What It’s Like to Live With One of Psychiatry’s Most Misunderstood Diagnoses - Dissociative Identity Disorder
- What It’s Like to Live With One of Psychiatry’s Most Misunderstood
- Diagnoses- A Randomized Controlled Trial Assists Individuals With Complex Trauma and Dissociation in Finding Solid Ground
- Finding Solid Ground program
What It’s Like to Live With One of Psychiatry’s Most Misunderstood Diagnoses - Spurred by her past struggles with dissociative identity disorder, she has devoted her professional life to studying it. By Maggie Jones
Maggie Jones interviewed more than two dozen people who have been diagnosed with dissociative identity disorder along with nearly 20 experts. Jan. 30, 2026.... Experts in trauma have long argued that D.I.D. is an ingenious survival tool born in childhood. It typically begins by the time a child is 5 or 6 as a response to repeated abuse, often by a caregiver. Before about 6 years old, children generally have not yet formed a coherent sense of self. They may have imaginary friends or displace their own thoughts or feelings onto stuffed animals. (“My bunny is sad. He hates school.”) They may believe they will become a princess or Superman. It’s all psychologically typical, and over time, most children develop a unified self.
But for a small subset of abused children who have a capacity to dissociate — which experts theorize is in part genetic — developing a unified self becomes disrupted. To endure the physical and emotional pain, their mind makes it seem as if it is not happening to them but to someone else, someone inside them. “When it’s too overwhelming to feel such fear, too dangerous to feel what is happening to their body, they feel like that’s not me,” Kaufman says, noting that the phrase “me, not me” captures a core feeling for people living with D.I.D. And because children frequently don’t tell anyone about the abuse, the feeling of having inside people can be soothing.
Often people with D.I.D. unconsciously create an angry “part” as a protective mechanism, which tries to silence other parts that bring up traumatic memories. Many girls create boy parts, explains Richard Chefetz, a psychiatrist who treats people with complex post-trauma and dissociative disorder, because they believe if they were male, the abuse would not have happened. Other parts — like Kaufman’s nice lady who helped her speak in class — have certain skills that keep children engaged in school and in the larger world and help them experience humor, joy, hope.
That’s the adaptable aspect. But the flip side is that if a child has D.I.D. their mind doesn’t follow the usual developmental pathway to form a coherent self. “It’s like a jigsaw puzzle, where the pieces have never fully been put together,” explains Richard Loewenstein, a pioneer in dissociative research and treatment and the founder of the trauma program at Sheppard Pratt, a psychiatric medical center in Baltimore. While we all have self-states — a work state, a social state, a family state and so on — “most people who are well integrated can move among their different parts” without feeling unstable, says Frank Putnam, an expert on child abuse and dissociative disorders and a professor of psychiatry at the University of North Carolina School of Medicine.
Most people, too, experience some dissociation — when they drive from the grocery store to home with little memory of how they got there, or they lose track of time while immersed in a video game. But for those with dissociative disorders, the experiences are more pervasive, intense and disruptive. They may regularly feel disconnected from their thoughts, feelings or bodily sensations, a psychological phenomenon known as depersonalization. They may also experience derealization, in which the world seems blurry, dreamlike or unreal.
People with D.I.D. have both, along with fragmented self-states, which often cause them distress and can make daily functioning difficult: Among other things, one self-state can be unaware of actions taken by another state....
But in contrast to the 1980s and 1990s, neuroscientists now have more clues about how severe dissociation appears in the brain. In the late 1990s, Ruth Lanius, a psychiatrist and neuroscientist who is the director of the PTSD research unit at the University of Western Ontario, was running a PTSD study using a standard approach for measuring responses to trauma memories: A person narrates a memory, which is recorded and then played back during an fMRI scan. Typically, the subject’s heart rate, blood pressure and activity in their amygdala — which facilitates the fear response — increases.
One subject had been so horrifically abused as a child that Lanius expected the narrated memory would trigger a flashback and the woman would feel as if she were reliving her trauma, causing her heart rate to spike. Instead, to Lanius’s surprise, as the woman lay in the scanner, her heart rate dropped. Lanius had her listen to her trauma narrative two more times with the same result. When she interviewed the woman afterward, the subject said she felt numb and completely disconnected from her body. In further studies, Lanius was able to pinpoint areas of the brain that suggest subjects like her have a dissociative subtype of PTSD. In response to trauma, their brains — unlike classic PTSD patients’ — blunt arousal: Activity in their amygdala decreases, while processing in a part of the frontal lobe, where emotions are controlled, increases.....
A Randomized Controlled Trial Assists Individuals With Complex Trauma and Dissociation in Finding Solid Ground - Brand, B. L., Schielke, H. J., Putnam, K., Pierorazio, N. A., Nester, M. S., Robertson, J., Myrick, A. C., Loewenstein, R. J., Putnam, F. W., Steele, K., Boon, S., & Lanius, R. A. (2025). A randomized controlled trial assists individuals with complex trauma and dissociation in Finding Solid Ground.Psychological Trauma: Theory, Research, Practice, and Policy, 17(8), 1717–1727. https://doi.org/10.1037/tra0001871
Objective: Evidence-based treatments are urgently needed for individuals with trauma-related dissociation (TRD), including severe dissociative disorders, the dissociative posttraumatic stress disorder (PTSD) subtype, and complex PTSD (International Classification of Diseases-10). TRD is strongly associated with severe trauma, a more refractory treatment course, and high suicidality and nonsuicidal self-injury. We evaluated changes in symptoms and adaptive capacities in individuals with high TRD through participation in an adjunctive online program based on the Finding Solid Ground (FSG) psychoeducational program. Method: We provide an interim report on an ongoing, randomized controlled trial of FSG on an international sample of 291 outpatients with dissociative identity disorder, dissociative PTSD, other specified dissociative disorders, complex PTSD, or dissociative disorder, unspecified (International Classification of Diseases-10). Outpatient therapists continued to provide psychotherapy. Participants were randomly assigned to either receive immediate access to FSG or be on a 6-month waitlist before accessing FSG. We did not exclude for suicidality, nonsuicidal self-injury, recent or concurrent hospitalization, or substance abuse. Results: Although initially comparable on outcome measures, at 6 months into the study, the Immediate FSG group showed significant improvement in emotion regulation, PTSD symptoms, self-compassion, and adaptive capacities in comparison to the Waitlist group. At 12 months, the Immediate group showed large effect size changes in these areas compared to study entry (tra_17_8_1717_math1.gif s = 0.95–1.32). The Waitlist group showed comparable improvements after accessing the FSG program for 6 months. Conclusions: This randomized controlled trial demonstrates that adding FSG to psychotherapy of individuals with TRD results in improvements in emotion regulation, PTSD symptoms, self-compassion, and adaptive functioning.
Prospective and retrospective cross-cultural studies in clinical and general population samples of children, adolescents, and adults find that dissociation is a partially genetically mediated, transdiagnostic psychobiological process related to trauma (American Psychiatric Association, 2022; Loewenstein, 2018). Studies demonstrate that high levels of dissociation are linked to multiple types of severe trauma, most commonly childhood maltreatment and/or neglect. Dissociation is associated with earlier age of onset, greater severity, and longer duration of maltreatment and, particularly, maltreatment by primary attachment figures (Dutra et al., 2009; Lyssenko et al., 2018; Vonderlin et al., 2018). The Diagnostic and Statistical Manual of Mental Disorders, fifth edition, text revision dissociative disorders (DDs) are strongly linked to antecedent trauma, particularly the most symptomatically severe and complex DDs (CDDs), dissociative identity disorder (DID), and other specified dissociative disorders....
These findings indicate that FSG offers an evidence-based method to assist dissociative patients and the therapists that work with them. Such materials may also be of particular help to clinicians learning how to better serve these populations (Kumar et al., 2022; Nester, Hawkins, & Brand, 2022). A major strength of FSG is its systematically structured, sequential approach to psychoeducation and skill-building that emphasizes individualized pacing. This program allows for repeated access to educational materials and appears to help both patients and therapists to conceptualize and work systematically on basic goals of trauma treatment: stabilization of severe symptoms and development of safety and recovery-based ways to self-regulate. This is the antithesis of the approach proposed by researchers who advocate rapid, intensive focus on trauma processing (e.g., van Minnen & Tibben, 2021) and who aver that stabilization is unnecessary for trauma treatment. In our model, stabilization is defined as developing recovery-oriented self-regulation that reduces reliance on high-risk behaviors, including NSSI and substance abuse. These behaviors drive treatment at more restrictive levels of care and may disrupt therapy; increase treatment costs; and reinforce a sense of failure, shame, and demoralization.
Stabilization of dissociative symptoms is another defining aspect of stabilization. Dissociation declined over time for participants in both groups....
This RCT shows that FSG is an evidence-based stabilization-focused program for individuals demonstrating high levels of trauma-related dissociation and substantial comorbidities. The effect sizes were large for symptom improvements after 1 year of FSG. In view of the challenges and high health care costs associated with trauma and dissociation, it is promising that this program is associated with amelioration of severe symptoms, adaptive capacities, and self-compassion. The inclusion of patients irrespective of the severity of their symptoms, safety issues, or other comorbid conditions suggests broad applicability of this program. https://psycnet.apa.org/fulltext/2025-86664-001.html
EASY-TO-UNDERSTAND SUMMARY: FINDING SOLID GROUND PROGRAM
What is the Finding Solid Ground program, and how is it unique?
Finding Solid Ground is a program that Ruth Lanius co-developed with Bethany Brand and Hygge Schielke, and they co-authored the book for clinicians and workbook for clients on this innovative approach for helping people with dissociative disorders. Finding Solid Ground is the first research-backed program for trauma-related dissociative disorders. Finding Solid Ground is a program that Ruth Lanius co-developed with Bethany Brand and Hygge Schielke, and they co-authored the book for clinicians and workbook for clients on this innovative approach for helping people with dissociative disorders. Finding Solid Ground is the first research-backed program for trauma-related dissociative disorders.
Unlike trauma treatments that focus solely on narrative or exposure-based work, Finding Solid Ground begins by helping clients build the foundational skills needed for emotional and relational safety. The book and workbook guide therapists and clients through the program, which provides an evidence-informed, practical, and accessible approach for the stabilization and treatment of patients with complex trauma and dissociation. You can learn more about the book and workbook on our Books page.
The Finding Solid Ground program teaches 4 crucial skills:
Grounding
Separating past from present
Healthy ways of regulating emotions
Getting healthy needs met safely
Complex trauma refers to repeated and prolonged exposure to traumatic events - often during childhood, and at the hands of parents and/or other early attachment figures. Dissociative disorders, including the dissociative subtype of PTSD, involve feelings of significant disconnection, including disconnection from one’s body, emotions, memories, surroundings, and/or personal identity. Typically, this type of disconnection begins as a way to endure terrifying events when physical escape is not possible, for example during physical abuse, military combat, or a horrific car accident.
At its core, dissociation is a survival response, and one that can become automatic whenever a threat, or perceived threat, is present or approaching. While this response can help someone get through horrible experiences, it is difficult to “turn off”, even after the person is safe and the threat is long gone. Dissociation can really disrupt people’s lives by interfering with their ability to emotionally connect with family and friends, to notice sensations in their own body (hunger, pain, etc.), to know who they are/what they want, and to navigate their environment, to name just a few examples. For this reason, it is important for us to find an effective treatment for dissociative disorders. https://www.ruthlanius.com/finding-solid-ground-summaries
