Diagnosing Dissociation

Doctors and therapists have been trained to believe that DID (multiplicity) is very rare. They have also been trained that “when you hear hoof beats, look for horses, not zebras.” In other words, look first for the most common explanation of a set of symptoms. Once you have ruled out common diseases or conditions, start looking for the rarer ones. That’s common sense, but multiples are hardly zebras — they are far too numerous.

In the past, the most common misdiagnosis of multiplicity was schizophrenia. Why? Because both multiples and schizophrenics often hear voices. For multiples, it’s the voices of their alters or an auditory memory and the voices are usually heard inside the head. For schizophrenics, it’s auditory hallucinations and the voices usually seem to come from outside the head. This is not a hard and fast rule, because multiples sometimes hear the voices of their alters outside themselves, but it’s a good guideline.

Other things besides hallucinations – autism, flat affect and loose associations –  characterize schizophrenia and are not commonly associated with multiplicity (except if one particular alter has been made to be schizophrenic.) Autism in this context means extreme self-absorption, an inability to take other people into account, or not using words in the way other people do. Flat affect means that emotions are toned down to the point of seeming non-existent a lot of the time. And loose associations means being all over the place in one’s speech; rhyming, making up words, jumping from one thing to another. A description slang term is “word salad.”

Multiples are not misdiagnosed as schizophrenic as often these days, but it still happens. I believe that, today, the more common misdiagnoses are bipolar disorder, cyclothymic disorder (rapidly cycling mood changes), and borderline personality disorder. This is just my opinion and is not based on studies that I have read.

In this case, the therapist is not focusing on whether the client hears voices or not, but on mood changes. The main characteristic of bipolar and cyclothymic disorders is mood swings from elation, often to the point of mania, to depression. In borderline personality disorder, the mood changes are secondary to changes in perception and/or beliefs. Another person may be seen as all-good for a while and then suddenly seen as all-bad, with the emotions changing accordingly. (Look for a blog entry on borderlines on July, 2011.)

If somebody has DID, mood changes can be traced to switching alters.  Naturally, alters have different moods. Some are even created to ”hold” one emotion or another. Those that experienced the abuse tend to be depressed, hopeless, grieving, while those that dealt with the non-abusive world are more competent, social, and optimistic. So it makes sense that therapists, if they missed the multiplicity, would make these mood-based diagnoses.

PS. Andreas Laddis published “Dissociation and Psychosis in Dissociative Identity Disorder and Schizophrenia” in the Journal of Trauma and Dissociation, Vol. 13 No. 4, pp.397-413. I don’t have a citation for mood disorders and dissociation.

9 thoughts on “Diagnosing Dissociation

  1. Dear Mark:

    You and I have agreed to disagree on how wide-spread cults are in society. I believe that some, but not all, people in positions of power are cult-active. I also believe that some cult-active people and some survivors have no power at all in our society.


    1. Thank you for your reply. I based my understanding on studying history of power and the insides of the cult. Perhaps, it should be agreeable that multiplicity should be diagnosed along with the other signs of being in the cult.


    1. What an excellent article you have written! I wish I could organize material like you do. As far as I can see, where we might disagree is on misdiagnosis of DID as bipolar or borderline. This isn’t based in research, but on my observation of RA survivors over the years.


      1. thanks for your comment – you are spot on about BPD as a misdiagnosis, it often co-exists with DID (BPD seems to be caused by serious emotional neglect and most of the BPD criteria refer to ‘unhealthy coping mechanisms so it’s no surprise to find it co-existing with sexual/physical abuse).
        Of course if bipolar and DID both occur at once then diagnosis gets even trickier. It’s good to hear of another blogger aware of the horrors of RA too and raising awareness of DID.


  2. This is simple from my position. However, official medicine will not help there much.
    Multiplicity is a defensive mechanism that occurs nearly always in childhood due to abuse.
    In general population, it is extremely rare that a child recieves constant extreme abuse. When this causes multiplicity, it can be seen by distinct different personalities appearing later and lost memories.
    Since there is the cult that rules our society, the members of the cult are kept under mind control and have multiplicity, as you already know. This makes multiplicity a part of the issue with the cult. The members of the cult can be easily identified as people with any kind of power to form life of society. Under mind control, multiplicity is, usually, well hidden and alters don’t notice it, or, think it is normal. Diagnosis, here, becomes simple determining who belongs to the ruling elite. If you make any decisions that form life of the other people, you are in and you have it.
    Misdiagnosis and denial are well known, the cult doesn’t want you to know that it is nuts. If you feel that it’s more than mood swings, search for more.


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