Dissociation, Structural Dissociation and DID

Today when therapists use the term dissociation, they often use it in a broad way to describe 'symptoms of dissociation’ rather than to describe dissociation of the personality.

Dissociation symptoms range from more ‘every day’ altered states of consciousness such as tuning out when someone is talking to you, not hearing someone when you are watching your favourite sport, being absorbed in a task, arriving home after your usual drive from work and not remembering the trip and normal daydreaming. These mild forms of dissociation are very common and experienced by most people.

However, dissociation may become more concerning and destabilising when one experiences “out of body” experiences and amnesia. A person may experience more fragmentation of their personality and feel less like a ‘whole’ or individual self.

Dissociation can be broken down into different experiences and it can be understood better on a spectrum. I have added an image that provides a brief outline to illustrate the spectrum of dissociation that can be a helpful guide to understanding the various descriptions of dissociation that people may be referring to when using the term dissociation.

As with all frameworks and theories, there is no perfect or right one, sometimes the language in many of the theories can be unhelpful and as with science there is always room for more research and new ways of understanding things.

Why does dissociation happen?

We all experience dissociation to some degree, perhaps when our brains need a rest or are bored- we daydream. However, more severe forms of dissociation can be linked to traumatic experiences. Those who have experienced highly traumatic experiences as a child or adult and those who were/are exposed to chronic trauma- especially during their formative years are far more likely to have higher more severe symptoms of dissociation. They may also develop a dissociative disorder as they get older. The data is clear in showing us that the greater the severity of the trauma and the more chronic it is the more severe the dissociative symptoms may be.

Some of the studies have included victims of childhood maltreatment and/or neglect, adult rape, combat, prisoner-of-war (POW) experiences, torture, trafficking, genocide, civilian dislocation during wartime, repeated painful medical procedures, accidents, and natural disasters. 

These studies show that earlier traumas that were cumulative and repetitive as well as early attachment trauma, particularly disorganised attachment strongly predicted elevated dissociation scores for people later on in life and/or development of a dissociative disorder. 

What happens in the brain with dissociation?

Dissociation is a coping and defence mechanism. When one is put in a situation in which they are exposed to something so stressful and so overwhelming that the mind or body can not tolerate it. The brain finds a way to compartmentalise (split into parts) and protect the self from consciously experiencing this trauma.

In the case of chronic trauma in childhood- when attachments are formed. The normal integration of parts (consciousness, memory, identity and perception) of the brain are disrupted and this can lead to dissociative amnesia, depersonalisation, and DID (which is when distinct identities are created to cope with the ongoing trauma).

Structural Dissociation Model

The theory of structural dissociation of the personality is a trauma model. The model characterises people that have compartmentalised parts of the brain after experiencing trauma, essentially they have developed different ‘parts’ as a protective measure.

A simple way to understand this division that can occur is through the natural division of the human brain, as we all have a left and right hemisphere.

Human brains are designed to split if things get too much or too overwhelming... the split between the two hemispheres enables the left-brain aspect of self to ‘keep on keeping on’... while the right brain mobilises the “corporeal and emotional self” (Cozolino, 2002), with its more physical survival resources (Fisher, 2017).

This quote gives an insight into how the left-hand side of the brain works to continue on with day to day life despite traumatic experiences and the right-hand side of the brain holds the experience of trauma and our emotional parts.

A person’s going on with everyday life parts and trauma/emotional parts remain split off from one another or unintegrated, meaning that many trauma parts are stuck in patterns of traumatic experience and unhelpful behaviours as they hold the memories of trauma that have not been able to be processed or integrated.

Structural dissociation can be understood as:

1.     Primary dissociation, often seen in a single incident trauma or with PTSD. 1 everyday part and 1 trauma/emotional part.

2.     Secondary dissociation, often seen in complex trauma or with C-PTSD. 1 going on with everyday part and multiple trauma/emotional parts.

3.     Tertiary dissociation, seen in extreme and chronic complex trauma. 2 or more distinct personally states/alters each with their own sense of self and with amnesiac barriers.

(the structural dissociation model refers to “going on with everyday parts” as Apparently normal parts- these are responsible for hunger, social engagement, work, sleep etc.

Emotional parts (trauma parts/holders) embody all hypo/hyper arousal states (fight, flight, freeze, fawn, submit)

Primary structural dissociation

Primary structural dissociation is generally characterised in trauma-related experiences such as post- traumatic stress disorder (PTSD) and involves a single “going on with everyday life part’ and a single ‘trauma part.

In primary structural dissociation, the going on with everyday life part is tasked with the dual tasks of living daily life despite traumatisation and avoiding traumatic memories. The traumatized part is the part that is fixed in trauma memories. It may hold different memories and emotions as well as internalised messages and core beliefs. 

The trauma part is kept from integrating with the going on with everyday life self because it holds the traumatic experiences and memories that could overwhelm the self and prevent the person from being able to function in their day to day life. This means that a person’s fight, flight, freeze, and submission responses to trauma and the memories and internalised messages associated with them are dissociated, or not integrated, with the going on with everyday life part.

For those with PTSD, this allows the going on with everyday life part to remain numb and avoidant towards the traumatic memories and experiences except when something triggers the trauma part.

When this happens the trauma part is activated alongside the going on with everyday life part and the person experiences the trauma intruding into their life, commonly through, dissociative flashbacks, hyper vigilance, feelings of panic, overwhelm, irritability and recklessness, emotional outbursts, negative thoughts about the world, others and themselves, nightmares and other somatic symptoms.

This is experienced a bit like a hijacking where it feels like the trauma is happening right now in the present rather than back then in the past.

Secondary structural dissociation

Secondary structural dissociation is generally characterised in multiple trauma related experiences such as complex post traumatic stress disorder (C-PTSD)  and involves a single going on with normal life part and multiple trauma parts within an individual.

When a person has experienced trauma at a younger age or before certain parts of the brain have fully developed the may have a less integrated personality or sense of self. Repeated trauma that occurs over a period of time also requires a person to find a way to contain more traumatic material and memories.

Importantly, when abuse is perpetrated by someone who should be caring for the child and who is supposed to protect the child it creates a conflict between their two opposing biological drives of attach and defend. This may cause a splitting of parts so one part can deal with the trauma and defend and the other will form the attachment and the attachment part may remain unaware of the trauma the defend part experienced and in doing so the person can go on with their daily life.

As in primary structural dissociation, the going on with everyday life part in secondary structural dissociation is responsible for managing day to day life tasks while multiple trauma parts hold the traumatic materials that the going on with normal life part could not integrate. Instead of just one trauma part as seen in primary dissociation, the trauma parts’ of the self becomes more compartmentalised in secondary dissociation. Separate subparts evolve reflecting the different survival strategies and complexity needed in a world that is dangerous and un-safe. The trauma parts may also be more highly developed and may manifest in voices or confused identities.

Trauma parts are sometimes categorised and referred to as animal defence survival strategies against trauma, namely:

Fight: A fight part is often hypervigilant and on guard. They may also be angry, judgemental and blaming towards others. Fight parts hold self- harm behaviours and suicidality and has access to aggression.

Flight: A flight part is looking to numb, avoid or escape. This can be seen in a number of ways including being distant, running away from triggering or seemingly threatening situations, strong ambivalence, addictive behaviours or eating disorders that support the person to escape or numb painful thoughts, feelings, emotions and sensations.

Freeze: A freeze part is fearful. This can be seen in the part being frozen, terrified, wary, phobic of being seen. A freeze part will often isolate and may be agoraphobic, have panic attacks and experience anxiety.

Submit: A submit part holds shame. This can be seen in the part having strong feelings of hopelessness and depression, being ashamed and filled with self-hatred. This part is the opposite of the fight part or aggression. It is passive, looks to be the “good child’ and is often people pleasing and self-sacrificing.

Attach: An attach part may feel lonely and abandoned or trapped. This part can experience a deep need for connection, that feels like the desperation of a small child. The attach part may crave rescue, connection and nurturing and is often sweet, innocent and playful with a desire to depend on others. This may be a ‘little’ or inner child who craves the attachment it was unable to receive when the body was younger.

When each of these parts are active, they are in ‘trauma/emotional time’ and are engaging survival strategies. The parts may be trying to to fight back, they may be freezing or fleeing or going into a shut down/submit response or an attach yearning to connect and play or be nurtured.

It is important to understand that all of these parts hold survival strategies that once protected the self/system from experiencing harm and helped an individual to survive.

The goal in healing is to help the parts cooperate and communicate, by welcoming them, thanking them for their contribution to the body’s safety and approaching them with curiosity and compassion.

Tertiary structural dissociation  (Dissociative Identity Disorder DID)

Tertiary structural dissociation is generally characterised by multiple, severe and long lasting, complex trauma experiences as in the case of DID. Tertiary dissociation involves multiple going on with everyday life parts as well as multiple trauma/emotional parts/alters/states within an individual.

In tertiary structural dissociation the going on with everyday life parts may each handle different aspects of a person’s day to day life. For example, a person may have a going on with everyday life part/alter that has the role of being a caregiver as well as another part/alter that has the role of being a working professional and another part/alter that has the role of being a partner.

A going on with everyday life part may be referred to as a ‘host personality’ or host as they are the identity that most frequently manages the body and day to day life.

Going on with everyday life parts often do not hold trauma memories.

As in secondary structural dissociation trauma parts of the personality hold traumatic memory and are often stuck in the experiences and survival defences associated with trauma. Parts/alters that hold traumatic memories help, because the rest of the system does not have to know about the memories and the going on with everyday life parts/alters can focus on day to day life and continue to function.

The challenge, is that the parts/alters who hold the trauma memories are often living in ‘trauma time’ consumed by their experiences, seeing and feeling everything through the lens of their traumatic experiences. this can result in the past feeling like it happened only yesterday or that it is still happening now.

Some parts/alters may also hold emotion, particularly if there is a certain emotion that feels difficult to cope with. Having a part/alter hold the difficult emotion may make life feel more manageable, because if one part/alter can contain all or most of that emotion, then the other parts do not need to feel it. The difficulty with one part holding these difficult emotions is that this part/alter will often experience the emotions with much intensity and overwhelm.

In DID both the going on with everyday life parts and trauma parts may be referred to as parts, aspects, alters, head mates, friends. Many people have different preferences around language.

An alter can be described as a dissociated self state that may be associated with either dissociative identity disorder (DID)or other specified dissociative disorder subtype 1 (OSDD-1). Alters may or may not be aware of each other or that they are part of a whole. They experience themselves as completely unique individuals and may view the other parts/alters as either completely separate individuals or experience them as ‘me but not me’. Alters have different thoughts, perceptions, and memories relating to themselves and to the world around them.

Alters may also speak to having a certain age, gender identity, sexuality, appearance, source, or even species. Some alters may see what they expect to see when they see their reflection in a mirror, whilst and others experience disbelief and distress when they see that the body that they are in does not match their idea of how they believe they should look. Alters will often reject the idea that they are only an aspect or part of a complete person.

Alters can also be referred to as parts, alternate personalities, personalities, fragments, "head mates," internal family members like sisters, brothers, cousins etc), or self states. 

The word system is also used to describe the collection of alters that exist.

Fronting The part/alter that is ‘controlling’ the body is said to be the one.

Co-conscious or Co-Con is when more than one part/alters are conscious simultaneously. When this occurs two or more alters are aware of the other's presence, and have an on-going memory of a situation or particular period of time. Whilst one alter may have more executive control of the body, another alter will observe, listen and think about what is occurring. Co-consciousness is an important part of improving day to day functioning and co-operation between alters as well as helping reduce amnesia.

When an alter changes from one to another, this is known as a ‘switch’.

Switching can involve one alter taking control of the body, being given control by another alter. Generally in DID, most if not all alters are able to take on control of the body in which they reside.

For some people when one alter switches with another alter. they may lose time or have amnesia about what has occurred. Amnesia is one of the distinct features of DID and one of the most frequently reported symptoms. For others a person with continual co-consciousness will not ‘lose time’ or experience amnesia in the present, however they may meet the diagnostic criteria for DID because they still have some amnesia for past events. If there is no amnesia for past or present events, then a person with alters is likely to fit the criteria for OSDD.

Switches can happen through what is known as passive influence, where there is an intrusion from another alter that isn’t prominent This is usually seen in an experience of thoughts, emotion and behaviours that feel alien. Memories that are received through passive influence may not remain once the influence is over, leaving the fronting alter unable to recall what the memory contained, alternatively passive influence may also lead to certain memories, emotions, sensations, or views becoming inaccessible to the fronting alter until the influence ends.

Below are some examples of common alters, this is by no means an exhaustive list as there are many other DID alters that have other functions and every system is unique but the following may be helpful in describing some of the common functions of alters. Please know that language is also important, again the best way to understand a system is to speak to them and ask their preference around language.

Examples of alters and their functions

Original: The original may be known as the original child, this is considered by some to be the part first born to the body. Some see the original as the owner of the system, the part that has the most power and influence over other parts, and the most important part which the other parts were created to protect. DID allows for many variations, and the absence, presence, or strength of one or more original or original going on with normal life parts is one such variable.

Protectors roles are as they sound, they are designed to protect the system, the body and other alters. A system may have have emotional protectors that take on emotional abuse and comfort other alters, physical protectors that enact aggressive behaviours or who step in to protect against physical abuse and sexual protectors that may engage in sexual affairs, regardless of consent. They are often looking to feel in control and they may be more sexual in nature, as a result of past trauma experiences, which can lead to further victimisation and unsafe situations.

Gatekeepers function to controls the “switching”, or whoever gets access to the “front”. A lot of systems call this process “fronting”. You can think of the gate keeper as the supervisor of the whole system.

Persecutors may seek to harm the system, body, alters, and/or destroy personal relationships and the body. The term misguided alters is often helpful because, all parts are trying to protect the system, in the way that they have learned, for these parts they are often misguided in their thinking and attempts to do so. They are often focused on the goal of controlling and ruling the system through abuse, they may be reenacting trauma, reasoning that more trauma isn’t harmful and will just balance things out. They may hold a belief that by hurting the system they will be able to protect it. They may also be fearful of good of pleasurable things like good new, experiences, and feelings. They may prefer to a get rid of them as a way to avoid feeling hurt or disappointed. Some protectors are introjects of abusers (see below) and may not understand that they themselves are not abusers.

Introjects may be alters based off other people. An example could be a supportive family member, teacher or friend who had a positive influence. They may also be a historical figure a child found strong, kind or courageous. They may also be abusers. In the case of abusive introjects, they may often re-enact past trauma to reinforce the ‘lessons’ from abusers. they may also not see themselves as the person they represent, they may also experience a level of self-disgust around ‘where they came from’

Fragments are alters who did not fully develop or don’t have their own unique attributes. They may exist to complete certain tasks, or maintain single memories and/or emotions. Individually, they may not encompass an entire person and need other alters to complete them.

Caretakers care for specific members of the system, like littles, pets, teens, animals and system groups. Their main role is to ensure the body is taken care of. They may act like a parental figure to other alters, and those they may be referred to as mother, grandfather or father by other alters in their care.

Trauma holders are also called memory holders because they hold the trauma. Each alter will also have other memories apart from atraumatic memories, however some may hold more trauma than other and also have fewer pleasant memories.

Children/little alters include young children, middle aged children and teenagers. Ages of each vary from system to system. Certain things can trigger them like names, objects and smells, which can mean that a child alter fronts and may get into an inappropriate situation that can be dangerous or unsafe.