Leigh was four years old the first time she came to therapy. Her father and step-mother thought she should see a therapist because Leigh had recently begun complaining about nightmares and ear pain (with no physical origin) and had become very clingy. Leigh’s behaviour varied a lot from session to session, she was sometimes aggressive, kicking and cursing at the therapist, insisting her name was Melissa, and at other times Leigh sat quietly, as if in her own world.
During one particular session Leigh had an aggressive tantrum, where she threw a vase at the therapist and ran out of the room. When she came back, quiet and shy, she asked the therapist what happened to her arm and could not remember what had just transpired. After a few months of therapy, the clinician discovered that Leigh had resumed contact with her biological mother, who had abandoned her at the age of two, and whenever she went to visit her biological mother’s home, her step-father’s nine years old son secretly sexually abused her. Soon, Leigh was diagnosed with Dissociative Identity Disorder.
The International Society for the Study of Trauma and Dissociation characterizes Dissociative Identity Disorders (DID; previously known as Multiple Personality Disorder) by the presence of more than one distinct identity or personality, each of which takes control of the person’s behaviour at different times. There is a striking inability to recall important personal information. Each personality state can have a distinct name, past, identity, age, and even various abilities and disabilities. Most of us are familiar with DID in adults, as depicted in film or TV. However, DID can also be seen in children since the disorder usually starts early due to severe neglect, abuse or trauma that occurred in childhood.
Psychiatrist Frank Putnam, National Institute of Mental Health, supports this view of the disorder’s etiology. Young children faced with severe sexual or physical abuse or neglect, have no effective way of fighting or avoiding the offender. To escape the painful reality, the only tool available during the abusive incident is that of dissociation. Separating mind from physical experience provides a sense of protection. In addition, dissociation interferes with the process of memory encoding, so that sometimes there is little or no memory of the traumatic event.
Although dissociation may help children cope with maltreatment in the short run, it can become problematic. Some traumatized children use dissociation to cope with stress in a wide variety of settings, including the classroom, playground, and at home. Frequent dissociation of memories, emotions, and thoughts interferes with normal functioning and results in socialization problems.
Accurately diagnosing children with DID can be a challenge. And often, children are misdiagnosed with more common mental illnesses such as depression and attention deficit hyperactivity disorder, leading to incorrect treatment.
Jeffrey Haugaard, a professor of human development at Cornell University outlines some symptoms in children with DID. Common signs are frequent trance-like states (“spacing out” or daydreaming), as well as the child reporting that people often become angry or upset with them for unknown reasons. Or, the child shows dramatic changes in preferences, such as food, games, or clothes, as well as changes in language, accent, or even voice or handwriting style. The child may experience recurrent periods of amnesia or missing blocks of time, such as having no memory of the previous day, which may include denying behaviours that others have personally witnessed the child do. These could be negative behaviors, but may also include behaviours that the child would appear to have little motivation to deny. Additional common signs in children with DID are having an imaginary friend well into school-age, as well as unprovoked rages and violent behaviour that may seem to come out of nowhere.
Lise McLewin, a psychologist practicing in Victoria, British Columbia suggests a few differences between the imaginary play of typically developing children and those with DID. Children with DID are much more likely to develop imaginary friends at a younger age (two or three years old), and often have more of them. These friends seem very real to the child with a great deal of reality confusion and persistent impersonation. The imaginary friend does not always “act” in the best interest of the child. And, the child may be truly unable to remember misbehaviours, blaming it on the imaginary friend.
Typically developing children better appreciate the difference between real and pretend, and that their imaginary friends are not real. They also tend to discontinue this kind of play by the age of ten.
Individuals with DID are treated mostly with psychotherapy. Nonverbal forms of psychotherapy such as hypnosis, art, and play therapy are also common because they help the patient express the trauma when it is too difficult to express verbally. Children with DID are easier to treat than adults and have higher recovery rates, so it is important to bring to the attention of healthcare professionals and parents the signs of this disorder so that it can be treated early on.
-Noga Lutzky Cohen, Contributing Writer