How is Dissociative Identity Disorder Treated? Understanding Your Loved One’s Path to Healing

Treating dissociative identity disorder in stages is not a new idea. In fact, renowned French psychologist Pierre Janet advocated multi-stage treatment as early as the late 1800s. In the past three decades, however, support for phase-oriented psychotherapy has grown significantly and it has now become the gold standard for dissociative identity disorder treatment. The most common course of treatment consists of three stages:

1. Establishing safety, stabilization, and symptom reduction.

The first stage of dissociative identity disorder treatment seeks to ensure the safety of your loved one, particularly as it relates to acute symptoms such as self-harm, suicidal ideation, or other dangerous behaviors.

As noted in the Journal of Trauma & Dissociation, “DID patients usually give a history of having been abused or having their safety disregarded throughout their early lives. They tend to reenact these behaviors, venting their aggression, shame, fear, horror, and other overwhelming affects onto themselves through self-injurious and destructive behaviors.” Treatment must help your loved one replace any harmful coping mechanisms with healthy alternatives. Simultaneously, clinicians will work with them to address posttraumatic symptoms, enhance self-awareness and emotional regulation, increase distress tolerance, and build more positive social relationships.

At this stage, clinicians also begin working with your loved one to help them “understand, accept, and access” alternate identities while improving cooperation between and acceptance of these identities.

2. Confronting, working through, and integrating traumatic memories.

The majority of people with dissociative identity disorder have experienced significant trauma, typically in early childhood, and it is this trauma that is believed to spur the development of DID. Addressing this trauma in a safe and organized way in order to help your loved one acknowledge, process, synthesize, and effectively integrate traumatic memories is thus essential to healing. This not only helps your loved one gain a greater awareness of the impact of these experiences, but helps them build distress tolerance, appropriately contextualize their trauma in their present life, and more effectively manage reactions to their memories.

Multiple alternate identities may be involved in this process, and the process itself may lead to greater unification of identities. Of course, it is essential that this phase is approached with the utmost care in order to prevent re-traumatization and help your loved one stay safe.

3. Integration and rehabilitation.

The integration and mental health rehabilitation phase focuses on further cooperation between and unification of identities in order to forge a more cohesive self-identity. As identities fuse, your loved one will likely experience greater emotional stability, inner tranquility, self-awareness, and confidence. This is also a critical time for addressing emotional and functional challenges in everyday life. This includes not only further strengthening self-regulation skills, but enhancing social, vocational, and self-care skills to increase independence and effectiveness.

There is no single therapeutic modality that is currently used to treat dissociative identity disorder. As explained in Innovations in Clinical Neuroscience, “A course of psychotherapy for patients with dissociative disorders may be complicated and sometimes require an eclectic approach or periods of change between various approaches.” As such, it is important for treatment programs to offer a wide variety of modalities that can be tailored to suit the needs of your loved one at each phase of the treatment process. These modalities may include insight-oriented, cognitive, holistic, and experiential therapies. Family therapy may also be an invaluable part of the recovery process.

While there are no medications designed specifically for dissociative identity disorder, some individuals may benefit from pharmacotherapies in order to address specific symptoms such as mood disturbances and anxiety.

The relationship between the client and the clinician is referred to as the therapeutic alliance. The quality of this relationship is known to be instrumental in achieving positive treatment outcomes in many mental health disorders and is particularly critical for people struggling with DID. A study published in the European Journal of Psychotraumatology, found that stronger therapeutic alliances are associated with greater symptom reduction, lower levels of general distress, and better overall functioning.

Multiple case studies reaffirm this relationship, demonstrating that “expressing empathy, compassion, and nonjudgment” can be critical to helping clients reduce internalized stigma while simultaneously “counter[ing] the negative treatment experiences [they had] with past treatment providers.” The ability to develop a positive therapeutic alliance is greatly bolstered by collaboratively setting treatment goals, managing distress arising from the therapeutic process, and maintaining a flexible approach.

People with DID often have co-occurring disorders, including mood disorders, anxiety disorders, personality disorders, and substance use disorders. In order to create true healing, it is essential that treatment addresses the full scope of your loved one’s needs. This includes engaging in appropriate modalities that target the symptoms of these co-occurring disorders as well as investigating the relationships between disorders to help your loved one better understand their experiences and develop meaningful coping skills. By creating multidimensional treatment experiences designed specifically for your loved one’s individual situation, clinicians can help them achieve the best possible outcomes.

While understanding of dissociative identity disorder and how to treat it has grown significantly in the mental health community in recent years, it unfortunately remains misdiagnosed, underdiagnosed, and undertreated. This is due in part to the fact that many clinicians do not have the specialized knowledge required to identify or treat DID effectively. In fact, some clinicians still question the existence of DID altogether. As such, seeking out treatment providers with the training and experience necessary to correctly diagnose and treat DID is essential to the healing process.

Due to the complexity of dissociative identity disorder and significant duration of treatment needed, long-term residential treatment centers often offer the best environments in which to start the journey toward recovery. These programs offer in-depth assessments to clarify diagnosis—including identifying co-occurring disorders—and create treatment plans designed to address each person’s individual needs. In an immersive, safe, and nonjudgmental environment, your loved one can participate in a broad range of therapies appropriate for each stage of treatment. This allows them to quickly develop trusting therapeutic alliances and achieve more rapid relief from symptoms than would be possible in an outpatient setting.

However, high-quality residential programs recognize that dissociative identity disorder affects not your loved one, but your entire family. As such, they offer specialized family programming to help you participate in your loved one’s healing process while gaining the support you need to cope with the impact of their illness. Together, you can gain the insight and skills necessary to move forward in a positive and develop greater resilience both individually and as a family.