Image by Maggie Bao

TW: self-harm, psychosis

Note: Please note that throughout this article, I may switch between personal pronouns. This is on purpose, which will hopefully be explained by the article’s topic (Dissociative Identity Disorder). Typically, ‘I’ describes a specific alter, whereas ‘we’ is used for our collective system in this shared body. A glossary of terms used is at the end of this article. 

As I write this, we are recovering from one of the worst psychotic episodes we have had in years. The tentative optimism of my last article feels hard to grasp, my ‘two-year streak’ without needing medical attention for self-harm has vanished, and we have (temporarily) been as ill as we were when we were a teenager. The faint silver lining is that I have been here before, and I know why it is happening. 

When people discuss mental health, they often speak of insight. In my experience, insight decides who does and does not receive treatment. If you have this magical ‘insight’, you are deemed well enough to look after yourself, and if you are struggling, well then, you must be attention seeking because you have ‘insight’! Throughout this current episode of psychosis, I have largely maintained a degree of insight. There have certainly been periods where I have not had insight and have been unable to tell real from not real. 

The challenge, when you have DID, is that our reality is entirely different to others. For as long as I can remember, I have had voices in my head, these are who I now know and love as my fellow headmates. To many people, our DID is a fiction (at best) and a psychosis (at worst). We recently lost a so-called ‘friend’ who claimed we were too comfortable living in a delusion: my DID is a reality. I spend so much time and energy educating about DID, especially medical and psychiatric professionals, telling them that my condition is real and I am not delusional. 

The problem is we are delusional at times! Alongside our DID diagnosis, we have a psychosis diagnosis. Our most prominent symptoms are hallucinations and paranoia, and when unwell, we’re hardly a reliable narrator. However, we have learnt the difference, by using that divine gift of insight, between a hallucination speaking (external) and an alter (internal). 

We used to talk of ‘an angry teenage girl who lived in my head’ (this was the first alter we discovered: Fern, our internal persecutor), ‘a young child texting my friends’ (hallucinations don’t text your friends! Alters do!), and an internal monologue which had many different voices narrating the day. Ironically, I don’t think we recognised that these experiences were not hallucinations until we began to hallucinate. Suddenly, at 17, we had our psychotic break, an experience which our host at the time, Liza, never really recovered from. I still remember that day: we appeared at school, crying and shaking, and promptly tried to hide under the desk whilst screaming ‘don’t hurt me’. From that point on, the voices and visions were unmanageable (at least until I started antipsychotics, which really do work, as this recent experience of being unmedicated has shown me and others). At that point, we knew the internal voices weren’t there to hurt me but to protect me, no matter how distressed or aggressive they were: even persecutors, as I have mentioned before, rarely harm others, and harm the body and other alters as a trauma response; a misguided protection. I knew that those voices were mine, and that the threats and graphic visual hallucinations I experienced as part of the external world, were not a part of me. 

Yet, whilst they are two different conditions, neither exists in a vacuum. One of the quirks of DID is that different alters can have different experiences of the body and symptoms. Disregarding mental health difficulties, this can be seen in our dyslexia (one of our alters locks us out of emails frequently by misspelling our legal surname!), different alters being right or left-handed, our different physical strengths, and our different academic abilities (I, Evelyn, am very much not an Oxford student, we leave that to Electra…) It follows that some symptoms are worse for certain alters. For us, this is seen in our psychotic symptoms and our OCD traits. Some alters experience this to the extreme, others do not have any psychotic traits at all. Remember, we are different people, so why would we share the same illness? Obviously, some conditions are shared, and it is the levels of symptoms that vary: we all have a dysautonomic condition (PoTS) and ME/CFS, but the fatigue affects some alters less than others (although we then tend to overdo it, because this condition affects the body as a whole!) 

The other thing I have learnt about the interaction between my DID and psychosis, I only realised during this psychotic episode. My psychosis is overpowering, so much so that I cannot take comfort in my DID. For two weeks, we did not know who was fronting the system and we did not know who we were. If you were to wake up one day and not recognise yourself in the mirror, how would you feel? We spent hours in therapy expressing this confusion and fear. When you are being assaulted by hallucinations, you want to find some way of grounding yourself, especially grounding yourself in who you are: the hallucinations are external, your sense of self is internal. But we could not find this safety. The day we switched, our lovely protector Amethyst ended up triggered out in hospital. We had been trying to reach her from the beginning of this episode with positive triggers, playing Evanescence and Halestorm on a loop. We had no control over switches, entirely unusual for us, and the fact that she was triggered by a negative trigger did not help much. 

Indeed, our psychosis in itself is a negative trigger. It is a reminder of trauma and of mistreatment we suffered when psychotic, a reminder of cruelty from medical professionals, a reminder of the strange and scary things we have done in psychosis. But, our paranoid delusions have an increasing impact on our trauma responses. I do not know what threats are real or not: the voices threaten the same as the people who abused us. 

Real or not real? As we continue our recovery from this setback, we know who we are again. 

We know that the external voices are not the truth, and that our inside world is still an immense comfort. We experience psychotic delusions, but our DID is very much real. The threats? That I’m less certain about… 

Glossary: 

DID: Dissociative Identity Disorder, previously known as Multiple Personality Disorder. A condition where a child’s brain, due to extreme and ongoing trauma throughout childhood, does not form the same way as most people, leaving a person with distinct identity parts and a level of amnesia between them.

System: the term people with DID typically use to describe themselves as a collection of alters.

Alter: a distinct identity part within the system. Others may call these parts, identity states, headmates, or simply people. Some still use the term personalities, though this is less common and can cause controversy. Alters can be different ages and genders, look different internally, use different names, and have different interests and personalities.

Headmates: another, more informal, term for alters. We often prefer this term because an alter suggests ‘alter ego’ and that we are fragments of one original person; due to how DID forms, we have never been ‘one person’ so we aren’t parts of a whole: we are a group of individuals who happen to share a body. 

Persecutor: alters that purposefully harm the body, system, host, core, or other alters, sabotage the system’s goals or healing, or work to assist the system’s abuser(s)

Protector: an alter who protects the system, the body, other alters, etc. We have a number of types of protectors including verbal protectors who may take verbal abuse or attempt to counter verbal attacks and spiritual protectors who usually have strong faith and connection to a higher power (for us, we are Christian) which they use to guide the system through difficult times.

Fronting: a term used for when a specific alter is out and doing things as themselves.

Switch: when the alter fronting changes. 

Positive trigger: something which encourages an alter to front because it brings them joy. Often for us this is an alter’s favourite music. 

Negative trigger: what people typically think of as a trigger, something that reminds them of a traumatic memory.