When I was in graduate school at The Adler School of Professional Psychology, I wanted to specialize in what was then called Multiple Personality Disorder, now known as Dissociative Identity Disorder (DID). I believed this disorder represented an intelligent way to cope with horrific trauma experienced in childhood. Essentially, the mind compartmentalizes the abuse by splitting into different alter personalities, referred to as “alters,” who hold distinct memories. I was intrigued!
I approached my advisor to inquire about how I could develop a specialty in this area so I could treat DID when I entered the mental health field. However, I encountered a roadblock: pure Adlerian psychologists do not believe the mind can split. They view the entire being as a unified whole—no parts. To them, this meant Dissociative Identity Disorder couldn’t exist. I was told I would have to wait to develop this specialty after earning my doctoral degree. Disappointed, I continued my studies in Adlerian Psychology, which I believe has significant applications in mental health counseling but not in this specific area.
What is Dissociative Identity Disorder?
Dissociative Identity Disorder is characterized by someone having at least two or more distinct personalities. It most often develops as a response to severe early childhood trauma, functioning as a coping mechanism to avoid memories associated with the trauma. Each personality has a name, a set of characteristics, a function, and unique behaviors. In my experience, the host—or main personality—is sometimes aware of the others and sometimes not. When the latter is the case, therapy often helps the alters become aware of one another.
In childhood, DID can serve as a way for the individual to cope with traumatic memories or abuse. The mind develops alter personalities to absorb or take on the abuse. However, later in life, when this coping skill is no longer needed, it becomes dysfunctional. This dysfunction can manifest as memory lapses, loss of time, confusion, difficulties in relationships, and struggles in daily life. What began as a brilliant protective mechanism becomes a disorder that disrupts functioning and socialization.
Although DID was once considered rare, it is now believed to affect approximately 1.5% of the global population. Over 26 years in the mental health field, I’ve worked with and treated a significant number of people with this diagnosis.
Bethany’s Story
Earlier in my career, I worked with Bethany (not her real name), who was 11 years old when I first met her. Her mother sought counseling for her due to severe headaches that caused Bethany to miss school frequently. Mom reported no early abuse, trauma, or attachment issues—common root causes of DID. I worked with Bethany and her mother for a couple of years to manage the headaches, for which no medical cause had been identified.
When Bethany turned 13, she began exhibiting behavioral issues at home, including intense rages that frightened her mother. Most of the time, Bethany was sweet and pleasant, but she often didn’t remember her outbursts. Her mother eventually placed her in the residential treatment center where I was the clinical director. At the center, Bethany began experiencing what appeared to be seizures. Paramedics rushed her to the hospital several times, but no medical cause was found. A doctor in the emergency room eventually told me not to send her back when the pseudo-seizures occurred, as there was no medical explanation.
The next time Bethany experienced one of these episodes, I was called to her room. She lay on her back, apparently unconscious. When I approached and spoke to her, she responded with a low, guttural moan. After a while, she came out of the episode but had no memory of it. This led me to consider the possibility of alters.
The next time Bethany was in my office, I asked, “Are there others?”
She replied, “Yes.”
We discussed this briefly, and I asked her to create a chart of her alters. In DID, all the alters together are referred to as the “system.” The next day, Bethany brought me a chart identifying 26 alters in her system. When I asked why she hadn’t mentioned them in the three years I’d been working with her, she simply said, “You never asked.”
I called Bethany’s mother to share my findings. Her response surprised me: “Yes, I know.”
When I asked why she hadn’t mentioned it, she replied, “I didn’t think about telling you.”
The headaches now made sense. Bethany developed headaches when her alters switched. People with DID describe alters as “coming to the front” and taking control of the mind and body. For Bethany, this caused headaches. The pseudo-seizures were the result of an undeveloped alter who had no speech but was in psychological pain—most likely from severe trauma.
Through therapy, Bethany revealed that, as a toddler, she had been left with her half-brothers while her mother worked. These boys, young adolescents, tortured and sexually abused her for years. Her mother had no knowledge of this until it came out in therapy. I reported the abuse to social services in the town where it occurred and continued working with Bethany under a new treatment plan. My work with her continued until I relocated to another state. Sadly, Bethany has continued to face physical and mental health challenges.
Jerry’s Story
Another client, Jerry, was a 20-year-old living with his parents. When he first came to me, he reported difficulty regulating his emotions, a history of three hospitalizations for suicidal behavior, and no close friends. During our first session, he expressed anger and admitted to hurting his parents’ dogs. However, in subsequent sessions, he presented as a completely different person—kind, calm, and deeply connected to animals.
For the first year, Jerry dominated our sessions, pontificating on various topics. His intelligence was remarkable, and I suspected he had a genius-level IQ. Gradually, Jerry began to trust me, and I was able to offer more feedback during sessions.
Eventually, I administered a diagnostic assessment, which indicated a probable diagnosis of DID. When I presented this to Jerry, he confirmed it. He later brought in a detailed map of his system, which included nine alters. Each served a distinct purpose in his life. Jerry explained that his protective alter, who presented as mean and scary, disliked animals, while the other alters loved them.
Over two years of therapy, Jerry worked toward cooperation within his system. He described his alters as a “patchwork quilt”—separate but functioning cohesively. Most of the time, Jerry, the host personality, remained in control. In times of stress, other alters would come to the front, but this no longer caused the same disruptions in his daily life.
Treating Dissociative Identity Disorder
There are two primary approaches to treating DID: integration of all alters into one personality or fostering cooperation and cohesiveness among the alters. Most clients I’ve worked with, including Jerry, have chosen cooperation over integration.
In my 26 years of practice, I’ve worked with approximately 15 people with DID, which aligns with the estimated prevalence of 1.5% of the population. While I continue to use elements of Adlerian theory in my practice, I do not believe all people are unified wholes. My experiences with clients like Bethany and Jerry have shown me that DID is a very real diagnosis—a complex and intelligent coping mechanism for severe childhood trauma.
Though treatment for DID is long and intensive, it can be deeply rewarding. With encouragement and proper mental health care, people with DID can lead fulfilling, productive lives.
If you or someone you care about is struggling with Dissociative Identity Disorder or other mental health challenges, know that support is available. At Melissa Muller Counseling, we provide a safe, compassionate space to explore your experiences and begin the journey toward healing and integration. With personalized therapy and a deep commitment to understanding your unique story, we can work together to help you navigate life’s challenges with resilience and strength. Contact me today to take the first step toward a brighter, more balanced future.
In Kindness,
MM