ABSTRACT
Some people with DID, despite years of DID-specific therapy (using the three-phase approach, ISSTD, 2011), seem unable to get better. In particular, they seem unable to remain physically safe (“Phase One”) and report continued exposure to abuse. As every fresh hurt causes fresh dissociation, their DID becomes further entrenched over time. Moreover, as dissociation makes the person more vulnerable to being re-abused, they become caught up in a vicious cycle, which further obstructs their efforts toward recovery. In this paper, I propose the existence of two distinct presentations of DID, a Stable and an Active one. While people with Stable DID struggle with their traumatic past, with triggers that re-evoke that past and with the problems of daily functioning with severe dissociation, people with Active DID are, in addition, also engaged in a life of current, on-going involvement in abusive relationships, and do not respond to treatment in the same way as other DID patients. The paper observes these two proposed DID presentations in the context of other trauma-based disorders, through the lens of their attachment relationship. It proposes that the type, intensity and frequency of relational trauma shape—and can thus predict—the resulting mental disorder. It then offers an initial (partial) classification of trauma-based attachment modes and their corresponding symptomatic sequels. The analysis and formulations presented in this paper are based on attachment theory and extensive clinical observations.
