto one that doesn’t – whether you’re a multiple hoping you’re not, or someone with something else going on who’s feeling forced into the multiple label, can be another way of denying what’s really happening with you and what you actually need. Many people, even those at the far end of the multiplicity spectrum, with taped evidence of other parts, just don’t want to know about it. It’s frightening to contemplate sharing your body, not always being in control, not being able to drug or get rid of symptoms quickly, and having to work on something as fundamental to you as your own identity.
Add to that mix fear, ignorance, and huge stigma about these issues even within the mental health community – for example, I know of many people with these concerns who have been denied treatment from mental health facilities and told they were faking their condition for attention- it’s no surprise that people want to put their head in the sand and hope it all goes away. A lot of the pain and stress about multiplicity is about how poorly it is understood and responded to by our wider community, which is an unfair extra burden on those of us trying to find the courage to deal with it. Another aspect of the pain and distress of multiplicity is that for many of us there are deeply destructive trauma histories we are struggling to deal with – and that is the case for many people whether it turns out multiplicity or something else is going on.
There’s often a misunderstanding that the choice is between “I have multiplicity” and “I’m fine”. Whatever is going on that you and your doctor are wondering about DID, it’s often happening in a context of a lot of pain and confusion. Things are going on that are causing you some troubles and for which you’re looking for support. On the other hand, I’ve also heard from people who turned up to a local counsellor for some help with a relationship issue or something else fairly common who found themselves with a question mark about multiplicity because the counsellor thought that feeling like you are younger around your parents means you are switching to child parts. Which caused a whole lot of needless confusion and stress. Everything boils down to this, really:
Whatever is going on, you deserve to have help and assistance to learn about it, work with it, and get on with your life.
So really, the whole question becomes a very simple case of asking what works. What helps you function better, what gives you greater freedom, what makes sense, what moves you forwards and helps you have a life? Hopefully, you’re not trying to work all this through by yourself, but have a good doctor of some kind on board, who isn’t afraid of or fascinated with the idea of multiplicity. Confirmation bias can feed into both over and under diagnosing conditions – this is where we look for information that supports our theory, and disregard anything that doesn’t. If you’re worried this is at play, perhaps you could try and keep two lists – one of anything that suggests you are a multiple, and one of anything that suggests you aren’t, or of alternative possible explanations for what you’re going through. See how it plays out over time and what you end up with. Or, forget about the labels and just go with the framework that’s getting you results. Good luck, whatever is going on for you, you still deserve love and support and you will still be okay!
For more information see a list of my other articles in Multiplicity Links, scroll through posts in the category of Multiplicity, or explore my Network The Dissociative Initiative.
11 thoughts on “How do I know I’m multiple?”
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Thank you so much for writing this. It helps us frame the things that have happened to us in a better light, and it makes our mental illness easier to process rather than trying to deal with dozens of ‘almost’ diagnoses at once. We have depression, anxiety, and fit some of the requirements for BPD/C-PTSD, but multiplicity settles some of the doubt and the fear. Thank you.
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They’ve consistently diagnosed us with bpd even though we dont have 5 symptoms. we know, some of us have known all our life, that we are multiple. We don’t need a diagnosis to know that it’s true or not true and we fit all the symptoms anyway. but we do need it to have the freedom to actually Talk to our mental health workers about it in that ‘multiple’ way. since they are set on not giving us the diagnosis and still keep treating us like a borderline (they even laughed at us when we talked in DID language or they just dont answer at all etc), there’s been more and more secrecy towards them and we can say that it’s at least not helping and giving us a lot of distress. The therapist who did see our DID said that she dx’d us but now she’s retired and we find out through another therapist that our dx bpd is still on and now we got a bpd specialist. i cant work under that framework at all, so therapy is leading nowhere and i lost my precious specialist cause we had too much secrecy to be open about our stuff in DID words. so i find myself compulsively trying to hide the DID and being distressed about them not seeing it at the same time. we dont have anywhere else to go. conclusion is help yourself you know yourself best and dont wait for someone else to help you. if we would have waited for their help we still wouldn’t have been any better off now. but we are our own therapist in a way so we are helping ourselves. it’s just sad cause everyone who’s been damaged like this needs that person who really knows you and who can really help if we cant do it. but we’ll still get there with or without help. DID is a journey of a lifetime and it’s not going away just cause we ignore it or cause they ignore it. it’s a sort of way of life. and we’re determined to keep living life and improving. sad they wont help us. really sad. i dont even understand why they are like this. it’s just the truth that we have multiple identities who take control with timeloss some of the times and all the other symptoms, we have so many symptoms and they still will not listen to us. our previous t talked to at least 5 different alters more than once so we just dont understand what’s even happening that’s making them so anti DID dx. we really really want our old t back and we’re so sorry for wasting her time with secrecy. she deserved to know us but we were too scared. now she’s gone. now we have someone who just got out of school and she is also pregnant and not educated about DID at all and she wants to do voices dialogue even though DID is a big counter indication for that. we’re only more scared and maybe we shouldn’t even go back there for our own health. i dont know. just wanted to add something so people can know they’re not the only ones who fight alone collectively. thanks for your blog.
Hi there usses15, sorry for missing your comment. It can be really frustrating when our experiences and understandings aren’t given any credence by people working with us. 😦 I can relate to your stress around needing it to be acknowledged but also wanting to hide it, it can be a really hard place to be in and I feel the exposure stress pretty keenly myself! I agree that taking on the role of helping yourself can be really powerful and effective – I hope you’re still finding it so. It’s made a big difference for me. I still see therapists and doctors, but they support me, I don’t sit at their feet hoping they’ll ‘fix’ me, and that makes a big difference to my experiences.
It’s pretty common for confused and undertrained medicos to really deliberately ignore even overt signs of multiplicity, I recall Dr Middleton, a psychiatrist who runs the trauma and dissociation inpatient unit at Belmont Hospital, talking about how someone’s doctors would call him saying ‘Look, I don’t believe in DID, but I have a patient here who has it…’ and the amazing contradiction in that sentence!
While I absolutely recommend going with your gut, I did want to suggest that voice dialogue therapy is not contra-indicated for DID and can be very similar to the process of system mapping and starting to learn about the others.
Thanks for commenting, I appreciate you sharing your situation. Good luck and take care.
You're welcome, I'm glad you found it helpful 🙂
YOU are a fine writer and I can almost feel the experiences etc. you share, but also I can embrace the writing and learn so much re; my health/illness/ recovery skills etc. thank you so much for sharing your experiences and knowledge I am grateful to be able to read and grow from it.
You’re welcome 🙂
THANK YOU. I am diagnosed Borderline Personality Disorder, and I meet all 9 criteria so I am confident in the diagnosis… however, the dissociative symptoms have been very severe under recent stress… and I've been concerned about what is going on. This is MOST helpful.
Thankyou very much Carolyn, I'm pretty passionate about raising awareness and reducing stigma for other people with dissociative difficulties of any kind. There's been too much arguing and not enough being helpful in this area!
This is a very interesting look into something I personally know nothing about. I've read about this, seen it on the big screen and so on, but hearing it from someone who lives with it and has done serious thinking about it feels, finally, like the truth.
The fact that you are a fine writer Sarah, makes the words come to life. I can feel what you're saying and what you're living with. Promoting this kind of thing is so important.
We all need to know about the full range of health and wellness, mental, physical, spiritual. Reading about it can lead to better understanding.