Theories of Dissociation: Integration of Subjective Experiences of Multiplicity and DID

Abstract
Dissociative Identity Disorder (DID) and the related dissociative experiences that accompany it present complex clinical challenges in both diagnosis and treatment. Despite its high prevalence, identification of the disorder can be difficult due to its covert nature and a lack of accurate diagnosis often delays onset of treatment significantly (Nester et al., 2021). Treatment for DID requires specialized clinical training and involves protracted intervention that can be arduous for both clinicians and the clients, as clients often require extensive external support for safety and stabilization prior to addressing complex trauma (Dorahy et al., 2014). While significant advancements have been made in the field, many theories of dissociation that inform current treatment models fail to integrate the subjective experiences of individuals with DID, particularly in relation to the experience of multiplicity. Multiplicity presents the unique subjective experience of more than one first-person point of view, each of which bilaterally experiences the cognitive and emotional content of the others as dissociative phenomena. This project evaluates prominent theories of dissociation to identify common omissions related to subjective multiplicity and internal bilateral dissociative experience. Major theories, including the 4-D Model (Frewen et al., 2022), the Structural Theory of Dissociation (van der Hart and Moskowitz, 2018), and the Attachment Model (Farina, Liotti and Imperatori, 2019) will be discussed and considered from this unique perspective. Utilizing a multidisciplinary approach to inform further theoretical development, anthropological theories of dissociation and multiplicity in a cross-cultural context will also be examined. Incorporating data from the subjective perspective of individuals experiencing multiplicity has the potential to foster theoretical, phenomenological, and intersectional research that can consider previously overlooked aspects of dissociative experiences, including post-clinical outcomes in which people with DID retain the subjective experience of multiplicity without distress or impairment, to provide evidence-based direction for instances when unification is unattainable or undesired (Lester, 2022; Blunden and Billie, 2021). A more accurate characterization of post-clinical experiences of multiplicity has the potential to not only inform treatment models, but also supply guidance for medical and mental health care services to better meet the unique needs of these underrecognized individuals (Eve et al., 2023). Expanded theoretical models that are responsive to perspectives accounting for bilateral dissociative experience could more comprehensively account for the full spectrum of experiences of dissociative identities and thus could lead to the development of novel treatment models and applications to better provide clinical support for this highly underserved population.