The sad part is, treatment for actual severe dissociative disorders is the same as treatment for PTSD. A person who legitimately has something like what the DSM entry for DID is supposed to cover has been through severe trauma during an early developmental stage, everyone diagnosable with DID has PTSD. A genuine diagnosis of any type of severe dissociative disorder is not made out of the blue, because the problems will be obvious. The vast majority of real DID diagnoses are made after 10+ years of other diagnoses, because it’s obvious something is wrong, DID is just not literally multiple personalities that introduce themselves to you. - most common misdiagnosis is bipolar disorder. Lou has not even been on the radar. He can’t get any kind of social assistance as he constantly reminds everyone (until he gets himself that DID label.) This “DID” out of the blue is a red flag, and he’s going to struggle to get an actual, reputable diagnosis from someone knowledgeable in dissociation, that other doctors will take as a serious diagnosis of dissociation and not just a demanding patient jumping on the bandwagon.
But the treatment for DID is the treatment for PTSD, and the vast majority of people with severe dissociative disorders are made worse by separating it further and personifying and naming every dissociative episode, and focusing on being “multiple” or a “system.” People with genuine DID may never receive the actual label, if being given the diagnostic label is not necessary to treat and heal the dissociative condition, or if viewing the symptoms through that lens will make healing and coming to function in the world too difficult. The real condition is not at all about multiple personalities. It’s severe PTSD and dissociation, and as long as you’re lucky enough to access treatment for that, you don’t actually need to “discover your system”, personify or name your dissociated responses. You deal with the dissociative, phobic reaction to the reminders of your terrifying childhood, and you move on. Or you wind up homeless and struggling to hold it together, and not in the cute, ebegging way.
Lou wants to be able to explore his “multiple personalities” with a therapist holding his hand and validating, while he uses the roleplaying of multiple personas to process his life and dysfunction and maybe find more happiness and better functioning, all while fleshing out a “multiple personality system” to play out online and in grifting circles. It’s actually very popular right now, to get “medically recognized,” but it’s nothing like DID and the treatment is not the same. It’s almost like they’ve found a way to get BPD patients to engage with treatment.
Honestly, Internal family systems therapy would probably be really good for people like that. It even has system in the name.
