Dissociative Identity Disorder

Starting off with a disclaimer that I do not have D.I.D nor am I an expert on the subject. I know that only people with first hand experience of having the disorder and specialists who treat the disorder are going to have way more experience that me.  So what I'll be explaining is just from a layman's perspective. 

"According to the Diagnostic and Statistical Manual of Mental Disorders, 5th edition, text revision (DSM-5-TR), there are five types of dissociative disorders: 

• dissociative identity disorder (DID)
• depersonalization/derealization disorder
• dissociative amnesia
• unspecified dissociative disorder
• other specified dissociative disorder" (psychcentral.com)

I'm not too knowledgeable with the others, so I'll just focus on D.I.D here.  So here goes. 

1. D.I.D is a trauma based disorder that occurs when in early childhood, a child has experienced trauma that has affected them to such an extent that they are unable to cope with what has happened to them or possibly what they were forced to witness. According to the theory of structural dissociation it "works off of the assumption that no one is born with an integrated personality. Instead, infants operate based off of a loose collection of different ego states that handle their different needs- feeding, attachment to a caregiver, exploring the world around them. Over time, these ego states naturally integrate into one coherent and cohesive personality usually by the ages of 6 or 9" (did-research.org). 

2. When a child develops D.I.D, those identity states start operating on their own as alters or altered states of identity.  Each identity state will have its own memories, likes/dislikes and personality. Alters are not the same as someone who actively decides to be someone else or be a different personality state. We all have those personality states - at home, at work, with our friends but they're still us. I know the series was trying to use the amnesia barriers as a way to show D.I.D but all they were doing is making Eunho look like she was playing pretend (intentionally) before she forgot about it. The development of alters all depends on how the individual's brains works and how it copes with trauma. Two children might have the same trauma experience but both might not experience D.I.D or one of them  might. It all depends on the individual.

3. Alters can communicate with each other both in the real world and in the subsconscious but it's not always straightforward. We do have "Haeri" writing letters to Eunho (as the show is somehow depicting amnesia barriers between personality states) but there is no subconscious communication between them. I have read that it might not always be easy for alters to communicate with each other. Some might just want to be left alone. Some might be more active and want to stay closer to the conscious mind. Subconsciously they can communicate with each other inner world or consciously through co-fronting or being co-conscious with each other. I'll explain what they are in a bit. 

4. Inner world is basically a headspace that the brain creates for the alters to interact with each other. It is unique to systems who have inner worlds as one can be a room, another a house, a city, planets, anything that the mind decides to create. Sometimes a system might identify it as a lucid dream. However it is important to note that not all systems i.e. system of alters would have an inner world. According to powertotheplurals "Innerworlds are a therapeutic tool. It is widely used for many therapies and reasons, one of them being Dissociative Identity Disorder. Some people with DID (or OSDD) grew up with their innerworld. Others want to create one after a diagnosis or when they read about innerworlds."

5. Before I go into writing about co-conscious and co-fronting I need to explaining what switching is. Switching is what happens when alters switch places from the conscious mind to the real world. The alter in the real world would be known to be "fronting". Sometimes switching can be conscious and intentional while other times it can be out of the blue. Switching can happen due to both positive and negative triggers. Eg a positive trigger could be an alter's favourite song. A negative trigger could be dealing witha  bully. Switching can be covert and unnoticeable to others around them. But sometimes it can be overt and have a longer and uncomfortable dissociation process. Contrary to what certain dramas like to portray (and this isn't about Dear Hyeri btw) switching is not someone going back and forth talking to themselves like a crazy person. @ Dramas who do that - enough already. We do see Eunho and Haeri switch via sleep and waking up and I can't say whether or not that is a way switches happen irl. Only systems would know. However the series is feeding into inaccuracies by only showing sleep and waking up on a schedule as the only way to depict how switching will occur. 

6. Since I mentioned fronting, it's time to mention co-fronting and co-conscious.  Co-fronting is when at least 2 alters are in control of the body. In this case, their identities will temporarily blend together as they will be able to coordinate the body's moments. However co-conscious means that the alters are in the conscious mind but are not the ones fronting. It is easier for those in the conscious mind to communicate with each other and with those fronting as well. 

7. Alters can have various roles within the systems. There can be trauma/memory holders, protectors, gatekeepers, caretakers, persecutors etc. I know persecutor alters can be mistaken for "evil" or "bad " when it's their way of keeping the system under control so they wouldn't go through more abuse from the outside world. It's a complex situation that does need healing on all sides. Also if DID was being portrayed correctly, Haeri would be known as a type of Introject alter as she is based on someone Eunho knew irl.

8. Within the series, Eunho's psychiatrist has spoken about merging while Haeri expressed her fears as to what would happen to her once she and Eunho "meet" or something like that. So let's pretend for a bit that they're depicting D.I.D correctly. Haeri will not disappear or die.  However the psychiatrist using only merging as the solution is not the way to go. The system can decide on functional multiplicity, integration or final fusion. Functional multiplicity means all within the system working together as a team, integration is about lowering of amnesia barriers between or among alters but still having separate identities while fusion is a more complete lowering of barriers between or among alters where they gradually fuse into one identity. However one important to note that even after fusion, there is a possibility of that falling apart and alters being formed again if the person is retraumatized.

9. System Accountability - this is basically all alters understanding that their actions can affect everyone in the system and with that sense of accountability they can be more responsible in how they act. Does that mean every alter is going to be picture perfect good? It doesn't. Everyone has flaws, everyone makes mistakes and if something happens that hurts another person, system or not, owning up to it is another way of taking responsibility while making sure it will not happen again.

10. One more thing to add is that, even if a child develops D.I.D they may or may not be aware of the alters existence. Sometimes alters might not realize there are others around. I guess depending on situations and people realizing certain things about their lives then they can be something unusual is going on with them but they don't understand what it is exactly. They might suspect some form of dissociation, however it is always best to talk to a professional who specializes in these cases in order to know what the official diagnosis for the individual would be. Plus even though alters start to develop in early childhood because the brain has already been conditioned in that way, it is possible for new alters to form or for alters to have their own alters as well.

11. Edit added: There's something else I wanted to point out because I have seen comments like this (elsewhere). Alters are REAL (not imagined personalities) and are just different identity states that haven't integrated together. D.I.D is not a disease and shouldn't be treated callously like wishing someone has it. It's a defense mechanism against trauma but that doesn't mean the system of alters is going to go through life without any problems. And yes there is the problem of people pretending to have D.I.D and use them for tiktok trends because they want to seem quirky. However it is a condition that affects a lot of people. Also it is important to note that whenever you learn about someone who has D.I.D, don't ask about their trauma. If they want to talk about it, it's up to them. However sometimes people might use that knowledge to say things like "Well I went through something like that but I didn't get D.I.D" or "Really, that doesn't sound that bad." Please don't do that.

There is a lot more to discuss in relation to D.I.D but right it is almost 1 am and my brain is fried. So please forgive me if I made any mistakes along the way concerning D.I.D and what it's about. I hope this will help people understand a bit more about the condition.

Thank you for making this thread. 

Eventho the show is really entertaining, but they present innaccurate information about real life D. I. D. 

Hope people can enjoy this awesome show.

 Shidinje:

How do we even get so much information about this. It seems to me that DID should be very rare. Cause of the intensity of the trauma that can cause it and other implications like how did they even get around to diagnosing it.

I'm wondering how real life people manage this lifestyle and how people even get to be specialist doctors in this. How many case studies were taken to make definitive points about the condition 

Like I'm just wondering if someone had something like this in my country, at best they'd be labelled as mentally unstable. Even amongst educated people. It's likely the doctors would tell the family that it's a spiritual problem

Psychology and psychiatry are not sciences or medical professions in normal sense. They diagnose people based on symptoms, not causes (and symptoms are usually self reported). There is no mri scan, nor blood test, nor any other method through which we can diagnose and objectively perceive mental and personality disorders.
 
Thus, misdiagnosis galore.

I wouldn't be surprised if there were countless people who have DID who were diagnosed with something else, as well as countless people who should have been diagnosed with something else who were diagnosed with DID.

I also wouldn't be surprised if DID was a scam, a hoax. We have many precedents of mental disorders being removed from DSM (most famously homosexuality), and it's possible this is the fate that awaits DID as well. Already it has be re-labelled from MPD (multiple personality disorder) to DID because it was decided that the previous name doesn't do justice to the nature of the disorder, we aren't dealing with multiple personalities here, but  a single one that splits. 

 kretuzerwilhelmxiii:

Psychology and psychiatry are not sciences or medical professions in normal sense.

That's only partially true. Neurology is one of the more prominent areas in psychological research and the more we will understand how brain works and how overall how our bodies affect how brain works, hormones etc, the field will be in fact more and more medical. There are some neurological basis for a lot of psychological issues, and the only true reason we often still rely on the symptoms only is - it's cheaper 🙂

One of the biggest struggles in the field is how many disorders can have "different origin" and the patomechanizms are often complex and realistically speaking... as of now, we are too stupid to understand how brains work 🤡

 kretuzerwilhelmxiii:

Interesting. Can you tell me what are neurological basis for some of the most commonly diagnosed disorders, such as NPD, BPD or HPD? What could be the neurological basis for DID?  

If we are talking about pathomechanisms - it's complex and it's never just "brain". But if we are talking about diagnosis, all the disorders have unique compared to "typical" and similar to each other brain activity patterns and there is also the reduced gray matter volume in specific areas. But no one is going to do brain scans like PET to diagnose personality disorder when you can do it cheaper and still rather correctly with other less expensive ways.

 kretuzerwilhelmxiii:

They diagnose people based on symptoms, not causes (and symptoms are usually self reported)

As for this - many medical illnesses are based not on the causes - cancer being one. Tumor is a symptom, not the cause, technically speaking what causes tumors to grow is the cause of cancer, not the tumor itself. 

While self reported symptoms are one of the ways to get the proper view of someone's mental state, diagnosis is (or rather should, whenever it happens depends on how good the psychiatrist is) based on validated tests with current norms, background check that includes community interviews, medical records etc. It should be a detailed process. 

And even if we have some research that shows there are specific brain activity and structure patterns that could be used to diagnose some disorders, it's not enough to be used as a diagnosis as of today. While changes in medicine happen all the time, even if there are some groundbreaking research in psychiatry or psychology, the change follows way slower... lack of founding, lack of care from society and governments... many reasons. Mental health is not treated as seriously as physical health, and it shows with how much is done to improve one area over the other 🥲

Example of a research of potential diagnosis of DID with brain scans: accuracy of distinguishing "healthy" brain from the brain of a person with DID - 72%. Seeing how controversial and honestly not that well research DID is, 72% is truly a high number, that I can assume would get higher with more data. 

https://www.cambridge.org/core/services/aop-cambridge-core/content/view/DCF85A7D69652C06E61524593B266E8C/S0007125018002556a.pdf/aiding-the-diagnosis-of-dissociative-identity-disorder-pattern-recognition-study-of-brain-biomarkers.pdf