DID in children

Hello everyone! I'm a child and family therapist working in a day treatment and I work with traumatized children. Currently I specialize in the TF-CBT approach and I work with children ages 8-13. Recently we had a guest speaker by the name of Dr. Dorothy Lewis come to the school to present on DID. She had a wonderful personality but her presentation lacked the substance I was really looking for. Her presence however was to confirm the suspician that several of the children in treatment had DID. I immediately pulled out all of my old books to reread (The Flock, Shatter, Sybil etc.) and started researching again. While very good information was gathered from these books- there is serious information lacking on identifying this before adulthood. My question is- how would a therapist or caring adult recognise the signs of DID in a child? I work with many children who have been through tremendous abuse and dissociate to some degree. But could what is often seen as severe mood swings (the psychiatrists in my organization are forever diagnosing every child with BiPolar) really be the moods of other personalities? I thought the people who might know would be on this forum. I would appreciate anything thoughts you have on this topic.

Bear in mind that biographical books on people with D.I.D. tend to be blown WAY out of proportion by the writer, whereas autobiographical ones do not. Going by books like "Sybil" isn't going to give a person a clear picture of what the person(s) with D.I.D. truly experience(s) in a daily life scenario.

I don't think there are any psychiatrists, psychologists, or psychotherapists on this forum, let alone ones who specialize in D.I.D., and those of us with it don't really know how we behaved in childhood since the disorder is basically there so that we didn't know those things, and a lot of us still only have very minimal memory of childhood, if any at all. Therefore, we may not be able to help you all that much. Before going on the word of people who live with it, I would reccommend speaking to someone in the mental health field who specializes in dissociative disorders and has had many multiples as patients.

So, the only thing I really feel comfortable suggesting is only my opinion and may not be too terribly valid. But you asked:

But could what is often seen as severe mood swings (the psychiatrists in my organization are forever diagnosing every child with BiPolar) really be the moods of other personalities?

To which I would say, it could be and maybe it isn't. First I would (were it me) ask the child questions to figure out if s/he remembers these mood swings, negative behaviors, etc. but not set up the questions in a way that could lead the child to knowing what you're getting at. In other words, as opposed to coming right out and asking, "Do you remember doing such-and-such?" (because if the child does and knows s/he may be in trouble, s/he could use this as a convenient excuse to get out of said trouble) ask things like, "What were you feeling when you did such-and-such?" The child who dissociated won't know what s/he was feeling. But any child might say, "I don't know." (Many times, kids don't know, even if they do remember it.) The dissociative child will look completely confused and not know why on earth you're asking this in the first place. ...That's one way they figured it out in me. But I was 16 by that time. It's probably even touchier to figure out in a young child. Unless you see proof of another personality there (as in, that other personality has come right on out and introduced him/herself to you) don't assume it's D.I.D.

What kid knows who they are from one moment to the next, anyhow?

Best of luck!

-Leigh

Dear Leigh,
thank you- I agree with you about many things- and it seems almost impossible to diagnose in children. We have very signifcant child mental health services in my area,but no one specializes in DID, many have not even seen it, and some definitely don't believe in it. It is very easy, once you are learned about it,to begin seeing it everywhere and I want to avoid that. Since I specialize in trauma- I do get a lot of children who "blank out", but there are not idenitifed personalities, though it always seems strange when a small, even tempered sweet girl can attack staff and begin shouting "###$ ass bitch whores", but that is usually what we see. We have one child in program who is clearly DID- and Dr.Dorothy Lewis- who has actual experience in this area with kids- will be coming back to consult- but my understanding is that this is very rare- this child has very clear changes in voices, drawing, tone, handwriting and interests. I just don't want to miss anything with my other children.

Hi bex1974,

I think you will see dissociation to some degree as an underlying mechanism for many traumatized children and adults, whereas DID almost by definition belongs to a more or less matured person. It may not really show up until at middle age, when all else fails. The one example that you mention of a child with clear changes in personality may be the 'typical Eve' of 'typical Sybil' (already), while for most of the other traumatized kids you'll will have to see how dissociation and other coping strategies are going to make up the person. So it's not clear cut. I see 'trust' as the most essential issue for DID. Even when all goes well for years, one part may be in hiding, until needed.

Personally, to answer your question, sudden and serious moods changes for me are pretty much the same as personality changes. For myself I call them changes, moods, states, alters, or parts. I think what characterizes all of that as belonging to DID is the loss of (pieces of) memory and the confusion as a result of bits and pieces of information and experience being stored under different parts/moods/personalities.

Remember to see dissociation as a positive, creative tool of survival! I remember reading abusing fathers comment that their daughters 'liked' the sexual abuse: they saw them going to school singing and happy the next day... That is how dissociation can work. You can only slowly work with these parts, and maybe not until the person has matured.

I think the very best thing to do with a sweet child that shows a very unexpected mood change is to tune in to where she is and deal with her as she is. Do not try to address her at a level where she normally would be functioning, by referring to those situations, or by trying to correct her using consequences that are valid in another state but may have no meaning here. Take her at face value and be accepting, and encourage her to communicate whatever she is trying to communicate while providing reassurance that what she communicates is being understood or at least accepted. In the meantime, be aware that not all of her may be there and should not be addressed directly, but only indirectly, indicating that you know that 'all of her' may be listening, but 'none of her' has to respond.

Diagnosing DID for the mere sake of diagnosing it right does not really serve any purpose. The question is what you can do with that information. When you cannot place children away from their abusive environment, what other (better?) coping mechanisms are you going to teach them? My very best memories of support when I grew up were the people who accepted me for who I was, were non-confrontational, respectful of boundaries, appreciating of what I thought and felt, kind, who believed in my abilities, and were somehow able to see me as 'my own' and not connected to 'where I came from'. The safest people are the gentle ones who see and let be.

pob