What it's like to live with nine personalities: Sufferer reveals the 'hell' of multiple personality disorder The disorder is more commonly known as Dissociative Identity Disorder (DID) The disorder is characterized by 'switching' to alternate identities In most cases, people with the disorder have a history of childhood abuse To cope with the traumatic experiences, the child 'dissociates' – splits into parts The absence of an attachment to an adult also affects the likelihood of having it Until she was 40 years old, Melanie Goodwin had no memory of her life before the age of 16. Then, a family tragedy triggered a cataclysmic psychological change. Suddenly she was aware of other identities inside her, and the barriers between them were crumbling. Formerly known as Multiple Personality Disorder, Dissociative Identity Disorder (DID) is characterized by 'switching' to alternate identities The different identities belonged to her, Melanie felt, but 'her' at different ages, from three years old to 16 and on into adulthood. These ages were not random. Amid the confusing, terrifying mingling of different voices in one consciousness came memories of child abuse, the first episode occurring when she was three, the last when she was 16. 'I have no proof,' she notes. 'I have to go with what I believe happened, and my reality.' Melanie has what used to be called multiple personality disorder, which is now more commonly referred to as dissociative identity disorder (DID). The change in name reflects an understanding that it's more than just changes in personality that are involved. Memories, behaviours, attitudes, perceived age – all can switch together. 'We' – she generally refers to herself as 'we' – 'had lots of adult parts. 'Development should be seamless… But because we didn't grow up naturally, we would update ourselves… Finally, there were nine different adult parts, each managing a stage of our abuse-free adult life.' Living with DID can be 'hell', she says. It is a breakdown of an aspect of everyday existence that the rest of us take for granted – our sense that we are one individual self. For Melanie, the abrupt awareness of her many different identities warring inside her was overwhelming. How could she possibly find a way to accommodate them all? Melanie is talking from a sofa in a quiet consulting room at the Pottergate Centre for Dissociation and Trauma in Norwich, UK. The centre is run by Remy Aquarone, an analytical psychotherapist and a former director of the International Society for the Study of Trauma and Dissociation. SYMPTOMS OF DISSOCIATIVE IDENTITY DISORDER Formerly known as Multiple Personality Disorder, Dissociative Identity Disorder (DID) is characterized by 'switching' to alternate identities. According to the Mayo Clinic, people with the disorder may feel the presence of two of more people talking or living inside their head, and they may feel as though they're possessed by other identities. Each identity may have a unique name, personal history and characteristics, including differences in voice, gender, mannerisms and even physical qualities such as the need for eyeglasses. There are also differences in how familiar each identity is with the others. People with DID typically also have dissociative amnesia and often have dissociative fugue - when people temporarily lose their sense of personal identity and impulsively wander or travel away from their homes or places of work. Over a 30-year career, Aquarone has worked with hundreds of people with a dissociative disorder. In most cases, he says, they have a history of childhood abuse, generally starting before the age of five. In an attempt to cope with the traumatic experiences, the theory goes, the child 'dissociates' – it splits itself into parts. One part endures the abuse and contains the horrific emotional and physical impacts; another part exists afterwards. Or, there might be one part that endures the abuse, another that gets the body back to its bedroom, and another that goes down to breakfast in the morning. If the abuse goes on over years, and also if different scenarios and perpetrators are involved, many different parts may splinter off. It's the dissociation that allows the child to keep going. In fact, 'it's the ultimate adaption system. 'It's using your unconscious cognition to adapt your way of thinking and behaviour in order to be more safe,' Aquarone says. Melanie describes it this way: 'If you're in a totally impossible situation, you dissociate to stay alive. 'Trauma can freeze you in time. 'And because the trauma is ongoing over years, there are lots of little freezings happening all over the place.' Not everyone who endures childhood abuse – or any other form of ongoing major trauma – develops a dissociative disorder. Based on his work, Aquarone says there's another critical factor involved: the absence of a normal, healthy attachment to an adult. In the field of developmental psychology, 'attachment' has a specific meaning: it's a bond that forms between an infant and a care giver who supports and looks after that child, emotionally and practically, while also helping that child to learn about and manage his or her responses. Without that bond – prevented by bereavement, neglect or abuse – a child undergoing a trauma is left to fend for itself. Reflecting on people with DID as a group, Melanie says: 'What we didn't learn as small children is a parent metaphorically holding you and helping you learn how to manage yourself.' Infants who do develop secure attachment go on to cope better generally with life, says Wendy Johnson, a psychology professor at the University of Edinburgh. 'First of all, they're better at dealing with other people in a way that is successful. Their relationships tend to be smoother. 'They tend to earn more money, be better appreciated and recognised by others, and get into less fights. 'They also tend to experience life more smoothly, so it's more pleasant to them.' People with the Dissociative Identity Disorder (DID) may feel the presence of two of more people talking or living inside their head, and they may feel as though they're possessed by other identities This is not to say that our personalities are set for life in those early years. A relatively stable environment, in terms of relationships and work, helps to maintain a relatively stable personality. 'I think the fact our environments tend to have a lot of stability to them contributes to the consistency that we tend to display,' says Johnson. But if these external influences change, we can change too. Parenting, losing a job – these kinds of major life changes can provoke behaviours that surprise us, as well as changes in traits such as conscientiousness and extraversion. It's no wonder that young adulthood frequently involves a major questioning of identity, adds Johnson, as this is so often a time when lots of things – home, surroundings, friends – are in flux. Without the unified sense of self that attachment and stability brings, dissociated identities can make someone's personality appear to swing wildly. Melanie has an anorexic part, and a part that attempted suicide twice because the pain of the barriers coming down felt unbearable. Her three-year-old part is easily scared by things that remind her of past traumas – like a scent or a man's way of walking – and in these situations she will freeze or even hide. Another critical factor involved in Dissociative Indentity Disorder is the absence of a normal, healthy attachment to an adult On the other hand, the 16-year-old can be flirty. It makes sense that Melanie will behave differently depending on 'who' is to the fore in her mind. She is not acting like her three-year-old self, or even remembering what it was like to be three. She is that three-year-old – until another identity comes to the fore. Because memories of time spent in one identity are not always accessible to others, some people with DID 'lose' chunks of time – they feel as though they're often jumping forward days or even weeks. 'Some people go off and have affairs. 'Well, they're not really affairs, because they have no memory that they're married,' Melanie observes. For her, the effect is that she has no sense of the order in which things have happened in her life: 'As babies, you get born and you have a timeline that goes through your whole being. 'If you get fragmented, you don't get that timeline.' Her memories are further blunted by the subduing of normal emotional reactions – which are essential, both she and Aquarone say, to helping a person cope with severe trauma. But this lack of emotion didn't end when the abuse stopped: it had become the way Melanie's brain worked. 'I know I got married,' she says, for example. 'But I watched and observed it, rather than being fully engaged.' With Dissociative Identity Disorder (DID), each identity may have a unique name, personal history and characteristics, including differences in voice, gender, mannerisms and even physical qualities such as the need for eyeglasses People with a dissociative disorder often report feeling very superficial, says Aquarone. 'And in a way, they are, because the essence of who you are is held inside.' For most of us, our memories, enhanced by the emotions we felt at the time, provide a personal chain that reaches all the way back into childhood, providing a sense of self-continuity. 'I can refer back to my behaviour as a teenager, for example,' he says, 'and hold on to a bigger picture [of myself]… The price of [dissociation] working is that… there's no tracking back to see how things were.' TYPES OF MENTAL ILLNESS There are many different conditions that are recognized as mental illnesses, and the more common ones include: · Anxiety disorders: People with anxiety disorders respond to certain objects or situations with fear and dread, as well as with physical signs or panic, such as a rapid heartbeat and sweating. An anxiety disorder is diagnosed if the person's response is not appropriate for the situation or if the person can't control the response, or if it interferes with normal functioning. · Mood disorders: Involve persistent feelings of sadness or periods of feeling overly happy, or fluctuations from extreme happiness to extreme sadness. The most common are depression and bipolar disorder. · Psychotic disorders: Involve distorted awareness and thinking. Two of the most common symptoms of psychotic disorders are hallucinations and delusions, which are false fixed beliefs that the ill person accepts as true, despite evidence to the contrary. Schizophrenia is an example of a psychotic disorder. · Eating disorders: Involve extreme emotions, attitudes and behaviors involving weight and food. Anorexia nervosa, bulimia nervosa and binge eating disorder are the most common examples. · Impulse control and addiction disorders: People with these types of disorders are unable to resist urges or impulses to perform acts that could be harmful to themselves or others. Pyromania (starting fires), kleptomania (stealing), and compulsive gambling are examples. · Personality disorders: People with these types of disorders have extreme or inflexible personality traits that are distressing to the person and/or cause problems in work, school or social relationships. · Obsessive-compulsive disorder (OCD): People with OCD are plagued by constant thought or fears that cause them to perform certain rituals or routines. An example is a person with an unreasonable fear of germs, who constantly washes his or her hands. · Post-traumatic stress disorders (PTSD): PTSD is a condition that can develop following a traumatic or terrifying event, such as sexual or physical assault, the unexpected death of a loved one or a natural disaster. People with PTSD often have long lasting and frightening thoughts and memories of the event. · Stress response syndromes: Stress response syndromes occur when a person develops emotions or behavioral symptoms in response to a stressful event or situation. Stressors make include natural disasters, crises such as a car accident or interpersonal problems such as divorce. Stress response syndromes usually begin within three months of the event or situations and ends within six months after the stressor stops. · Dissociative disorders: People with these disorders suffer severe disturbances or changes in memory, consciousness identity, and general awareness of themselves and their surroundings. These disorders are usually associated with overwhelming stress, which may be as a result of traumatic events. Dissociative Identity Disorder (DID), formerly called multiple personality disorder, and depersonalization disorder are examples or dissociative disorders. · Factitious disorders: Factitious disorders are conditions in which a person knowingly and intentionally create or complain of physical and/or emotional symptoms in order to place the individual in the role of a patient or a person in need of help. · Sexual and gender disorders: These include disorders that affect sexual desire, performance and behavior. Sexual dysfunction, gender identity disorder and paraphilias are examples of such disorders. · Somatic symptom disorders: A person with this type of disorder experiences physical symptoms of an illness or of pain with an excessive and disproportionate level of distress, regardless of whether or not a doctor can find a medical cause for the symptoms. · Tic disorders: People with tic disorders make sounds or display nonpurposeful body movements that are repeated, quick, sudden, and/or uncontrollable. Tourette's syndrome is an example of a tic disorder. Other diseases or conditions, including sleep problems and forms of dementia, are sometimes classified as mental disorders because they involve the brain.