Chapter 11. Basic Attitude for the Treatment of Dissociative Disorder (7)

Once in the stable phase of the treatment, different identities in DID patients may coexist peacefully. Switching might occur, but most of time patients may be able to control when it to occur. One of my female patients in her late twenties is working as a shop clerk that her efficient host personality takes charge of, while at home in the evening, her child personality shows up and plays house with her male partner. She is generally satisfied with her current living style. When her treatment started a
couple of years ago, she was in her previous relationship and was not in psychotherapy yet. She was already in her current work, but her workload was much heavier. Quite often during the work hours unexpected switching occurred, and her child personality popped out and started to cry or hyperventilate. She often needed to take days off her work, and she was about to be fired due to her absenteeism. Obviously her dissociative symptoms were worse two years ago, but her uncontrollable and unexpected switching was rather a result from her excessive workload and her conflicted relationship with her previous partner.
Similar to this case that I stated above, many DID patients have trouble controlling switching in their workplaces. If unexpected switching occurs in these settings, it would confuse their co-workers who would blame the patients for not informing them of the illness beforehand. However, disclosing their dissociative disorder might not have been their best choice for them either, as if they did in their job interview, they might not have been offered the job first of all. Whether or not to disclose their disorder to others thus can be a huge dilemma for many DID patients.
Iatrogenic creation of new identities should not be of concern in most cases
How to approach patient’s different identities varies largely according to clinicians. Many of them are of an opinion that different identities should not be dealt with as a different person. For example, if a patient A has an identity with a name B, that name B should not be mentioned or called upon in the treatment, according to them.