Dissociative Identity Disorder: Contemporary Look at a Classic Mystery

Dissociative identity disorder (DID), once called multiple personality disorder, is an extraordinary syndrome in which two or more integrated alter selves co-exist simultaneously in a single body. It appears to have roots in severe child abuse and is puzzling and painful both for the persons who suffer from it and for the therapists who treat it. Yet researchers and expert observers of the field now say that DID may be the basis for a new understanding of the nature of the mind and its elusive relation to body and brain function.

In a person living with DID, different personalities who sometimes have no awareness of one another alternately control the physical body. The process by which control of the body passes from one personality to another is called switching, and when personalities switch so do a variety of other features.

Alter personalities may differ in terms of voice, posture, physiognomy, handedness and - if preliminary research studies are correct - numerous physiological features such as brainwave patterns, immune status, and skin electrical responses. Behavior patterns, reported life history and (subjectively perceived) sex and age also tend to vary. Different personalities have often mastered different physical abilities, interpersonal skills, and intellectual subject areas. Some may even command entirely different languages!

The average number of alter personalities is 8 - 13, although some may have more than 100 alternates.

By studying such changes and the mechanisms responsible for them scientifically, researchers hope to illuminate a host of key topics in psychology, psychiatry, and related fields such as psychosomatic medicine and brain research. Studies of dissociative identity disorder  are expected to shed new light on such questions as:

• What are the mechanisms of conscious awareness, and how can multiple streams of conscious activity occur in the mind at the same time?
• How do processes occurring outside of phenomenal awareness influence experience or behavior?
• How do mental and emotional factors influence pain perception, immune function, and other psychosomatic processes?
• What are the mechanisms of volition or "executive control" in human consciousness? What are the mechanisms of "downward causation" in patterns of brain activity?
• To what extent are personality traits or abilities such as intelligence, sensitivity or creativity determined by genetic and environmental influences, and to what extent are they consciously or unconsciously "chosen"?

Cases of DID have always fascinated lay audiences, from fictional accounts such as The Strange Case of Dr. Jekyll and Mr. Hyde to contemporary true stories such as Sybil or The Minds of Billy Milligan. They have also intrigued professional observers from the 17th century to the present. Until recently, however, psychiatrists considered DID to be extremely rare, and understood little of its scope or dynamics. Now, known cases and new knowledge about DID are growing at a rapid rate.

Based on clinical research encompassing hundreds of individuals with DID, as well as on preliminary findings from controlled research, a broad picture of multiplicity is beginning to emerge.

Presence of Alter Personalities

When a person living with DID switches it is typically rapid, usually occurring in 1-2 seconds although in some cases slightly more time is required. Switching may be a voluntary or involuntary event, initiated either through conscious willing, in response to an unconscious emotion or a situation which triggers "automatic" switching, or as a result of biochemical changes in the body.

Drs. Corbett Thigpen and Hervey Cleckley reported one of the first contemporary cases of DID in 1954, in The Three Faces of Eve. They described their initial meeting with one of Eve's alters in a way that conveyed the eerie, trance-like quality that switching sometimes has:

The brooding look in her eyes became almost a stare. Eve seemed momentarily dazed. Suddenly her posture began to change. Her body slowly stiffened until she sat rigidly erect. An alien, inexplicable expression came over her face. This was suddenly erased into utter blankness. The lines of her countenance seemed to shift in a barely visible, slow rippling transformation. For a moment there was the impression of something arcane. Closing her eyes, she winced as she put her hands to her temples, pressed hard, and twisted them as if to combat sudden pain. A slight shudder passed over her entire body.

Then the hands lightly dropped. She relaxed easily into an attitude of comfort the physician had never seen before in this patient... In a bright unfamiliar voice that sparkled, the woman said, "Hi, there, Doc!"

Actually to meet the alter personalities for the first time is both fascinating and disturbing. If the disparity between one personality and the next is great - as when an adult is replaced by a child, or a female by a male personality - one's first question may well be, "Is this real?" or "Is she (he) acting?"

This question has been posed throughout the history of psychiatry, and in specific cases one cannot definitively answer "Yes" or "No" immediately. Diagnostic issues aside, however (they are discussed elsewhere in this bulletin), it is interesting to note that what gradually impresses one meeting a person with DID is less the obvious differences between personalities and more the nonverbal, intangible dimensions of personality that are rich, subtle and difficult to fake. These qualities of being tend to be subconscious and are usually perceived subconsciously; it is the discrepancy between them from one personality to another that eventually shakes one's sense of what is real and what is not.

Still, the differences among alters can be impressive. In the notorious case of Billy Milligan - described by Daniel Keyes in The Minds of Billy Milligan - Milligan's 24 alter personalities included:

• Arthur, a 22-year old Englishman who is rational, emotionless and staunchly conservative. Arthur is expert in physics, chemistry, and medicine, and speaks with a British accent. He also reads and writes fluent Arabic. The first to discover the existence of all the others, he dominates in safe places and decides who will come out and hold the consciousness. Wears glasses.
• Ragen Vadascovinich, 23, the "keeper of hate." His name is derived from "rage-again." Yugoslavian, he speaks English with a noticeable Slavic accent, and reads, writes and speaks Serbo-Croatian. A weapons and munitions authority as well as a karate expert, he displays extraordinary strength, stemming from his ability to control his adrenaline flow. His charge is to be protector of the family, and of women and children in general. he dominates the consciousness in dangerous places. Ragen weighs 210 pounds, has enormous arms, black hair, and a long, drooping mustache. He sketches in black and white because he is color-blind.
• Adalana, 19, the lesbian. Shy, lonely and introverted, she writes poetry, cooks and keeps house for the others. Adalana has long, stringy black hair, and since her brown eyes occasionally drift from side to side with nystagmus, she is said to have "dancing eyes."
• Christene, 3, the corner child, so called because she was the one to stand in corner in school. A bright little English girls, she can read and print, but has dyslexia. Likes to draw and color pictures of flowers and butterflies. Blond shoulder-length hair, blue eyes.
• The Teacher, 26. The sum of all twenty-three alter egos fused into one. Taught the others everything they've learned. Brilliant, sensitive, with a fine sense of humor. He says, "I am Billy all in one piece," and refers to the others as "the androids I made." The teacher has almost total recall.

Milligan's alter personalities referred to being in control of the body as being "on the spot." One explained:

"It's a big white spotlight. Everybody stands around it, watching or sleeping in their beds. And whoever steps on the spot is out in the world... 'Whoever is on the spot holds the consciousness.'"

A woman with DID named Cassandra who was interviewed at the First International Conference on Multiple Personality/Dissociative States revealed a similar range of personalities. Several of her alters (she claims to have more the 180 personalities or fragments in all) spoke openly about their experiences and abilities.

• Larry is an adult male who sits on what Cassandra calls her Inner Council, whose purpose is to provide guidance and moral direction for the "family." As are several other members of the Council, Larry is an American Indian. Thoughtful and direct, he has a strong masculine face and manner and will not enter the body if Cassandra is wearing characteristic feminine attire. Larry is responsible for protecting the body from physical harm, a function he fulfills even when he is not in control of the body by virtue of being co-conscious.
• Celese is a 14-year old member of Cassandra's family who has detailed knowledge of human anatomy and physiology, obtained through her study of medical textbooks. Formerly a selfmutilating personality, Celese now serves as the body's healer. She claims to have healed third-degree burns, internal organ damage, and even brain damage using visualization, which she practices with exceptional refinement personality, which means that she does not experience pain, and with men she is a delightful adolescent flirt.

• Chris is a 10-year old boy with all the normal interests and ambitions of boys that age. he enthusiastically tells stories of playing ball and of going fishing, and looks forward to being able to drive when he grows up. Presently forbidden to do that, since he cannot see over the dashboard when sitting in the driver's seat, he nonetheless admits to once taking the car anyway. Purportedly he drove it by stationing four other alter personalities on its two front and two rear corners to direct him!
• Stacy is a shy little girl who plays incessantly with her hair, often hiding her face beneath it. She speaks in a high-pitched voice with a strangely archaic syntax and vocabulary, and controls the body only briefly. Stacy's name is derived from her function, which was to "stay" and "see" what happened when Cassandra was abused.

With more than 180 alters, by her reckoning, Cassandra is what psychiatrists call a "super-multiple." She would have astounded investigators of DID prior to the present era, since most prior reports of DID involved cases of dual personality. Much more rarely, individuals with three, four, or possibly five alternate personalities were reported.

Cassandra is unusual even today, but her case is not unique. Dr. Richard Kluft of the University of Pennsylvania Medical School has found that the average number of alternate personalities is 8 - 13, though dual personalities are still "not too uncommon" in men and there are other "super-multiples" with more than 100 alternates.

Dr. Frank Putnam of the National Institute of Mental Health reported similar findings at the 137th Annual Meeting of the American Psychiatric Association (APA) in Los Angeles. Putnam found an average number of 13 personalities (or personality fragments) in 100 people that he surveyed, and noted in addition that the greater the number of alternate personalities, the greater a person's self-destructiveness.

Putnam's survey also revealed that 75% of all individuals living with DID had child personalities under 12 years of age, 50% had alter personalities of the opposite sex, and over a third exhibited changes of handedness from one alter personality to another.

Inner Faces of DID

Other common types of alter personalities found include Inner Self Helpers (ISHs) and persecutors. First identified by Dr. Ralpf Allison of Morror Bay, California, ISHs are exceptionally knowledgeable and helpful personalities who guide the person with DID and sometimes aid the clinician in therapy. In his experience, said Allison in Minds in Many Pieces, ISHs often exist in a spiritual hierarchy with those highest in the hierarchy (those closest to God) being most reluctant to enter the body or communicate with the therapist.

Persecutors aim to dominate the person's inner family or even to destroy other alters. A product of the anger and hostility evoked by abuse, persecutors are nearly ubiquitous and are often responsible for sociopathic behavior which gets the person in trouble. They also embody strong masochistic tendencies, which psychiatrists say are common in those living with DID. Until they accept a cooperative role in the intrapsychic system (and like every other alter they personify important aspects of the whole personality), they are a source of misery and terror.

The fear that persecutors can elicit was described by Dr. Robert de Vito of Loyola University, who said in a paper prepared for the conference in Chicago:

If one could imagine the original personality "on stage" with one or more alters "in the wings" watching and/or talking to or about the original, one could begin to approximate the daily torment experienced by the original or host. When the original, host or presenting personality becomes aware that an alter or group of alters want to torture, humiliate, or even "murder" him/her, each waking moment is filled with dread. As a former patient of mine put it, "It is as if I took out a contract on myself."

The extent and strength of the dissociative barriers defining each personality vary tremendously. There may be personalities with continuous memory (given the name memory-trace personalities by Dr. Cornelia Wilbur of the University of Kentucky), personalities with continuous awareness, and yet others who are amnesiac for all or some of those with whom they are sharing a body. In short, Dr. Eugene Bliss of the University of Utah has observed, clinicians may find all gradations of awareness and control among the personalities.

Alternate personalities who are aware of the thoughts, feelings or actions of other alters are said to be co-conscious (a term coined by one of the first U. S. investigators of DID, Dr. Morton Prince). Frequently, a primary personality will be amnesiac for other alters, while one or more secondary personalities is co-conscious.

Co-presence is the ability of an alter to influence the experience or behavior of another personality. Psychiatrists such as Dr. Richard Kluft of the University of Pennsylvania (who coined the term) and de Vito think that co-presence may be a factor in producing many of the diverse symptoms that people living with DID exhibit. These encompass the full range of classical dissociative and conversion symptoms- blindness, paralysis, etc. - as well as unusual symptoms such as dissociative void, in which the body appears temporarily vacant of any personality. The latter, de Vito said, may reflect an internal struggle for executive control among alters.

Another unusual symptom sometimes observed in DID is dissociative panic. This occurs when no alter can maintain control of the body for more than a few minutes, so that a rapid cycling or switching of personalities results. An episode of dissociative panic was described in The Minds of Billy Milligan following the administration of the anti-psychotic drug Thorazine to Billy:

They threw him into a small bare room...and locked the door. When Ragen heard the door slam, he got up to break it down, but Arthur froze him. Samuel took the spot, dropping to his knees, wailing, "Oy vey! God, why have you forsaken me?" Philip cursed and threw himself to the floor; David felt the pain. Lying on the mattress, Christene wept; Adalana felt her face wet in the pool of tears. Chistoper sat up and played with his shoes. Tommy started to check the door to see if he could unlock it, but Arthur yanked him off the spot. Allen started calling for his lawyer. April, filled with desire for revenge, saw the place burning. Devin cursed. Steve mocked him. Lee laughed. Bobby fantasized that he could fly out the window. Jason threw a tantrum. Mark, Walter, Martin and Timothy raved wildly in the locked room. Shawn made a buzzing sound. Arthur no longer controlled the undesirables.

An alter who is amnestic for other personalities experiences those periods when alters are in control of the body as "lost time," or blackouts. Such experiences are one of the most frequent symptoms of multiplicity, and they create tremendous bewilderment and confusion. People living with DID may "wake up" in unfamiliar situations with no idea where they are, how they got there, or who the people around them are - even though those people may be well known to one of the alter personalities!

One of the consequences of such amnestic episodes is that people with DID are frequently accused of lying, since an alter may deny remembering or being responsible for events or actions that occured while another alter controlled the body. Some alters develop exceptional memories to compensate.

In Sybil, the story of Sybil Dorsett's pioneering treatment by Wilbur, Flora Rheta Schreiber described the pragmatic and emotional consequences of lost time. As a result of her amnestic experiences, Sybil remembered, she "found herself floating in and out of blackness":

Disguising the fact, she became ingenious in improvisation, peerless in pretense, as she feigned knowledge of what she did not know. Unfortunately, from herself, she couldn't conceal the sensation that somehow she had lost something. Nor could she hide the feeling that increasingly she felt as if she belonged to no one and to no place. Somehow it seemed that the older she got, the worse things became. She began derogating comments: "I'm thin for a good reason: I'm not fit to occupy space."

What happens to alters when they are not in the body is different for different people. Cassandra reports that her personalities frequently have out-of-body experiences in which they travel to a non-physical domain which she calls the Third World. In others, alter personalities report residing inside certain regions of the head or body. Some alters "sleep," while others are aware of their inner companions and can watch the activities of whomever is "in the body."

Some people living with DID have elaborate inner worlds in which they play and communicate with other alters. Some personalities may even live almost entirely within, and rarely or never enter the body. The experience of these and other mysterious alters with no known origin or function often have a surreal or numinous quality quite difficult to convey using ordinary language. A glimpse is provided by one of Milligan's alters who had no name:

"When I'm not asleep and not on the spot," he said, "it's like I'm lying face down on a sheet of glass that stretches out forever, and I can look down through it. Beyond that, in the farthest ground, it seems like stars of outer space, but then there's a circle, a beam of light. It's almost as if it's coming out of my eyes because it's always in front of me. Around it, some of my people are lying in coffins. The lids aren't on them because they're not dead yet. They're asleep, waiting for something. There are some empty coffins because not everyone has come there. David and the other young ones want a chance at life. The older ones have given up hope...David named this place, " he said, "because he made it. David calls it the Dying Place."

Exceptional Abilities

Some people living with DID learn to use their multiplicity in conscious and constructive ways. Cooperation among alters which exist harmoniously may take many forms.

Alternation of personalities extends time during which a person is able to function at peak capacity. A personality who is tired or has used alcohol or drugs for instance, can yield the body to another personality who will be alert, sober and able to continue functioning. A personality who is in pain can yield the body to a more anesthetic personality who does not feel the pain, or to another personality who will remain in the body until he or she can no longer endure the pain and must switch.

Co-consciousness also facilitates cooperation among alter personalities. Using co-consciousness, Milligan's alter selves Arthur and Ragen would observe what was going on in the environment and decide who should be "on the spot." Cassandra's alter personality Celese, too, apparently uses co-conscious processing to continue with the task of visualization and healing even when she is not in the body.

"Parallel processing is not only possible with me, allowing a higher level of productivity than normal," Cassandra has written, "it is also inevitable."

When the pressures of graduate school are beyond the limits of any one person, I call on the others to help me. When I am writing a paper on dichotic hearing, on e of the others is composing the proposal for "my" master's thesis. Someone else has prepared dinner for me and will later clean up the kitchen while I sleep...I can no more prevent the others from working than I can prevent the change of the seasons. Even as I write this, one of the others is probably thinking about something as obtuse as critical flicker frequency. We share the body so the time I am at the typewriter of necessity limits the others use of the physical aspects of the body. It does not prevent anyone of them from using the brain to plan, design, or compose....I think that this is mind wandering deluxe!

DID also causes people to exhibit other unusual abilities, according to clinicians. These include "perfect" memory (sometimes having a near-photographic quality as well as strong auditory, olfactory and somatic components) and the ability to heal more rapidly than normal. Paranormal experiences are also reported to be common. Are these somehow related to a "passion to survive"?

Those with DID also tend to be highly intelligent, perceptive and sensitive. "I've never met a multiple with an IQ of less than 110," said Wilbur at the First International Conference on Multiple Personality, while Dr. David Caul noted that they are exquisitely sensitive to cues and signals. "They can smell a liar at a thousand paces in one-ten thousandth of a second," he said. Are these traits, like their high hypnotizability, somehow related to the capacity for dissociation?

Such purported abilities pose questions and present opportunities for research.