The difference between Ego States and dissociative parts

Ego State approaches are becoming more popular. People are reflecting on their own identity and notice that they actually aren’t one whole, they have ‘parts’. After the ‘Inner Child’ trend in the 80s we are experiencing a new trend where people talk about ‘their inner child’ or ‘their inner teenager’ in an Ego State context. An increasing number of these people come to this DID blog in search for answers. I think it is about time to explain the differences between Ego States and dissociative parts of the personality. Please note that these are models, that try to explain experience. Definitions differ slightly between authors, so we stick with Nijenhuis.

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Identity and how it develops

Nobody is born with a personality, identity or Self. It develops out of the feedback we get from our repeated interactions with the same person, with different people and with our environment. With each interaction we receive information about ourselves that form fragments of ideas of self. Over time we pull these fragments of self together into a bigger picture of how we experience ourselves and who we are, we integrate them. Integration is never perfect. Usually bigger chunks form, what we call States. The way we are at work will be different from how we are at home. While we are always the same person we shift between States. Some fragments don’t get integrated that well because they don’t fit in. We exile that experience of who we can also be because acknowledging it would lead to psychological conflict.

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Conflicts and failure to integrate

Life doesn’t always give us feedback that fits easily with our other experiences and sense of self. Our desires, needs and goals might end up not fitting together. As a kid we love our mother and want to be close to her, that is one state with its own desires and goals. But maybe she regularly does things that scare or shame us and we want to avoid her and seek distance, a second state with very different desires and goals. Because we depend on her we can’t just leave, so we need to find a way to get our needs met and function in her presence. We numb our scared feelings, a third state. The desires and goals of these different states cannot easily be negotiated. Either we approach or we avoid. Either we have strong feelings, positive or negative, or we are numb. That is why these desires and goals and the state they belong to are kept separate from each other to avoid the conflict. One state might get integrated into the bigger picture of our sense of self while the others are exiled. This kind of failure to integrate is at the core of any ‘part’ we can notice inside. But there are differences in the extent of the failure of integration that is happening.

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Different levels of failure to integrate

Healthy

In a healthy person the different states can be noticed through reflection. There will be situations where the person feels like on the one hand they have this desire and goal and on the other hand there is that other desire and goal and they are in conflict with each other. The person is then able to find an adaptive compromise or a creative solution to navigate the situation. It needs a moment to figure it out but life isn’t impacted in a negative way.

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Mild problems

A lot of mental illnesses can be understood as a mild expression of a conflict of less integrated states. Usually the person has a main desire and goal in life but a less integrated state becomes dominant with a very different desire and goal so that functioning is impacted. We can see that in anxiety disorders where the person wants to go outside and knows very well that it isn’t dangerous but an anxious state dominates their behavior so they stay at home. The person is always aware that it is them who experiences the anxiety and who is acting. In Ego State Therapy they would imagine this anxious state in the shape of a person and start communicating with it to negotiate a compromise.

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Bigger problems

In some people states developed in a way that leaves them with two or more states that are dominant and have conflicting desires and goals. We usually find this in BPD, other PDs or Ego State Disorder. Therapists might switch to calling these ways of being the person goes into ‘modes’. The problems get more complex and negotiations can be more difficult but the person is still aware that this is all their own experience of inner conflict and that they themselves feel and act that way. Not properly integrated is not the same as dissociated.

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Dissociation of the personality

When we look at structural dissociation we notice that the parts are not merely less integrated; because of the intolerable trauma they carry they are separated from each other through dissociative barriers that actively keep them from contact with each other and integration. The early fragments of self developed independent from each other and formed their own sense of self. We never had one personality that somehow got divided. Instead conflicting desires and goals and the corresponding action systems got separated, creating a set of dissociative parts that often show a predictable pattern in their concepts of self (fragile child, caregiver, protector etc). The distinguishing trait in these parts of the personality is that they have their own consciousness, something that we don’t see in merely less integrated states. There is a deep sense that these other parts are ‘not me’ but someone else entirely.

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Self-model Theory (Metzinger) simplified

When a conscious sense of self is the defining difference between less integrated parts and dissociative parts, we need to figure out what makes up a sense of self. For that we need to look at some philosophy and yet another model.

There are 2 big aspects of being a conscious self. One is being conscious of the own experience of being and being someone. It means experiencing an ‘I’. That ‘I’ thinks, feels and senses in a way specific to itself. It is not necessary to have a name for that ‘I’ or to even have language. Experiencing it is enough. In dissociative disorders there are several separate experiences of ‘I’ that don’t feel like a model for explaining things, they just are.

The other aspect is being conscious that there is a world around us and getting information from interacting with this world.

A self experiences a world it lives in and their understanding of themselves (in the world) is based on that experience. Dissociative parts base their understanding on very different experiences of the world, more like multiple separated worlds that exist parallel to each other within one system. The result are difficulties understanding each other and vastly different realities intruding on parts eg in flashbacks.

A self also experiences the world as happening Now. But in disscociative parts the Now that is experienced can vary greatly. Some parts can be stuck in 1996 and experience that as Now. When a part like that fronts they reenact a world and a reality that isn’t happening right now. They are unable to see it as part of their history.

And a self experiences the world as real and existing without question. A part might be totally off when it comes to the right year, but the way they experience things is absolutely real to them. We can sometimes see that in uncontrolled abreactions where people act as if they were in a traumatic situation.

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So when we look at parts that we have identified as not properly integrated, we need to ask ourselves if they have their own separate experience of an ‘I’, of the world and themselves in that world, of Now and of what is real. The experiences can change with integrative actions but we usually don’t start there. Without a conscious self, parts are not dissociative in nature.

There are studies that prove that while people can fake the superficial symptoms of DID they can’t fake having different selves because they don’t experience the world differently. In DID the differences between parts are visible in brain scans.

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Some of the symptoms of having dissociated selves

• amnesia, for both big chunks of the past as well as time periods in the present

• (partial) amnesia for trauma

• finding out you must have said or done things you can’t remember

• not recognizing your friends, spouse or home at times

• coming to in strange place you don’t remember going to

• not knowing the topic of the conversation you find yourself in

• finding items you can’t remember getting or notes you never wrote

• feeling like you live in a different year or decade

• feeling like you are way younger than you are

• feeling like you are someone else and not who used to be there a moment ago

• feeling that someone else takes over and you vanish

• finding yourself in everyday situations you don’t have the knowledge or skill to master

• noticing that you hate something you usually like or the other way round

• hearing voices that are inside, consistent over time and that have their own desires and goals

• watching yourself say or do things without being able to control or stop it

• getting flooded with trauma memories you didn’t know existed

• feeling strong and overwhelming emotions out of nowhere

• feeling impulses for actions you don’t want to perform or can’t explain

• memories that you consider as ‘not my’ memories

• thoughts and feelings that are ‘not my’ thoughts and feeling

• physical sensations of past trauma that feel like it is happening now

• derealization/depersonalization while other parts are fully aware

• a deep sense of having these parts inside that are ‘not me’ and don’t belong there

• severe avoidance of the inner experience of these parts, especially at first

• not being able to communicate inside or being utterly unaware that there are others, especially at first

• not being able to know what other parts feel or think unless you ask and listen to what they share, especially at first

• sudden shifts in abilities, knowledge and emotion

• feeling numb, including for pain and physical needs while other parts can feel it

• ….

• ….

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You can only get diagnosed with a dissociative disorder if you have at least some of these dissociative symptoms. Just sensing the presence of less integrated parts inside is not enough for a diagnosis like that. That’s just being human.

People who find a ‘child part’ inside and immediately take it everywhere and feel a deep love and connection are usually not dealing with a dissociative part. Phobic avoidance of traumatized parts is typical for dissociative disorders. We usually don’t just hang out and have fun with child parts unless we have put some seriously difficult work into it.

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We regularly hear therapists who treat dissociative disorders claim that ‘Everyone has parts’. I hope this list of symptoms that come with having dissociated parts of the personality makes it very clear that this is Bullshit. Everyone has different states and less integrated parts but only about 1% of the population has this kind of dissociative parts. There is no excuse for misinforming patients like that. It isn’t as helpful for accepting the inner experience as Ts think it is. The opposite is true, it can lead to more confusion, doubt and denial. Claiming that all failure to integrate is the same is not a sign of expertise.

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Treatment for dissociative disorders looks very different from Ego State work. We first need to establish contact and co-consciousness with other parts, something that isn’t even an issue when they are not dissociated. The focus of our therapy is on integrative actions, not just negotiating compromises for desires and goals. While many ideas from DID therapy can be used for working with less-integrated parts, the tools of Ego State therapy are not enough to treat dissociative disorders. The main topics, dissociation and trauma, are typically not covered there.

Ego State therapists are responsible for making the differences between states and dissociative parts very clear to their patients. Not fully integrated is not the same as dissociated. I have way too many people who come here because they weren’t properly educated and mostly healthy people got confused or started to get invested in seeing themselves as separate.

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If you are reading this because you get Ego State therapy for some issues in your life and you have a friend who has DID, please talk to them about your use of words when it comes to your therapy work. Not everyone can bear it when you talk about ‘your child part’ when the experience of having dissociated child parts is full of excruciating suffering because of the trauma they bear, and full of shame and fear because they act outside of our control. It is not the same experience. It can harm your relationship if you pretend that it is or assume you know what it is like to have DID.

I hope this article shows you very clearly if the parts you sense inside have their own sense of self and create the specific symptoms that come with it, or not.

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If you like your brain twisted in a knot you can read a detailed discussion about the nature of dissociative parts in The Trauma Trinity – concepts and facts of dissociation in trauma by Ellert Nijenhuis.

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