TERRIFIED: Fading In And Out Of Lost Time. Possible DID?

Based on what you’ve described in this letter, my impression would be that you’re dealing with one or more dissociative conditions, possibly including dissociative amnesia, fugue and dissociative identity disorder (DID; what used to be known as multiple personality disorder). I am thinking in this dissociative direction based on some of the terms and descriptions you’ve used in presenting your condition, but these may not be entirely clear to other people reading your letter, so I will define them.

The author uses the term "fading" and then describes fading between "present" and "non-present" states. Initially these terms are undefined, but later in the letter they take on more meaning. Specifically, she describes being "present in my non-present" state and having a conversation with several children, one of whom accuses her. I can’t know for sure, but what appears to be being described is a short of shifting sense of being in control of herself. When she is present, she is running the show. When she is not-present, she is aware, but not running the show – has taken a back seat of some kind. Note that her ability to retain memories of the events she is experiencing are not entirely tied to her ability to remain "present".

There aren’t many compelling explanations that are consistent with self-report of being "non-present" in this manner other than dissociation. Drug intoxication could possibly produce something akin to this report, but there is no report of drugs being used here – you’d ask if you were doing a clinical interview. I suppose that some organic condition could be implicated as well and that could not be ruled out without a neurological examination and/or brain imaging. On the other hand, depersonalization experiences are fairly common, especially in populations which have experienced abuse or trauma of some sort.

Then there is the report of speaking with the children. Are these literal children or are these imagined (e.g., hallucinated) children? A third possibility is that they are "alters"; personality fragments that make up the complex ecosystem that is the mind of a person with dissociative identity disorder. Alters are not hallucinations, but rather dissociated parts of a person’s personality. The typical dissociative identity disordered person develops the condition in childhood, with particular aspects of experience becoming dissociated (not remembered) from other parts, often because they contain troubling abusive experiences. The part of the person who does not remember the abuse (or whatever) gets cut off from the part that does. Once this process is underway, a variety of alters may be produced, some containing painful or emotional memories, and some not having those memories; some becoming social facades and some not having a social role; some becoming socially mature and reality oriented and some remaining encapsulated, child-like and fantasy oriented. In my experience (which is limited to be sure) some alters have the "big picture" and understand the nature of the various alters and how they inter-related and dissociate, while others are kept in the dark. Also in my experience, it is fairly common for one group of alters to pick on another group, not unlike children pick on each other. It is not in the nature of alters to be terribly socially mature and compassionate, as those qualities require life experience to have been digested and processed; something alters don’t see a lot of.

If this letter is a report from someone with dissociative identity disorder, it is written by an alter who fulfills the role of social facade (or "customer service" if you want to think about a similar role in a large organization) and who doesn’t necessarily have the full perspective on the DID system. The children and the 25 year old may be other alters.

I’m always apprehensive suggesting to someone that they may have a dissociative condition, particularly one as complicated as DID. Dissociative people are by definition suggestible, and you don’t want to create a situation where one is not necessary. So, for the record, I need to say that I don’t have all the information that is necessary to make a diagnosis and cannot, and that what I’m presenting here is informed speculation based on the limited evidence that has been put in front of me. It is a direction to pursue and rule out; not anything definitive.

People understand other people based on their experience of themselves. This means, we assume that the other people we’re confronted with are more or less like ourselves (at least until we mature out of that position). When confronted by someone with DID who presents alters rather than an integrated personality, the strong tendency is to make the assumption that each alter is a whole personality; as though there are multiple people living in a single skull. This process is known as reification (treating something that isn’t real as though it is). This is not correct. Alters are fragments of a single person, even though they claim to be different people. They don’t share memories and they may yell at each other as though they are separate beings, but ultimately they are all branches from the same tree. Keeping this perspective in mind is important for all "people" involved with someone with DID – most especially the alters themselves. In their dis-integrated state, individual alters may act out in self-destructive and impulsive ways without consulting their fellow-alters. The very dissociation that made it possible for the DID person to survive whatever it was that set them on the path to DIDness as a child, makes it terribly difficult for them to take responsibility for their actions as an adult. As the letter writer correctly points out, she could easily end up in jail and not know why (because some immature angry part of her acted out without consulting the part of her that is writing the letter). This state of affairs can lead to some really psychotic stuff happening.

There is no medication that can treat DID, although there are medications that might be prescribed to DID patients for help with associated symptoms like anxiety or depression. The only way to tackle DID is via psychotherapy, and unfortunately, since the problem is a deep one and chronic, this process can require some significant time and expense.

The goal of any DID psychotherapy is to get the various alters to move towards an integration position where hidden memories are shared, boundaries are broken down some, and most importantly, the personality system learns to take holistic personal responsibility for actions and to be compassionate to all alters. This is therapy as an act of diplomacy. Full integration into a normal whole personality may be impossible, and more importantly is not necessary. What is necessary is that there develop a dialog and cooperation among the parts so that the important aspects of adult functioning can occur (e.g., taking unified responsibility and honoring commitments, reigning in impulsive and self-destructive actions and learning how to problem solve and cope a in constructive manner. Being dissociated all the time is a developmental wound, but people can learn to live with such wounds.

I’m not aware of any therapy that is particularly well suited for helping dissociative patients. Dialectical Behavior Therapy (DBT) would be useful, in as much as it helps to teach coping and self-soothing techniques to people who need them as well as ways to manage impulsivity, but it is not designed to help integrate the alters of a DID patient. Neither am I aware of any particular field that has particular expertise in addressing DID sorts of problems. This isn’t completely true. Clinical hypnotists may have useful expertise to offer in this capacity (as dissociation is very much related to hypnosis), but not just any hypnotist will do. For a hypnotist to be able to provide useful help, he or she would have to be capable of offering useful treatment without using hypnotism – so you’d want a psychologist who is also a hypnotist, and not just a hypnotist. Using hypnotism to work with dissociation is like fighting fire with fire (as the two are essentially identical). Badly done hypnotism could make dissociation worse, when what is desired is to work towards integration.

What is needed here is a good senior psychotherapist who has been around the block, has worked with a few dissociative patients in the past, who will not reify the alters, who is affordable (because your going to need to go for a long time), who will work towards useful integration and responsibility taking, and who can offer good non-judgmental witnessing. I suspect that most communities of any size will have a few therapists of this sort around. The easiest way to find one would be to call around to area therapists and ask for a referral to someone who treats dissociative patients. If you do this a few times and end up with the same person being suggested each time, you’re on to something.

This might be a disturbing reply to read, because if my guess of DID is at all accurate, this is really a rather chronic and difficult to treat condition that can have a person acting quite psychotically even though they don’t have schizophrenia. A working integration (if not an actual one) is possible to achieve though, and psychotherapy is the primary way to work on achieving it.

There are many DID sorts of folks out there who have come to terms with their DID in one form or another. I ask the favor of such readers to add comments below so as to help this woman generate ideas to help her move forward and get her life under better control.