EDIT: Hi everyone, this AMA has ended. Thank you for all the wonderful questions! Visit www.rebeccalester.com to learn more about Rebecca Lester's work, including her latest book "Famished: Eating Disorders and Failed Care in America" (2019).

Dissociative identity disorder (DID)—commonly referred to as “split” or multiple personalities—is a clinical psychological condition in which a person has two or more distinct identities that regularly take control of the person's behavior. DID is traditionally treated with the goal of integrating the fragmented parts, but that’s not the only solution.

In an article published by Scientific American, I shared my experience of treating “Ella” (pseudonym used to protect the patient’s privacy), a young woman with 12 different personalities. Ella’s identities ranged in age from two to 16. Each part had a different name; her own memories and experiences; and distinctive speech patterns, mannerisms and handwriting.

Read the full story: https://www.scientificamerican.com/article/a-traumatized-woman-with-multiple-personalities-gets-better-as-her-parts-work-as-a-team/

Therapists must remember that we are guests and that however much training and knowledge we may have, we can never truly know what it is like to live with a particular inner reality. The client is the true expert on their own experience. I took this approach to my work with Ella and her parts, who were adamant that they did not want integration. My goal, then, was to focus less on the number of selves she had than with how those selves worked together—or not—in her daily life. Was it possible to bring those selves into a harmonious coexistence? Ella thought it was, and so did I, so that was the mission we embarked on in therapy.

Proof: https://imgur.com/a/QSP0Wmq

Disclaimer: I cannot provide therapy on social media. Please call 911 if you’re experiencing a mental health emergency. If you are in crisis and need help, contact the National 988 Suicide & Crisis Lifeline (dial 988 or visit 988lifeline.org) or Crisis Text Line (Text START to 741-741).

Comments: 649 • Responses: 31  • Date: 

Gainesy88440 karma

What are you thoughts on the now famously debunked Sybil case? Stigma it has thrown onto DID and it's veracity as an actual disorder? Since it is impossible to ever truly know someone's inner workings do you ever have the slightest doubt that your patients are faking?

scientificamerican389 karma

Thank you for this question! This is an important issue. Because we don't have a definitive test of psychiatric conditions like x-rays or blood tests, it is always possible that someone is faking any mental illness. A trained therapist knows how to gather comprehensive information that can reveal inconsistencies or signs someone is not for real. That doesn't mean it doesn't happen. Therapists are still human. But I do find it interesting that DID is viewed with such suspicion compared to other disorders like schizophrenia. When someone tells us they are hallucinating, we only have their word for it. But we don't tend to doubt them the way we do with claims of DID. I think it's because DID challenges a really fundamental commitment of western psychiatry to a particular concept of the "self."

Mister_Terpsichore117 karma

How does your patient function with a two year old personality? I imagine there are many situations when that particular personality would put "Ella" at risk.

Also, what does the transition from one personality to another look like? Is it abrupt like a light switch? Can people with DID control it to any extent? Is there a time when multiple of the personalities can "converse" with each other?

scientificamerican155 karma


The two-year-old didn't come "out" often but was often present in the background and sometimes came out in therapy. You're right that the child parts could put her at risk. We talked about that quite a bit.

The transition between personalities was often quite subtle, often preceded by a brief pause. Ella did learn how to control her DID to a certain extent, how to call particular parts forward or try to prevent them from coming out. It didn't always work, though.

The only time I witnessed parts actively conversing with each other was over email. They would sometimes email each other and copy me on the emails.

warnerg88 karma

Has anyone done a brain scan on a DID patient to see which parts of their brain light up during each personality’s appearance? I’m curious to know whether the different personalities live in different areas of the brain.

scientificamerican152 karma

They have! People with DID have different brain scans on fMRIs than people who pretended to have DID (as part of the study).

dot123478 karma

What were some of the major breakthroughs that contributed to the end result of “community” within the individual?

scientificamerican122 karma

The most important thing was helping Ella's parts communicate with one another in a way that felt safe and manageable. She started by using external tools, like keeping a common notebook or journal. That helped her get to know her different parts and what each of them needed in order to feel heard and safe. One we understood her system and what specialities different parts had, we could help them learn to work together.

scientificamerican105 karma

The most important part, though, was building trust. This meant essentially building a new therapeutic relationship with each part.

scientificamerican118 karma

Another huge breakthrough was when two of Ella's parts that had been in really intense conflict began working together for a common goal.

rexarooo65 karma

Do the younger personalities "age" (or mature) or are they perpetually stuck at those ages?

scientificamerican102 karma

In Ella's case, they all remained stuck at the age they were when the trauma happened.

Fallen31162 karma

How can you tell what would be I guess the "primary" identity? Their true self

scientificamerican188 karma


Well, that's an interesting question. I don't necessarily believe there is a "true self," for Ella or any of us, really. We all have parts--just for most of us, there's not a disconnect among them. For Ella, the person who originally came to see me for therapy was referred to by the parts as "Big Her," and they insisted she was not a real person but just a shell.

mlperiwinkle57 karma

Was any of your approach based in IFS ?

scientificamerican73 karma

Yes! I'm trained in IFS and I found it incredibly helpful as a foundation to work from.

MNConcerto49 karma

Worked with a client who was diagnosed with DID. She later denied it was true and denied the severe abuse and trauma she experienced. The diagnosis was confirmed by several reputable providers, we documented distinct identities in our interactions with her. The abuse and trauma was also well documented and proven.

Could this be one identity becoming dominant or protective by suppressing the others and the trauma?

scientificamerican38 karma


It's quite possible, yes.

Clown_smasher66649 karma

I'm curious to know what your exact thoughts are, as a professional with experience, on the sort of stuff that young kids and teens on tiktok are doing by making claims that they have DID, and I suppose, the same going for people who call themselves a "system"?

I run into so many people saying that they're part of a "system" of multiple fictional characters.

scientificamerican77 karma

This is a fascinating phenomenon. We can't know for sure who does or doesn't have DID from seeing them on TikTok. As an anthropologist, I wonder why this is trending NOW. What is it about claims to multiplicity (whether "real" or not) that has become so meaningful for so many people? And why the impetus to share publicly? I will say that Ella went to great lengths to HIDE her condition from others. She absolutely didn't want anyone to know. That doesn't make talking about it publicly wrong or necessarily indicate it isn't real, it's just an interesting contrast.

the_honest_liar41 karma

When you first met her, did Ella understand what was going on? Or from her perception did she think she was she just experiencing blackouts?

I'm curious if people with DID can recognize what's happening or if it's usually family/friends that are realizing what's wrong first?

scientificamerican103 karma

When we first met she did not know what was going on. It wasn't until about a year in that she started sharing her experiences of "spacing out" and weird things happening, like stuff being moved around in her room or conversations people referenced that she didn't remember happening. It wasn't until the 7yo part came out in therapy that either of us realized what was actually happening.

No_Information465740 karma

What do you feel are the biggest misconceptions of DID?

scientificamerican94 karma


Some of them are that anyone who claims to have DID is faking. DID is a real disorder.

Another is that someone with DID dramatically switches among alters so that it's super obvious to everyone what's happening. Often it's quite subtle.

Another is that they are completely anomalous. DID is an extreme condition of something that is actually quite common in the human experience.

tyme71 karma

DID is an extreme condition of something that is actually quite common in the human experience.

Could you expand on what you mean by this?

scientificamerican194 karma


Sure. We all have "parts" of ourselves. What we experience as our "self" is really a dynamic system of different aspects of our ways of being in the world. For example, I have a perfectionist part that is diligently trying to answer every question here or wants to get everything done on deadline, etc. I'm not really experiencing my "mom" part at the moment, which is more present when I'm hanging out with my kids. For me, those different parts still feel like "me" and I remember things from each experience without difficulty. With DID, the parts we all have are so dissociated from one another that they don't share consciousness or memory.

ExtraDistressrial36 karma

Do you have advice for children of people who had DID? One of my parents did while I was a teenager it was horrifying. Apparently she does not have it any longer, which is equally mystifying to me. Nevertheless, the scars I have…

scientificamerican60 karma

I'm so sorry to hear this. That must have been incredibly difficult. My best advice is to seek your own therapy with a therapist who takes DID seriously. That's incredibly important.

Sullyville35 karma

If the eldest decided to drink or have sex, isnt that child abuse towards the younger selves?

scientificamerican99 karma

This is such a good question and brings up some of the thorny ethics involved. This did happen in this case. If the older part engaged in sexual activity, the younger parts experienced this as abuse because they were not consenting to it. What then to do as a therapist? There's nowhere to report the abuse because the body was 19 years old, not 7 or 2. So it required a lot of "family therapy"-type work with the parts to help the younger ones understand the older one's right to engage in age-appropriate behavior, while also helping the older one understand how it affected the younger ones. They eventually came to some workarounds that everyone could live with.

VanessaClarkLove34 karma

Does someone with DID have one personality that is their ‘main’? For example, with Ella, is there an Ella personality that is the main one, the one with a license, job, who pays taxes, etc?

BassWingerC-13728 karma

Yeah, who paid the bill for all of this work? Did someone show up saying "I dont know what this is? I'm not paying?"

scientificamerican62 karma


In this case, Ella's parents paid for her therapy. They were not aware of the DID, but did know of her extensive trauma history.

Tianoccio33 karma

In their head are they like in a room? How do they decide which personality comes out? Do they fight for position?

scientificamerican56 karma

This was something we worked on in therapy, coming up with some sort of figurative space where the parts could encounter each other. Ella imagined like a big living room that had other rooms branching off of it.

As far as deciding who comes out...sometimes it seemed random or could be triggered by something external. As Ella got to know her parts better and started to build community, they could often agree on whom would be out. They did sometimes fight for position, which was really uncomfortable and distressing for her.

mystik8933 karma

Man I have SO MANY questions. Given the difference in age ranges between Ella’s personalities, how did they reach agreement on topics such as “we don’t want integration”?

In this case my question is not as clear since it seems the oldest was 16yo, but what if there was a 30yo personality defending that only she can make a true adult decision about this, overriding everyone else? How do you coach this from a therapist perspective? Do people with DID usually recognize one of their personalities as the main one?

Being mindful of patient data protection, generalizing also this question: can a person with DID have personalities that are older than (and I’m sorry, I don’t know how to phrase this respectfully) the “real individual”?

scientificamerican51 karma

Such great questions! On integration, the parts were absolutely agreed they did not want it. In terms of other decision, there were often power struggles, especially between "Ada" (the 16yo part) and "Violet" (the 7yo part). Sometimes Violet or one of the younger parts wanted to do something that was absolutely not appropriate (like playing with stuffed animals during a college lecture). In those cases, Ada would often assert her authority as the eldest. The other parts were a bit intimidated by her so they tended to listen.

As far as therapeutically, I encouraged consensus building rather than autocracy in how the parts managed community, so it was only in extreme situations having to do with safety that I would back a more top-down decision.

I'm not sure if there have been cases with a part older than the body. Interesting question.

sherilaugh32 karma

How do the splits with DID differ from splitting in BPD?

DramDemon32 karma

As someone with an SO that has BPD, I’m interested in this as well. From what I can tell DID splits are more “complete” so to speak, whereas BPD splits still acknowledge being the same person.

scientificamerican50 karma

Yes, exactly. I think of them as being on a continuum.

jester3230 karma

Fascinating, but to play devil’s advocate, how would validating the parts of her identity be conducive to a successful life? Rather than focus on the issues underneath which could even have a chance of bringing together he identity?

I’m thinking like having the 7 yo appear when driving or when studying for exams in school or job prospects. It doesn’t seem like a very sustainable treatment to me. Is it more of a case of a severe mental illness that would prevent this ‘normal’ life either way?

scientificamerican27 karma

Well, it's not either/or. We definitely focused on the trauma that produced the parts in the first place. My view was that as she worked through the trauma, perhaps the need for separate parts would diminish. But perhaps not. As long as they could all coordinate and collaborate so that, for example, only the 16yo part was allowed to drive (which they agreed on), she could function quite well.

prylosec27 karma

How do other identities work when they aren't active? Is it similar to turning a phone off where any activity is effectively halted, or is it more like shutting the screen off where tasks can still be executed in the background?

scientificamerican75 karma

Great question! I imagine it's different for everyone, but for Ella the parts that were not active were often kind of operating in the background, but some were stronger than others. There were occasions where parts "went away" completely and then later returned. When I asked where they had been and what it had been like, they said it was just nothingness and they had no memory of that time.

thesweeterpeter18 karma

How do pop culture representations of DID relate to reality?

Specifically I'm thinking of Doom Patrol, as your intro and approach reminds me of the Jane narrative.

Thanks for doing this

scientificamerican58 karma

Pop culture is getting better with how it represents DID. It used to portray it as dangerous and violent, a kind of Jekyll and Mr. Hyde thing. Most people with mental illness, including DID are NOT violent. They are much more often the targets of violence. Doom Patrol is a good example. The United States of Tara was also pretty accurate, from what I could tell.

homesickexpat16 karma

What’s the link between DID and trauma? Can people have it without trauma? How do the different identities cope in one body (for example the 2 year old’s response to puberty)? Lastly, you sound like a perfect fit for this patient—how did she find you? ETA Just realized many of my questions are answered in the article!

scientificamerican47 karma

DID is most often linked to significant trauma, whether abuse or something like a natural disaster or torture situation. I have not heard of anyone having it without trauma. The different identities did have a hard time being in a 19yo body. Ada (the 16yo part) coped ok, but the younger ones had a really difficult time during menstruation, for example. Some found it scary, others found it gross and disturbing. The younger parts also struggled with the normal kinds of sexual feelings a 19yo body can feel. This was terrifying for them. It was a real challenge for her.

Ella found me through a referral from a university colleague who taught Ella in one of her classes. Ella had two incidents of psychogenic seizures in class. She disclosed a bit to my colleague about what was going on, and the colleague referred her to me.

i_just_haveaquestion12 karma

What was the most helpful part of your background in anthropology when treating this patient?

scientificamerican47 karma

Understanding that our western notion of the self as unitary, whole, bounded, and singular is a cultural construct. There are lots of different ways that humans understand subjective experience. Our view of the self is just one among many.

strayaares9 karma

How does it feel for you to be trusted in such a way to work with Ella?

Thank you for your work.

scientificamerican19 karma

It's awesome in the sense of inspiring awe. I feel so incredibly honored. It's a huge, huge gift, and a responsibility that I take extremely seriously. For someone to allow you to accompany them in this way is an experience beyond words. I feel that way with all my clients.

paul_caspian8 karma

Are there any similarities between the treatments you provide for DID and the Internal Family Systems framework? I noticed your use of the term "Parts" which is, of course, a major part of IFS. I was treated via the IFS framework - although not for DID or related areas - and found it incredibly helpful. I'm interested if there's a crossover in terms of approaches, getting different identities to harmonize, permissions from other parts, a central sense of "Self" etc.

scientificamerican13 karma

Yes, there are a lot of similarities! I am trained in Internal Family Systems therapy, and it definitely informed my approach. There are some differences, but there is a lot of crossover as well.

Phasnyc4 karma

Are there different voices with each identity?

scientificamerican25 karma

Somewhat. The 7yo part's voice was a bit higher than the 16yo part's. Their speech patterns were very different and I could also tell which part was writing an email before I saw the signature based on syntax and tone.

GreenerGrassOrPass1 karma

I'm too embarrassed to let anyone know of my DID because of how it's been presented through social media. Mine looks NOTHING like theirs do, so I feel like I'm a fake. I don't want to be one person, I like that I have another person to take on the harder stuff, or to keep me organized and get important things done. Is it OK to not want to treat my DID? I am in therapy and have been for 3 years to improve coping skills and there is a lot less switches, but to get 'rid' of it completely seems terrifying.

scientificamerican28 karma

I can talk in generalities here. In my opinion, there are situations where not getting rid of DID can be a good outcome. That's what happened with Ella. Her parts did work together much better over time and started to share some co-consciousness, but it didn't go away. In my personal opinion, the question is how well someone is functioning in their daily lives and if they are able to live life to the fullest extent that they want to. If someone can do that without getting rid of DID completely, I don't personally see a problem with that. Not all clinicians would agree, though.