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Dissociative Identity Disorder Quotes

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Dissociative Identity Disorder Quotes

“Identity Confusion in Patients With DID We can locate the identity confusion characteristic of DID in the middle-to-upper range of severity. Identity confusion is a significant factor in DID, when an environment created and sustained by one personality conflicts with the expectations of another personality who is not prepared to function in this alternate environment.”

“Interviewer: Have you ever felt as if there was a struggle going on inside of you as to who you really are? Patient: Yes, for years, and I still can't find out who the fuck am I, man. Excuse my language, doctor. I don't know who the fuck l am. Interviewer: What do you mean by that? Patient: Who is [A.B.]? Who the fuck am I? I don't know. I don't know who I am. I really don't know who I am. I look at the rest of my family and I say, "I ain't part of this family, man, this can't be. They're all different than me. They also look alike, but they look different to me." (SCID-D interview, unpublished transcript) As the preceding example indicates, the theme of puzzlement is characteristic of patients at all levels of educational achievement and verbal ability. The clinician should be alert to the presence of this theme in the self-descriptions of all patients endorsing dissociative symptoms, not just in those of patients who completed a college degree or who are accustomed to introspection and self-analysis.”

“People with DID often experience conflicting advice or opinions emanating from their alter personalities. Individual alter personalities may have coherent, consistent identities, but, taken as a group, the incompatible internal personalities generate an atmosphere of conflict as well as incoherence. As one patient described it, "Do you know how hard it is to get a hundred and four minds to come together to a single decision?”

“We must understand that those who experience abuse as children, and particularly those who experience incest, almost invariably suffer from a profound sense of guilt and shame that is not meliorated merely by unearthing memories or focusing on the content of traumatic material. It is not enough to just remember. Nor is achieving a sense of wholeness and peace necessarily accomplished by either placing blame on others or by forgiving those we perceive as having wronged us. It is achieved through understanding, acceptance, and reinvention of the self. At this point in time there are people who question the validity of the DID diagnosis. The fact is that DID has its own category in the Diagnostic and Statistical Manual of Mental Disorders because, as with all psychiatric conditions, a portion of society experiences a cluster of recognizable symptoms that are not better accounted for by any other diagnosis.”

“Those who are aware of their condition and experience themselves as "multiple" might refer to themselves as "we" rather than "I." I shall use the term "multiple" at times, in respect for their internal experience. It is important to point out, however, that I recognize that someone who is multiple is actually a single fragmented person rather than many people. On the outside, a multiple is probably not visibly different from anyone else. But that image is only an imitation: people who are multiple cannot think like the rest of us, and we cannot think like them. (In fact, since it is difficult for the multiple to understand how singletons think, some of them might think that is is you who are strange). Just as a singleton cannot become a multiple at will, a multiple cannot become a singleton until and unless the barriers between the parts of the self are removed. Those barriers were put up to enable the child to tolerate, and so survive, unavoidable abuse. p20 [Multiple: a person with dissociative identity disorder (DID) or DDNOS. Singleton: a person without DID or DDNOS, i.e with a single, unified personality]”

“The "apparently normal personality" - the alter you view as "the client" You should not assume that the adult who function in the world, or who presents to you, week after week, is the "real" person, and the other personalities are less real. The client who comes to therapy is not "the" person; there are other personalities to meet and work with. When DID was still officially called MPD, the "person" who lived life on the outside was known as the "host" personality, and the other parts were known as alters. These terms, unfortunately, implied that all the parts other than the host were guests, and therefore of less importance than the host. They were somehow secondary. The currently favored theory of structural dissociation (Nijenhuis & Den Boer, 2009; van der Hart, Nijenhuis, & Steele, 2006), which more accurately describes the way personality systems operate, instead distinguishes between two kinds of states: the apparently normal personality, or ANP, and the emotional personality, or EP, both of which could include a number of parts. p21”

“It is not unusual for subjects diagnosed with a Dissociative Disorder on the SCID-D to be surprised at having their symptoms validated by a clinician who understands the nature of their disorder.”

“In this chapter I restrict myself to exploring the nature of the amnesia which is reported between personality states in most people who are diagnosed with DID. Note that this is not an explicit diagnostic criterion, although such amnesia features strongly in the public view of DID, particularly in the form of the fugue-like conditions depicted in films of the condition, such as The Three Faces of Eve (1957). Typically, when one personality state, or ‘alter’, takes over from another, they have no idea what happened just before. They report having lost time, and often will have no idea where they are or how they got there. However, this is not a universal feature of DID. It happens that with certain individuals with DID, one personality state can retrieve what happened when another was in control. In other cases we have what is described as ‘co-consciousness’ where one personality state can apparently monitor what is happening when another personality state is in control and, in certain circumstances, can take over the conversation.”

“I honestly didn't believe I could bear any more suffering. I was convinced that the child within me was just too young to endure all this, much less understand it. She just wanted to be normal. But another part of me knew that to become normal, all the pieces of this puzzle had to become conscious. p164”

“When sleep came, I would dream bad dreams. Not the baby and the big man with a cigarette-lighter dream. Another dream. The castle dream. A little girl of about six who looks -like me, but isn’t me, is happy as she steps out of the car with her daddy. They enter the castle and go down the steps to the dungeon where people move like shadows in the glow of burning candles. There are carpets and funny pictures on the walls. Some of the people wear hoods and robes. Sometimes they chant in droning voices that make the little girl afraid. There are other children, some of them without any clothes on. There is an altar like the altar in nearby St Mildred’s Church. The children take turns lying on that altar so the people, mostly men, but a few women, can kiss and lick their private parts. The daddy holds the hand of the little girl tightly. She looks up at him and he smiles. The little girl likes going out with her daddy. I did want to tell Dr Purvis these dreams but I didn’t want her to think I was crazy, and so kept them to myself. The psychiatrist was wiser than I appreciated at the time; sixteen-year-olds imagine they are cleverer than they really are. Dr Purvis knew I had suffered psychological damage as a child, that’s why she kept making a fresh appointment week after week. But I was unable to give her the tools and clues to find out exactly what had happened.”

“Dissociative Disorders have a high rate of responsiveness to therapy and that with proper treatment, their prognosis is quite good.”

“Denial returned, like a nagging cough you can never quite shake. Actually, it was always close at hand, and even though "satanic ritual abuse" did describe what had happened to me when I was a child. the concept was so foreign and so horrific that some part of me still wanted to stay in denial. Devil worship dominated my childhood. That was undeniable, even if it was still nearly impossible to contemplate. Both of my parents and any number of their friends, as well as "respected" members of our community, had worshipped Satan. I pushed the notion aside with all the power I could muster. I kept thinking to myself that it was ridiculous and impossible. p157”

“During this hour in the waking streets I felt at ease, at peace; my body, which I despised, operated like a machine. I was spaced out, the catchphrase my friends at school used to describe their first experiments with marijuana and booze. This buzzword perfectly described a picture in my mind of me, Alice, hovering just below the ceiling like a balloon and looking down at my own small bed where a big man lay heavily on a little girl I couldn’t quite see or recognize. It wasn’t me. I was spaced out on the ceiling. I had that same spacey feeling when I cooked for my father, which I still did, though less often. I made omelettes, of course. I cracked a couple of eggs into a bowl, and as I reached for the butter dish, I always had an odd sensation in my hands and arms. My fingers prickled; it didn’t feel like me but someone else cutting off a great chunk of greasy butter and putting it into the pan. I’d add a large amount of salt — I knew what it did to your blood pressure, and I mumbled curses as I whisked the brew. When I poured the slop into the hot butter and shuffled the frying pan over the burner, it didn’t look like my hand holding the frying-pan handle and I am sure it was someone else’s eyes that watched the eggs bubble and brown. As I dropped two slices of wholemeal bread in the toaster, I would observe myself as if from across the room and, with tingling hands gripping the spatula, folded the omelette so it looked like an apple envelope. My alien hands would flip the omelette on to a plate and I’d spread the remainder of the butter on the toast when the two slices of bread leapt from the toaster. ‘Delicious,’ he’d say, commenting on the food before even trying it.”

“This new co-consciousness brought me to a state of awareness in which my core personality was directly able to experience "her" personality. Being co-conscious with her, he explained, would stop me from experiencing the feeling of leaving my body or dissociating.”

“Given that recent research has demonstrated the complex psychopathology of DID, equating the disorder with one specific but broadly denned behavior (multiple identity enactment) is clearly unwarranted. The latter should be conceptualized as one observable behavior that may or may not be related to a feature of the disorder (identity alteration). As an analogy, equating major depressive disorder with "acting sad" would be similarly unwarranted because the former is a complex depressive disorder characterized by a clear group of depressive symptoms, whereas the latter is one specific behavior that may or may not be related to one of the symptoms of the disorder (sad affect). One could also easily generate a list of factors that affect whether one acts sad that would have little relevance to the complex psychopathology of depressive disorders.”

“By contrast, moderate identity alteration differs from its milder countepart in that the alterations are not always under the person's control. In addition, moderate identity alteration does not always manifest the presence of distinct alter personalities. Someone who experiences moderate identity alteration may present with mood changes and behaviors that they perceive as uncontrollable. Patients with nondissociative psychiatric disorders (e.g., manic depressive illness) may report moderate alterations in behavior/demeanor that they cannot control; for example, one patient diagnosed as manic depressive mentioned being bothered by his inability to "keep his mind from racing" (SCID-D interview, unpublished transcript). However, these alterations do not coalesce around distinct personalities. Similarly, individuals who have borderline personality disorder tend to fluctuate rapidly between radically different behaviors and moods; however, these changes do not involve different names, memories, preferences, distinct ages, or amnesia for past events.”

“There are distinct mood changes with borderline individuals that may be experienced as very alien or disconnected to the client. The loss of memory associated with DID, however, does not occur in BPD, and the mood changes do not constitute a change in personality to the extent that a part of the psyche takes control of the body outside the individual's consciousness.”

“How can I put this? There's a king of gap between what I think is real and what's really real. I get this feeling like some kind of little something-or-other is there, somewhere inside me... like a burglar is in the house, hiding in a wardrobe... and it comes out every once in a while and messes up whatever order or logic I've established for myself. The way a magnet can make a machine go crazy.”

“The primary driver to pathological dissociation is attachment disorganization in early life: when that is followed by severe and repeated trauma, then a major disorder of structural dissociation is created (Lyons-Ruth, Dutra, Schuder, & Bianchi, 2006).”

“Research has also revealed that women who have developed PTSD in relation to early childhood sexual abuse often develop borderline personality disorder. Some severe cases will result in the development of dissociative identity disorder or depersonalization disorder. Patients who have been exposed to protracted and repeated sexual abuse may also develop schizophrenia simultaneously with PTSD.”

“The case of a patient with dissociative identity disorder follows: Cindy, a 24-year-old woman, was transferred to the psychiatry service to facilitate community placement. Over the years, she had received many different diagnoses, including schizophrenia, borderline personality disorder, schizoaffective disorder, and bipolar disorder. Dissociative identity disorder was her current diagnosis. Cindy had been well until 3 years before admission, when she developed depression, "voices," multiple somatic complaints, periods of amnesia, and wrist cutting. Her family and friends considered her a pathological liar because she would do or say things that she would later deny. Chronic depression and recurrent suicidal behavior led to frequent hospitalizations. Cindy had trials of antipsychotics, antidepressants, mood stabilizers, and anxiolytics, all without benefit. Her condition continued to worsen. Cindy was a petite, neatly groomed woman who cooperated well with the treatment team. She reported having nine distinct alters that ranged in age from 2 to 48 years; two were masculine. Cindy’s main concern was her inability to control the switches among her alters, which made her feel out of control. She reported having been sexually abused by her father as a child and described visual hallucinations of him threatening her with a knife. We were unable to confirm the history of sexual abuse but thought it likely, based on what we knew of her chaotic early home life. Nursing staff observed several episodes in which Cindy switched to a troublesome alter. Her voice would change in inflection and tone, becoming childlike as ]oy, an 8-year-old alter, took control. Arrangements were made for individual psychotherapy and Cindy was discharged. At a follow-up 3 years later, Cindy still had many alters but was functioning better, had fewer switches, and lived independently. She continued to see a therapist weekly and hoped to one day integrate her many alters.”

“My other client, whom I will call Teresa, thought Lorraine had MPD and hoped I could help her. Almost no one recognized this condition in those days. Lorraine was forty years old and had been in and out of psychiatric hospitals since she was thirteen. She had had various diagnoses, mainly severe depression, and she had made quite a few serious suicide attempts before I even met her. She had been given many courses of electric shock therapy, which would confuse her so much that she could not get together a coherent suicide plan for quite a while. Lorraine’s psychiatrist was initially opposed to my seeing her, as her friend Teresa had been stigmatized with the "borderline personality disorder" diagnosis when in hospital, so was seen as a bad influence on her. But after Lorraine spent a couple of months in hospital calling herself Susie and acting consistently like a child, he was humble enough to acknowledge that perhaps he could learn some new things, and someone else’s help might be a good idea.”

“The SCID-D may be used to assess the nature and severity of dissociative symptoms in a variety of Axis I and II psychiatric disorders, including the Anxiety Disorders (such as Posttraumatic Stress Disorder [PTSD] and Acute Stress Disorder), Affective Disorders, Psychotic Disorders, Eating Disorders, and Personality Disorders. The SCID-D was developed to reduce variability in clinical diagnostic procedures and was designed for use with psychiatric patients as well as with nonpatients (community subjects or research subjects in primary care).”

“Pierre Janet, a French professor of psychology who became prominent in the early twentieth century, attempted to fully chronicle late- Victorian hysteria in his landmark work The Major Symptoms of Hysteria. His catalogue of symptoms was staggering, and included somnambulism (not sleepwalking as we think of it today, but a sort of amnesiac condition in which the patient functioned in a trance state, or "second state," and later remembered nothing); trances or fits of sleep that could last for days, and in which the patient sometimes appeared to be dead; contractures or other disturbances in the motor functions of the limbs; paralysis of various parts of the body; unexplained loss of the use of a sense such as sight or hearing; loss of speech; and disruptions in eating that could entail eventual refusal of food altogether. Janet's profile was sufficiently descriptive of Mollie Fancher that he mentioned her by name as someone who "seems to have had all possible hysterical accidents and attacks." In the face of such strange and often intractable "attacks," many doctors who treated cases of hysteria in the 1800s developed an ill-concealed exasperation.”

“As Mollie said to Dailey in the 1890s: "I am told that there are five other Mollie Fanchers, who together, make the whole of the one Mollie Fancher, known to the world; who they are and what they are I cannot tell or explain, I can only conjecture." Dailey described five distinct Mollies, each with a different name, each of whom he met (as did Aunt Susan and a family friend, George Sargent). According to Susan Crosby, the first additional personality appeared some three years after the after the nine-year trance, or around 1878. The dominant Mollie, the one who functioned most of the time and was known to everyone as Mollie Fancher, was designated Sunbeam (the names were devised by Sargent, as he met each of the personalities). The four other personalities came out only at night, after eleven, when Mollie would have her usual spasm and trance. The first to appear was always Idol, who shared Sunbeam's memories of childhood and adolescence but had no memory of the horsecar accident. Idol was very jealous of Sunbeam's accomplishments, and would sometimes unravel her embroidery or hide her work. Idol and Sunbeam wrote with different handwriting, and at times penned letters to each other. The next personality Sargent named Rosebud: "It was the sweetest little child's face," he described, "the voice and accent that of a little child." Rosebud said she was seven years old, and had Mollie's memories of early childhood: her first teacher's name, the streets on which she had lived, children's songs. She wrote with a child's handwriting, upper- and lowercase letters mixed. When Dailey questioned Rosebud about her mother, she answered that she was sick and had gone away, and that she did not know when she would be coming back. As to where she lived, she answered "Fulton Street," where the Fanchers had lived before moving to Gates Avenue. Pearl, the fourth personality, was evidently in her late teens. Sargent described her as very spiritual, sweet in expression, cultured and agreeable: "She remembers Professor West [principal of Brooklyn Heights Seminary], and her school days and friends up to about the sixteenth year in the life of Mollie Fancher. She pronounces her words with an accent peculiar to young ladies of about 1865." Ruby, the last Mollie, was vivacious, humorous, bright, witty. "She does everything with a dash," said Sargent. "What mystifies me about 'Ruby,' and distinguishes her from the others, is that she does not, in her conversations with me, go much into the life of Mollie Fancher. She has the air of knowing a good deal more than she tells.”

“The physical shape of Mollies paralyses and contortions fit the pattern of late-nineteenth-century hysteria as well — in particular the phases of "grand hysteria" described by Jean-Martin Charcot, a French physician who became world-famous in the 1870s and 1880s for his studies of hysterics..." "The hooplike spasm Mollie experienced sounds uncannily like what Charcot considered the ultimate grand movement, the arc de de cercle (also called arc-en-ciel), in which the patient arched her back, balancing on her heels and the top of her head..." "One of his star patients, known to her audiences only as Louise, was a specialist in the arc de cercle — and had a background and hysterical manifestations quite similar to Mollie's. A small-town girl who made her way to Paris in her teens, Louise had had a disrupted childhood, replete with abandonment and sexual abuse. She entered Salpetriere in 1875, where while under Charcot's care she experienced partial paralysis and complete loss of sensation over the right side of her body, as well as a decrease in hearing, smell, taste, and vision. She had frequent violent, dramatic hysterical fits, alternating with hallucinations and trancelike phases during which she would "see" her mother and other people she knew standing before her (this symptom would manifest itself in Mollie). Although critics, at the time and since, have decried the sometime circus atmosphere of Charcot's lectures, and claimed that he, inadvertently or not, trained his patients how to be hysterical, he remains a key figure in understanding nineteenth-century hysteria.”

“Dissociative identity disorder is conceptualized as a childhood onset, posttraumatic developmental disorder in which the child is unable to consolidate a unified sense of self. Detachment from emotional and physical pain during trauma can result in alterations in memory encoding and storage. In turn, this leads to fragmentation and compartmentalization of memory and impairments in retrieving memory.2,4,19 Exposure to early, usually repeated trauma results in the creation of discrete behavioral states that can persist and, over later development, become elaborated, ultimately developing into the alternate identities of dissociative identity disorder.”

“When experiences or emotions become too overwhlming, the mind clevely encapsulates the material and stores it for safe-keeping. Many people respond this way in the face of trauma, but the additional step that occurs in this process, in the case of DID, is the formation of distinct ego states that carry the experience.”

“Scientists, doctors, and trained ordinary citizens use drugs and torture to render children machines that do others' bidding. The commands these perpetrators put in the victims are called "programming". They take an isolated, barricaded piece from one stream in the mind and another and another and sometimes tie them together at the bottom and twist them together and tell them to act but not remember.”

“Working simultaneously, though seemingly without a conscience, was Dr. Ewen Cameron, whose base was a laboratory in Canada's McGill University, in Montreal. Since his death in 1967, the history of his work for both himself and the CIA has become known. He was interested in 'terminal' experiments and regularly received relatively small stipends (never more than $20,000) from the American CIA order to conduct his work. He explored electroshock in ways that offered such high risk of permanent brain damage that other researchers would not try them. He immersed subjects in sensory deprivation tanks for weeks at a time, though often claiming that they were immersed for only a matter of hours. He seemed to fancy himself a pure scientist, a man who would do anything to learn the outcome. The fact that some people died as a result of his research, while others went insane and still others, including the wife of a member of Canada's Parliament, had psychological problems for many years afterwards, was not a concern to the doctor or those who employed him. What mattered was that by the time Cheryl and Lynn Hersha were placed in the programme, the intelligence community had learned how to use electroshock techniques to control the mind. And so, like her sister, Lynn was strapped to a chair and wired for electric shock. The experience was different for Lynn, though the sexual component remained present to lesser degree...”

“Although it is important to be able to recognise and disclose symptom of physical illnesses or injury, you need to be more careful about revealing psychiatric symptoms. Unless you know that your doctor understands trauma symptoms, including dissociation, you are wise not to reveal too much. Too many medical professionals, including psychiatrists, believe that hearing voices is a sign of schizophrenia, that mood swings mean bipolar disorder which has to be medicated, and that depression requires electro-convulsive therapy if medication does not relieve it sufficiently. The “medical model” simply does not work for dissociation, and many treatments can do more harm than good... You do not have to tell someone everything just because he is she is a doctor. However, if you have a therapist, even a psychiatrist, who does understand, you need to encourage your parts to be honest with that person. Then you can get appropriate help.”

“Among DID individuals, the sharing of conscious awareness between alters exists in varying degrees. I have seen cases where there has appeared to be no amnestic barriers between individual alters, where the host and alters appeared to be fully cognizant of each other. On the other hand, I have seen cases where the host was absolutely unaware of any alters despite clear evidence of their presence. In those cases, while the host was not aware of the alters, there were alters with an awareness of the host as well as having some limited awareness of at least a few other alters. So, according to my experience, there is a spectrum of shared consciousness in DID patients. From a therapeutic point of view, while treatment of patients without amnestic barriers differs in some ways from treatment of those with such barriers, the fundamental goal of therapy is the same: to support the healing of the early childhood trauma that gave rise to the dissociation and its attendant alters. Good DID therapy involves promoting co­-consciousness. With co-­consciousness, it is possible to begin teaching the patient’s system the value of cooperation among the alters. Enjoin them to emulate the spirit of a champion football team, with each member utilizing their full potential and working together to achieve a common goal. Returning to the patients that seemed to lack amnestic barriers, it is important to understand that such co-consciousness did not mean that the host and alters were well-­coordinated or living in harmony. If they were all in harmony, there would be no “dis­ease.” There would be little likelihood of a need or even desire for psychiatric intervention. It is when there is conflict between the host and/or among alters that treatment is needed.”

“I understood these things intellectually, the way I understand that the world is round or that gravity is a universal force. But it took me a long time to truly grasp what Dr. Summer had told me many times before: "To survive a violent childhood, you created aspects of your consciousness that held information about the violence away from you. That's why you remember it as if it happened to someone else. You have many ways of being you.”

“When a personality is created out of a trauma situation, the personality can watch and learn by looking and hearing out of your eyes and ears. The personality doesn't have to be the one in charge of the body to know what is going on. If the personality is created while you are of a very young age that personality can remain at that age, even though you are growing and maturing. A personality can also be hidden within the memory that created them and they don't realize time has moved on.”

“The System Map is like an internal family tree, though it can be drawn out in whatever format, in whatever way is easy for the System to understand. It will contain and illustrate information such as who split off from whom and how you all relate to each other. As you become more aware of your System over time, your System Map may grow as you encounter newly discovered parts. It may also change over time as you come to have greater understanding of your System and how you all relate to and interrelate with each other.”

“Some of the parts inside me were ready to come up and tell what had happened, but others didn't want me to know they even existed, I learned that when parts were in conflict with each other or didn't like what I was doing, I felt pain and panic, Dr. Summer encouraged me to pay attention to the parts and address the issues they raised, but to also challenge them and keep doing as many of my normal activities as I could.”

“I closed my hand into a fist and captured the details of the feeling for later, when I might need them. Storing thoughts in my fist was a way of creating parts of myself, brighter rooms in the house that was my mind, parts that could hold on to feelings of being loved.”

“The diagnosis shouldn't have surprised me, as we had been talking about my symptoms for so long. But it's easier to think you just have a bunch of parts inside. Everyone says things like "A part of me wants to go to the movies, but another part of me wants to just stay home." Using the term "part" made me feel normal. I knew I was a little different in that my parts were quite separate aspects of me. I knew my consciousness wasn't whole and knew that it was unusual to have some thoughts come to me in Spanish. I knew most people didn't experience terror and struggle to catch their breath when they were in benign situations. But we hadn't been calling this DID, so I'd been able to avoid fully accepting the implications of having these special parts.”

“Steve said he was glad that I trusted him to develop relationships with the other personalities. He knew that my acceptance of them was a sign of greater health, but he really liked me best and wanted to know when I'd be integrated—when the other personalities would be gone. "Look, Steve," I said, "whether you like it or not, all of the personalities are part of this entity. No personality is ever going to disappear.”

“Neurobiological differences have been demonstrated between dissociative identities within patients with DID and between patients with DID and controls. Given the current evidence, DID as a diagnostic entity cannot be explained as a phenomenon created by iatrogenic influences, suggestibility, malingering, or social role-taking. On the contrary, DID is an empirically robust chronic psychiatric disorder based on neurobiological, cognitive, and interpersonal non-integration as a response to unbearable stress. While current evidence is sufficient to firmly establish this etiological stance, given the wide opportunities for innovative research, the disorder is still understudied.”

“The first time I caught the ball before it touched the ground, Mike yelled, "Good job!" I held on to the feeling, capturing his words in my fist. In this way I created a part that could play basketball—a part that could focus on the ball to the exclusion of all other distractions. These types of "happy" and "good" parts countered desperate times and feelings and made it possible for me to succeed in school, receive praise and positive reactions from others, excel fearlessly in sports, and develop friendships.”

“Because DID requires the presence of amnesia, DID patients are, by DSM-5 definition (American Psychiatric Association, 2013), unaware of some of their behavior in different states. Progress in treatment includes helping patients become more aware of, and in better control of, their behavior across all states. To those who have not had training in treating DID, this increased awareness may make it seem as if patients are creating new self-states, and “getting worse,” when in fact they are becoming aware of aspects of themselves for which they previously had limited or no awareness or control. Although some DID patients create new self-states in adulthood, clinicians strongly advise patients against so doing (Fine, 1989; ISSTD, 2011; Kluft, 1989).”

“Managers usually have extensive knowledge of events and of the system. They are often available to explain to the therapist the internal systemic dilemmas that are not otherwise evident. Generally, they are fairly empty of affect. Another term for managers has been internal self-helpers (Putnam, 1989).”

“To preemptively protect the child so that the child may anticipate the abuse rather than be surprised by it, protector parts become persecutors modeled on the abusers. Thus, parts who were protectors when the person was a young child may become persecutors in time, holding anger and rage and meting out punishments to other parts of the self.”