The more recent literature that explains therapy approaches for DID seems to focus on impulsive behavior, visible stress responses and maladaptive coping like self-harm and drug use. It describes how demanding these patients are, how chaotic, and the kind of extreme boundaries it needs for therapists to protect themselves. I feel a growing unrest about that and I remember Leeds asking the question ‘Are we forgetting something?’ Not all DID looks like that. I am not even sure if the majority of DID looks like that.
I am not a researcher and I have not run any studies, but I want to show you a different way that DID can look like, based on my experience with people who present that way, including myself.
The trinity of trauma
Nijenhuis calls the main modes of dissociative functioning Ignorance, Fragility and Control. It is my firm belief that dissociative systems vary in how much of each of them is visible on the outside. There is a not-knowing (Ignorance) but it happens on a spectrum. Some ANPs know nothing, the dissociative barriers are extremely high. Others do know a bit or even a lot. A System as a whole can show a lot of the Fragility that lives within or almost none of it. The same is true for Control. We just don’t talk about it, possibly because it does not cause obvious trouble. I propose that some people with DID function from a base of dissociative Control and they are over-looked, undertreated, and their suffering does not get enough attention to develop treatment options for them.
I will pick the areas where control-based systems differ most from fragility-based systems to explain how the representation and the therapeutic challenges change.
Attachment
The visible attachment style in control-based systems is dismissive/avoidant. That does not mean that there is no part inside that is anxious and clinging, it means they are almost never visible. There won’t be displays of attachment cry. When the parts in control feel abandoned or disappointed, the attachment system gets deactivated completely and is replaced by emotional numbing, cool logical thinking and detachment. There will be no drama. It is much more common that these people silently cut contact and never look back without showing much distress about it. Where we would expect a protest against a relational exchange that hurts interpersonal needs, we get nothing at all. Getting close to a system like that is difficult. It feels like there is a wall that keeps people at a distance, and a lack of vulnerable information. The inner life stays hidden from view. A system like that does not approach their therapist and the recommended strong boundaries seem absurd because nothing is ever expected from the therapist, let alone demanded from them. Setting strong boundaries here is a sure way to lose contact with the patient completely, while they will also keep showing up like clockwork. Therapists feel frustrated and useless at once.
Impulse control
A control-based system will not follow natural impulses. They learned to notice them and suppress them immediately. It does not mean that there are no impulses. The system just learned to hold still, and Freeze (not Shutdown) is the dominant response to distress for them. When something inside moves and therefore leaves the stillness that is held with a lot of control, freeze stops it from showing on the outside or being turned into an action or movement. Everything inside is held under tight control and switches are rare. If at all, these systems tend to switch to even more controlled parts when they get stressed and fragility only becomes visible when all controlling parts are used up. The result is a crash but it happens so rarely that the window of diagnosability is even smaller than usual. Stress responses are mostly invisible here. We might notice a stiffening when the freeze response catches the natural expression of distress, that’s all. A system like that might go without self-harm or impulsive coping for years. If there are scars at all, they are in hidden places. Everything that feels like losing control and that draws attention to them has to be eliminated. Their coping is usually one of over-control, like in a restrictive eating disorder that heightens the sense of control, or work. Teaching them ‘skills’ to control their inner experience even more, is a treatment mistake. A control-driven system will always do ‘the right thing’ and disregard how they feel about it as unimportant. It leads to none of the classical dysfunctional behaviors being present and over-control being the main dysfunctional behavior that gets in the way of a happy and relaxed life.
Functioning
This kind of system uses work and mental challenges as their main coping strategy. Functioning without drawing negative attention is their highest goal. The more distress there is, the more they will focus on work to keep everything inside quiet. This level of high functioning happens at the cost of natural needs. The suppression of emotional and relational needs eventually shows up in chronic pain, autoimmune problems or other more physical expressions of distress. The ruthless exploitation of the body leads to exhaustion and crashes.
It feels a lot easier to increase control over nutrition, workouts and sleep than it is to actually get in touch with the tangible signals the body is giving them to regulate these areas. Even if they manage to avoid a crash by using control to make their bodies work, it is based on artificial control and not an integrated sense of the body. Everything that comes up is resolved by using more control.
Emotions are usually numbed to the point that they have become unrecognizable. The mind is able to understand that this is a weird way to function but it can sometimes be incapable of imagining how to function differently. Things like acting on impulses or expressing a need are so far out there, they have become unimaginable. If it is attempted, it comes with a sudden fear of falling apart or dying. Even when it becomes possible to think about this mechanism itself, the intense distress about doing things differently does not change and is actively resistant to change. The mind is rigid in all things concerning the control patterns that are considered necessary for survival but not in other things.
A profile like this comes with a very covert system that puts a lot of energy into making themselves invisible. It is not rooted in unawareness of an inner life, just in control. I believe that it mostly serves the purpose of making needs invisible because they are so extremely painful and scary. It hides all the dysfunction behind a wall of control. That does not reduce the suffering, it just hides it really well.
DID is often called a ‘disorder of hiddenness’. Some of it hides behind patterns of trauma-based over-control. It alarms me, when this knowledge is forgotten.
Possible reason for control-based representations?
I haven’t seen any research about this topic specifically. Leeds does touch on the fact that neglect might play a bigger role in the development of DID and that there might be a connection between neglect and avoidant attachment in trauma patients. Here is how I would explain it:
One element might be the experience of consistent neglect. There was no caregiver who sometimes responded to needs and sometimes didn’t, not the classical ‘frightened and frightening’ person and instead just nothing. The kid learned early on that they have to save themselves, pull themselves together, take charge and do things that are too big for them. Expressing needs or feelings consistently led to punishment and never to a response that got them anywhere, so it was discarded as useless behavior. There was no way to be a living person with needs and be allowed to exist with them because merely existing was too much for the people around them (hard to call them care-givers when no care was given).
The most peaceful way to be was invisible for adults and so the child created a way to be invisible in all the things that could get them into trouble. Doing chores, learning by themselves and performing well in school were the only things that were reinforced with neutral attention. That makes work a safe behavior that can be used to regulate oneself. Maybe there was an ideology that claimed that showing weakness (= needs) was wrong or that acting on emotions or impulses was undignified or uneducated. That is a common abuser strategy to keep children from showing signs of distress that would get them help. Self-control and detachment were the only coping strategies that did not cause more trouble than they were worth. They helped to survive a childhood that was hostile to a natural development, creativity, play and being a child. The child parts in a system like that might seem older and put together at first before it becomes clear how young they really are. The most fragile, dramatic parts in a system like that might actually be the abuser-imitating parts that demand care. Parentification might accompany the neglect. While neglect like this is probably not the sole cause of DID, other things happened on top of it, it might be an element that changes the representation. That is, of course, just a personal observation.
Personality disorder?
What we get is something that does not look like Borderline PD at all. Not all DID looks impulsive, unstable and chaotic. Not all DID comes with obvious disorganized attachment and plenty of problems in relationships. In control-based representations, there are difficulties but they are mostly concerning inner experiences and the neglect we put ourselves through in a reenactment of the past. Other people usually don’t notice a thing. Maybe they see a moment of stiffening at times but that is it. It does not help when the treatment options for DID focus on co-morbid BPD so much that they become useless for people who don’t show any of these issues. It just makes it look more plausible that BPD and DID have so much overlap that they could be the same. They couldn’t. But that only becomes obvious when we look at other representations and not the loudest and most dramatic ones.
OCPD vs control-based DID
If anything at all, the control-based representation of DID might look a bit like obsessive-compulsive PD.
Similarities
- incredibly high standards towards oneself
- struggle to express emotion
- difficulties being close in relationships
- preferring work over leisure
- rigid rules for oneself, sometimes connected to control over body functions
- strong sense of duty and responsibility
- …
Differences
- does not expect the same from others
- easily accepts errors others make, understanding that they are merely human
- high-functioning: not getting lost in details or perfectionism, ending projects as planned
- efficient planning, no over-planning, adaptive in changing plans to make things work
- no illogical obsessive thoughts or compulsive actions
- no magical thinking (except maybe that more control is the magic that fixes everything)
- not responding to inner impulses or urges
- often not isolated from other people, in important roles surrounded by people, just emotionally not connected to them
- personal rules are easily explained with trauma experiences
DID does not generally look like BDP. It is not generally overt or driven by fragility, and people are not generally coping by following impulsive actions. The amount of Ignorance, Fragility and Control that is visible on the outside varies. That is especially important to know when we are looking at online spaces, where overt expressions are dramatically over-represented. We might react with shock and a deep conviction that we are nothing like that and don’t even want to be close to any of that. That is understandable. But that should not keep us from accepting a DID diagnosis. DID can have different faces and the control-based one is a valid one that is not as rare as treatment textbooks and the internet make us believe. It can feel like a big relief to find systems that function in similar ways. I promise, it isn’t a rare expression of DID. It is just a quiet and hidden one that does not make so much noise because that is literally how it works as a defense. You are not alone or strange. But it is harder to get treatment that works because therapists have not made it a focus to develop one. We are so low-maintenance and seem to do it all ourselves anyway… it is a symptom, not the solution. The question is echoing in my mind: Are we forgetting something?
If you recognized yourself in this, here are some articles that might be interesting for you
Restoring connection the the body
Getting out of chronic dysregulation
Dissociating helpers as a result of neglect
Radical Openness for our thoughts
Earned secure attachment between parts
The article referenced here is by Andrew Leeds, Developmental pathways to dissociation: Are we forgetting something? published in the ESTD Newsletter December 2012. It points out the role of neglect in the development of structural dissociation as something that is being neglected in research and treatment. He continued to look into neglect and avoidant attachment and developed a first attempt of an EMDR tool for that. I don’t expect anyone to get obscure references like that but I do enjoy them personally when writing.