Dissociative Identity Disorder, To Integrate Alters or Not to Integrate

Paula McHugh is our guest speaker. She is a licensed therapist who has been working with Dissociative Identity Disorder (DID), Multiple Personality Disorder (MPD) clients for the last 10 years.

David Roberts is the HealthyPlace.com moderator.

The people in blue are audience members.

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David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com.

Our conference tonight is on Dissociative Identity Disorder, Multiple Personality Disorder. We'll be discussing "Whether to Integrate Personalities or Not To Integrate" and other DID, MPD issues.

Our guest tonight is Paula McHugh. Ms. McHugh is a licensed therapist and member of the International Society for the Study of Dissociative Disorders. She has been working with Dissociative Identity Disorder (DID) clients for the last 10 years. She counsels about 4-6 clients a week. She has helped 2 clients totally integrate, which she says can take anywhere from 4-8 years of consistent therapy to accomplish.

Good Evening, Paula and welcome to HealthyPlace.com. We appreciate you being here tonight. I know our audience members have different levels of understanding, so briefly, can you define Dissociative Identity Disorder, DID? Then we'll get into deeper issues.

Paula McHugh: Hello everyone. Dissociative Identity Disorder is a continuum of the ability to back away from stress. It helps people get away from trauma and forget about it. This usually happens in childhood when there is intense abuse, for instance, childhood sexual abuse. The result is a kind of splintered personality, where there is amnesia between people of the same system.

David: Before we also get deeper into the subject, please tell us a bit more about your expertise and experience in working with DID clients.

Paula McHugh: I have worked in this field for 10 years. I learned from my clients and from the experts how to help someone open up communication in the system.

David: What is involved in doing therapy with a DID client?

Paula McHugh: I bumbled around a bit in the beginning because it's a very complex thing and people are hypersensitive to any kind of criticism or rejection because they have seen this too many times before. First, is trust and safety, getting to know each other, then comes communication with alter personalities, if they are ready.

David: And in the type of therapy you practice, what is the end goal?

Paula McHugh: The hardest thing for clients is remembering what happened to them. That is the first goal, and it takes a long time.

There is competition between alters, so it's not easy going for the client, and they have to go slow in the beginning. It's pretty hard getting used to the idea that you're not the only one in the house - so the speak. It kind of freaks people out at first - like someone's watching. They kind of knew it before but didn't want to know it, if you know what I mean.

They always felt different because people would tell them they were lying about what they did or didn't do. Very confusing things appeared that they knew didn't belong to them. Time gaps where they all of a sudden appear at the beach or somewhere when the last thing they remember was being in school months or weeks or days before. So at that point, clients know something's wrong - but they don't know what, and they feel ashamed - paranoid, etc.

David: I imagine it must be a pretty scary thing to discover that you have these alters, separate beings so to speak, inside of you. How do people adjust to that or don't they?

Paula McHugh: It takes time. Sometimes they remember things that fit with Multiple Personality Disorder, MPD, and other times they say I'm out of my mind. Of course, I just say - well maybe I am.

The goal in therapy with Dissociative Identity Disorder always changes according to the client's needs.

David: At the top of the conference, I mentioned that you successfully helped clients integrate their alters. From your standpoint, as a therapist, is that your end goal?

Paula McHugh: That used to be my goal before I learned to listen better to my clients. Some people know that they want to integrate, but most people don't want to even talk about it!

I have learned that people change in therapy, alters become more similar - less opposite or different. The increase in communication in the system helps them feel more "together" - like a family. That may be all they want, or it may be all they want for awhile or for years. If it works for them - great!

Integration is not a must - it's a choice. No one can be forced to integrate and, my oh my, don't ever try to force someone with DID to do anything. No one wants to be forced, and they had to put up with people forcing them and abusing them forever, and they're not going to put up with it anymore. I didn't even think I ever tried to control things until one of my clients pointed out subtle things. That's what I mean when I say, I learned.

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David: Paula, here are a few audience questions:

imahoot: Do you feel that when someone is very much in the healing process, that they unconsciously begin the integration process?

Paula McHugh: Yes, I do think so. It just kind of happens because there's not so much need for protection and barriers and the amnesia is gone.

debb: Do you think people are ever 'cured' or do we dissociate for life.

Paula McHugh: Yes, people are cured. They will always be susceptible to stress, so they have to watch out when they feel stressed because they know how to split, and it can happen again.

But that's not the end of the world. You just deal with the new person until they're OK. They will probably decide you don't need their help anymore. Alters formed after total integration do not have the hold on their life the way alters who had been there for years did. They're just there to help for a while.

dendroaspis: How do you define "cured"?

Paula McHugh: Cured is total integration which remains stable for 3 years. It's all the alters together - into one being. No one is lost, they are just all there in a different way, they don't have to share time anymore, everyone is up front all the time but in an organized, calm way.

David: Is splitting a conscious act on the part of the individual or is it something that happens unconsciously?

Paula McHugh: Totally unconsciously. These are children, and they feel trapped, desperate, and terrified. Somehow, they tap into an ability in the brain to split away to be in the trees or asleep, while someone else takes over. It's not conscious and I think it's a survival skill.

The other options are to go crazy - or kill yourself. So it's better to let our unconscious take over.

David: Here's the next question Paula.

deli: Once the personalities come together, what's the next step?

Paula McHugh: A long step. It's getting used to the idea of being a singleton. Like there's only Pepsi in the icebox because no one else buys milk, so you have to remember to buy the milk. But people tell me they feel "right," they feel good, calmer, less afraid.

They also have to get used to being alone. That's kind of sad for them for a while in between feeling better.

danalyn: You say it takes 4-8 years for integration. How many hours a week of work is that?

Paula McHugh: I think it's necessary to have therapy twice a week - and room for crisis sessions in between. Sometimes a 2 hr session if memory work needs to be done. It's arduous - but DID people are persistent. They are also in a lot of pain and want some relief. They do feel relieved after they do memory work and the nightmares stop.

David: Here's an audience comment:

dendroaspis: I guess that if a poor person wants to integrate, they are out of luck. I'm having no luck even getting a doctor.

David: That can be pretty expensive. My guess is many people can't afford that, especially if they don't have insurance. What then?

Paula McHugh: It is expensive, but people seem to think it's so important to them, that they will give up just about anything to have their therapy.

whalevine: How will we know we are ready to integrate?

Paula McHugh: You will know because it will feel right and it won't be so scary. If you're wondering, it's probably not time. All the memory work has to be pretty much done or the integration just won't work.

insight: There is total amnesia with some people with multiple personality disorder. In my case, I am co-conscious in the background when an alter takes over. Do you work with many clients with co-consciousness DID?

Paula McHugh: Yes, I do. There are many faces and many forms to DID. They are all different and all similar. There is not just one right way.

Pam: How does one deal with very self-destructive alters and keep themselves safe?

Paula McHugh: Everyone has to work together to be as aware as possible when the alter is really down or depressed or hurt. Sometimes a protective place - a beautiful room - inside can feel safe for them. Most of all, I believe that alter needs to be heard in therapy. They need to get the worries out in the open, so they can dissipate. That takes a long time. So in the meantime, whatever you all can do to be aware of what he or she is doing -- will help.

David: I have a question. How does one explain to others who are important to them that they have Dissociative Identity Disorder; that there are alters inside of them?

Paula McHugh: Do you mean outside family or friends?

David: Yes, exactly, friends, family.

Paula McHugh: Gently --- and in a questioning tone, especially RESPECTFULLY like - "do you think it might be possible?", "what do you think happened when you didn't remember the weekend?" NOT judgmental or critical --- just soft and gentle.

Also, it's hard for family members because they are probably in denial too, but that's a whole other discussion.

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David: I would imagine that would be one of the most difficult things for someone with DID to tell someone else and not appear "crazy." And on the other side, I'm trying to imagine being the recipient of the message, not knowing much about DID and hearing this. So I do understand what you are saying.

Paula McHugh: Yes, it's scary to come out because you can never tell ahead of time how people will react. Most people are curious and helpful but some are not. I wouldn't recommend telling your boss either. Lots of people want to know more. They want to help. Sometimes, they want to know too much, too many questions, and DID people begin to wonder do you like me only because I'm DID?

David: If you have a therapist, is it important to have the support of family and friends to work through the issues involved. For instance, in eating disorders recovery, the professionals stress the importance of a support system. What about with DID?

Paula McHugh: You're very lucky if you have family support because more often the family is in denial and even tends to blame the person or say they are lying. I find that some people do have the support of good friends or a spouse. They are lucky. Other people find help in DID support groups or in other support groups where people understand pain.

David: For the audience: if you have told someone about your DID, either how did you say it or what was their reaction? I think it would be helpful to many here tonight. I'll post the responses as we go along.

Paula, a few of the audience members would like to know if you have personal experience with DID.

Paula McHugh: No, I don't, but I admire the heck out of people who survive this.

David: Judging from the comments that I'm getting from audience members, I think many feel you really "understand" what they are going through and what they are saying.

Here's another audience question.

Maia: How do you deal with clients who have been hospitalized, and the other professionals do not believe in Dissociative Identity Disorder, which prevents them from being helped or feel safe?

Paula McHugh: That's a tough issue for me. There's one hospital in this town that accepts Dissociative Identity Disorder - and TALKS to alters. The other hospital does not. It irks me! People deserve respect and time to just talk, it helps them let go of worries and move on. I work with psychiatrists who believe what I believe. I just can't ignore alters. I know that seems to work for some doctors and some therapists, but I don't know how they do it. I have to do it the old way, the way Frank Putnam wrote about in his book, "Diagnosis and Treatment of Multiple Personality Disorder". The outlines dealing with alters and helping them. Sorry if I got on a bandstand, but it's something I feel strongly about.

David: And that is a difficult issue because there are professionals, psychiatrists, and psychologists, who do NOT believe in Dissociative Identity Disorder, Multiple Personality Disorder. So, therefore, it's important to find a therapist who does, and I would be very upfront and ask the person directly before I got involved in doing therapy with them.

Here are some of the audience responses to "how did you tell someone else about your DID and/or how did they react once you told them" :

whalevine: Have you ever seen or heard about the movie Sybil? If they say yes, then I tell them I am like that person. If they do not know about the movie, then I tell them I was hurt so bad when I was little, that I made people inside called Alters to survive!

Tyger: Most people thought I was making it up, or got scared and ran away.

patscrew: When I first told my girlfriend I was an alter, she thought I had been neutered!

insight: I have to feel absolutely safe with a person before I disclose. I have had outside family come to a session to learn more about DID, especially those who have to live with me when I switch under stress.

freckles: One good friend has stopped communicating with me after I told her. She just smiled and was non-committal.

TXDawn27: I told my psychology teacher and he was very supportive. He helped me make up the class work I missed while in the hospital.

JoMarie_etal: We usually tell somebody when we feel trapped and it is the only way to explain something, i.e., switch in the middle of a project, etc.

imahoot: The doctors and therapist told my family and friends while visiting me at the hospital and educated them on it.

freckles: I'm fortunate to be in a relationship with another DIDer, and to have friends who are DID. My mom just thought "it's another one of her crazy moods" when I told her I was DID.

danalyn: I have found you must really know and trust a person if you are going to tell them. Telling can cause more hurt and rejection.

TXDawn27: Everything you've said feels so "right" to me. It goes a long way to making me feel less crazy and alone. I agree that trust should be the first priority in a therapy relationship.

David: Here is an audience question:

CryingWolves: I would like to know if the feeling of blending is a step toward, or a part of, the process of integration.

Paula McHugh: I think it's both. Blending is a process of integration. Lines become blurred -- less bold. People who used to be passive - become assertive, people who were just angry - learn to cry and love.

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David: Here are some more audience responses:

pensive: I don't tell people because it tends to make them look at me differently. I just want to be treated like anyone else.

berrybear: I tell them I've been in a war far worse than any they have ever imagined, and that like war veterans, I have a strong case of Posttraumatic Stress Disorder (PTSD) from it.

sammi1: I lost my career as a nurse. All my friends abandoned me. My daughter, age 16, left home.

JoMarie_etal: We don't even trust each other, and trusting a therapist takes a very long time. They really have to prove themselves. There is NEVER complete trust.

David: I have a question: From what I know, most of the people who have Dissociative Identity Disorder, it developed because they were abused in some way. Is there any other way to develop DID?

Paula McHugh: I heard of a case which developed because of seeing violence and people being killed accidentally, but I think that's very rare. Everyone I know experienced sexual abuse.

David: How common is ritual abuse in Dissociative Identity Disorder cases?

Paula McHugh: All too common. It's a factor in about 1/3 of the cases I have worked with.

oryakos: Question: How does one start to identify triggers BEFORE switching?

Paula McHugh: Time. Time and practice. Also, someone to help you - someone to talk to.

janedid: I am afraid that if we integrate, we will be gone, that we will not know who we are anymore. Does this ever happen, or are all the alters still aware of themselves?

Paula McHugh: I know it's scary at first, but I've never known anyone to be lost, and people stay the same. I mean, they know exactly who they are. At first, they are a blending of "Shirley, Sue, Joe, etc." Later, it's just "me," but Shirley, Sue and Joe are still there. I can see it in the person's action, in their eyes, in their choice of words.

Les M: Is integration considered to be a oneness, or like, if the process happens unconsciously, do we "lose everyone"?

Paula McHugh: Yes, it's a oneness. No, no one is ever lost. I've never seen anyone getting lost. Everyone is there. You can't believe it until you feel it.

David: I'm wondering why, after the trauma that caused the Dissociative Identity Disorder, the splitting and alters, why after a period of time, say a year or more, does one continue to develop alters? And also, without therapy, does that process just continue throughout one's lifetime?

Paula McHugh: Alters develop when there is overwhelming stress. Yes, I think it may continue without therapy. Splitting is just a reaction to anxiety and fear which you can learn new ways of reacting and new ways of coping, so you don't have to split off anymore.

David: What about hypnosis therapy for Dissociative Identity Disorder? Is that effective?

Paula McHugh: I think so. Dissociative Identity Disorder is a mechanism of self-hypnosis. DID people are experts at using hypnosis, even if they don't even know it. Every time there's a switch - it's through hypnosis. Hypnosis in therapy helps people go back and experience the past, then redo the past into a better solution. It helps to relieve the fear, anger, and sadness, and replace it with some safety.

David: Here's an audience question:

Tyger: How do you, as a therapist, deal with satanic abuse? Most people don't believe me when I tell them, so I just stopped talking about it.

Paula McHugh: I believe it happened. Keep trying to find people who understand. I'm not a doctor, I'm a counselor, I just talk to people - no pills.

David: Here's another question:

angel wings: I have one part that so hates the part called Body for what it did, that she threatens to kill us if she is made to share the same physical body as Body. What hope is there that they will ever integrate?

Paula McHugh: Lots of hope. They just need to know more about each other. All that anger belongs somewhere else. It needs to be directed toward the perpetrator - not the inside family. People just don't know what to do with all that anger. They need someone to accept them as they are and listen to why they are so very angry.

JoMarie_etal: How do you work with highly suicidal clients?

Paula McHugh: Sometimes medication helps a little, sometimes the hospital helps. Most of all trust helps. The person has to get to know me and know that I care before they can really talk about why they want to die. Usually, it's the memory stuff that haunts them. When we can clear that out, the world looks better.

trill: Do you ever recommend that DIDers take some pills? Do you send them to psychiatrists? When? Why? What's your opinion on using or not using medication for this deal?

Paula McHugh: Yes, sometimes pills help. It has to help the whole system though. Antidepressants work if they help the right people chill out a little and don't put the little ones to sleep. Yes, I recommend doctors if I think people need them. Dissociative Identity Disorder people taking medications is not at all like other people on medications. It always works differently, and you have to go slow and see if it's helping or not.

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David: Here are a few audience comments on what's being said:

Tyger: I have mostly child alters and medication only make them sleep. All the other medications hurt my body. Even contemplating the hospital nearly sends me into fits.

Jimmy2of7: Meds don't help all of us, only some of us. It just makes me be quiet.

whalevine: We are allergic to a lot of meds, or some alters will hoard them and then take them all at once.

David: What about the ability to have healthy relationships with other people who do not have Dissociative Identity Disorder?

Paula McHugh: That's perfectly possible if the other people are reasonable and also patient. Gentle is good, reliable is good, it depends on the people. There are some good guys out there, male and female.

David: A few more audience comments on what's being said tonight:

fuffie: Patient, gentle, reliable and a sense of humor!!

dendroaspis: Sense of humor is a must.

Paula McHugh: Humor is WONDERFUL

JJ1: My husband has been my best support.

myrias: I think it's much more interesting when two or three DIDers get together!

Tyger: That's funny, my ex became my roomy after finding out I was DID. He was afraid a child alter would pop out.

JoMarie_etal: Hospitals don't help when you have no money. They are actually too cruel. It just postpones the problems and sometimes makes them worse. We end up not talking about the need to die because of so many bad hospital experiences.

dendroaspis: I wish I could get a tax break on my alters :-)

Paula McHugh: That's humor, dendroaspis. I like it.

myrias: Yeah, like how many dependants do YOU have? Giggle!

Paula McHugh: Good giggle.

trill: It seems to me that I've got someone inside that was an actual person whom I once knew and was once very close with, but he died. The version of him on the inside doesn't seem ever to come out, or at least I haven't received any reports of that or seen any evidence of it, but he keeps me company at different times. What's that about?

Paula McHugh: I'm not sure, but it would be good to ask him.

scrooge027: And how effective is EMDR on treating DID?

Paula McHugh: That's a good thing to use after a client gets through with a lot of memory work. Before that, it seems like it would be too powerful. I only use it later in therapy, when I know how a person reacts in most situations. I don't want to get into more than we can handle. EMDR is great for finishing up stuff in therapy.

David: Well, it's getting late. I want to thank our guest, Paula McHugh for coming and sharing her knowledge and expertise with us. You have been a wonderful guest. And I want to thank everyone in the audience for being here tonight. It's been a great discussion and I appreciate everyone participating and sharing your experiences and questions.

Paula McHugh: Bye everybody. I appreciate the time here, this is one of my favorite topics because I really do care about these folks.

David: If you haven't been to our main site yet, http://www.healthyplace.com, I want to encourage you to visit.

Thank you again, Paula, and good night everyone.