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An Introductory Guide to Assessing Dissociative Identity Disorder (DID)
Dissociative experiences are common among clients, especially those who have experienced complex trauma and attachment wounds. In fact, disorganized attachment is a strong predictor of dissociation, with anywhere between 15–25 percent of clients with this attachment style having experienced dissociation. What’s more is that, besides DID and OSDD, at least a dozen diagnoses in the Diagnostic and Statistical Manual of Mental Disorders (DSM) have dissociation listed as a possible symptom.
The DSM estimates that 1–1.5 percent of the population meets criteria for DID but the reality is that the condition is likely much more prevalent than is currently reported. That’s because, unfortunately, many clients who meet criteria for DID are underdiagnosed or misdiagnosed, so they are only treated for co-occurring disorders that are easier to recognize (e.g., PTSD, BPD). However, until a client’s DID diagnosis is acknowledged, treatment for any comorbid conditions is unlikely to be successful.
Once you accept that DID is not rare, you will discover that the likelihood of encountering a client with this condition is high, especially if you work from a trauma lens and routinely encounter clients with early childhood trauma and attachment wounds. Therefore, it is imperative that you become comfortable in assessing the types and degrees of dissociation that your clients are experiencing in order to rule DID in or out.
An accurate diagnosis of a DID client requires a client to experience five types of dissociation: (1) dissociative amnesia, (2) depersonalization, (3) derealization, (4) identity alteration, and (5) identity confusion. Since dissociative disorders are at least as common, and perhaps more common, than many other psychiatric disorders, the International Society for the Study of Trauma and Dissociation recommends that every new client be assessed for these symptoms.
You can begin by asking whether the client loses chunks of time (dissociative amnesia) and whether their body feels like it doesn’t belong to them (depersonalization). If they cannot remember what happened during the lost time and if they don’t feel their body belongs to them, this increases the likelihood of a DID diagnosis. In addition, you should ask clients whether they’ve ever had the experience of a familiar setting suddenly becoming radically unfamiliar (derealization), as well as whether they have experienced strangers recognizing them and claiming to know them—possibly even calling the client by a different name (identity alteration). Finally, you should ask the client whether they sometimes feel like they don’t know who they are, as if they feel like they are another person (identity confusion).
Use these free screening questions to help you get started in assessing Dissociative Identity Disorder, so you and your client can have early discussions that are instructive to the diagnostic process.
And while An Introductory Clinical Guide to Dissociative Identity Disorder is a great resource, due to the complexity of this work, I encourage you to seek out additional training and ongoing supervision when working with clients with DID. Equally important is that you be aware of the risks of countertransference, especially if you grew up in an environment characterized by insecure attachment. This work requires that you be fully present, curious, nonjudgmental, flexible, and emotionally stable. Although these attributes are necessary for any therapeutic work involving complex trauma and attachment wounds, they are especially important when working with clients with DID.
The DSM estimates that 1–1.5 percent of the population meets criteria for DID but the reality is that the condition is likely much more prevalent than is currently reported. That’s because, unfortunately, many clients who meet criteria for DID are underdiagnosed or misdiagnosed, so they are only treated for co-occurring disorders that are easier to recognize (e.g., PTSD, BPD). However, until a client’s DID diagnosis is acknowledged, treatment for any comorbid conditions is unlikely to be successful.
Once you accept that DID is not rare, you will discover that the likelihood of encountering a client with this condition is high, especially if you work from a trauma lens and routinely encounter clients with early childhood trauma and attachment wounds. Therefore, it is imperative that you become comfortable in assessing the types and degrees of dissociation that your clients are experiencing in order to rule DID in or out.
An accurate diagnosis of a DID client requires a client to experience five types of dissociation: (1) dissociative amnesia, (2) depersonalization, (3) derealization, (4) identity alteration, and (5) identity confusion. Since dissociative disorders are at least as common, and perhaps more common, than many other psychiatric disorders, the International Society for the Study of Trauma and Dissociation recommends that every new client be assessed for these symptoms.
You can begin by asking whether the client loses chunks of time (dissociative amnesia) and whether their body feels like it doesn’t belong to them (depersonalization). If they cannot remember what happened during the lost time and if they don’t feel their body belongs to them, this increases the likelihood of a DID diagnosis. In addition, you should ask clients whether they’ve ever had the experience of a familiar setting suddenly becoming radically unfamiliar (derealization), as well as whether they have experienced strangers recognizing them and claiming to know them—possibly even calling the client by a different name (identity alteration). Finally, you should ask the client whether they sometimes feel like they don’t know who they are, as if they feel like they are another person (identity confusion).
Use these free screening questions to help you get started in assessing Dissociative Identity Disorder, so you and your client can have early discussions that are instructive to the diagnostic process.
And while An Introductory Clinical Guide to Dissociative Identity Disorder is a great resource, due to the complexity of this work, I encourage you to seek out additional training and ongoing supervision when working with clients with DID. Equally important is that you be aware of the risks of countertransference, especially if you grew up in an environment characterized by insecure attachment. This work requires that you be fully present, curious, nonjudgmental, flexible, and emotionally stable. Although these attributes are necessary for any therapeutic work involving complex trauma and attachment wounds, they are especially important when working with clients with DID.
An Introductory Clinical Guide to Dissociative Identity Disorder: Best Practices for Working with Multiplicity, Attachment Wounds, and Complex Trauma
If you are skilled in working with complex trauma, you can effectively treat DID.
Media portrayals of dissociative identity disorder (DID), formerly known as multiple personality disorder, are often misleading and sensationalized at best, or harmful and inaccurate at worst. As a result, outdated myths about the disorder persist, including the belief that it is rare, scary, or not a “real” condition. With so much stigma and disinformation floating around, clinicians often feel ill-equipped to treat DID, or are skeptical of it altogether, leaving clients without the therapeutic support they need.
This book offers a solution to that problem. Based on Greg Nooney’s 30-plus years of working with DID, this introductory how-to guide provides you with foundational, yet easy-to-follow, best practices for identifying and working with multiplicity.
As a therapist, you will never be able to directly experience the inner world of a client with DID, but you can help them navigate that world with greater flexibility and ease.
Media portrayals of dissociative identity disorder (DID), formerly known as multiple personality disorder, are often misleading and sensationalized at best, or harmful and inaccurate at worst. As a result, outdated myths about the disorder persist, including the belief that it is rare, scary, or not a “real” condition. With so much stigma and disinformation floating around, clinicians often feel ill-equipped to treat DID, or are skeptical of it altogether, leaving clients without the therapeutic support they need.
This book offers a solution to that problem. Based on Greg Nooney’s 30-plus years of working with DID, this introductory how-to guide provides you with foundational, yet easy-to-follow, best practices for identifying and working with multiplicity.
As a therapist, you will never be able to directly experience the inner world of a client with DID, but you can help them navigate that world with greater flexibility and ease.
Meet the Experts:
Greg Nooney, MSW, ACSW, LISW, LCSW, has worked with clients with serious mental illness and dissociative disorders for over 35 years. He’s received specialized training in treating severely dissociated clients and is the author of Diagnosing and Treating Dissociative Identity Disorder: A Guide for Social Workers and All Frontline Staff (National Association of Social Workers Press, 2021). A highly respected trainer on trauma-related dissociation, dissociative identity disorder, ethics, narrative therapy practices, treating severe trauma, and burnout, Greg shares his years of knowledge and clinical experience with professionals at seminars and conferences throughout the country.
Learn more about his educational products, including upcoming live seminars, by clicking here.
Learn more about his educational products, including upcoming live seminars, by clicking here.
