December 2009

Dissociative Identity Disorder and Domestic Violence

This month, Katie Webb, LMSW at BFL’s Non-Residential Domestic Violence Program (Secret Garden) takes a look at DID as it relates to Domestic Violence.

Background

Formerly known as Multiple Personality Disorder, Dissociative Identity Disorder (DID) is used to describe a person who displays two or more distinct personalities or identities, each with its own unique pattern of relating to and perceiving its environment. The term dissociation refers to the act of separating or the state of being separated.

DID is highly related to prior incidents of trauma or severe stress, and a large percentage of people with DID report histories of severe abuse, often in childhood. While this trauma often exists in the form of extreme sexual or physical abuse, an unpredictable or frightening home environment, such as a home with significant domestic violence, may also trigger DID.  The most common theory for development of DID is that people with the disorder use dissociation as a coping mechanism to escape serious trauma.

DID is generally treated with psychotherapy, and medication is often used to control symptoms from co morbid disorders. The goal of treatment is generally focused on integration of the alternate personalities and improved functioning and interpersonal relationships. It takes time for connectedness of the personalities to return, and psychotherapeutic interventions may be lengthy, often involving multiple weekly appointments for several years.

DID and Domestic Violence

People with DID dissociate as a method of coping with trauma. While this dissociation may act as protection during childhood people with DID carry this defense with them into adulthood. This affects their ability to cope with trauma, including domestic violence.

When people with DID enter into relationships, they are more at risk for domestic violence. Because people with DID have generally experienced abuse in their childhoods, they are more likely to enter into relationships that represent these learned patterns of violence. Abusers may limit access to medications, psychiatry, or other treatments that may assist people with DID. In addition, abusers may use the knowledge that their partners have DID to limit the victims ability to have help by stating to the police that their partner has a psychiatric history of dissociating and is unable to accurately depict incidents of domestic violence.

Successful treatment of DID requires extensive psychotherapeutic intervention. Because of this, it is essential to maintain a collaborative multi-agency approach to treatment when addressing DID and domestic violence.  

Treatment relating to the consumer’s DID should be left to their DID specialist (see resources below for a link to potential resources in your community). An appropriate linkage to a skilled therapist allows domestic violence workers to address safety planning, psycho education, and any additional mental health diagnosis that arise as a result of domestic violence, such as depression, anxiety, or post traumatic stress disorder.

Regular communication with the consumer’s other mental health specialist ensures that DV professionals are prepared to address DID symptoms during their sessions, such as disorganized thought processes, splitting, and switching to alternate personalities.

As with any consumer in crisis, persons with DID can struggle to maintain focus during sessions and clear boundaries with their workers. It is the role of the worker to ensure the consumer stays on task during their work together. This seemingly obvious point is easier said than done for the worker who is dealing with a lifetime of a person’s thought patterns and living habits. To that end, workers should clearly define their role as a professional and establish concrete limits to their working relationship.

In the initial sessions, a solution focused treatment plan pertaining exclusively to domestic violence issues should be formed to further solidify these limits. This helps the person stay on task and differentiate between the role of their DID therapist and the role of their domestic violence workers.

Splitting, the act of viewing people and events as “all good” or “all bad,” is a defense mechanism commonly used by domestic violence survivors to cope with their trauma. Splitting is often essential to the victim to emotionally cope during their trauma, but it can wreak havoc on their relationships with workers. Individuals frequently carry over this once helpful coping mechanism to their helping relationships, and view one of their workers as all good, and their other worker as all bad.

The collaborative approach to treatment is also helpful to alleviate the effects of this phenomenon. It can be helpful for workers (i.e. case managers, counselors, and/or social workers), to occasionally meet with their consumer together in a supportive environment to prevent the consumer from splitting. If it is not possible to meet together, frequent communication between workers via phone can also be helpful to prevent splitting.