Plurality from a medical perspective

Everything We say here can be confirmed externally. Please be critical and compare what We say against the ICD-11, DSM-5-TR and modern replicated psychology studies. When We reference “DSM” or “ICD” without specifying which version, We’re refer to these versions.

Throughout this page, We reference those sources, sometimes with direct links, sometimes with unlinked diagnostic codes. Any reference without a link is only lacking one because We have not found a reliable location to link to, but reliable information can still be found at the reference material that the diagnostic code refers to.

We encourage you to employ critical thinking while reading this page, including checking Our sources for any signs that they might not be reliable.

Glossary

The following uncommon terms are used in this page:

• Plurality – A state of existence where there is more than 1 person sharing the same body/head.
• Headmate – A person who exists sharing their head with at least 1 other person. The other is also called a headmate.
• System – A form of plurality where the headmates tend towards specialties in how to manage the body’s life.
• Dissociation – When one’s mental state is momentarily removed from that which is external to one’s body.
• Dissociative – Something is considered to be dissociative when it exists due to dissociation
• Integration – The state of having recovered from a severe chronic mental disorder which had once caused the brain to be strongly compartmentalized. An integrated brain is typical in that it is not strongly compartmentalized.
• Fusion – When 2 or more headmates become 1. The resulting fusion often has their own distinct identity, but not always.
• *PTSD – Post-Traumatic Stress Disorder – This disorder involves moments where the subject is struck with flashbacks or similar dissociative episodes regarding the trauma which caused the PTSD, but otherwise can live a non-disordered life.
• CPTSD – Complex PTSD – A form of PTSD where the subject’s whole life is affected by disorders caused by the trauma which introduced the CPTSD.

Disordered Plurality

DID

Dissociative Identity Disorder, or DID (ICD 6B64; DSM F44.81), is a form of disordered plurality where multiple distinct identities share a body, separated by memory barriers. These are often referred to as “headmates” (not a medical term).

Diagnosis of DID requires 1 body to experience all of the following:

• Multiple distinct personality states, which could identify as anything ranging from variations on a single person, to completely separate people with completely separate identities/perspectives/etc.
• At least 2 of these states take executive control of the body
• When a personality state takes over, their senses/affect/cognition/memory/motor-control/behvior/etc. *are different than the one which was previously in control**
  • Tends to be comorbid with Dissociative Amnesia (ICD 6B61; DSM F44.0)
• These experiences can’t be better described as something like Schizophrenia or similar - These experiences can’t be better explained by the use of a psychoactive substance, withdrawl symtoms, seizues, sleep-wake disorders, etc.
• These experiences are a disorder, meaning they cause significant imparement/distress to the body’s ability to live a normal life, be that personal, familial, social, educational, occupational, or otherwise. The body might still be able to make it through these, but that would be through significant effort of those piloting it.
  • Broadly-accepted cultural/religious experiences don’t count
  • Childrens’ imaginry friends and similar also don’t count

If any one of these isn’t met, then the person cannot be diagnosed with DID under the ICD nor the DSM.

It’s important to note that this demonstrates a key part of modern psychology: In order for something to be considered a disorder, it must be an internal cause of clinically-significant distress in the subject’s life.

P-DID

Partial Dissociative identity Disorder, or P-DID (ICD 6B65), is a form of disordered plurality, similar to DID, but more subtle.

Diagnosis of P-DID requires the same criteria as DID except:

• One of the personality states, often called a “host”, is dominant and functions in daily life (like work, school, parenting, etc.), and the othes take over for more specific scenarios.
  • The host sees this as interfering with the host’s daily life
• Memories tend to be at least partially shared

UDD

Dissociative disorders unspecified (ICD 6B6Z), or Unspecified Dissociative Disorder, or UDD (DSM F44.9), is a placeholder for when a psychology doctor (psychitrist) can tell that there’s a dissociative disorder, but can’t assign a specific diagnosis to it.

OSDD

Other Specified Dissociative Disorder(s), or OSDD (ICD 6B6Y; DSM F44.89) is like UDD, but the doctor can tell enough about it to at least give it a general category.

The ICD doesn’t offer any specific categories for the doctor to use in this diagnosis, but the DSM offers these examples:

1. Chronic & recurrent syndromes of mixed dissociative symptoms – This can include things like DID with soft or no memory barriers
2. Identity disturbance due to prolonged & intense coercive persuasion – This is what you tend to see in depictions of “sleeper agents” and other such conditioning
3. Acute dissociative reactions to stressful events – basically temporaary dissociative disorders such as derealization/depersonalization, caused by a specific event and lasting about a month or less.
4. Dissocitive trance – Where someone basically sleepwalks while awake. Many DID/P-DID systems experience this from time to time.

You’ll notice that examples 1 and 2 would fall under P-DID. Since the DSM uses these examples under OSDD but provides no concept of P-DID, and the ICD provides P-DID but has no examples under OSDD, some plurals say they are OSDD-1 or OSDD-2, rather that DID/P-DID/etc..

You’ll also notice that examples 3 and 4 don’t describe a plurality experience. That’s on-purpose! Not all dissociative disorders involve plurality, and not all plurality involves a dissociative disorder.

What causes disorderd plurality?

The modern understanding of how DID, P-DID, and OSDD-1 most commonly start, falls under the theory of Structural Dissociation, and occurs as follows:

1. Every human is born with no personality nor identity at all.
2. Through the first year or two, distinct personality states start to form. The infant occupies exactly one of these at a time.
   • This can be thought of as a form of plurality, but that thinking is uncommon.
3. The personality states start gaining more awareness and definition as the child ages.
   • This can be described as a form of plurality, which is the basis for the theory of Structured Dissociation.
4. Throughout the human’s childhood (ages 4~12), the personality states typically fuse into one solid identity; one person. In a typical/ideal childhood, neither the child nor their caretakers notice this; it’s just seen as maturation.
5. If the child experiences significant and persistent trauma in these formative years, the personality states do not fuse, and instead remain separate.
   • Natural maturation still occurs, however, so each personality state separately stabilizes into solid identities; many people. This state of existence will remain until the trauma that disrupted fusion is addressed, although addressing that trauma does not imply fusion (exactly why is discussed in the next section).

Because of this, DID/P-DID/OSDD-1 are almost always comorbid with CPTSD. They can be considered symptomatic/subsets of CPTSD. Because of this, the term “traumagenic” (not a medical term) was coined in reference to the fact that these forms of plurality originate from trauma. Plurality origin: traumagenic.

These forms of disorderd plurality are natural, and evolved in order to allow the body to proceed with life, address the traumas later, and to be the person needed to tackle these recurring traumtic scenarios.

Because humans are a social species, they have to fit into their tribes to be accepted. Since the typical human is a singlet, that means that traumagenic plurals instinctively deny/ignore/are-blind-to their own plurality. This is referred to as a “covert disorder” (not a medical term).

Healing from disorderd plurality

Because disordered plurality comes from trauma, the best defaault treatment plan is to address that trauma. There are many long-accepted ways to do this; for example gently moving in and out of flashbacks until they’re just painful memories, then regularly recalling those until they’re just normal memories without pain.

Each specific trauma event requires its own specific way to address it, and no one solution fits all, but generally addressing these traumas will resolve the CPTSD which underlies the disordered plurality, and will thus resolve the disorder.

Because of the way dissociative plurality is created, many of these traumatic memories are locked away in one headmate’s specific memories, inaccessible to all others. This means that addressing that specific trauma necessrily means talking to that specific headmate.

While it’s possible for disordered plurals to fuse into a singlet, or to place all but one member into dormancy, these actions can’t address the CPTSD trauma, and can in fact make it more severe, make it harder to address, and even cause new traumas.

After (or to facilitate) integration, fusion can be a useful tool if all members of the fusion agree & consent completely, but the CPTSD trauma still needs to be addressed either way.

Non-disorderd plurality

As you can tell from the diagnosis requirements for DID, P-DID, and OSDD-1, plurality would have to cause clinically-significant problems, in order to be diagnosed as a disorder.

This means that, if your plurality does not cause clinically-significant distress/impairment in personal/family/social/work/school/etc. life, then it’s not DID/P-DID/OSDD/etc., and it’s not disordered.

These forms of pluralty are not discussed in the DSM/ICD, and generally not discussed in medical literature, because they don’t cause problems. There’s simply too much to worry about for these organizations to bother concerning themselves with people who are living happily.

• This was not always the case; earlier (1920s~2010s) medical literature considered all forms of plurality/homosexuality/transgender/etc. to be disorders because they deviated from the writers’ expectations of normality. Outdated editions of the DSM/ICD and their predecessors exhibit this.

Formerly-disordered plural systems

There are various ways that a traumagenic plural system can live without their plurality being a disorder.

Integrated unfused formerly-DID/P-DID/OSDD systems

These are plurals who once had DID/P-DID/OSDD, and have since resolved all the trauma that created their disordered plurality, integrated their memories into one shared memory pool, but still remain plural.

Self-regulated traumagenic plurality

This is when a plural system which came about due to trauma, like a DID system would, finds ways to live their life without clinically-significant distress/impairment caused by that plurality.

Never-disordered plural systems

There are multiple ways that a plural system can come about without that plurality ever being a disorder.

Here are two which are generally useful to know about.

Endogenic plurals

These are plurals whose plurality arose through non-traumatic means. Whether intentionlly or not, headmates joined through something other thaan trauma.

As mentioned above, this isn’t studied very much in medical literature because it isn’t a medical concern.

Tulpagenic plurals

These are plurals who decided to intentionally manipulate their psyche to cause plurality. Headmates created intentionally like this are often referred to as “tulpas”.

These are considered a type of Endogenic plural. Just like any other endogenic plural, tulpagenic plurals aren’t studied very much in medical literature because their plurality isn’t a medical concern.

tl;dr

DID, P-DID, and OSDD-1 are subcategories describing “plurality that develops out of trauma, usually early in life”. These are colloquially called “traumagenic” plural systems.

A subject must experience clinically-significant distress caused by something within themself in order to consider that thing a disorder.

According to the theory of Structural Dissociation, everyone starts out as plural, but this plurality isn’t usually noted, and most folks slowly fuse into a singlet throughout their childhood. Trauma between the ages of 4~12 can disrupt this fusion and cause permanent plurality.

Traumagenic plurality is almost always comorbid with CPTSD.

CPTSD is treated by addressing each traumatic event individually until there is no more CPTSD trauma. Other traumas might still exist, but not have contributed to CPTSD.

When a disordered plural’s CPTSD treatment is complete, their plurality is generally no longer disordered.

Traumagenic plurality naturally means that these traumas are separated across various headmates.

Treatment for traumagenic plurlaity therefore requires talking to individual headmates about their traumas, and addressing them individually and specifically.

Suppressing/ignoring the headmates only makes everything worse.

Other forms of disordered plurality also exist, but aren’t as well-documented.

Non-disordered forms of plurality also exist, which aren’t tied to trauma, like tulpas. These are colloquially called “endogenic” plural systems.