Putting the Pieces Together
Despite such practices, persuasive evidence for discrete coexisting personalities in individuals is lacking. The reported distinctions among alters are mostly anecdotal, unconfirmed and difficult to interpret. For instance, the handwriting and voices of people without DID may also vary over brief periods, especially after a mood change. And disparities in physiological reactions, such as brain waves or skin conductance, could be similarly attributable to differences in mood or thoughts over time, according to University of Arizona psychologists John J. B. Allen and Hallam L. Movius. Individuals with DID almost surely experience dramatic psychological changes across situations, so it would be surprising if their physiology did not change as well.
If alters are truly distinct personalities, they should have memories that are inaccessible to other alters. Yet Allen and psychologist William G. Iacono of the University of Minnesota reported in a 2001 review that although most direct memory tests—such as asking patients to recall a list of words in one alter state that they had previously encountered in a different alter state—reveal a lack of transfer of memories across alters, subtler tests usually reveal that memories formed by one alter are in fact accessible to others. In these less direct tests, which tend to be more sensitive and less prone to intentional manipulation of responses, subjects may be asked, for example, to complete a word such as “kin_” after an alter was presented with a related word, say, “queen.” Most subsequent studies bear out this conclusion, suggesting that alters are not distinct entities.
If alters are not discrete personalities, what are they? One hint: individuals who develop DID often meet the diagnostic criteria for borderline personality disorder, bipolar disorder and other conditions marked by instability. Indeed, a review in 1999 by one of us (Lilienfeld) and his colleagues found that between 35 and 71 percent of patients with DID also have borderline personality disorder. Understandably, then, many individuals prone to DID are bewildered by their unstable moods, self-destructive behavior, impulsivity and erratic relationships and are seeking an explanation for these disturbances. If psychotherapists or others ask suggestive questions such as “Is it possible that a part of you you’re not aware of is making you do and feel these things?” patients may become convinced that their mind houses multiple identities.
Data show that many therapists who treat DID patients use hypnosis, which may fuel these people’s difficulties in distinguishing fantasy from reality. Thus, DID may reflect an effort by individuals to make sense of extremely puzzling behaviors and feelings, a hypothesis proffered by the late psychologist Nicholas Spanos of Carleton University.
If so, techniques for making alters talk to one another may backfire, encouraging patients to falsely believe that the varied thoughts and feelings reside separately in their minds, often rendering them more difficult to integrate. For example, a patient could become convinced that one of her alters is responsible for her intense anger toward her husband, causing her to disregard her true feelings.
A better approach would be to help patients understand that their painful psychological experiences are created not by different personalities but by different aspects of one troubled personality. That way those suffering could begin to come to grips with these experiences and recognize that their thoughts and feelings are genuinely their own.