I have asked myself this question several times.
What puzzles me is making the distinction between having clearly defined parts with having parts that take over without the recollection of the whole or of other parts. When someone describes his/her alters with full detail, that indicates to me that there is fragmentation, but that there is no amnesia between parts.
All people suffering from complex trauma are fragmented, and all of them have parts that take over without consent from the whole or other parts, but they leave a trace, and if questioned, the person is able to recount the behavior and experience of the alters; maybe not in detail, but they know about the “alters” behavior and attitude.
I find the diagnosis of DID to be one of the most debilitating, and —I’d say, dysregulating— labels a person can carry.
I have seen several videos of people that go for DID treatment and seems evident to me that they are “performing” the parts. I have also seen in front of my eyes how someone’s energy shifts in such a way that their faces and corporal expression changes, their voice transform, their syntaxis gets altered; yes, they become a child, or an abuser, or a “mother” version of themselves. And I know they were not performing. But I also know that they stay with me somehow, and that if I take the opportunity to meet this part, they will give do it for me. I can see that is a dissociative phenomenon, but I also know that I don’t really lose the person. It’s like a trance, but they will have a pretty good recollection of what they are saying and doing even if they may not identify what they were feeling. If I bring it up, then they can acknowledge it.
I’d say that it’s pretty common for me to witness that type of interaction. I use IFS (Internal Family Systems) pretty often, and almost every time I ask my clients to go inside and unblend from a specific part, I’ll witness some unfolding of the unconscious into a specific ego-state. The parts can be wild, or childish, or any other type of manifestation. I have a client that calls “Mojo” to his part that likes having sex.
All that said, I don’t see any of my clients as having DID.
I had a client for several years that told me a couple of times that she had been accused of practicing prostitution at her apartment. I asked her if she did, and a couple of times she said no, but one day she said she was not sure. “Maybe,” she said. “I sometimes have extra money that I don’t know how I got.” That client could have had DID, but how could I have known if she didn’t know?
The DSM specifically says “signs and symptoms may be observed by others or reported by the individual.” Did I need to talk to her landlord to find out whether she had visitors? I imagine that’d have been the only way for me to find out. Or she could have tried to find out herself. But if she didn’t, then I guess she didn’t want to know because the dissociation was helping her somehow. In that case, why would she tell me?
When a client recounts all these alters with such detail, where are their defenses? Are they accusing them? what’s the purpose of disclosing a structure that has been helpful or protective? That’s why they get created in most cases.
I have a supervisee that claims to have several clients with DID. She tells me about a male client that has 20 alters but his wife doesn't know. According to my supervisee, he only shares his alters with her. How could someone be able to hide 20 alters from the wife? Hard to imagine.
I think that we, therapists, can influence the mind of our clients in huge ways. I find that DID diagnosis could influence some individual’s behavior. Some of our clients, the most vulnerable, can be very easily influenced, and if having alters pleases the therapist, or give the client some advantages, instead of working towards integration, treatment could be moving into worse dissociation. I don’t want to invalidate anyone’s experience. I know many people experience alters. I have had some too. But believing the person has no control whatsoever over the parts should then be the goal number one in treatment. Regaining some level of control.
Fragmentation and dissociation are clear signs of complex trauma. Therefore, ego states, and/or emotional states coming from stuck energy from the past, can be present in most of the victims. Trauma treatment is all about integrating those parts. Differentiation is the first step; clients need to identify their parts and unblend from them. Once that’s done, the integration starts.