Living with dissociative identity disorder …

Herschel Walker had reached a level of success few athletes ever experience. He won the Heisman Trophy, became one of college football’s greatest running backs, and spent years playing professional football. Away from the stadium, however, there were portions of his own life that he could not explain. Walker later described stretches of time that seemed lost to him and behavior that other people remembered but he did not. Eventually, he was diagnosed with dissociative identity disorder, or DID.

Walker wrote publicly about the diagnosis in his memoir Breaking Free. He described different identities that could take control at different times, sometimes without his later remembering what had happened. His experience provides a real-life glimpse into a condition that has often been sensationalized in movies and television but is much more complicated than the familiar idea of a “split personality.”

Dissociative identity disorder was formerly called multiple personality disorder. In DID, a person experiences two or more distinct identity states, and the separation can be accompanied by significant disruptions in memory. A person may know what happened during one period of life but have little or no access to it later. The missing time can involve ordinary activities as well as traumatic events. Someone may discover that a conversation occurred, find something that was purchased without remembering buying it, or learn that an action took place that cannot be recalled. These experiences can be profoundly confusing because the person is encountering evidence of events from his or her own life without having the corresponding memory.

The most common cause of DID is severe, overwhelming childhood trauma, particularly repeated physical, sexual or emotional abuse and severe neglect, although DID also occurs in adults. Other traumatic experiences associated with DID include devastating loss, frightening medical experiences, prolonged terror or helplessness, rape, severe violence, torture, captivity, and combat. The circumstances can differ, but the trauma can overwhelm the person’s ability to process and integrate the experience.

Dissociation can begin during an overwhelming experience. A person may feel detached from the body, experience the surroundings as unreal, or feel strangely distant from what is happening. The event remains real, but the person’s experience of it changes. An experience that would ordinarily be processed as one connected event can instead become separated into aspects that are not fully integrated with one another.

Dissociation is involuntary. Under extreme circumstances, the normal integration of awareness, memory, emotion, and identity can be disrupted without conscious control. When severe trauma is repeated, the separation can become part of how the person experiences different circumstances. A person may have one set of experiences in which fear, pain, and the need for protection dominate, and another in which ordinary activities can continue without those experiences being present. The memories and emotions connected with one situation may not be available in the same way during another. What began as a response to an overwhelming experience can therefore become a more enduring division in the person’s experience of life.

Childhood trauma has particular significance because identity is still developing. A child normally develops a continuing sense of self as experiences, memories, and relationships accumulate over time. Severe and repeated trauma can interfere with that development, particularly when the trauma occurs within a relationship on which the child depends.

A particularly difficult circumstance occurs when the person responsible for providing safety is also the source of danger. A child may depend upon a caregiver for food, shelter, affection, and protection while simultaneously experiencing abuse or terror from that same person. The child cannot simply leave the relationship. Ordinary life must continue even though the person on whom the child depends has become a source of fear and danger.

Dissociation can allow these conflicting realities to remain psychologically separated. The child may be able to attend school, play, form relationships, and participate in ordinary activities without continuously experiencing the emotional reality of the abuse. During threatening experiences, attention and emotional responses may instead become organized around surviving what is happening. When this pattern is repeated, traumatic experiences can remain separated from other experiences that would ordinarily become part of one continuous personal history.

As development continues, these separations can become organized into distinct identity states. Different states may be associated with different memories, emotional responses, perceptions, and ways of behaving. One state may have little access to experiences that are readily available in another. The person can consequently experience substantial changes in identity without consciously deciding to become someone different.

These differences can become apparent through switching, the transition from one identity state to another. A change may involve speech, facial expression, posture, emotional response, or behavior, although sometimes it is difficult for others to notice. The person may also have limited awareness of what occurred during the transition or during the period that followed it.

The resulting memory disruptions can be profound. A person may discover that a conversation occurred without remembering it, find an object without remembering obtaining it, or learn about an action that cannot be recalled. These experiences can leave the person trying to reconstruct portions of a life that other people remember but the individual cannot access.

Walker’s experience illustrates how DID can exist alongside extraordinary achievement. His athletic accomplishments were real, yet he also described portions of his own life that were inaccessible to him. Serious dissociation therefore does not mean that a person is incapable of functioning effectively, achieving goals, or developing significant abilities.

DID can consequently remain hidden. A person may compensate for missing information, rely on other people to fill in details, or interpret unexplained inconsistencies as ordinary forgetfulness. Changes associated with different identity states may also occur only under particular circumstances, making the underlying pattern difficult to recognize.

Treatment begins by establishing safety and stability. A person who has spent years responding to overwhelming experiences through dissociation first needs enough stability to recognize what is happening without becoming overwhelmed by it. Therapy can help identify dissociative patterns, recognize the circumstances associated with different identity states and develop greater awareness of experiences that previously seemed disconnected or inexplicable. As stability increases, treatment can address the traumatic experiences themselves. This work must proceed carefully because bringing previously separated memories and emotions into greater awareness can be overwhelming. The aim is to help the person process what happened without continuing to require dissociation as the primary means of managing those experiences.

Over time, treatment can help create greater continuity across the person’s life. For some people, this may involve integration of identity. For others, progress may involve increased cooperation among identity states, fewer disruptions in memory, greater awareness during transitions, and a stronger ability to remain present in ordinary life. The central movement is toward a life in which traumatic experience no longer produces the same degree of separation between identity, memory, and daily functioning.

Scotty