Because you have most likely been working with clients afflicted with Dissociative Identity Disorder (DID) in your caseload without recognizing it!
Spitzer et alia (2006) note that i “The prevalence of pathological dissociation [pathological dissociation refers to DID] in the general population of North America was estimated to range between 2 and 3.3%.” ii Vedat Sar (2011) notes that “overall, the prevalence of dissociative disorders in inpatient and outpatient psychiatric settings seems to be around 10%, while approximately half of them (5%) has DID.” iii Sar further states that these rates jump dramatically for special populations such as alcohol dependency (9.0%), chemical dependency between 15% and 39% and exotic dancers and women in sex work (no statistic given). iv Practically speaking the percentages are really much higher because DSM-IV defines DID very strictly and excludes many who in terms of presentation and treatment are DID.
What are common presentations in an MFT office?
A couple came in for pre-marriage evaluation. It seems they went to a party where an ex was present and Sue (identifying characteristics have been changed) left her current boyfriend behind. She woke up the following morning in the ex’s bed not knowing how she got there. Easy diagnosis revealed she lost things, lost time and people come up to her calling her a different name than she knew. I had seen Bill for about a year for individual work when he brought in his wife. I understood the problem better when I found he had an alter that totally closed down and shut her out when she got upset with him. Bill knew nothing about this alter who needed to be worked with along with Bill to help resolve relationship issues.
Jacqueline, a woman in her 70’s presented with a history of therapy going back to her 20’s that included LSD therapy and other dramatic kinds of therapy that did not help. In the initial interview I asked if she heard anything inside her. She began to cry and said, “Yes, I hear a baby crying.”
The next session I used EMDR to release the baby’s experience of being molested and integrated the infant. “I feel more complete now,” Jacqueline said. She had other alters that we worked with using different approaches ways until they were integrated, with her traumatic feelings gone. After about a year she was vibrant and bursting with energy!
In the first session with Sabrina she suddenly froze with her tongue stuck out of the side of her mouth. I could not contact her and I suddenly felt like someone had drawn the blood out of my veins. Desperately I pulled myself out of the sudden deep hole I was in and asked her to pull her legs up to her chest. Slowly she began to do this but sitting on a chair made that difficult. I suggested it might be easier for her to sit on the floor and coached her to continue and hold her arms around her legs hard. She did this, came back and I could breathe again. What had happened? Sabrina had abreacted a child part frozen in time in a traumatic experience of the past. I had her concentrate on her body by curling into a tight ball and that brought her back to her adult self. She had first split into parts as an effect of sexual abuse when an infant by her mother. Later we found her mother also had DID.
DID covers a wide spectrum of presentations and I am only touching on a few in this article. While DID usually begins before 8 years old and sexual abuse is most commonly present, the DID can be caused by other overwhelming events. Bill, mentioned above, grew up with major abandonment in a war torn country. John was extremely brutalized both physically and emotionally by a raging alcoholic father. Carol was isolated as an infant and also grew up with a violent alcoholic father without early sexual abuse. Of course people who are gay or lesbian may also have DID. Sometimes the violence from a father increases if a child appears gay.
Here is a caveat. If someone wants to have a sex change operation, check very carefully to see if he or she has DID. Sometimes one part may take over who is a different sex than the body but all the other parts have the body’s sexual orientation. The sex change operation can create irreparable damage. Such conflicts within the “system” is common with DID.
When I get a client with a history of trauma, either from abandonment, sexual abuse, violence or severe attachment breaches, or with diagnoses such as bipolar, schizoid, borderline, schizoaffective, or somatic disorders I almost automatically expect DID. DID alters may present with almost the entire DSM’s diagnoses. It is estimated that it usually takes from six to eight years in the mental health system (that includes MFT’s) before an accurate diagnosis of DID is made.
Sabrina, mentioned above, had all of the above diagnoses and more from 25 years in the mental health system beginning in a hospitalization with her mother! before I diagnosed her with what was then called Multiple Personality Disorder. Needless to say, hospitalization with a perpetrator of abuse is NOT ideal.
I have learned the hard way that to be effective I need to be always aware that a given client could be DID. But how can you tell?
Switches between alters can be clear with head rolling or a suddenly different appearance. Sometimes a client will appear to be a child or even much older in a minute. But it can also be very subtle. Even the client may not be aware of the switch. Sometimes a client may have a mask-like face – that often indicates another part is taking a peep to see who you are.
DID is not always present even with extensive trauma. However trauma itself is often hidden from the client. DID, by its very nature, is almost always hidden from the client. Clients with DID generally don’t have a clue they have it. I strongly recommend taking the training provided by the International Society for the Study of Trauma and Dissociation. Go to ISST-D.org and look under “Training and Conferences.” I would also recommend training in EMDR (Eye Movement Desensitization and Reprocessing) and (EFT) Emotional Freedom Technique, as each of these are useful in treating trauma and the traumatic memories found in DID.
Gil Shepard LMFT has been licensed over 35 years and specializes in treating individuals with severe trauma issues, PTSD, and especially Dissociative Identity Disorder (DID). He has specialized in treating DID for the last 12 years. He is trained in and uses EMDR (Eye Movement Desensitization Reprocessing,) EFT (Emotional Freedom Technique,) and Hypnosis and has found that combinations of these speed up healing. He is also trained in Breema and Ortho-Bionomy, two forms of bodywork that provide a strong somatic base for his work. His office is in Walnut Creek (very close to Hwy 24 and to Hwy 680) and can be reached at 925-937-3337 or at gilshep@pacbell.net. He is listed on TherapyNext.com, SmarterYellowPages.com and articles he has written can be found by searching his name.
