[Disclaimer: I have used aliases to protect the confidentiality and identity of clients or patients. No other names have been changed.]

In the last chapter, I mentioned the interaction that I had with Jessica and her alters. I also mentioned that there were two other clients that I had who might have Dissociative Identity Disorder (DID).

I want to help you, dear reader, to understand dissociative disorders because it can this can be confusing and seem more complex than it is. Also, we all have experiences that are trance-like or dissociative in nature that would be problematic if these experiences were happening very frequently or for long periods of time.

Consider zoning out or driving to work and realizing that you made the entire trip on autopilot and you cannot remember anything from your drive. If someone was in the car with you that might be problematic or if this happened frequently.

Distress and lack of control are other key factors that concern us – whether I am speaking as a mental health professional or speaking from personal experience. People come for help when things are happening that bother them or cause them problems.

My own experience with hypnosis has been very valuable in understanding dissociative disorders and how the mind and body respond to stress and trauma.

Derealization is a symptom in more than one dissociative disorder. It's a subjective feeling or sense that things are not real... that they are more like a dream. Some people report a sensation in which they are looking at the world as if through a fog – perhaps it's no surprise that in movies and TV shows this device is used to indicate a dream sequence.

Sometimes you might recall being aware that you were dreaming, or you are unsure if you have awakened. This subjective experience can be disturbing for us, or it has been for me. Eventually, I wake up and all is fine. The frequency and the severity of things like this are what differentiates normal experiences from those that cause a person to seek therapy.

Depersonalization describes another class of symptoms that are found in more than one dissociative disorder. This is a sense that part of our bodies is far away or distorted. They might feel like they are standing next to themselves.

I can recall experiences like this from my hypnosis training or sessions. The hypnotherapist might refer to the hand instead of your hand. This might help with creating numbness to eliminate a sensation of pain. I have had experiences in a trance where I could get rid of tension or other headaches.

People who experience panic attacks have described alterations in their perceptions of parts of their bodies, almost like they are growing or floating up off the ground. These would be similar to depersonalization-derealization as found in dissociative disorders.

This should begin to make these mysterious disorders seem less so. Even if you haven't had a panic attack what I just described might not seem all that hard to imagine.

LCD and psilocybin (magic mushrooms) are said to create similar alterations in perceptions – with objections and colors moving in a kaleidoscopic swirl-like looking through some cylindrical object with an eyehole at one end.

Personally, I have never knowingly ingested any of these mind-altering substances. I say knowingly because later I had some unusual experiences on a few days in 2000.

Identity disturbances are also found in dissociative disorders as well as in anorexia. In the latter case, a sufferer may perceive her body to be much heavier than it actually is. With dissociative disorders, a person might report that at times they do not recognize themselves.

Again, some of these phenomena (experiences) might seem like natural things that happen to us all from time to time. Other experiences might seem very unusual if this is not part of your own experiences.

If these phenomena happen a large percent of the time for a person, they might be experiencing a dissociative disorder of some type. The distress that they feel is what brings them in for therapy.

People with DID will report hearing voices of people having conversations inside their heads. This is common in schizophrenia as well.

Diagnosing DID and Dissociative Disorders

As stated elsewhere, dissociative identity disorder (DID) has been considered the most extreme form of dissociative disorder, and it includes many of the symptoms of other dissociative disorders, such as dissociative amnesia, and derealization- depersonalization disorder.

One has to rule out various other explanations for a person's problems.

I had found the Dissociative Experiences Scale to be helpful in talking to clients about these things. As the name implies, it deals with experiences. These are subjective experiences. It helps the client realize that their own experiences are not so unusual as they imagined and they are not alone.

This scale is developed and copyrighted by Eve Bernstein Carlson, Ph.D. & Frank W. Putnam, M.D. In this discussion, I am taking examples from the DES-II. Here is a link to the website where you can view the DES-II, as well as get a score: http://traumadissociation.com/des

This is more of a screening instrument. It helps the client and the therapist to understand the symptoms and experiences of the client.

After a client completes one of these questionnaires, I would ask them "what is that like?" – a very open-ended question to get them to elaborate. This is a process of exploration that usually goes on for some time.

Sadie and Patricia, who I mentioned previously, had been aware of these experiences for some time and could identify with what was being described in the newspaper article about the workshop.

Jessica and another two women were referred to me by John Freifeld. He had told me that he was running an online community for people who are dealing with addictions. When he referred Jessica to me and I read the transcripts of her conversations with John, I was concerned that she had not seen a more qualified mental health professional before she "discovered" she had these other personalities.

When I spoke to him, he began to act as he knew more and more about these disorders with each conversation. He had gone out of his way to say that he was "just a support person" in a way that sounded defensive.

I asked whether he had any training in the field and he said that he had not. He had not even had college courses in psychology as I had at Georgia Tech when I was studying engineering. John said he only had some technical coursework from a community college.

I am summarizing different conversations, but it was clear from his own admission that he didn't have any credentials that would qualify him to provide treatment or make diagnoses.

I became increasingly bothered about what he did with Jessica and others. Jessica was talking about how John was helping her every day and she said he was helping others who had the same problems.

I don't remember the exact moment that I heard all these things. I am summarizing my observations.

The idea that he happened to run into more than one person, Jessica, with this rare disorder while he was running an online community for alcohol and drug addictions is bizarre and disturbing. He was running a 12-step based treatment program online. They were using the model of AA – Alcoholics Anonymous – and NA – Narcotics Anonymous."

Jessica described him as "the leader" of the online community.

To which I said, "but there are no leaders in AA or NA."

She got a bit defensive and said, "no, but he runs the community."

She then started talking about some problems he was having with some of the people he was helping. I cannot recall the details of this discussion other than the fact that he had admitted to her and others online that he wasn't a therapist.

She said, "now he calls himself a support person."

"So, people thought he was a therapist?" I asked, adding "he has been telling me from the beginning that he doesn't have special training in the field or anything."

I noticed a phenomenon that I learned in social psychology that we will find ways to justify our actions once we make a choice. Jessica needed his help when she wasn't meeting with me, or so she said, and this allowed her to overlook what concerned a person like me.

She was overlooking the fact that she knew he had lied and misrepresented himself and his skills or expertise. It would seem to me to be common sense that if someone said they were a therapist that would mean they had a graduate degree in psychology or an allied field, such as social work, along with certain credentials.

He had referred two other women named Tracy and Alice for therapy with me as well and that was sometime after he referred Jessica to me for treatment/therapy for DID. I'll discuss their situation later, but I wanted to state that it was hard for me to imagine that someone running a 12-step AA/NA program would run into one or more people with such a rare disorder.

Some of the effects of drugs can mimic dissociative symptoms but those experiences do not continue to exist when they are not under the influence of a drug or in withdrawal.

I have been focusing on dissociation that is related to stress, anxiety, and trauma because these are problems that I can treat as a mental health professional.

I cannot treat medical conditions.

There has been an open debate about who can diagnose a mental illness. Obviously, only a doctor can diagnose medical conditions, and mental illness or psychiatric disorders can be caused by medical conditions.

Another important factor about diagnosing this condition is related to the complexity of the problem. There has been some concern expressed in the literature that the condition might be iatrogenic – caused by the interventions of the therapist. So, there was a reason to be concerned about the "support" interventions of John.

Jessica was the first referral that I got from John but not the only one. Two others came to me also believing that they had DID. I wasn't John's partner, but I did want to help anyone who reached out to me, however, they found me.

I was trying to point out to my clients that what he was doing was similar to what I was doing as their therapist. I explained that he was doing things that a therapist does and that it is not good to be getting treatment from more than one person, even if the other person was trained in the field.

Things were about to getmore complicated.