With DID, ego states can become dysfunctional. The more an alter remains hidden to the person, the possibility of harmful, even life-endangering behaviors also increases. For example, a client comes to therapy because her partner is very concerned about recent suicide attempts. Upon inquiring, it was learned that the client had no recollection of suicide attempts, and in fact, suicide was in direct conflict with her spiritual beliefs and values. Diagnostic work revealed she had a “self-loathing ego state” who was trying to kill the client because she did not deserve to live. This ego state or alter of hers had taken on much of the painful abuse she had undergone as a young child. She had unconsciously assigned an ego state to take this pain, in order for her overall personality to not be burdened with it or impaired by it. Unfortunately, even though this pain was being housed in a part of her personality, the pain didn’t disappear, it manifested as self-hatred and self-disgust which contributed to these suicide attempts.

The fact is, the pain this part of the client took from the abuser was real. It did not go away and had to be controlled and managed in such a way so as to not bring too much interruption to the client’s life, so she could work and manage daily tasks of living. As often is the case with ego states in pain, the pain can’t remain repressed and has to be expressed somehow, most often in some kind of damaging behavior.

When the boundaries of an ego state are relatively permeable and flexible, we think of it as normal and adaptive. When the boundaries become rigid and impermeable, such as the case with the client’s self-loathing ego state, it is called dissociated. The client referred to “walls in her mind” that separated those highly painful and traumatizing experiences. 

In many cases of DID, an “Introject” is formed to represent outside people, and these introjects typically believe they are separate people, but they are, in fact, part of the DID system. For example, a mother introject will tell you what to do, how to behave, what to say, the same as the actual outside mother. The main purpose is to control your behavior when you are away from your mother with the same intensity as if you were right in front of her in order to remain safe. A “Persecutor Part” can be the same as an introject, but not always. They are alters that internalize the rules of the perpetrator and continue to follow those rules. An abuser often gives some form of twisted logic for their abusive actions, like “you made me do this because…” The survivor depended on not doing or saying the wrong thing at the wrong time, so the persecutor/introject hopes if you do everything right, you might prevent some of the abuse from happening. In some cases, if a person has overidentified with her abusive parent, persecutor alters can present as an abused child who grows up and then harms her own children.

By not challenging the ego state’s unique identity, but by increasing the communication of ego states with each other we encourage an adaptive togetherness and unity. Ego states can have co-consciousness with each other, meaning no events or experiences will remain hidden from other parts. This work helps clients learn their ego states so that the parts may find new roles to best help the client navigate life, professionally and personally. The formerly dissociated ego state becomes an ego state which cooperates with the other ego states in the personality system, as they work to maintain the individual’s inner and outer worlds. Parts can learn to come out when their behavior is appropriate and helpful. It is not uncommon for many of the original alters, when their need for separateness no longer exists, disappear spontaneously, their energy and capacity fusing into the remaining ones. The remaining differentiated entities are now simply - functional ego states – and the individual manifests only one personality to the outside world.

There is treatment for Dissociative Disorders and DID. We utilize various combinations of Ego State Therapy, the Dissociative Table Technique, EMDR and Brainspotting.

Dissociation is best understood as stretching along a continuum of severity. On the left side of the continuum are things that we all do, like highway hypnosis, daydreaming, and a child’s imaginary play. In the middle are symptoms from Acute Stress Disorder and PTSD, such as flashbacks, detachment, depersonalization, and derealization. This happens when an individual dissociates or checks out from the traumatic experience, as it exceeds his or her ability to cope. To the right of the continuum are symptoms of Dissociative Disorders where individuals can experience fugues and trance states. On the far right of the continuum is Dissociative Identity Disorder (DID), previously termed Multiple Personality Disorder, where there is the presence of separate parts or alters (also referred to as ego states) of the personality which functions independently of one another. There is often amnesia between an alter’s activities and the primary personality. The absence of this amnesia is called co-consciousness, which is always the goal in treatment.

Original ego states came into being to help the primary personality adapt and remain safe. These ego states remained because they were successful in these functions. They further developed to enhance the individual’s ability to cope with a specific problem or situation or to absorb pain in the case of trauma. Parts originate out of the unique needs of the individual, particularly with demanding interpersonal relationships or significant challenges. An example is anger turned inwards. It is a sign that you didn’t have permission to be angry as a child. It wasn’t safe enough to express anger when you were younger, because the adults around you could not tolerate the intensity of the experience, so an alter formed to hold that unexpressed anger and it was turned inward instead of expressed. (For more information on parts and alters, refer to Ego State Therapy and Structural Dissociation.)