My client who has only three alter personalities besides the ANP was unaware of her multiplicity until she encountered a work-related trauma at age sixty. She became symptomatic as the hidden parts emerged to deal with the recent trauma.

Dissociation is numbness and nothingness; it is a feeling of being lost; it is floating on a cloud that threatens to suffocate; it is automatic speech and action without awareness or control; it is looking at the world and blinking to try to remove the blurry fog; it is hearing and seeing the immediate world and simultaneously feeling very far away; it is raw fear; it is unfamiliarity in familiar places; it is possession; it is being haunted everyday by unknown monsters that can be felt but not seen (at least not by others); it is looking in the mirror and not knowing who is looking back; it is fantasy and imagination; and, above all else, it is survival. Dissociation is all of these things and none of them at once.

When evoking personal recollections, patients with depersonalization often complain that memories feel as if they really didn't happen to them.

The SCID-D may be used to assess the nature and severity of dissociative symptoms in a variety of Axis I and II psychiatric disorders, including the Anxiety Disorders (such as Posttraumatic Stress Disorder [PTSD] and Acute Stress Disorder), Affective Disorders, Psychotic Disorders, Eating Disorders, and Personality Disorders.The SCID-D was developed to reduce variability in clinical diagnostic procedures and was designed for use with psychiatric patients as well as with nonpatients (community subjects or research subjects in primary care).

Dissociative Identity Disorder is borne out of trauma. Many individuals who survive severe trauma will later experience marked anxiety, which may or may not relate to triggers from the original trauma. Individuals with DID are highly likely to have a great deal of anxiety.

It is not unusual for subjects diagnosed with a Dissociative Disorder on the SCID-D to be surprised at having their symptoms validated by a clinician who understands the nature of their disorder.

Due to previous lack of systematic assessment of dissociative symptoms, many subjects experience the SCID-D as their first opportunity to describe their symptoms in their own words to a receptive listener.

Pathological dissociation is characterized by profound, functional amnesias and significant alterations in identity; normal dissociation is expressed primarily in the form of intense absorption with internal stimuli (e.G., daydreams) or external stimuli (e.G., a fascinating book or television program).

...The vast majority of these [dissociative identity disorder] patients have subtle presentations characterized by a mixture of dissociative and PTSD symptoms embedded with other symptoms, such as posttraumatic depression, substance abuse, somatoform symptoms, eating disorders, and self-destructive and impulsive behaviors.2,10A history of multiple treatment providers, hospitalizations, and good medication trials, many of which result in only partial or no benefit, is often an indicator of dissociative identity disorder or another form of complex PTSD.

Prior to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV), the diagnosis of Dissociative Identity Disorder had been referred to as Multiple Personality Disorder. The renaming of this diagnosis has caused quite a bit of confusion among professionals and those who live with DID. Because dissociation describes the process by which DID begins to develop, rather than the actual outcome of this process (the formation of various personalities), this new term may be a bit un.