Formerly called “multiple-personality disorder” and most often associated with murderous con artists on shows like Law & Order: SVU, dissociative-identity disorder (DID) is a widely misunderstood and controversial diagnosis. DID remains listed in the DSM-5, the most recent psychiatric diagnostic manual, where it is defined as “an identity disruption” involving two or more personality states, each of which may vary in behavior, memory, affect, and sensory-motor functioning, among other factors. Yet many professionals in the field have argued for its removal, even going so far as to call the diagnosis “bogus.”
Those who affirm DID’s legitimacy, like Bethany Brand, a clinical psychologist and professor of psychology at Towson University, say that much of the controversy stems from the fact that most mental-health professionals have “shockingly little” training in trauma. DID, she says, is a trauma-based disorder, typically (though not always) formed by children in response to “very early, profound, chronic childhood abuse.”
Symptoms of DID are often severe and frequently difficult to diagnose — most DID patients spend five to seven years in treatment before they’re correctly diagnosed, Brand says. These patients often have depression and anxiety in addition to DID, and it’s not uncommon for them to struggle with self-harm and substance abuse. Other common symptoms include what may look like “daydreaming,” which is actually spontaneous dissociation, says Brand; sudden, unexplained mood shifts; and frequent nightmares. More than 70 percent of people with DID also hear voices, says Brand, which means that they can be misdiagnosed as schizophrenic. Where DID patients differ is in their level of self-awareness. “They’re not psychotic,” says Brand. “They know that [hearing voices] sounds ‘crazy.’” For reasons like these, Brand calls DID a disorder of “shame and secrecy,” adding that people with the disorder are unlikely to discuss it openly.
Because DID is a coping mechanism developed over time, it may be that suggested agency on the part of the patient that contributes to skepticism, Brand says. Though a patient’s personalities may be in part created in response to traumatic events, that doesn’t mean they’re entirely under the patient’s control. Treatment for DID involves teaching patients “containment skills,” says Brand, which are meant to help the patient realize when they’re not actually in danger, thus reducing the need for their learned trauma responses. For many people, says Brand, treatment begins and ends there — there is no medication for DID, and no known cure.
I recently spoke to a 25-year-old with DID who goes by the name “Dia” and who prefers to use they/them pronouns to better incorporate their 21 personalities. (They often use “we” to refer to themselves for the same reason.) We met because Dia is in a relationship with Rudy, a man diagnosed with narcissistic-personality disorder, whom I also interviewed. Dia was diagnosed with DID at 22, after many years of diagnoses they felt didn’t fit. Our discussion, edited for length and clarity, is below.
Can you tell me about when you first realized there was something different about you?
Ever since I was very young, I would hear, in my head, other people talking, but I knew it was me, in a way. It’s not like I heard George Washington, or someone outside of myself. I knew that some part of me that wasn’t quite me was telling me things, but growing up, I thought that was normal, because I watched Pinocchio, and they tell you about the conscience, and how the conscience is the little voice in your head telling you right from wrong. I thought that’s all it was. Maybe in the beginning that’s even how it began — I named these voices, and over time they began to develop beyond an imaginary friend, or the voice of your conscience that’s telling you, “Don’t play with your mom’s makeup.”
When and how were you ultimately diagnosed with DID?
When I was 22, I really knew there was something wrong. The doctors had given me a diagnosis of “bipolar with frequent psychotic episodes.” But I didn’t feel like that made sense for me. They said, “Bipolar makes sense, because sometimes you’ll just switch into this impulsive person, which is a manic episode, and then you’ll switch back into a depressive episode.”
But with bipolar, the switches take more time. You don’t switch, like, moment to moment, in a few seconds, ten times a day. For most people it’ll be a manic episode for like a week, and then a depressive episode for two months. I knew something about it sounded off, but I thought, Maybe I just have really fast switching.
When I look back, we had one personality who would always go to the therapy visits. She would always tell the doctors things were going well, because [for her], everything was good. She wasn’t conscious of the issues we were having, and I think that’s what contributed to the doctors thinking the medications were working, even though they weren’t. But we knew we were still having issues and problems, and we felt like we were deliberately lying to the doctor. The rest of us were like, Why would I say that? Why would I lie when I know things aren’t good?
Around that time I became incredibly detached from reality, because all of our different parts were so disconnected from each other that we couldn’t tell what was a dream, or if we were really awake, or if the experience of one personality was a true experience, because you feel like it didn’t happen to you. If one of my personalities went to the store, I might have a vague memory of going to the store, but it’s like watching a movie — a movie you’re not very invested in because you forget the details and it’s boring.
I was starting to become very unhinged. Am I awake right now? Is any of this real? Am I here? Is anyone here? At a certain point I felt like, Maybe I’m a god, or I’m some sort of deity, or I’m a ghost, because I felt so far removed from a sense of physicality because of dissociation.
What does dissociation feel like to you?
It’s like a numbing of the senses so you don’t have to feel the intensity of an experience. Everyone experiences dissociation to a degree. If you’ve ever gotten in a car and driven somewhere but you don’t remember how you got there, you were dissociated. It’s an autopilot mode, where you shut down the focus and the details of life so you can just get something done. It was like that, but all the time. I’d walk around, go to the bathroom, eat my food, get dressed — but I felt like I wasn’t there. I wasn’t present, I couldn’t feel things. I would injure myself and not even know I was injured until I saw blood because I couldn’t feel pain. I had very little sense of time. I couldn’t tell if it was three in the morning or three in the afternoon. It all felt like the same time. I started getting scared. That’s when I started looking for answers online.
When I was 22, I asked a web forum about narcissistic-personality disorder, because I was curious if that’s something I had. At that point, there were times I felt like a god — I’m so great, I’m above everyone else, I have this out-of-body experience that is beyond others, and I’m special, so I thought maybe it’s a narcissistic thing. So I asked the question, “Does believing you’re special, or better than other people, mean you have NPD?” Rudy responded, “That’s not the case. It’s a common misconception that people with NPD believe they’re the greatest thing ever, when in reality they have very low self-esteem and it’s a defense mechanism.” He explained that to me, and I was like, okay, dead end. I don’t have that. I thought that would be the end of it.
He sent me a private message at the time, like, “Hey, what’s going on in your life that you’re wondering these sorts of things?” Which I thought was creepy, to be honest. Who is this person? Our interaction should’ve just ended there. But then I thought, I don’t think they know I’m a young girl, so it can’t be a creepy thing. So we just started talking about what was going on, and I spoke about how often I feel like I’m better than everyone else, or things don’t make sense, and I can’t feel things, and I thought that meant that I didn’t have any empathy. He said, “Why don’t I help you figure out what’s going on?” At the time I didn’t have any friends or real connections, so I was like, You know what, it can’t hurt.
We started Skyping. I don’t know exactly how long it took, but he eventually noticed me switch personalities. The personality that came out was like, “Who the fuck do you think you are? I’m just using you. You’re nothing to me.” He was like, “You don’t sound how you sounded the other day. The other day you were thankful for the progress we were making.” He started to suspect the multiple-personalities angle. In the past, my best friend of seven years had suggested that possibility to me, but I didn’t look into it.
But after Rudy said that, I started doing more of my own research into multiple personalities —
— I’m sorry. We switched, in the middle of the conversation, so I have to try to remember what we were talking about.
[Ed. note: Dia’s voice here drops in pitch, becoming less playful and more deliberate.]
What does it feel like when you switch? Who am I talking to now?
I’m Bea. I am, I guess, the more responsible one. I’m the one who spoke to our therapists in the past and told them everything was going swimmingly, not knowing there were others in my head having a difficult time. You were just speaking to Michaela previously.
How does it feel to switch? It’s hard to describe. It feels very natural to me. In fact, it wasn’t until after the diagnosis that we started training ourselves to pay attention to the switches, because in the past, as far as everyone was concerned, we were the same single person. Even if we switched it was, This is how I always am. [As for] what it felt like just a few seconds ago, I felt … fuzzy, is the best way I can describe it.
Do you have any idea why you might have made that switch just now?
Michaela is not good at speaking technically about things. She most likely felt as if the conversation was overwhelming, so then the dissociation came in to protect our senses, and then I came in to basically secure the continuation of the conversation. So it sounded smooth, but we did have a difficult time picking up exactly where we left off. When I came in, the moment I came in, I felt clarity, like I understood the content of this conversation in more depth than Michaela does.
Does each personality have those sorts of strengths and weaknesses? Do they come out in certain situations?
Every personality does have their own strengths and weaknesses. For example, Michaela is much friendlier and great at socializing and very likable, but she has ADHD, so she loses focus easily. I have OCD, so when I’m washing the dishes, it has to be done like five times, and I have to do a specific order: utensils, then plates, then bowls, then cups, and they each have to be scrubbed a certain number of times and then wiped a certain number of times. But I’m great with managing responsibilities — our budget, cleaning. I have the highest anxiety of our personalities.
I don’t know if Michaela mentioned this earlier, but DID varies greatly from person to person, because systems develop depending on what is needed. For us, the majority of the time, our switches are involuntary. We get triggered by something in the environment, or our brain controls it itself. It decides you don’t fit in that situation, so I’ll stick someone else in who fits better, like what happened a few seconds ago.
There are moments when we can control a switch. It takes a lot of coordination. I think it would be similar to a normal person acknowledging a feeling within themselves and consciously making a decision to project that feeling. You know how sometimes you just feel a little angry inside, but you can ignore it, but it’s something in the back of your head? It would be like deciding, I have this anger, and I’m going to focus it and allow it to be expressed in a way that is healthy, and I’m going to utilize it right now openly. I think that’s the closest I could compare it to a normal brain.
If we can go back, you met Rudy, and he suggested the possibility of multiple personalities. Did that click with you? Did you want a second opinion?
Not exactly. We both started looking stuff up. I can’t remember exactly which of us found it first among all the list of things we looked up, but I remember going to a website where they had a trauma-dissociation test. The thing I noticed about the questions was that they didn’t seem weird to me. Rudy took the same test, and he felt like the questions were weird. There were things like, “How true is this statement: It’s not uncommon for me to forget where I am.” And I’m like, Yeah, that’s not weird! Another one was, “People often have no memory of what they were doing for the past hour.” I was like, Yeah, that seems usual. But then Rudy said those aren’t experiences most people have. Another one was, “Often people walk up to me like we know each other, but I’m not familiar with them.” For me it was very common that people I had met as another personality would say hi to me and I wouldn’t recognize them and I’d wonder why they were talking to me. I’ve never seen this person in my life. Or people would know things about me I swear I’d never told them. But apparently another personality had told them. That’s when we started looking more into DID.
The official diagnosis I got was from a well-known psychiatrist who specializes in that field, Dr. John Chardavoyne. (He’s no longer practicing.)
How did you find him?
There is an organization called ISSTD, the International Society for the Study of Trauma and Dissociation, which conducts research on trauma disorders and dissociative disorders, and on their website they had a list of therapists that specialize in DID. He was on a list for ones in my area. I just went down that list and called all the doctors to ask if they were seeing new patients.
— Oh! We switched again. Hi.
[Ed. note: Dia’s voice and affect here become chirpier and more youthful.]
Hi! Who am I speaking to?
I’m Michaela. We were talking earlier. I really like Dr. Chardavoyne. The reason for that switch right there is because I’m remembering him fondly.
When he gave you the diagnosis, what did he suggest you do with this information? What does treatment look like?
He suggested intensive psychotherapy with a focus on emotional regulation. Emotional regulation is where you identify how you’re feeling and what the feeling is and then you control it. We would take dissociation to begin with, because we were just doing it all the time, unintentionally. It would disorder our lives. So he taught us how to recognize how we feel when we’re dissociated. It’s all about keeping your emotions below the threshold of dissociation, because when we get overly emotional is when the dissociation gets brought on. Our body wants to protect us from feeling, and if we learned how to make the feelings not as overwhelming, then it would prevent us from dissociating in the first place. That was very helpful.
Are those things you still practice now?
Oh yeah. I’m still working on it, actually. It’s really difficult. I really would have liked to continue with him, but what I learned in that year with him was life-changing. I know a lot more now than I did.
My doctor also stressed acknowledging other personalities and not feeling ashamed of them and communicating better internally so that we could work toward a common goal. While I was talking to him, we met a lot of new personalities. Previously, it was mostly arguing in my head: One personality wants to pet a puppy across the street, the other one wants to drive to McDonald’s, the other wants to go to work and be responsible, and it would all be yelling at the same time — all the things we want to do, no one agreeing, and I’d be going, “Shut up shut up shut up shut up.” Dr. Chardavoyne stressed identifying those things I wanted. What is the part that’s saying, “I’m gonna go pet the puppy?” Like, “Hey you who wants to pet the puppy — who are you?” It was about becoming familiar with the function of that personality, or how they came to exist in the first place.
To someone who doesn’t have DID, I wonder if what you’ve described sounds like having internal conflict, which we all do to some extent. How do you understand the difference between what you experience and another person’s competing impulse?
In your mind, you might hold a little debate with yourself, weigh the merits and consequences, even become frustrated at how difficult it is to decide … and eventually come to a decision you can live with (even if it isn’t a wise choice).
Before I started intensive psychotherapy sessions with Dr. Chardavoyne, I had little to no control over or even awareness of the personalities’ conflicting interests. We heard each other, but before the diagnosis, hearing another personality’s thoughts was more like having a song stuck in our head — annoying and repetitive and impossible to quiet. And acting on those thoughts was comparable to singing the song aloud throughout the day on impulse, without really paying attention to whether or not it was the appropriate time or place to sing.
Are you able now to converse between your personalities and assign tasks or make decisions?
It’s like a Socratic seminar in our head. It only happens in a few seconds, but to us it feels like a really long conversation, like, “We should do this,” “No, we should do this,” “Here are my reasons for wanting to do this,” “I think this would be the smarter way,” and presenting all these options. Eventually we come to a majority vote of what should be done. Certain personalities are better suited for particular problems, so if it was a vehicle-related issue, then Jason would handle it. Jason’s the guy in our head. He knows more about cars and stuff.
What are some of your other personalities? How many do you have?
We’ve got 21 personalities. I have a list, because I had to start writing it down or I wouldn’t remember everyone’s names. A lot of our personalities only come out for a very, very specific reason. We have one personality who comes out just to run away and hide: Anya. She was out a lot during a very difficult part of our childhood, but as we grew older, there’s less need to run away and hide in places.
There are four personalities that we consider “hosts,” which means they’re out very often, me included: I’m Michaela, and then there’s Bea, who you also met, Jason, and Jack. Two women, one man, one boy.
I hate to say it, but I’m not very mature at all. I get along with other people well, socialize well, but if there has to be a serious conversation, I’m not great at that. I also have ADHD, so if I wasn’t medicated, I would also be bouncing off the walls.
Bea is very responsible. She sounds the most adult. She sounds our age. She has a really high work ethic and good morals, and she always wants to do things the right way. She’s a bit of a perfectionist — a lot of a perfectionist — and she has OCD. Because of that, she gets really easily overwhelmed. She’ll set really high expectations, and if she doesn’t meet them, she gets upset with herself.
Jason … we like to think of him as an anti-Bea, like her foil. For example, Bea is a people pleaser. She doesn’t like to step on toes or inconvenience other people. She’s very tactful. Jason isn’t that way. He’s very direct, assertive. He’s not afraid to tell it like it is. He’s not particularly interested in hurting people’s feelings, but if the neighbor isn’t picking up their dog’s poop, he’s not afraid to let them know that’s not okay. He is gay. Physically he is stronger than the rest of our personalities. Different personalities do have different physical characteristics as well. Some will be right-handed, some will be left-handed. Some will have better or worse vision or hearing.
Jack is mentally 5 years old. I guess there’s not really much to say about that. He likes to make up songs and play with our puppy.
Does he come out often?
He seems to come out whenever the other three hosts are too overwhelmed. Like, sorry, can’t adult anymore, here’s Jack. Now I’m going to watch cartoons for two hours straight and eat lollipops and feel better. I think it’s the way he sees things that gives our system a break, because he just doesn’t get overwhelmed by the same things we do. So if you’re supposed to do the dishes and we’re all stressed, Jack is like, “Oh, this is fun,” and he’ll play in the dishwater with extra soap and bubbles for an hour. But the dishes get done, because he’s not thinking about it. He sees things differently. That’s not to say he doesn’t get stressed at all. If he trips, he’ll be crying for a good half-hour.
Rudy mentioned that one of your personalities is a rabbit.
Oh boy, yeah. We don’t know a lot about Rabbit, but that she’s … a rabbit. Rudy told me one time Rabbit was hungry and she was nibbling on his clothing and trying to eat his chest hair, so he gave her celery and then she was good. I don’t remember this kind of thing.
Do you know the reason for DID, how it develops?
DID is a trauma-based disorder. Basically, if you experience recurring abuse or neglect in your early childhood, before you have a developed, unified sense of self, you are at the highest risk of developing DID — particularly before the age of 5, when your imagination is at its peak. The different personalities serve different purposes for survival. You develop these ways of coping, but it’s like … Let me use Rabbit as an example.
We switched again — hi, it’s Bea. So, Rabbit developed because we were scared a lot as a kid. There was a lot of fighting going on in our household between my mother and my sister — threats with knives, screaming, cussing. We were homeschooled, so they pretty much didn’t get away from each other. It was 24/7: I’m gonna fucking kill you, bitch, holding an assortment of sharp, pointy objects. That started when I was 7, being scared all the time. I knew it wasn’t normal, but I wanted to tell myself it was normal, so when I’d be hiding under my bed and shaking, I told myself I wasn’t scared. I’m not scared, I’m playing pretend. I’m a rabbit, hiding from foxes.
Over time, doing that for long enough, it solidified. After a while, you do it long enough, under circumstances that are extreme enough, when you’re that young and you have that big an imagination, it just makes more sense, and it feels safer to believe you’re a rabbit than know you’re in danger. That’s how different personalities develop. It’s coping. It’s survival.