as my understanding of and competence in treating the disorder have grown, multiple personality has come to seem, though still horrendous, less unique and incomprehensible, and thus more manageable

Somehow the disorder hooks into all kinds of fears and insecurities in many clinicians. The flamboyance of the multiple, her intelligence and ability to conceptualize the disorder, coupled with suicidal impulses of various orders of seriousness, all seem to mask for many therapists the underlying pain, dependency, and need that are very much part of the process. In many ways, a professional dealing with a multiple in crisis is in the same position as a parent dealing with a two-year-old or with an adolescent's acting-out behavior. (236)

Each alter personality had a common goal and raison d'etre, namely my survival. They didn't all realize that though, and so were at odds with each other much of the time. So I continued to be fragmented and divided.

Because of media portrayals, clinicians may believe that dissociative identity disorder presents with dramatic, florid alternate identities with obvious state transitions (switching). These florid presentations occur in only about 5% of patients with dissociative identity disorder.(20) How ever, the vast majority of these patients have subtle presentations characterized by a mixture of dissociative and PTSD symptoms embedded with other symptoms, such as post-traumatic depression, substance abuse, somatoform symptoms, eating disorders, and self-destructive and impulsive behaviors.(2,10)

It was early in my career, and I had been seeing Mary, a shy, lonely, and physically collapsed young woman, for about three months in weekly psychotherapy, dealing with the ravages of her terrible history of early abuse. One day I opened the door to my waiting room and saw her standing there provocatively, dressed in a miniskirt, her hair dyed flaming red, with a cup of coffee in one hand and a snarl on her face. “You must be Dr. van der Kolk,” she said. “My name is Jane, and I came to warn you not to believe any the lies that Mary has been telling you. Can I come in and tell you about her?” I was stunned but fortunately kept myself from confronting “Jane” and instead heard her out. Over the course of our session I met not only Jane but also a hurt little girl and an angry male adolescent. That was the beginning of a long and productive treatment.

Although Dissociative Disorders have been observed from the beginnings of psychiatry, the Structured Clinical Interview for DSM-III-R Dissociative Disorders (Steinberg 1985) was the first diagnostic instrument for the comprehensive evaluation of dissociative symptoms and to diagnose the presence of Dissociative Disorders.