Understanding Dissociation and DID: What It's Really Like, and How People Recover | Being Well

Dissociative Identity Disorder: A Clinical and Personal Exploration

In this episode of Being Well, host Forest Hansen is joined by Dr. Melissa Kaufman, a trauma psychiatrist at McLean Hospital and Harvard Medical School, and Dr. Lauren Labois, a cognitive neuroscientist and assistant professor of psychiatry at Harvard Medical School. Together, they explore dissociation from everyday experiences to the clinical reality of dissociative identity disorder (DID), formerly known as multiple personality disorder. Dr. Kaufman, who personally experienced DID and made a full recovery, offers a rare first-person perspective alongside current neuroscience and treatment approaches. The conversation challenges popular media portrayals, clarifies what DID actually feels like, and emphasizes that dissociation is an adaptive response to trauma—not a defect.

Understanding Dissociation: From Everyday to Clinical

Dr. Labois defines dissociation as a disruption in the typical experience of consciousness. It exists on a broad spectrum:

• Everyday dissociation includes common experiences like “highway hypnosis,” where a person arrives at a destination without remembering the drive.
• Derealization involves feeling detached from surroundings, as if the world is dreamlike or surreal.
• Depersonalization is a sense of detachment from one’s own body, thoughts, or sense of self—like observing yourself from above.

What unifies these experiences is a loss of agency and ownership over one’s thoughts, feelings, memories, or body. Dr. Kaufman adds that dissociation can be understood as a discontinuity in integration—across perception, memory, attention, motor control, or sensation.

What Is DID? Beyond Media Stereotypes

DID is often portrayed in movies and social media as dramatic, rapid switches between flamboyant personalities. Dr. Kaufman explains that this is largely inaccurate. DID is a “disorder of hiddenness”—intense internally, but usually subtle externally. Research suggests about 95% of people with DID have a subtle, internal presentation, while only about 5% show more overt, dramatic symptoms.

Dr. Kaufman describes her own childhood experience of having “inside people”—a gang of kids living in her mind. There was a frightened little girl in a box, an angry boy, and later a composed “nice lady” who handled public speaking. These self-states felt real, vivid, and deeply “not me.” She knew this was unusual, but the experience was accompanied by confusion, concealment, and shame.

The term multiple personality disorder is problematic because it reifies these experiences as separate personalities. Dr. Labois emphasizes that people with DID are one person with one mind, but subjectively experience fragmented self-states. As Dr. Kaufman puts it:

“People with DID have a strong sense of self, but it’s fragmented. There’s no more or less sense of self than what you have, what I have now.”

Origins: Trauma, Adaptation, and Biology

DID universally begins in early childhood and is a post-traumatic adaptation to severe, prolonged abuse and neglect. However, trauma alone is not sufficient. A child must also have a biological capacity to dissociate—a trait distributed along a normal curve in the population. Children naturally use personification and displacement to manage conflict, such as saying, “My teddy bear is mad at you, not me.” In a highly dissociative child facing unbearable harm, this ordinary mechanism becomes a way to separate overwhelming experiences into “not me” states.

Crucially, this is not role-playing or a conscious choice:

“This is not a conscious decision. It’s not role playing. It’s not play acting. It’s really an unconscious adaptation that helps the child psychologically survive.”

The Neuroscience of Dissociation and DID

Dr. Labois describes key brain findings using symptom provocation paradigms, where participants listen to recordings of their own traumatic memories during brain imaging. Two regions are central:

• The amygdala, a salience detector that flags threats.
• The ventromedial prefrontal cortex, an executive controller that acts like the brain’s brakes.

In classic PTSD, the amygdala is hyperactive and the prefrontal cortex is underactive—producing emotional flooding and hyperarousal. In the dissociative subtype of PTSD, the pattern reverses: the brakes are on too tightly, leading to numbness and detachment. In DID, the same person can oscillate between these two patterns depending on which self-state is active. Simulation studies, in which actors are trained to mimic DID, consistently fail to reproduce the brain activity of genuine DID—strong evidence that DID is not role-playing or therapist-induced suggestion.

Clinical Controversies and Clarifications

Dr. Kaufman addresses the question of suggestibility. People with DID are not more susceptible to false memories than psychiatric controls; trauma history, not suggestibility, predicts dissociative symptoms. However, they are more susceptible to hypnotic suggestion, because trance states share features with dissociation. This distinction has often been conflated in past controversies.

The conversation also clarifies the difference between IFS “parts” and DID self-states. Everyone has self-states—such as being a different version of yourself at work versus with friends—but DID involves amnestic barriers and intrusive, personified self-states that feel like someone else. Despite this fragmentation, people with DID are not lacking a self; their sense of self is simply compartmentalized.

Treatment and Recovery

The gold standard treatment for DID is relational psychodynamic therapy, built on a safe, consistent therapeutic relationship. Treatment is often described in three non-linear phases:

1. Stabilization and safety—building grounding skills, recognizing dissociation as it happens, and titrating trauma exposure so the person feels in control.
2. Trauma processing—gradually working through traumatic memories with a sense of ownership.
3. Integration—developing a cohesive sense of self and a life that no longer relies on dissociation as a primary defense.

Dr. Kaufman emphasizes the importance of giving patients choice and control over whether and when to discuss traumatic material. A newer manualized phase-one treatment, Finding Solid Ground, has shown promising results in randomized controlled trials.

The term trauma-informed care has become diluted, but at its core it means recognizing the prevalence of trauma, asking about it, understanding problem behaviors as adaptations, and being mindful of power dynamics—both at individual and institutional levels.

Recovery looks different for everyone. For some, healing means self-states becoming cooperative and less distressing, even if they still exist. For others, like Dr. Kaufman, full recovery means no longer experiencing distinct self-states at all. A common fear is losing an aspect of oneself, but as Dr. Kaufman discovered, the “nice lady” did not disappear—she simply became integrated into a fuller sense of “me.”

Key Takeaway

Dissociation is not a defect; it is an adaptation that helped a child survive. The most important element in treatment is the therapeutic relationship—steady, consistent, and humanistic. People with DID and other dissociative conditions can be helped by good clinicians, even without specialized credentials, as long as the work is paced well and built on trust. Recovery is possible, and resources such as traumacontinuum.org offer education and advocacy for those affected by trauma and dissociation.