What Do You Do About Mental Health Warning Signs in DID?

January 21, 2011 Holly Gray

What do you do about DID mental health warning signs once you notice them?I'm not sure how to respond without resorting to dissociation. What do you do?

If you have dissociative identity disorder, dissociation is your primary coping mechanism. As such, it's both adaptive and maladaptive. It allows you to continue functioning despite overwhelming stress. But dissociation is also what prevents you from recognizing that you've fallen off a cliff until you hit the ground. The idea behind taking stock of mental health warning signs is to notice your free fall a little sooner. Ideally, you'd eventually have the awareness to see the edge of the cliff from a distance and avoid it altogether.


I've been thinking a lot lately about a reader comment that illuminated the missing piece of this plan. She wrote,

About 2 hours ago, something happened somewhere inside that felt like parts of me just crashed. But I am still going. Then I've just read your list, and I'm now like "oh okay, maybe I need to recognize some big red flags!" Problem is - what do you do once you recognize the red flags?!

Awareness is the antidote to all things dissociative identity disorder, and any improvement in that direction is something to be proud of. But pride aside, what good is recognizing mental health warning signs if you don't know what to do about them? Ultimately, lasting change - getting to the point where you can see the edge of the cliff and move away from it - requires not just recognizing mental health warning signs but responding to them in a way that halts and reverses the free fall. In other words, decreasing dissociation isn't enough. We also have to do something. But what?

I Don't Know What to Do about Mental Health Warning Signs

Photo by Peter ShanksOne thing I know about many people with dissociative identity disorder is that they started not just falling, but being tossed off of cliffs very early in life. The first few times they might have recognized what was happening and tried desperately to cling to the edge or, barring that, scream for help. But when there were no other options, and all of their resources were exhausted, dissociation cushioned them not from the fall, but from the awareness of it. As a result, many adults with DID haven't the foggiest idea what to do when they get into any kind of trouble. I certainly don't.

In my experience, the demands of daily life are unrelenting regardless of how sick, tired, terrified, or injured I am. So what if I recognize my mental health warning signs? There are still:

  • Chores to do.
  • Kids to feed.
  • Bills to pay.
  • Expectations to meet.

Life doesn't wait for us to catch our breath. Still, I know there are solutions here that don't include my old stand-by, dissociation. It's possible for me - and you - to learn to recognize mental health warning signs and rescue ourselves before we hit a wall. Let's brainstorm. We're going to have to figure this one out together.

APA Reference
Gray, H. (2011, January 21). What Do You Do About Mental Health Warning Signs in DID?, HealthyPlace. Retrieved on 2024, June 16 from

Author: Holly Gray

March, 4 2021 at 4:43 pm

I have not yet been officially diagnosed with DID but I/we know. I don’t know that I’ve fully accepted it. Parts of me have. I have been making deals and compromising with the alters who are aware...that my “core” is aware of. I believe my alters have been so helpful even though some of them are incredibly dysfunctional and self destructive. I feel lucky to have this feeling of a calm, almost knowing feeling that my whole system loves me and really wants the best for me/us. We just don’t know how. And if we do feels like we know how, someone stops us. Out of fear and protection. We have (the ones I know of...there seem to be groups or clusters of “me”) agreed to work together but there are a few pesky ones in the background daring is to try...
I say love, patience and trust are key.

October, 20 2016 at 8:02 am

I'm not sure if I have DID or not, but I've found when I'm extremely stressed out, there are a few things that help calm me pretty well. First, I put on a fitted jacket, and pull it tight around myself. Something about the pressure that creates is soothing, like being hugged. Second, I try to find a quiet space away from people to let myself cry and panic as overtly as I can manage. I've noticed my dissociative symptoms are reduced after I've let some emotion show. It seems as though I get exhausted from hiding my stress all the time, so letting it out gives some release of that tension. It also helps if I overtly express joyful emotions too. I don't really sing or dance in public, but I've noticed that doing those things when I have alone time allows me to bounce back from problems more easily. If you notice yourself starting to crash but aren't quite in the dumps yet, do things like laundry in advance, so you'll have fewer obligations when you are struggling. Cleaning things seems to give me a huge energy boost (Perhaps that's related to the fact that my family is made up of recovering hoarders). Play is also very good, for example I enjoy indoor rock climbing. Be sure to hydrate, it's good practice anyway, and being dehydrated can make you irritable. (If you don't drink water much, try standing and walking around on an empty parking lot for a few hours on a hot day, and you'll gain a new appreciation for it.) Try sitting outside for a while, the fresh air is helpful, and making friends with your local birds is a rewarding challenge to go after. If you happen to have some disposable income saved up, I highly recommend getting a gentle massage. Distraction is another coping method I've found that's quite powerful if used well. I used to get menstrual cramps that were extremely bad. Sometimes they were accompanied by nausea, I got so sick I had to go home from school on the worst ones, and overall it was just awful. One time I was having a bad cramp, and a voice in my head quietly asked, "what are your favorite flowers?" I was a bit confused, but I mentally started listing them, and when I had mentioned about five flowers, I noticed that my cramps were gone. I haven't had any problems with cramps since then. Now if I notice myself starting to panic, I try to find something that's mentally challenging enough to force me to think about something else, like trying to remember 15 state capitals, or what the last six foods I ate were.
I hope some of my coping methods will help you all. :D

System Called Leslie
September, 18 2014 at 5:47 pm

For us, pushing too far beyond the initial red flags will result in psychosis. The include immersion (thank you for lending us the word), lack of self-care, child-like thinking, anxiety that turns into muscle spasms, a sudden inability to focus and it all becomes foggy after that. We tend to dive into psychosis from there. We go to an ashram when it starts happening, before we reach the cliff's edge. We found a guru we trust (he's no longer alive, which makes him easier to trust), and a place we feel safe. And we go there and regroup and regain our grounding. Our therapist, Bruce, said it is very important to include spirituality in our solutions and highly encourages our meditation practice. It helps a lot. Having some place where we feel safe has made a huge difference. It allows us to work full-time and take care of our two kids. The house is a mess most of the time (with the occasional exception of when one of the personalities goes on a cleaning rampage, but she's not out and about very often), but all things considered, it's a pretty monumental feat to care for a disabled child, an infant and work full-time.
KJ, thank you for posting about how anxiety can affect the body. I always knew it was something to be watched closely when the muscle spasms start creeping up the legs and into the back. And yes, we have a couple of highly-sexualized alters and a couple confused kids whose abuse history drives the older alters acting out. We've found that it's all connected. The trauma link one to another get more complex and harder to sort out with each traumatic experience until it's a tangled mess. Perhaps undoing all the knots is the point where integrations happens. I hope so.

February, 4 2011 at 8:54 am

I can not be much help in the brainstorming arena, because I haven't yet figured out what to do. I see warning signs, but only because I just started a WRAP (Wellness Recover Action Plan) and have only begun to see what was always right in front of me. ..the triggers...the warning signs.
Most of my issue is trust. Isolation is the key, so far, because I don't want my kids to see me fall apart, I cannot afford to stop working, and although I have a therapist who has proven themselves time and again to be trustworthy...I cannot bring myself to go to this person for fear I will sound whiney. For the record, I hate myself worse when I whine. I guess for now until I learn some tools I just hold on for the ride and hope I don't fall off the edge. As a matter of fact, I currently see myself gaining momentum and barreling out of control toward the edge. Momentarily I have found solace in this blog, that I am not alone and maybe there are answers out there. Maybe I do have a solution, maybe I turn to the online forum to help at least slow down the inevitable. Thanks Holly for opening doors for me.

January, 26 2011 at 6:11 am

I think a big part of my process was ACCEPTANCE - that I needed extra time and that I am this way. Last December I took 2 weeks of sick time so I could withdraw and be a disaster. But because I did that, I think I'm doing pretty well this month! For me - allowing for alters and arranging time for them has really helped a lot. Plus just giving myself time to be down and sad and whatever it is I do!
It took time though. Earlier on in my process I couldn't work. I started by adding a part time job and slowly moved into full time. I just think that finding ways to work WITH my system really helped a lot... in time.

January, 22 2011 at 1:44 pm

Has anyone ever thought that the reason there is so much anxiety in this world is because it has been created from the things they have taken into the body? I really dont believe all this hereditary nonsense. You are your own person. What troubles me most is the plethora of crap that people watch on television (taken in the form of alpha waves - truly a brainwashing experience) and the rubbish they find in their local supermarket.
I have recently started growing my own herbs and i no longer eat meat (we are not designed to eat meat...period). Since I changed my diet and practised abdominal breathing I no longer experience that "climbing the walls" feeling. I no longer experience those panic attacks.
Alot of what goes into todays food/drug products are highly responsible for mental illness. Not to mention that staying away from that hypnotic machine on the wall in your living room also benefits those experiencing any kind of mental disorder.
Trust me, I'm a doctor! ( that famous saying could and usually does prove disastrous)
You may find that your doctor isnt helping you but helping his bank account...dont be fooled by these people when you think they care. Theres only one thing they care about ($$$)
The answers are all around you, they are all natural. The medical industry is a business....lets not kid ourselves here.
Stick to natural remedies and stay away from processed foods. Get at least 8 hours sleep per day (and at the right end of the day - most important). Always eat as close to the sun as you can - meaning all natural products. You'll live a "happier" longer healthier life....Youll also avoid costly medical rubbish which will kill you and your bank account in the short term.

In reply to by Anonymous (not verified)

Holly Gray
January, 22 2011 at 2:40 pm

Hi sean,
"Has anyone ever thought that the reason there is so much anxiety in this world is because it has been created from the things they have taken into the body?"
Yes. Many people, in fact.
While I'm very happy for you that changing your diet has made such a dramatic impact on your mental health, it's stretching things to the point of absurdity to posit that Dissociative Identity Disorder can be cured by a vegetarian lifestyle and eschewing mindless television entertainment. I do, however, absolutely agree that many things that go along with DID - depression and anxiety, for example - can only be helped by taking better care of our bodies and minds.

January, 22 2011 at 2:53 am

Hi Chariots,
That's a good idea. It seems so simple & yet I never thought of just giving myself time & place to fall apart.
Thanks for sharing this, it helps.

January, 22 2011 at 2:48 am

This is my problem - I have figured out some of my warning signs (intrusive images of self-harm, suicidal thinking, not eating well, increased nightmares, childlike thinking, desperation, etc). But when I realize that I'm starting to go down that path, I'm terrified. My everyday responsibilities are such that I'm unwilling and unable to go to the hospital even if it would be advisable (I'm in graduate school) - I'm afraid of being told that I need to because I don't want to lose the semester. So I just don't tell anyone. I'll tell my therapist pieces, but I never go in and say "Look, all of these things are happening and I'm afraid of what might happen." I prevent her from being able to see all the signs at the same time, and I present as confused and dissociated - it's not clear to her that I'm confused and dissociated AND not eating, not sleeping, etc.
I wish that I knew what to do BEFORE I reach the point where I stop functioning altogether. But school is so important to me that I am willing to gamble - maybe I can pull it together, maybe my stubbornness can keep me going and things will get better.
It's scary to have this secret knowledge that I've started to fall. Sometimes I catch myself and work my way back up, but I don't know how to get help before I'm at the bottom of the cliff.

In reply to by Anonymous (not verified)

Holly Gray
January, 22 2011 at 2:34 pm

Hi Laura,
Thank you for reading and taking the time to comment.
I can so relate to what you've said here. I also try very hard to keep my decompensation under wraps. I'm not really sure how to change that, or if I even want to, honestly.
"It’s scary to have this secret knowledge that I’ve started to fall."
Yes, it is.

January, 21 2011 at 5:18 pm

Yes, yes, yes... This post gets right to the heart of the difficulties of managing mental illness! You realise you're starting to fray at the edges, you try your best to contain things, to protect other people and save face, but you're very likely to choose unusual and perhaps unhealthy ways of doing these things because that's the nature of being ill. Trying to work out what does work is much harder that noticing what doesn't (even that is hard enough if you dissociate) because if it works, you wonder whether they were proper warning signs to begin with.
So thanks heaps Holly, for your thoughtful post!
Some paradoxes I find difficult to negotiate:
While isolating is dangerous and unhealthy, taking a break from people can be essential. As chariots said, we need privacy and space to listen to our system and reorientate/reground. It is also essential to rest.
While seeking help (from therapist and partners) is healthy and essential, independently coping and problem solving can be transformatively empowering.
We need to take risks and be optimistic to build up our lives but optimism shares borders with foolhardiness. Mental illness ups the stakes in any risks and rewards equation. The risks for just about everything are higher - eg. a new job is scary for anyone but more scary if you're at risk of losing touch or losing control. A bad day at work can result in disaster. At the same time the rewards are more needed too. A job is not just a way to get money - it is a place in the world for you. A good day at work can save your life.

In reply to by Anonymous (not verified)

Holly Gray
January, 22 2011 at 2:26 pm

Hi else,
Thanks for this really thought-provoking comment.
The paradoxes you mention are so on point. It is very difficult to know what to do for those reasons and more. I really appreciate you sharing your thoughts on that because it helped me understand why I get so stuck, even when I recognize that I'm beginning to decompensate.
"The risks for just about everything are higher - eg. a new job is scary for anyone but more scary if you’re at risk of losing touch or losing control. A bad day at work can result in disaster."
EXCELLENT point and example. The risks are higher - yes, so true.

January, 21 2011 at 4:36 pm

I spent a week this past summer in the hospital because the doctors thought I had epilepsy. After multiple tests, they came to the conclusion that I wasn't epileptic. While in the hospital, I had a session with a psychiatrist who had a strong feeling that I might have DID and/or PTSD (but I wasn't diagnosed). I did however take a psychoanalysis test and tested extremely high for anxiety. I always believed that I in order to have DID, you must have dramatic symptoms like Sybil (and some terrible tragic childhood event). After reading your blog, I think I might actually have DID. I have EVERY "red flag symptom" and my roommate of 3 years thinks that I'm just immature and emotionally unstable and she questions my ability to have a successful relationship with any guy. She also is easily frustrated (and so am I) that I can't remember simple tasks and I have a hard time understanding and answering her questions.
My question to you is this: Have you ever experienced an "alter" (for lack of a better term) that sexualizes and expresses excessive amounts of PDA with guys you've only had maybe 2 dates with, or have only known a month, or have a platonic relationship with? Like the real you is composed and respectable and all of a sudden you "wake up" to realize you were acting out as a sexual deviant.
Any help and feedback would be greatly appreciated.

In reply to by Anonymous (not verified)

Holly Gray
January, 22 2011 at 2:23 pm

Hi K.J.,
Thanks for your comment.
The thing about Sybil is that it's accurate in many ways, but so limited and narrow - we don't see the boring moments, for example - that the impression one walks away with about DID is entirely false. Many people with DID do exhibit dramatic symptoms, but not hour after hour, day after day. In general, Dissociative Identity Disorder is rather adept at concealing itself. So it's doubtful that the average person would ever be able to spot it. But they would very likely spot the symptoms, without realizing that that's what they are. For instance, people with DID are often told they're moody, or that they're liars. This is how the average person on the outside experiences DID. It's not that the Sybil moments don't happen. They do. But they look different in real life than on a movie screen.
Yes, DID is a trauma disorder. And one terrible childhood event won't do it. Repeated trauma, along with a combination of other equally important factors, causes DID. Having said that though, I'd like to point out that many people have misconceptions about what those traumas must look like. I see people with DID dig around in their memories for increasingly more horrifying material because they have this erroneous idea that what they suffered is somehow not sufficient. But I've never met anyone with DID who didn't already remember traumas that can - under the right circumstances - cause DID.
As for your question about alters, yes. And that's not at all unusual. Many people with DID have at least one brazenly sexual alter.
Do you have a therapist K.J.?

January, 21 2011 at 3:12 pm

I usually start to feel pressure and get more irritable and headachey, and maybe it's been a week or so since I dissociated. When I know it's coming, almost like an aura, I try to create free space in my schedule and actual physical space, so I can "be a mess" and dissociate. When I give myself room to fall apart - I usually experience relief afterward - and am able to function better. I learned a while ago that trying to keep myself together for too long eventually ends up in a melt-down. So rather than fight it - I try to create space for it.
Somehow I've been able to do this and very successfully work full time for several years now.

In reply to by Anonymous (not verified)

Holly Gray
January, 22 2011 at 2:27 pm

Hi chariots,
"Somehow I’ve been able to do this and very successfully work full time for several years now."
That gives me hope. Thank you.

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