By Mary Carpenter
FLORIDA LAWYER L.M. describes the occasional sensation of not being entirely “there” or present. As she wrote in an email, “I go through the motions . . . trying to be likeable but fearing that I come across as wooden, as if I must playact because I’m so detached.”
People rarely talk about momentary feelings of what’s labeled “common dissociation,” though many have similar experiences from time to time. The most familiar has its own label, “highway hypnosis”: daydreaming or zoning out while driving and not remembering the last few miles of highway. While momentary dissociation can cause difficulty concentrating and memory lapses, the mental health condition called dissociative identity disorder (DID) involves “an involuntary escape from reality that interferes with a work and/or family life.”
Recently claimed by Georgia Republican senate candidate Herschel Walker to explain past transgressions, DID replaces the earlier diagnosis of Multiple Personality Disorder. DID refers to people who have two or more separate identities or personalities that control their behavior at different times.
A key symptom of DID is “missing time,” according to the Atlanta Journal-Constitution—for example, ending up in a location and not knowing how you got there. Herschel Walker has reported having “12 alternate personalities—or alters—including the warrior (who played football), the sentry (who avoided emotional attachments) and the thrill seeker (who played Russian roulette with a loaded gun).”
But dissociation can be a useful coping mechanism for sudden trauma, as when rape victims experience floating above their bodies during the crime or those involved in serious car accidents remember very little afterward. While this kind of dissociation is usually temporary—people regain their normal perspective soon afterward—bouts of DID can also come and go, blurring its differences from common dissociative experiences.
Related to DID along a similar spectrum is depersonalization-derealization disorder. Depersonalization involves feelings of being disconnected or outside your body, as if you’re observing yourself from a distance or sensing that you aren’t real; with derealization, the surrounding world feels unreal or as if you are living in a movie.
In its milder form, dissociative amnesia refers to trouble remembering personal information or facts about your life. Dissociation can also include fugue states, “experiences where you travel or wander with no memory of what happened; blank spaces in your memory; or sudden lapses in recent memories or skills,” according to psychcentral.
Disorders of dissociation like DID affect from 1% to 3% of the population, occur more frequently among women and most often develop in response to physical or emotional abuse occurring in early childhood. While physical or sexual abuse is the most obvious and dangerous, emotional abuse or neglect by parents—reported by some 14% of Americans—can range from insulting or swearing to terrorizing, threatening to physically harm or otherwise making a child feel afraid.
DID most often originates from parental abuse that occurs before age 9, during the “not me” magical thinking stage of development when children personify dolls and stuffed animals, explains McLean Hospital psychiatrist Milissa Kaufman. “A child doesn’t have many other ways to cope. They can’t go to their parents, since that is the origin. . . . They feel like there are other people inside of them, and they can’t tell anybody.”
“Captivity, which brings the victim into prolonged contact with the perpetrator [including an abusive parent], creates a special type of relationship, one of coercive control,” according to trauma specialist Judith Herman. Herman describes “the psychological impact of subordination to coercive control” whether the context is public and political, or private—including domestic relations.
“People with dissociative disorders report the highest occurrence of childhood abuse and/or neglect among all psychiatric diseases,” writes University of Toledo psychologist Matthew Tull on verywellmind. And whereas PTSD can develop after a single traumatic experience, “repeated episodes of physical, emotional or sexual abuse . . . before the age of 9 years [are] most strongly associated with the development of dissociative disorders.”
On MRI brain scans of young adults who experienced childhood abuse or neglect, “the most obvious changes were in the brain regions that help balance emotions and impulses as well as self-aware thinking,” according to psychiatrist Martin Teicher and colleagues at Harvard and Northeastern University.
Potential effects of these brain changes include “being constantly on alert and unable to relax . . . weakened ability to process positive feedback . . . problems coping with stressors.” Because the damage originated in early childhood, most experts consider the best treatment to be talk therapy, such as cognitive behavior therapy or psychotherapy.
Signs of someone faking or mimicking DID include blaming bad behavior on the disorder’s symptoms, exaggerating symptoms and lying, and showing little distress regarding the apparent diagnosis. For most people with a DID diagnosis, on the other hand, each personality has no apparent awareness of the other(s); and even those experiencing momentary dissociation struggle to hide or cover up mild lapses in concentration or memory.
While Herschel Walker has said in past interviews and in motivational speeches that he is healed from DID, he continues to blame alternative personalities for alleged incidents of lying and violence toward women. Walker, who wrote about his battle with DID in his 2008 memoir Breaking Free: My Life With Dissociative Identity Disorder, declined an interview request from The Atlanta Journal-Constitution.
Dissociation joins a host of conditions with symptoms that vary from disabling to common and mild, without interfering with daily life. Other “spectrum disorders” are ADHD and OCD, although autism is the one most often given this label. But being on any spectrum can make an individual worry, even someone like L.M., whose experiences of dissociation are the mildest, briefest, and most common—in the midst of an otherwise productive, happy, friend-filled life.
—Mary Carpenter regularly reports on need-to-know topics in health and medicine.
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