Some Thoughts About Dissociative Identity Disorder as a Disorder of Attachment

ASI READ BARTHOLOMEW'S COMPELLING PRESENTATION of her relationship and work with her patient, S, two thoughts recur. First, I am grateful that possibilities for long-term intensive care remain in a “healthcare” climate that has all but eradicated such opportunities. I see S as a client who can especially benefit from such a setting for reasons that overlap with and also differ from those presented. The careful, thoughtful work occurring over time that has been her treatment is clearly invaluable.

Second, I note how our psychoanalytic theories have become less developmental in focus. In particular I struggle with the strange absence of attachment theory in formulations of clients with severe early trauma and loss. Bartholomew's protocol offers persuasive evidence for dissociative identity disorder (DID) (and possibly Dissociative Disorder, Not Otherwise Specified [DDNOS]) as an attachment disorder. The central theme is abandonment, but the central dynamic is attachment. In my comments, I will primarily be applying such a framework to my understanding of S and her relationship with Karen B.

Before I go further, I'd like to remind the reader of the limitations of our format. It is, of course, impossible to know accurately what the therapeutic relationship is and what the therapeutic work has been