Dissociative identity disorder: a disorder of diagnostic and therapeutic paradoxes

Dissociative identity disorder (DID) is life-long, childhood-onset, posttraumatic developmental disorder where chronic early-life maltreatment and attachment disturbances prevents the child's development of a continuous sense of self across emotional states, relationships, and social contexts. As development proceeds, these self-states acquire a sense of themselves, a capacity for information processing, memory, emotion, and behavior. Conceptualizing DID involves paradoxes and apparent contradictions. DID has been categorized as a severe mental illness with major psychiatric comorbidities. Studies show that DID individuals have a unique personality organization with repeated, often covert posttraumatic reactivity, especially in relationships (e.g., therapy). Paradoxically, research shows that, during development, DID individuals preserve psychological resiliencies consistent with responsivity to long-term, psychodynamically informed treatment. These include, when not stressed, capacities for therapeutic alliance, reality testing, and observing ego.

Automated summary

Dissociative identity disorder (DID) is a life-long, childhood-onset, posttraumatic developmental disorder that prevents individuals from developing a continuous sense of self across emotional states, relationships, and social contexts. Research shows that DID individuals exhibit repeated and covert posttraumatic reactivity in relationships, but they also have psychological resiliencies that respond well to long-term, psychodynamically informed treatment.