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“The term dissociation is ordinarily used to describe the phenomenon of compartmentalization or fragmentation of mental contents. It does not ascribe any particular mechanism by which the dissociative process occurs. Does dissociation occur as a result of automatic, nonconscious processes, or are there other specific mechanisms by which it occurs? Especially in the context of describing amnesia, the term repression is widely used in connection with several different mechanisms. As it is commonly used, it often implies how individuals may block our memories of uncomfortable or conflictual experiences. If done consciously, the mechanism is more accurately called suppression, which results from actively trying not to think about negative experiences.”

“Switches among identities occur in response to changes in emotional state or to environmental demands, resulting in another identity emerging to assume control. Because different identities have different roles, experiences, emotions, memories, and beliefs, the therapist is constantly contending with their competing points of view. Helping the identities to be aware of one another as legitimate parts of the self and to negotiate and resolve their conflicts is at the very core of the therapeutic process. It is countertherapeutic for the therapist to treat any alternate identity as if it were more “real” or more important than any other. Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision”

“Posttraumatic stress disorder (PTSD) also has dissociative symptoms as an essential feature. PTSD has been classically seen as a biphasic disorder, with persons alternately experiencing phases of intrusion and numbing... [T]he intrusive phase is associated with recurrent and distressing recollections in thoughts or dreams and reliving the events in flashbacks. The avoidant/numbing phase is associated with efforts to avoid thoughts or feelings associated with the trauma, emotional constriction, and social withdrawal. This biphasic pattern is the result of dissociation; traumatic events are distanced and dissociated from usual conscious awareness in the numbing phase, only to return in the intrusive phase.”

“The DID patient should be seen as a whole adult person with the identities sharing responsibility for daily life. Despite patients’ subjective experience of separateness, clinicians must keep in mind that the patient is a single person and generally must hold the whole person (i.e., system of alternate identities) responsible for the behavior of any or all of the constituent identities, even in the presence of amnesia or the sense of lack of control or agency over behavior. From p8 International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision: Summary version. Journal of Trauma & Dissociation, 12, 188–212.”

“Instead of showing visibly distinct alternate identities, the typical DID patient presents a polysymptomatic mixture of dissociative and posttraumatic stressdisorder (PTSD) symptoms that are embedded in a matrix of ostensibly non-trauma-related symptoms (e.g., depression, panic attacks, substance abuse,somatoform symptoms, eating-disordered symptoms). The prominence of these latter, highly familiar symptoms often leads clinicians to diagnose only these comorbid conditions. When this happens, the undiagnosed DID patient may undergo a long and frequently unsuccessful treatment for these other conditions. - Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, p5”