Beyond the binary question of “cure” lies a more meaningful journey. One of integration, communication, and reclaiming a life no longer controlled by dissociation.
While the portrayal of dissociative identity disorder (DID) in films like “Split” has brought more attention to the condition, it’s also created a lot of misconceptions about what is an incredibly complex disorder to manage.
And perhaps one of the most harmful myths is that DID is a life sentence of chaos and suffering with no possibility of change or healing.
The truth is that while DID develops in response to severe childhood trauma, there is a potential pathway to a brighter, more fulfilling life.
Cure is perhaps the wrong word. Trauma isn’t cured. It’s first understood, accepted and then integrated.
And as DID involves the fragmentation of the self, creating distinct personalities that serve as both protection and their own form of a prison, they really do need a specialised level of support.
These are highly sophisticated coping mechanisms, which need to be understood with great care and compassion. Not cured.
However, as is the case, with many mental health conditions, with great willingness and heart, there is absolutely no way to live more in alignment with one’s true, core values.
There is a pathway to greater health beyond simply managing the symptoms.
And there is a potential to create such an improvement that the word recovery could be used in a meaningful way.
What Does Recovery from Dissociative Identity Disorder Actually Mean?
The idea of recovery is such a relative experience. Recovery from a physical illness such as the flu has a very definitive and binary outcome. But the experience of recovery from dissociative identity disorder exists more on a spectrum rather than as a complete “cure.” It’s relative to the starting point of an individual. It is entirely possible to not only achieve a significant reduction in symptoms through dissociative identity disorder treatment.
Recovery typically involves either:
- Integration (merging of alters into a unified identity)
- Functional multiplicity (improved cooperation between identity states)
Regarding integration, it’s essential for all clinicians and therapists to adopt a “completely client centric approach.” What this means in practice is that a therapist “would never try to impose the idea of a full integration onto their client.” This isn’t to say that it isn’t possible. It is entirely in potential. However, this should never be the goal of any treatment plan. To bring this into the client-practitioner dynamic, where there needs to be a significant amount of trust building already, would place unnecessary pressure on someone who is already in place of significant distress.
The client’s personal objectives should always serve as the main focus for treatment since they typically involve achieving better life quality through enhanced relationship dynamics and occupational and daily life abilities. This is a far better way of looking at integration. Yes, it is entirely possible to integrate alters, but taking a ‘needs first’ approach as stated by the client is far more productive and likely to lead to the deep integration of those parts as a result of consistent therapy.
Success markers include:
- Reduced dissociative episodes
- Improved relationships
- Decreased self-harm behaviours
- Better daily functioning
- Greater control over dissociation
- Reduced dysfunction caused by switching between alters
What Type of Therapy is Best for DID?
The most effective therapeutic method for managing DID is phase-oriented psychodynamic treatment, as this approach offers a very clear and sequential process for addressing a condition which can often be complex and nonlinear throughout recovery.
The treatment methodology includes three sequential stages.
- Safety and stabilisation
- Trauma processing
- Integration or improved system functioning
The Schema therapy model is one of the approaches shown to deliver the most consistent results in treating DID. This is an integrative modality in which patients learn to view their different alters as “modes” instead of independent personalities while working on child trauma-based schemas.
Researchers documented substantial improvement in a 43-year-old woman with DID through 220 sessions which included reduced dissociative symptoms together with the complete elimination of suicidal behaviours.
Relational and integrative approaches form the backbone of this approach. The entire therapeutic process of treating DID could be seen as conducting family therapy as the main premise of this approach involves working with various parts of a fragmented system – which could be viewed as an internal family. During sessions, the therapist might at points directly interact with various alters while addressing their individual needs and conducting communication between alters based on the situation. However, this will only be if required and helpful for the outcome of the session.
For example, a therapist can bring out the problematic alter by saying “I wonder if [alter’s name] would like to meet with me?” This allows for the practitioner to develop a deeper understanding of the behaviours at play, and their motives through direct communication, building trust with the inner parts, and alters with the intention of creating a sense of equilibrium.
EMDR can also be a viable treatment path for DID. However, it does need to be modified with specialised protocols to accommodate the complexity of DID. The standard EMDR procedure needs to include supplementary stabilisation methods along with resource development and containment approaches that protect the patient from entering into a state of overwhelm.
Additional beneficial approaches include:
- Utilising a trauma-focused form of Cognitive Behavioural Therapy (CBT) to develop person centred coping skills.
- Using Dialectical Behavioural Therapy (DBT) to assist in emotional regulation and distress tolerance
- Dialectical behaviour therapy for emotion regulation and distress tolerance
- Internal family systems work to facilitate understanding between alters
- Creative approaches that allow for intuitive, in-the-moment interventions based on the system’s needs
The Success Rates of Treatment Differ When Patients Experience Different Types of Trauma
Part of the reason that the DID is so complex, is due to the nature, timing, and context of trauma that informs it.
Early childhood trauma: When the trauma that sponsors the presentation of DID takes place during the critical childhood development stages before the age 9, it creates a fundamental disruption in the development of healthy, secure attachment styles. This causes the brain to grow in such a way which requires deep and significant therapeutic intervention.
Interpersonal trauma: When there is extensive interpersonal trauma, particularly sexual abuse, involving trusted caregivers, or parental figures, it can complicate the therapeutic process significantly. Because trust has been so broken at an early age, resulting in the manifestation of alters as a coping mechanism, it can be extremely difficult for patients to fully surrender in a way that will allow them to be held by their practitioner or therapist.
Trauma duration and complexity also impact recovery:
The length of trauma exposure together with its complexity determines the extent of recovery:
- Type I (single-incident) trauma generally responds more quickly to treatment
- Type III (complex, repeated) trauma that created dissociative coping mechanisms over extended periods often results in more elaborate internal systems with numerous alters serving specific protective functions
Psychological treatment for medical trauma may progress differently than treatment for other forms of trauma. For example, medical procedures that were undergone and were experienced as traumatic, particularly in childhood, can create unique dissociative responses related to bodily integrity and physical boundaries.
The recovery process requires specialised concurrent interventions that ensure safety because patients with substance abuse and self-harm behaviours and suicidality need additional treatment support.
How Can a Person Be Successfully Treated for Dissociative Identity Disorder?
To successfully treat DID, there needs to be a complete dedication to the process on both the part of the therapist and client. Because of the rebuilding of trust that is so central to recovery, it can be difficult to make meaningful progress without both parties being fully committed.
This means that from the end of the client, there’s going to be a great challenge in finding the courage to build trust in a figure that may represent a trigger for their trauma when they attempt to surrender to the therapeutic process.
Betrayal has a long memory. And when it’s underscored by profound trauma, it can be extremely difficult to enter into a state of constructive vulnerability, which the nervous system will interpret as a threatening situation.
But that is largely what’s required. It’s having the courage to be vulnerable again, in measured experiences of self-exposure to the fragmented aspects of self and painful memories that the mind has worked desperately to keep hidden.
It is the role of the therapist to offer absolute unwavering presence throughout this entire process. Not only presence, but a deep and unconditional patience that has the stamina to last years, as well as a humility that recognises the pace of recovery is set by the client and not themselves.
It’s this therapeutic alliance, which forms both the base and spine from which all progress stands – the solid ground. It’s a relationship which needs to be strong enough to withstand the inevitable testing of trust, mistrust, and transference that might emerge when an individual with relational trauma begins to make deeper connections again.
Treatment Setting Considerations:
- Online therapy can be particularly beneficial for DID patients due to practical considerations. Online works really well with this client group because of the fact that they do lose time and gaps.
- Video recordings of sessions can help patients review what happened during dissociative episodes, providing continuity of care.
- Remote sessions eliminate transportation challenges, which can be significant for those who dissociate and may find public transport overwhelming or unsafe.
- Consistency in the therapeutic relationship is more important than consistency in the physical environment, though maintaining similar settings when possible can be helpful.
The Three Steps in the Treatment for Dissociative Identity Disorder
DID treatment follows a well-established three-phase approach:
Phase 1: Safety and Stabilisation
- Establishing physical and emotional safety
- Developing crisis management skills
- Building distress tolerance
- Additionally, attending Trauma-focused CBT workshop may help develop a deeper repertoire of grounding strategies and emotional regulation skills that may be useful in later parts of the recovery process. This is also known as “resourcing.”
- Before any type of trauma processing can be attempted, this foundation really needs to be solidly anchored in to prevent any kind of re-traumatisation.
Phase 2: Trauma Processing
- The deeper process of recovery begins by carefully working through traumatic memories, using modified exposure techniques and other approaches.
- Psychodynamic therapy also plays an important role in this face, as it helps patients understand how past trauma is currently influencing the current choices and relationships.
- The aim of this work is to facilitate the integration of fragmented, traumatic experiences into more coherent narratives that can be processed, and then stored as past memories, rather than current threats.
Phase 3: Integration and Rehabilitation
- Focus on identity integration (or improved cooperation between alters)
- Developing adaptive coping skills
- Rebuilding life after trauma
- Cognitive behavioural therapy techniques help consolidate new skills and thought patterns
Throughout each of the three phases, there must be clear, therapeutic boundaries and containment strategies to help minimise the impact of trauma that may surface. This is to prevent the client becoming overwhelmed by emotional flooding as they gradually expand their window of tolerance for emotional distress.
Is Living with Dissociative Identity Disorder (DID) Hard?
Living with DID can have a massive effect on the quality of life, and it can transform the most basic aspects of human experience into quite extreme challenges. And this is largely due to the unpredictable nature of the dissociation and the switching between different alters.
This constant oscillation between different personality types creates a fracturing of the continuity of living, which most people take for granted. For example, imagine finding yourself in conversations that you don’t remember, starting or discovering possessions you are, would you have no memory purchasing.
Key challenges include:
- Memory gaps that create a patchwork existence-missing hours, days, or even weeks that leave you piecing together your own life through evidence left behind
- The exhaustion of internal conflicts between alters with different needs, values, and perspectives, creating significant emotional issues that drain psychological resources
- The profound isolation of living with experiences few others understand, often leading to withdrawal from relationships to avoid explaining unpredictable behaviour
- The daily vigilance required to manage triggers that might cause switching in inappropriate or dangerous situations
- Navigating a society where media portrayals have sensationalised your condition, creating stigma that affects everything from medical care to housing opportunities
Despite how challenging all of this can be to navigate, with the proper treatment and support, many people with DID are able to develop effective management strategies, and allow them to significantly improve their quality of life.
