Kluft's (2005) "dissociative surface"

By popular request, this is a thread about Dr. Richard P. Kluft's term "dissociative surface". The term refers to what the clinician (psychiatrist, clinical psychologist, counselor, social worker) usually sees when the patient has DID.

The following quote is from pages 600-601 of Kluft's chapter 40, A Clinician's Understanding of Dissociation: Fragments of an Acquaintance, in the 898-page book Dissociation and the Dissociative Disorders: DSM-V and Beyond edited by Paul F. Dell and John A. O'Neil and published by Routledge in 2009. The book was awarded the ISSTD's Pierre Janet Writing Award for the best publication on dissociation in that year.

Dissociative identity disorder (DID) and allied forms of dissociative disorder not otherwise specified (DDNOS) are psychopathologies of hiddenness (Gutheil, quoted in Kluft, 1985). […] My own studies on the natural history of DID indicate only 20% of DID patients have an overt DID adaptation on a chronic basis, and 14% of them deliberately disguise their manifestations of DID. Only 6% make their DID obvious on an ongoing basis. Eighty percent have windows of diagnosability when stressed or when triggered by some significant event, interaction, situation, or date. Therefore, 94% of DID patients show only mild or suggestive evidence of their conditions most of the time. Yet DID patients often will acknowledge that their personality systems are actively switching and/or far more active than it would appear on the surface (Loewenstein et al., 1987).

What we usually see is the "dissociative surface" (Kluft, 2005), which takes effort to appreciate and decode. Alters need not assume executive control to influence the course of events. The dissociative surface reflects covert efforts of alters "behind the scenes" to influence behaviors, attitudes, feelings, and perceptions, or demonstrate the unintended leakage of other alters' feelings, issues, or intentions into others. Such intrusions are often subjectively experienced by the alter apparently in control as "made" passive-influence phenomena, like many Schneiderian first-rank symptoms of schizophrenia (Kluft, 1987; Ross & Joshi, 1992). Potential contributions/contributors to what is seen at the dissociative surface are listed in Table 40.1, and characteristic observations creating an index of suspicion for the activities in Table 40.1 are found in Table 40.2.

Table 40.1
The Dissociative Surface

• The host, or, the "usual patient"
• The semblance of the host or "usual patient"
  
  1. Passing for the host
  2. Isomorphism
  3. Tag-teaming
• Copresence combinations
  
  1. Mixed presentations
  
  a. Cooperations
  b. Clashes
  c. Vectors
  d. Temporary blendings
  2. Fluctuating presentations
  3. One-plus presentations
  4. Shifting one-plus presentations
• Instructed behavior
• Intrusions
  
  1. Simple
  2. "Up the food chain"
  3. From the "third reality"
• Imposed or "made" behavior
  
  1. Simple
  2. "Up the food chain"
• Switching, rapid switching, and shifting

Table 40.2
Typical Manifestations of Dissociative Surface Processes at Work

1. Brief amnestic moments, apparent amnesia or forgetfulness about matters under discussion or subjects of ongoing concern within the treatment, or abrupt changes in the subject of discourse.

2. Derailing of an ongoing conversation by the patient's appearing spacey, perplexed, or surprised by what is coming out of his or her mouth.

3. Transient anxiety or distress.

4. Palpable but difficult to characterize alterations in the manifestations of an alter.

5. Changes of the attitude, emotions about, and stance taken toward matters under discussion.

6. Fluttering of eyelids or rolling of eyes (suggesting an autohypnotic process).

7. Apparent distraction by attention to internal stimuli.

8. Appearances that often suggest a "double exposure" in which one alter's characteristic appearance seems superimposed upon or rapidly oscillating with the appearance of another, or gives the impression of blending two known alters' patterns of expression.

9. Certain aspects of facial expression being discordant with other aspects, such as smiling while the face otherwise expresses fear or sorrow, or one side of the face (the ocular region compared to the oral region) expressing one affect while the other side (or region) expresses another.

Both tables were published originally in Kluft's 2005 article Diagnosing dissociative identity disorder in Psychiatric Annals 35(8):633–643.

(The chapter in which the above quote occurs is primarily a case report of a brilliant PhD scientist who comes to Kluft because she thinks she has DID yet she can give no reason why she thinks that. It is a fascinating story.)

So, observations of the dissociative surface. Table 40.2 lists in general terms those signs we often observe when we are dealing with a multiple. Except one: Palpable but difficult to characterize alterations in the manifestations of an alter. This is a sign that we sense. It is a key feature of DID-dar, that "I just know it; I can feel it."

DID Forum: Do you have DID-dar?

Thanks for posting a thread on this.

During my last therapy session, my T let me in on something she has been observing that I wasn't aware of. She said that my face displays expressions throughout the session, but that whenever she asks me how I am feeling, that I always say that I feel nothing (which makes sense as true). But she says my expression and my tone change noticeably at different times.

So we talked about that for a while, and how this has been an issue for as long as I can remember. I've had several people over the years comment that my expressions are confusing, and there have been several times that I have become aware that my expression does not / did not match whatever I was actually feeling.

The overall gist of it that I left with was the weird and creepy notion that I don't control my face.

Probably one of the weirdest ones I figured out at some point in adulthood, is that when my anxiety spikes suddenly and rapidly (it's like a weird threat detection wave that comes up from chest and into my face), I tend to smirk or even give a weird, gaspy sort of laugh. I've always chalked it up to me just being extremely quirky, but after that session and then some of this reading material, I almost wonder if there is some kind of 'crazed' protector alter in our system or something.

Anyway since it seems possible that I am the "surface" this stuff is interesting and somewhat validating to read, thanks for posting.

Thanks, Una+! A dream come true.

CopperMoon wrote:So we talked about that for a while, and how this has been an issue for as long as I can remember. I've had several people over the years comment that my expressions are confusing, and there have been several times that I have become aware that my expression does not / did not match whatever I was actually feeling.

The overall gist of it that I left with was the weird and creepy notion that I don't control my face.

Thanks for sharing this. I discovered this about myself as a young adult, and I remember trying to "train" myself to be able to control my face in the mirror. I didn't succeed. People often say things to me about how my face reveals everything I'm thinking/feeling, but what they think it reveals is not usually what I'm aware of thinking/feeling. At the same time, when I am trying to be expressive, I feel I can't make my face do what I want. I am pathologically incapable of having a normal facial expression in photos. My mental image of myself is of a very inscrutable person with a great poker face (I am really good at poker, though I don't gamble), but I don't think others see me that way. They think of me as calm and pleasant but maybe somehow excitable? I'm not sure if this is really related to DID or not. (Today I'm not sure I have DID in general.)

The host, or, the "usual patient"
The semblance of the host or "usual patient"
1. Passing for the host
2. Isomorphism
3. Tag-teaming
Copresence combinations
1. Mixed presentations
a. Cooperations
b. Clashes
c. Vectors
d. Temporary blendings
2. Fluctuating presentations
3. One-plus presentations
4. Shifting one-plus presentations
Instructed behavior
Intrusions
1. Simple
2. "Up the food chain"
3. From the "third reality"
Imposed or "made" behavior
1. Simple
2. "Up the food chain"
Switching, rapid switching, and shifting

*TW for doubt and meditation*
One thing that my skeptical side says is, how is this different from a non-dissociative person? Isn't that how all people are, made up of all these different aspects of themselves that insert themselves into life more or less unconsciously?

If someone meditates enough, it becomes clear that what passes for oneself is a range of reactions, beliefs, sense experiences, habits; and underneath that there is a sense of presence or observing and consciousness. If every alter meditated, would each come up with his own set of reactions, and never the twain shall meet? There are moments in meditation when foreign feelings come up or when mental chatter is loud. According to every meditation instruction, this is normal. I observe them and release them, as instructed. In all these years, I have never noticed a presence of another alter.
-----
I have a meditation alter who lives in his own world. He is very good at getting into "states" and that is the only thing that interests him and almost all he does, inside or outside. In his mind, if everyone just meditated and engaged in spiritual practice more, the world's problems (and my problems) would disappear.

But I see his point. From a skeptical point of view, the "dissociative surface" seems somehow like a cop out. Like, oh, yeah, some people have alters that you never see and they cooperate to make it seem like the person is continuous. Under this concept, it feels like huge numbers of complex or relatively intelligent people could fit the bill. Maybe that is Kluft's point.
*End trigger*

I wonder how other systems work to "pass for the host." As I have written, we have maintained a strict set of rules in "how to be Legal Name." It is a major bother, because it means that rather than reacting according to our wishes or whims, we have to think about how Legal Name should react, and then do that. This is why I felt I might have borderline personality disorder--I read that one's identity in that disorder is similarly cobbled together. But the personality and typical reactions of Legal Name don't seem in line with borderline personality disorder, according to our therapist.

Now as I write about it, it seems so dysfunctional that I would live my life this way. No wonder I always feel trapped and unable to express myself and silently desperate. I have a broad social network, including long-term friendships, but it has always seemed that people consider our friendships deep even when for me they are pretty superficial. I have never been able to share that much of myself, beyond what is written into the script for Legal Name.

I remember when this format of Legal Name started. It was as soon as I left home and got a job. I realized I had no idea of how to relate to people. At this time, Alex was becoming a primary host for work/public situations. He observed how adults interacted, what were the goals of different interactions, and then made smooth interactions happen with what we had available, simply rejecting any thoughts/behaviors/feelings that would not be compatible with the environment. The main goal was to not make waves and to be competent but non-threatening. (There were times in work situations where we were too competent and others perceived us as threatening. Those situations were hell, because we had no desire to stand out.)

I guess that's what all people go through as they cross into adulthood, though.

Another thing about Kluft's list is that it is, of course, written from the outside point of view. Is it typical to experience oneself as being totally inconsistent, of thinking that you know an alter, and then suddenly it seems like that alter is different or mixed with another one?

It seems like the alters I can identify are inconsistent. I will just start to feel I'm getting a handle on "who" one is, and they change. For example, I have a distressed teen alter. Is she stuck in time and only comes out once in a while to be angstful in the 1990s, or is she around all the time and helping me make choices and influencing my behavior and arguing with my husband about what to have for lunch? Same teen: sometimes she seems to hate herself, sometimes she seems to think she is the only sane person in the world and seems quite happy with herself in a sarcastic, teenagery way.

And just my experience of myself changes from second to second. Now I feel like a housewife who thinks she might have DID; now I feel like a teenager who just got out of the hospital and just wants to sit around listening to music and making mix tapes; now I feel like a big mind full of ideas and who could do anything, and back to the housewife, and on and on. It's nothing that anyone else would notice on the outside. Is that what normal people experience? I guess this is identity alteration and not necessarily a DID thing. I don't know.

Other times, I will know that I am "with Alex" and we are operating together, sometimes switching from moment to moment and sometimes somehow merged, but then Alex will step away and while outsiders probably won't feel any change, I feel the wind taken out of me and am totally disoriented. I don't know what Alex feels like without B. I suspect much happier and better. When he is alone with the kids or just by himself, he sometimes comes out completely by himself, and he seems so different and less bogged down in all this.

So, those are my initial thoughts about this dissociative surface. Brings up so many questions.

Una+ wrote:(The chapter in which the above quote occurs is primarily a case report of a brilliant PhD scientist who comes to Kluft because she thinks she has DID yet she can give no reason why she thinks that. It is a fascinating story.)

Una, I read parts of the story. Very interesting in deed. For those who might want to read some of those parts, I found it here:

Trigger Warning - It might trigger some people.
Book: Dissociation and the Dissociative Disorders: DSM-V and Beyond

When I first read about the dissociative surface I spent some time crying and experiencing thoughts such as "I am not real, I am just a shell, a mask, a puppet operated by others." But that is not the case, at least not exactly. I am real and authentic and most of the time I have my own agency. I am an alter, however, which means that at times executive control is held by other alters. I am the host: I am the alter in executive control during most of my daily life. And now, thanks to the 3 fusions that have completed so far, I experience myself as a more multidimensional person than I was before.

That said, I do see that the dissociative surface concept fully applies to me. I acknowledge that I experience all the varied subjective phenomena listed in Table 40.1 and I know that other people observe the objective phenomena listed in Table 40.2. And I have observed those same objective phenomena in other multiples.

Facial expressions. My mother always got on my case about that. I was expected to maintain at all times a calm, pleasant, attentive, pleasing expression. Period. If I fell short I was criticized or shamed. I was shamed even for positive expressions. For example, if I looked proud or merely just pleased with myself I was told "self love stinks" etc. I was mostly successful at keeping my face at least neutral, but at a great cost: I achieved this neutrality by deliberately not attending to my feelings, by blunting my awareness of all sorts of things. Is it any surprise I have DID? Nope. Now, as an adult, no one tells me I am easy to read. The comment I get most often is that I am guarded and hard to read, sometimes also that my conversation is hard to follow, too complex, on topics that are too unfamiliar. Or that I look angry; this happens even when I am not angry but Alter 2 is forward. This is to be expected, because Alter 2 is an introject of my rageaholic father. Originally and for many years Alter 2's surface affect was rage. But now what he mostly feels---what I mostly feel coming from him---is loneliness. Another comment I get a lot from other people is that they sometimes feel I can read their mind, that I have an uncanny ability to read between the lines, hear what isn't said, etc. This makes me feel sad; I sometimes wish other people could read my mind, but they never do.

So this is how multiples are, but how are we really different from other people? To answer that, Onno van der Hart has a table that goes like this:

Code: Select all

What Is the Difference Between Ego States and Dissociative Parts

                            Ego States      Dissociative Parts
                                            of the Personality
Separate Sense of Self,     
First Person Perspective    No              Yes
Elaboration                 Minimal         Minimal to Profound
Autonomy                    No              Yes
Intrusion                   Yes             Yes
Amnesia                     No              Yes
Present in Everyone         Yes             Only in trauma
                                            related disorders


Una+ wrote:The comment I get most often is that I am guarded and hard to read, sometimes also that my conversation is hard to follow, too complex, on topics that are too unfamiliar. Or that I look angry; this happens even when I am not angry but Alter 2 is forward.

Oh yeah, I've gotten that numerous times. I recall a class in 8th grade (I think), so I would have been 14 years old. Some students were forced to group with me for a project. In my perception we communicated well enough and everything went fine. However, towards the end of this week-long project, one of the students sort of 'confessed' to me that he had always thought I was mean, bully sort of person. He said it like was genuinely shocked that I wasn't so hard to work with. I must have looked surprised and intrigued, myself, because he went on to explain that I always looked "angry" in an "evil way" like I might "beat someone up". He and the other students in our group gave what I perceived as a nervous laugh about it. My reaction to this input was more like >_> really?

Una+ wrote:Originally and for many years Alter 2's surface affect was rage. But now what he mostly feels---what I mostly feel coming from him---is loneliness.

Hey Alter 2, whenever you feel like it you can always write in here.

Sea

CopperMoon wrote:Oh yeah, I've gotten that numerous times. I recall a class in 8th grade (I think), so I would have been 14 years old. Some students were forced to group with me for a project. In my perception we communicated well enough and everything went fine. However, towards the end of this week-long project, one of the students sort of 'confessed' to me that he had always thought I was mean, bully sort of person. He said it like was genuinely shocked that I wasn't so hard to work with. I must have looked surprised and intrigued, myself, because he went on to explain that I always looked "angry" in an "evil way" like I might "beat someone up". He and the other students in our group gave what I perceived as a nervous laugh about it. My reaction to this input was more like >_> really?

Story of my life. Back in school I would get this comment from many different people, and when people got to know me they were equally shocked. They told me I provoked a 'bitch alert' in them when I was around. Except I am really nice. Most of the time.
Except I am a total flaw at hiding the idiotic facial expressions. For years I didn't even notice them. Now I can feel my face doing all sorts of things and I can't stop it. I am easy to read, or rather easy to misread. People assume that my facial expressions are how I am actually feeling, and I guess in some alter or another I am. But at the same time I am really guarded and never really express myself verbally.

This all makes a lot of sense. I have always wondered why people would expect DID to be florid and overt, which is not a particularly adaptive thing to be. I spent many months not positive on the diff between ego states and dissociative parts, and I think it would have been more clear if therapists bothered to look below the surface more. Ditto on wishing someone could read my mind instead of the other way around. I am at all times a presented personality, and frustratingly, it works!

vertices wrote:I have always wondered why people would expect DID to be florid and overt, which is not a particularly adaptive thing to be.

Of course that wouldn't be adaptive. Except when it is, for example when someone wants you to be a certain way and you comply and switch in front of them to the appropriate alter.

Concerning what people expect: The clearest way to show DID in works of fiction (books, movies, TV soap operas) is to make it florid. Most people know about DID only from these fictions, so naturally they know only about florid DID.

Subtle, even covert DID is normal, and why so many of us are diagnosed so late in life despite our signs and symptoms having been there all along. I have disclosed my diagnosis of DID to many people and by far the most common reaction I get is that I always seem the same to them. They don't really know me, that's all. I am not always the same, and I have always known this about myself. I am the same in a given environment but different between environments. My husband sees more of me, of course; his immediate reaction to the diagnosis was that it makes sense. In fact DID accounts for so many odd things about me and odd experiences I have reported having.

In any event, once you know what to look for, the dissociative surface is not hard to see, if you spend much time talking intimately with someone.