Therapy for Dissociative Identity Disorders
A dissociative identity disorder is defined as the presence of two or more distinct identities or personality states within the same person; each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.
Dissociation develops as a primitive, adaptive response of the mind to the overstimulation and pain of external trauma and may result in disturbances in awareness, memory, and identity. This defense results in a split, stimulating corresponding alternate states of mind alternately enacted but not integrated into the whole self. Dissociation exists on a continuum with multiple personality disorders representing the most extreme form of this kind of process.
Many victims of sexual molestation have suffered a trauma of monumental proportions in terms of the effect it has on later personality development. The molestation’s causal relationship to many of the person’s later difficulties qualifies it as a traumatic neurosis for some people. It also qualifies as a traumatic neurosis in that like other traumas, sufficient experience of the event failed to occur to allow symbolization and then forgetting and repression in childhood.
Forgotten experience is generally relegated to the preconscious where retrieval can occur by introspection, or to the unconscious where retrieval requires the analysis of defense. There is a horizontal split in the mind. In both cases, full articulation of the events in consciousness occurs before forgetting takes place. The situation is different with trauma.
Traumatic events present the mind with too many stimuli to experience and think about. The mind splits off, or dissociates, unsymbolized experience to avoid the experience of disintegration before the mind has been able to symbolize it. For example, when Father yells at Baby, Baby initially experiences her body being assaulted. An image of Father develops, if the yelling is not traumatic. This image can then evolve into a thought of Father yelling and Baby can compare that thought with other more benign images of Father. She can thus soothe herself. Adequately symbolized experience relegates Father’s yelling to the preconscious and forgetfulness or to the unconscious and repression. However, traumatic yelling confronts the mind with too much stimulation, foreclosing experience and articulation. This process creates a splitting off, resulting in a dissociated state of mind as a somatic memory; a sensory experience devoid of images or words. This forms the basis of a dissociated state. Representational functioning fails in trauma.
The dissociated state returns with particular force when it is first recovered. Some accidental occurrence will often trigger this recovery. For example, association to a dream may lead to memories of being raped as a child. Recovery of dissociated states often engenders the experience of flashbacks and somatic memories where the person relives the childhood sensory experience.
This reliving often has a terrifying reality, and past can become confused with present. Lack of prior symbolization has deprived the memories of a structure and context in time. An example of such a state would be extreme pain in the vagina that causes the person to double up. She relives the experience of being penetrated as a child, but lacks words or images to attach to the experience. The person needs help in bearing the distress and owning the memory if thought about the experience is to evolve. Bearing the distress facilitates a sensory experience being brought to a level of cognition and formulated thought.
Recovery of the trauma stimulates a pattern of alternating states of mind where the person alternately experiences themselves as being molested or unprotected and then denies the events. During states of denial, the person may function quite adequately, albeit without the knowledge of previously conscious states of mind. Treatment then becomes a matter of either helping the person to put words to and make sense of the trauma, or analyzing their resistance to facing the trauma.
Dr. Daniel Paul is a caring Los Angeles psychologist treating those who struggle with Dissociative Identity Disorders. Contact his Beverly Hills counseling office today for an appointment, by calling 310-271-1858.