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!