ON ALTERS

Please refer to the Sidran Foundation Brochure  for definitions and descriptions of "alters"
and other words commonly used in describing Dissociative Identity Disorder.

Refer to the Sidran Foundation for information & articles about Post Traumatric Stress Disorder (PTSD)

I call this image an "Imbroglio" image of confused mass of energy, feelings and thoughts.

            Stress of any kind can aggravate Dissociative Disorders and post traumatic stress reactions.   Depending on how far you've come in therapy or in developing other ways to cope (rather than "spacing out," dissociating, losing time, being amnesic), there may still be times that a you might go through what I call a state of imbroglio where emotions, thoughts and energy are all mixed together.   While therapy helps reduce these times, your inside world might feel very confused at times.  If you still have separate alters,* you might feel like every "part" you have inside are all going in a thousand different directions!

            These times may feel more acute as one gets older or when there is a lot of stress, such as in situations that are triggering or when there is new (current) trauma or during times of stress like physical illness.

             Emotions for any person can be very strong when a person becomes ill, or has been dealing with an illness a long time.  Indeed, sometimes the initial upheaval of emotions calms down, only to re-emerge after months or years of illness.  Some chronically ill patients might develop Post Traumatic Stress Disorder (PTSD) after being ill for a while, or find that their PTSD symptoms become aggravated by any one of a number of triggers, like:

• Repeated doctor visits or especially, hospitalizations;

• Having to deal with numerous strangers (doctors, nurses, Aides, and techs - for X-Rays, blood-work etc.

• Having to have different Aides and Nurses inside the patient's home;

• Having little or no privacy, especially physical privacy;

• Having no control over the circumstances;

• And, any number of other types of stresses.

These same examples can trigger PTSD problems for those with DID / MPD.   Old issues may re-surface, or there may be new issues that come up.   For example, it is common for people with a history of being abused to have body image issues and privacy issues.   Even though you thought you had "dealt with that before," you may need help to develop ways to cope with having to be hospitalized for surgery or some procedure.  You might find that you are re-triggered by having to have help getting a bath or shower when dealing with an illness or after surgery.   If your physical condition becomes chronic, and you need home care, you might find it very difficult to accept daily help from an outside.  Questions arise like "how can I keep my alters quiet during home health aides visits?" or "how can I find ways to increase my comfort level enough to allow a health aide to help me with bathing or getting dressed?"  "How can I receive care from another person, but keep my inner world calmer, quiet-(er), and less upset?"

Internal system of alters often get very intense during stress. 
But when you are able to separate out the different emotions, thoughts, and triggers,
you'll notice everyone is a lot calmer.  It doesn't mean everything is resolved though, and issues buried further down can re-surface later.

            In any trauma, feelings, thoughts, memories and reactions to the trauma can become separated, as well as being separated from the person.   The person's responses etc. are disconnected - hence the expression of "getting in touch with one's feelings," but in trauma the separation of feelings, thoughts, memories and reactions can be severe.  An "event" of trauma is any instance of an event or circumstance that was so traumatic for that individual person as to cause a lasting internal response to the "trauma."  Although most people react to certain things as "traumas," such as witnessing a murder, or being sexually abused, other persons may suffer trauma from what are benign events to others, such as being teased repeatedly in grade school or even feeling unduly humiliated.

There are 2 definitions of "integration" of trauma used in therapy.    The most basic meaning of "integration" in trauma therapy is to re-integrate the traumatic event with the feelings, thoughts, memories and reactions associated with it.   When the event is reviewed and discussed by the person, they can get "back in touch" with aspects they repressed or forgot about, and come to terms with what happened and their responses.   In severe traumas, the person might develop Post Traumatic Stress Disorder, especially when the trauma is repetitive / repeated  (i.e. A person might not react severely to feeling humiliated one time, but if they are humiliated repeatedly or the person perceives being humiliated repeatedly, that may develop into a trauma.)  PTSD became widely known with the return of Vietnam Veterans, but was quickly seen to be an issue with those who had been abused as children.

Most DIDers often heard or hear of integration in terms of integrating the alters "back into" one cohesive self or "the Core Person."   This type of therapy was strongly pushed in the 1980s (Coincidentally, this is the decade when an increase was seen in the diagnosis of what was then called Multiple Personality Disorder; this increase in diagnosis, in part, led to increased claims of False Memory Syndrome or FMS.  This website won't be addressing FMS since there are many websites, articles and books that discuss FMS.)   Integration of alters involves each part / alter sharing their memories of & reactions to a trauma with the other parts/alters.  This therapy believes the Core Person must be "given back" the memories, feelings, thoughts, and reactions that parts / alters have held separate from the whole person.   Integration of alters into the Core was considered by therapists, and still is by many professionals, to be the only way to resolve MPD/DID.   But, many MPD/DID persons found this to be an unrealistic goal.  Other clients felt that integration was a betrayal to the parts/alters who kept them alive through the abuse and traumas they had endured.

           While many therapists and DID-ers strive towards "integration" of alters, many DID-ers are more comfortable with achieving as much cooperation as possible between alters.   Many more DID-ers report that attaining total integration is not a reasonable goal and that a small group of alters might remain, even after years of therapy.   If this is true for you, working on co-operation among alters may help you all to live a calmer life.   

Whether you prefer integration or are satisfied with co-operation, you'll need to develop more coping skills if you are also going through added stress or the uncertainties of chronic physical illness.  You may find stresses increase as you grow older, as I discuss in "Changes As Abuse Survivors Age."   Unfortunately, there is no road map to tell you how to achieve co-operation.  Every person and their "system" is different, and each alter may have different wants, needs, expectations and triggers.  The key is finding out what everyone is comfortable with, and striving for compromises that meet as many of the alters' needs as you can at the time.  (Take care to negotiate as best you are able to, but realize there are some things that are not negotiable.  For example, there might be meds that are necessary (non-negotiable) but an alter may be satisfied with having you use a certain colored glass, or a certain liquid with which to take the meds.)

            Sometimes, you'll just have to test different ways to cope, and sometimes you'll need a solution on the spur of the moment.   Like, if you've had to be admitted to the hospital for a physical illness, you may not know ahead of time what to expect.  In such a situation, you might have to make quick decisions about what will keep your system calm.  The two biggest things about making spur-of-the-moment decisions is (1) knowing as much as possible about your system and (2) knowing how to calm and soothe any alters who might be upset about the decision you had to make.  For instance, maybe your doctor ordered a fasting glucose test and told you not to eat or drink for 12 hours.  You managed to follow those directions.  When you arrive for your test, the technician wants you to drink a container of glucose-solution, which may take some of your parts off-guard.  You quickly tell the kids to step back and let you do this part of the test and tell them that if they cooperate, then later they can have their favorite snack which is yogurt with the fruit in the bottom.  Later, several other alters remain upset, and you aren't sure how the rest are responding.  So you take the time to hear their reactions and try to make agreements about what to do if you are in a similar situation again.