Handling different names and switching between parts
As someone with dissociative identity disorder (DID), I aim to help people understand this rare condition better. I’ve previously written about what it was like to discover I have DID, what it can be like to handle religion when you have DID, and what myths exist about DID — and why they’re wrong. Now I want to handle two more delicate issues: respecting the different names that the personalities inside someone with DID, and whether or not you have the right to force someone with DID to switch from one personality to another.
To provide some background context, according to Karlyle Bistas and Ramneet Grewal, in their article “Unraveling the Layers: Dissociative Identity Disorder as a Response to Trauma,” DID is more common than you might think, and it takes years to diagnose:
"In the United States, the 12-month prevalence of PTSD is 4.7%, with 14.4% of PTSD cases meeting the criteria for the dissociative subtype [1]. DID is observed in 1%-1.5% of the general population [4]. Patients often undergo treatment for five to 12.5 years before receiving a DID diagnosis [14]."
For those unfamiliar with this mental health disorder, Cleveland Clinic explains the symptoms of DID in this way:
"Having at least two identities (personality states). These affect your behavior, memory, self-perception and ways of thinking.
Amnesia or gaps in memory regarding daily activities, personal information and traumatic events.
Different identities affect your ability to function in social situations or at work, home or school."
A few terms should be defined upfront to minimize confusion. In modern clinical terms, the different “personalities” inside someone with DID — which used to be named multiple personality disorder — are most often called parts, identities, self states, or personality states. In older terminology, they are also personalities or alters, but I personally can’t stand the term alters. Each person with DID has their own preference about terms, so just ask them. For the rest of this article, I will call them self states.
The clinical name for the collection of self states inside a person with DID is System. Out of respect to my System, I now always capitalize it. That also distinguishes it from the generic term system, such as a computer system. (Some people with DID hate the term System because it sounds too cold or mechanical, so always ask them what they prefer.)
Disclaimer: I don’t have a PhD in psychology; I only have a BA. This is not medical advice. I am speaking from both personal experience and the lived experiences of my life partner, Keith, who also has DID.
Now let’s begin!
Respecting Names of People in DID Systems
Perhaps one of the better known facts about DID is that different self states in the System have individual names. These individual self states will be a mix of male and female, and perhaps even third gender, so there will be both male and female names.
Part of respecting a friend or loved one with DID is asking them if they wish to be called by their legal name or by their individual self state names. Whatever the answer is, abide by it. Think about it this way: If your name is John, and someone insists on calling you Joe instead, wouldn’t you be irritated? Or what if your name is John, and someone insists on calling you Janet? That would infuriate you.
So what happens if someone has a really unusual name in the System? It doesn’t matter if someone is named Lord High Snugglebottoms III; if that is their genuine name in their System, you have no right to call them anything else. Your embarrassment is nothing compared to theirs if you mis-name them. It is exactly the same debilitating experience as a transgender person being misgendered. Since a person with DID only has one body and one face, our vibes (or energy patterns, as some psychologists call them) and our names are all we have. If you cannot either read vibes or sense energy, then all we have for you are our names. Don’t disrespect that.
Other than unusual names, another phenomenon you might experience is meeting someone with DID who has titles instead of names for their self states. An example can be found in a case study reported by Bistas and Grewal:
"He describes experiencing 11 distinct personalities [self states], yet he provides detailed accounts of only two. One personality, labeled “Macho Man,” emerged when he felt undermined or threatened, exhibiting directness, loudness, and confidence. Another personality he identified was the “Security Guard,” activated when he sensed he was being followed or watched."
You might be tempted to find “Macho Man” humorous, but notice that this self state protects his System by being confident when the System feels threatened. That’s no laughing matter.
Neither Keith nor I, Patrick, have people with fantasy novel-style names or who go only by titles. However, we do have people with names from other countries not the U.S. To the everyday American, these names would sound strange or perhaps even funny. However, in other countries they would be normal names, and Keith and I want to be called by our self state names everywhere not at work or among strangers. At work and around strangers, we go only by our legal names.
However, not everyone is like Keith and me. Some people with DID have unusual or highly creative names, not names you can find in a baby name database. So, again, even if the self state says her name is Queen Etherellia of the Skytide, you just need to roll with it. If she tells you she is an 800-year-old elf, then roll with it. She’s not insane. (DID is not a psychosis.) This is the persona she has decided on in order to help her System. Perhaps seeing herself as an old, wise elf places her in the position of protector of her System. Or perhaps she doesn’t want to be seen as a human because humans have only ever hurt her. Seeing herself as an elf helps her love herself more. That’s nothing to make fun of.
The key to this is respect. If your name is Robert, but you only want to be called Bob, then people should call you Bob. If your name is Suzanne, and you never want to be called Susie-Q, then no one should call you Susie-Q. Most people respect those kinds of things. Respect it for self states, too.
Forced Switching by Other People and Emergencies
“Switching” is the act of changing who is speaking for the System. For example, if there are three self states in the System, and they’re named John, Tom, and Ruth, then switching would be changing who is speaking from John to Tom or from Tom to Ruth or from John to Ruth.
In cases where the person is in treatment, someone with DID can learn to switch whenever they wish to, although triggers may cause them to switch involuntarily. Triggers that cause switching are clearly outlined by Aubrey Bailey, PT, DPT, CHT and include heavy stress, strong emotions, memories/flashbacks, and a special event or holiday. When the person with DID has no idea what their diagnosis is and isn’t in treatment for it, switching may be completely random and/or uncontrolled. Also, since all brains are highly individual, some people with DID might never gain full control of switching no matter how much therapy they have. Keith and I have gained a high level of control, although heavy stress and PTSD flashbacks can still cause involuntary switches in us.
Does this mean that other people can purposefully induce a switch? At least for Keith and me, this is possible. People who know us well enough to know a few self state names can sometimes force a switch by unexpectedly calling a particular self state’s name. However, doing so without our permission would be unspeakably rude. You’re yanking around on the insides of someone’s brain when you do that. It’s like running an experiment on them without informed consent.
Because the issue of forcing a self state in a DID System to switch with another member of their System is a highly charged topic, it should be navigated with each person’s System individually. This is a serious discussion you would need to have with your friend or loved one. And I cannot stress this enough: Do not ever try to force a switch without the permission of authority figures within the System. (Each System typically has at least one authority figure. That person might have a title such as Mother, Father, Captain, General, Director, President, or even CEO. They might also identify themselves with the appellation Protector or Security Guard.) Forcing a switch may cost you your relationship with your friend or loved one. As I said, this is tantamount to experimenting on another person’s brain without permission.
Also, keep in mind that you don’t know what kind of debilitating physical symptoms people within a DID System may deal with as a result of a forced switch; a short list of symptoms includes dizziness, vertigo, nausea, vomiting, headache, and migraine. Also, an unauthorized switch will most likely cause the security guard(s) or protector state(s) in the System to mobilize and yell at you for physically harming the System.
However, there is an important exception: If the self state who is currently talking for the DID System causes imminent danger to themselves that could result in severe injury or death, then forcing a switch without permission might be the only way to save the person from hospitalization or death. For example, if one member of the System becomes suicidal, then you need to help your friend or loved one switch to someone in the System who is not suicidal. Then the suicidal feelings can be dealt with by the System as a whole. (As the Cleveland Clinic explains, people with DID can be at risk: “More than 70% of people diagnosed with DID attempt suicide or practice self-injury behaviors.” This is because of the level of trauma they have experienced.) Even so, keep in mind that they might never forgive you or that certain members of the System might hold a grudge, especially the self state who was switched against their will.
The best thing you can do if you know a loved one or friend has DID is to negotiate this before emergencies arise. When it is O.K. with them for you to initiate a switch from the outside, assuming that is possible in their System? (Accept that the answer might be never.) How can you help them handle any physical symptoms that may result? What methods are acceptable to stimulate members of their System to switch places? Is it safe to initiate a switch while the person is driving?
I can say this from personal experience: The only person who has permission to switch me without warning is Keith. My friends must ask me if they can speak to a different member of the System, and if I’m not sure why, then they need to tell me. For example, they could say, “Mark knows all about herb gardening. Can I talk to Mark for a few minutes? I have some questions about herbs.” Then, if that causes me (i.e., Patrick) no particular issues, I will switch with Mark. This is not, however, permission to badger me until I switch to someone you simply feel like talking to. “I like Mark better than Patrick” is not a valid reason. Mark and Patrick are still parts of the same person, so don’t badger us to switch like we’re an animal performing in a circus.
As a gentle word of advice, I will also say that if you have a loved one or good friend with DID, it is generally a good idea to talk with more than one self state in the System so you can get to know them — assuming, of course, they want to be known.
Remember, DID is the result of severe childhood trauma, so the person with DID may be understandably hesitant to allow more than one self state in the System to speak with you. The members of the System need to feel safe, supported, and loved before they open up to you.
Conclusion: Basic Human Respect
In a word: be nice. DID sounds exotic, but because it is a response to severe childhood trauma and is always paired with complex PTSD, it is a tough road to travel. Having people treat us with kindness and understanding while we heal is a genuine help. But also keep in mind that, yes, we can heal. According to Bistas and Grewal, DID is far from hopeless:
"Individuals who have access to treatment often experience a significant reduction in symptoms [1]. Treatment for DID typically follows a three-pronged approach: establishing safety, stabilization, and symptom reduction; addressing and integrating traumatic memories; and promoting identity integration and rehabilitation [14].
Keep in mind that “identity integration” doesn’t mean combining all the self states into one. It means not losing time between self states. We will always have more than one self state, which means those self states have individual names, and in a vast majority of cases, we will always be switching."
If I can underscore only one fact, then I want to say this: People with DID are still human. DID is a coping mechanism that child employ to survive high-level trauma and abuse. We are not “insane,” and we can live normal lives, despite what Hollywood might show you. Our worst problem tends to be complex PTSD from trauma, not the fact we have a System. So all we’re looking for is the same friendships and relationships that others have. Granted, we have a few unique things about us, such as multiple names, but everyone has something. And everyone in the world is owed basic human respect.
References:
Bailey, Aubrey. “Dissociative Identity Disorder: Identity Switch Triggers.” Very Well Health, 5 Sept. 2024. https://www.verywellhealth.com/dissociative-identity-disorder-switching-5212103.
Bistas, Karlyle, and Ramneet Grewal. “Unraveling the Layers: Dissociative Identity Disorder as a Response to Trauma.” Cureus, vol. 16, no. 5, 2024. https://pmc.ncbi.nlm.nih.gov/articles/PMC11185985/.
“Dissociative Identity Disorder.” Cleveland Clinic. 7 June 2024. https://my.clevelandclinic.org/health/diseases/9792-dissociative-identity-disorder-multiple-personality-disorder.
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