Functional Multiplicity As a Treatment Goal for Dissociative Identity Disorder

Is it possible to still have alters and be considered “treated” for dissociative identity disorder? Yes, and this is what functional multiplicity offers. 

Functional multiplicity is a community-created term [3], also known as “resolution” in research, and is one of two treatment goals for people with dissociative identity disorder (DID). It’s typically defined as a better quality of life while still having alters. Alters are the individual identities, or “self-states”, in someone with DID.  

A DID system who has reached functional multiplicity is able to maintain their level of treatment. The alters exist in a cooperative arrangement that allows for better functioning and adaptivity [1]. Basically, some or all alters still exist, but they work together to lessen the difficulties that amnesia causes, process trauma together and individually, and are better equipped to handle the challenges of life. 

What Defines “Treatment” in Dissociative Identity Disorder?

A clinical professional might assume that a client isn’t treated if they still have alters, because they don’t fit into the normative idea that a human must have one single identity. Functional multiplicity’s existence in research and the dissociative identity disorder community contradicts this. 

There are two treatment paths for dissociative identity disorder. One is functional multiplicity, or resolution. The other is final fusion, which is where all individual alters combine into one new self [1,2]. Final fusion is not always achievable or desired and is only successfully reached 16-33% of the time [2]. All of this combined makes functional multiplicity a valid treatment goal. 

A dissociative identity disorder diagnosis must meet five criteria, one of which is “the person must be distressed by the disorder or have trouble functioning in one or more major life areas.” If the DID system is no longer distressed by having alters, their amnesia, or other dissociative symptoms, and is able to function well, they would theoretically no longer meet the criteria for a dissociative identity disorder diagnosis and could be considered treated even if they still have alters.

Adding onto this, the final stage of DID treatment is described as “living well in the present, with traumatic memories relegated more to the status of bad memories rather than flashbacks, behavioral reenactments, and/or intense post-traumatic reactivity” [1]. All of these are possible while still having multiple alters.

How is Functional Multiplicity Achieved? 

The first stage of treating dissociative identity disorder is stabilization [1, 2]. Before trauma processing can occur, stability in the face of crisis, dissociative episodes, and life stress must be reached.

Inner communication and curiosity about alters is also prescribed in various literature and has been demonstrated to greatly improve stability [4, 5]. If alters can speak with each other, they can help with self-regulation and regulation of the system as a whole. For instance, one alter can give supportive words (through shared thoughts) when another alter is experiencing a traumatic flashback. 

Communication between alters is highly encouraged during treatment [1]. Good communication is the foundation of functional multiplicity. Defining functional multiplicity as all alters working together in harmony means collaborative communication must be a part of how that harmony is achieved. Silence between alters could never lead to the collaboration required for functional multiplicity. 

An additional step towards functional multiplicity can be understanding the missions, or roles, of each alter. When alters understand each other’s purposes for being there, they are less afraid of each other [4]. Less fear can naturally lead to an increase in positive communication. 

When alters can each accept each other and communicate with ease, it becomes easier to maintain a level of treatment and work collectively towards a better life.

Challenges Around Functional Multiplicity as a Final Treatment Goal

Functional multiplicity may be seen as a treatment path that is the best of both worlds—better functioning, without having to lose the connections between one’s alters. But, this option is not without challenges either. 

This treatment path can lead to higher states of dissociation, when compared to the other alternative of final fusion [2]. Many DID systems will self-report chronic fatigue symptoms. In my own journey, final fusion immediately resolved my chronic fatigue, whereas functional multiplicity did not. 

There is also professional and societal stigma around being multiple and living with alters, which is something that a system pursuing this treatment path may continue to face. Some of this stigma includes pressure to undergo final fusion from mental health professionals. Some notable professionals have even admitted to trying to force final fusion in their clients.

Although functional multiplicity has its challenges, it is a potential treatment goal for anyone living with dissociative identity disorder. The aim of this article is to validate this option, especially since it is so frequently dismissed by professionals for being less normative than final fusion. 

Learn More About Dissociative Identity Disorder

Mental health professionals: Join this training on dissociative identity disorder for a comprehensive introduction to the condition, based in evidence, lived experience, and community advocacy. These are treated as equally important aspects of learning how to support people with DID. 


References

[1] Brand, B. L., Loewenstein, R. J., & Lanius, R. A. (2014). Dissociative Identity Disorder. In Gabbard’s Treatments of Psychiatric Disorders (pp. 439-455). American Psychiatric Publishing. https://www.researchgate.net/profile/Bethany-Brand/publication/271770028_Dissociative_identity_disorder/links/54d17b8f0cf28959aa7b0a64/Dissociative-identity-disorder.pdf 

[2] International Society for the Study of Trauma and Dissociation. (2011, October 21). Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision. Journal of Trauma & Dissociation, 12(2), 115-187. https://www.isst-d.org/wp-content/uploads/2019/02/GUIDELINES_REVISED2011.pdf

[3] Clayton, Kymbra. (2005). Critiquing the Requirement of Oneness over Multiplicity: An Examination of Dissociative Identity (Disorder) in Five Clinical Texts. E-Journal of Applied Psychology. 1. 10.7790/ejap.v1i2.21.

[4] Öztürk, E., & Sar, V. (2016). Formation and Functions of Alter Personalities in Dissociative Identity Disorder: A Theoretical and Clinical Elaboration. Journal of Psychology & Clinical Psychiatry, 6(6). 10.15406/jpcpy.2016.06.00385 

[5] Fisher, J. (2014). The Treatment of Structural Dissociation in Chronically Traumatized Patients. Treatment of Dissociation in Anstorp & Benum. https://janinafisher.com/pdfs/structural-dissociation.pdf 

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About the Author

Hello! I’m Calion, a consultant educating mental health professionals, students, organizations, and the public about dissociative identity disorder. I have lived experience with the condition and have been studying it since 2017.

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September 15, 2021