Schema Story: Dissociative Identity Disorder

When Qi came to see me, she was in her twenties and deeply confused. She knew she would sometimes "come and go," as if "sometimes I'm here, sometimes I'm not," and then another version of herself would appear. She struggled to cope with living alone while studying abroad, so she was introduced to me by a friend for therapy.

When we first met, her biggest concern was explaining to her school why she needed a single room. She was easily triggered by unknown factors, which caused her vision to become blurry, or at times, she would feel as if she were having an out-of-body experience, "watching" herself freeze up. Other times, she couldn't hear what people were saying. The noisier the social environment, the more likely she will dissociate.

Qi was diagnosed with Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder, in which a person feels as though multiple identities exist within them. Many clinical psychologists and psychiatrists never encounter a case of DID in their careers, but I somehow found myself working with more than one. Over time, as word spread, more patients with similar conditions sought me out, allowing me to accumulate experience in this area.

Even though DID is recognized in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), many psychiatrists still doubt its existence and often misdiagnose cases as schizophrenia—treating a patient's perception of other identities as hallucinations or delusions. Furthermore, dissociative episodes can sometimes lead to stupor-like states, making it resemble symptoms of schizophrenia. Studies have also shown that DID patients may have some identities displaying symptoms of schizophrenia, making diagnosis even more complex.

One ANP and Multiple EPs

DID patients typically have an apparently normal part (ANP)—in Qi’s case, this was her main personality—but they also have multiple emotional parts (EPs), which may share or differ in names, ages, and even genders. Therapists often understand DID patients as a "system" composed of different parts.

When working with DID patients, therapists must be extremely patient and attentive, carefully noting any signs of personality shifts. Each session involves speaking to multiple individuals within the same body, and what one identity enjoys may be something another detests. Gaining the trust of all parts is key to effective treatment.

However, Qi came in requesting an official report for her school, meaning I had just met her and already needed to conduct a detailed 2 to 4-hour assessment that would inevitably touch upon traumatic memories.

To support her, I asked her to bring a trusted friend to the evaluation. During the process, she dissociated into a stupor multiple times, requiring frequent pauses and various grounding exercises before we could proceed. As her therapist, I felt torn—pushing forward felt risky, but Qi placed great trust in me, and in this process, we unexpectedly discovered some useful grounding techniques.

Discovering the Inner Parts

Qi had a joyful five-year-old girl inside her named Shan, who loved eating peanuts. Since Shan was one of Qi’s closer identities, I brought peanuts to our second session. The moment I took them out, Shan immediately emerged, excitedly shouting for the snack.

I encouraged Shan to talk while eating, testing if Qi could remain present with her. The joy of eating peanuts kept Qi stable, but I also had to be careful about introducing trauma-related topics, as I still didn't know when or how her trauma occurred.

Once I put the peanuts away and gently asked Shan to return to her "playroom" inside Qi, another personality surfaced—a male identity named Sheng.

Sheng embodied Qi’s anger and resentment. His emergence was striking: Qi’s body language shifted dramatically—she suddenly sat up straight, spread her legs apart, and stared at me intensely. Noticing my reaction, Sheng smirked and said in a rough, assertive voice,

"You told Shan to go back so that I would come out, didn’t you?"

Suppressing my surprise, I responded,

"Hello, what's your name?"

"Sheng." He lifted his head, narrowing his eyes at me.

"Nice to meet you, Sheng. Can you tell me more about yourself? When did you first appear in Qi's life?"

"When she was ten years old, the first time her father touched her." Sheng’s voice was loud and forceful—completely unlike Qi’s usual cautious tone.

Through Sheng, I learned about Qi’s past abuse, something I would never have uncovered otherwise. Sheng protected Qi’s anger—without him, those memories would have remained hidden.

One of the difficulties in writing an assessment report so early was that I hadn’t yet met all of Qi’s identities, yet I still needed to provide a comprehensive evaluation. DID patients can have numerous EPs, some of which only surface midway through therapy, when they feel safe enough to appear. Therapy aims to help these parts harmonize and cooperate so the patient can function better in everyday life—such as living independently and holding up a job.

In the end, it took me four full sessions (eight hours total) to gather enough first-hand information. More importantly, Qi agreed that my understanding of her condition was accurate.

Fortunately, thanks to the detailed assessment, I was also able to identify useful grounding techniques and gain insight into the roles of different identities in a short time. 

The Different Parts of Qi:

Qi is an ANP (Apparently Normal Personality). Most of the time, she behaves obediently and submissively, appearing calm or timid. When she feels scared, she involuntarily disappears, which significantly disrupts her life. During these moments, other EPs (Emotional Personalities) replace her, sometimes a child EP, leading to various issues. Qi has no memory of what happens during these periods.

The other EPs are:

• Sheng: An adult man who stores Qi's angry memories, including experiences of unfair treatment such as discrimination abroad, betrayal by friends, and more, excluding sexual assault. He usually doesn’t show anger outwardly but vents it on another EP, Shi, and even encourages Shi to self-harm. As a result, Qi often finds unexplained scars on her arms, wondering, "When did I cut myself?"

• Shi: A three-year-old who cannot speak but cries frequently, embodying all of Qi's pain and vulnerability.

• Yi: Around ten years old, she often feels shame and filth, holding the majority of Qi's memories of sexual assault.

• Shan: A five-year-old, carefree and happy child who is close to Qi. Qi perceives her as a child who is sometimes naive and a bit immature, with a love for peanuts.

• John: The same age as Qi, he is independent and adventurous, exploring new experiences. When Qi disappears and no child EP emerges, John takes actions Qi would avoid due to her timidity, such as accepting leadership roles. However, his confidence and optimism don’t always match his abilities, causing Qi distress.

Schema Therapy for Integrating Dissociated Identities:

Schema therapy is effective for cases of Dissociative Identity Disorder (DID) because it inherently uses different "parts" to understand the individual, making it easier for therapists to grasp the case. The therapy aims to fulfill unmet childhood needs, which helps integrate the various parts of DID cases. As the individual's internal sense of security increases, the parts coexist peacefully and assist each other.

However, DID cases are more complex due to the significant differences in EP personalities. They may not know each other or share memories, making communication difficult. Schema therapists often need to employ additional methods and techniques to understand the overall situation and help the individual gradually integrate different personalities, reducing conflicts and memory gaps.

Piecing together Qi’s life takes a lot of time. Even after a year of working with her, I continued to uncover new aspects of her story. This is the challenge of treating Dissociative Identity Disorder (DID). Qi’s mother passed away when she was around six years old, leaving her father to raise her alone. However, her father had his own issues, including alcoholism. Fortunately, her grandparents were financially stable and supported her education abroad when she turned fifteen. While this allowed Qi to escape her father’s control, she had already developed numerous physical and mental health symptoms, such as depression and anxiety. The school tried to contact her father, but he was indifferent. While abroad, Qi relied on antidepressants and anti-anxiety medication prescribed by a family doctor to cope.

Living alone in a boarding school without adult guidance, Qi was assaulted by older male students. Her response was to dissociate, creating the part known as Yi. During the assault, it felt as though her soul left her body, observing the scene from above like a ghost, detached and emotionless, merely watching the two individuals engage in the act. Yi, however, was the one being observed. Qi has always been aware of Yi’s existence. Yi only appeared to me much later in therapy, as she felt deeply ashamed and unclean, making it extremely difficult for her to show herself.

Reconstructing the Past: Complementing, Not Harming:

The process of assisting Qi involves exploring each part, understanding and reconstructing Qi's past—especially the parts she has no memory of—and addressing their needs. The goal is to ensure these parts complement rather than harm each other.

For instance, Sheng vents his anger on Shi, a three-year-old child. This behaviour needed to stop. In therapy, Sheng was invited to express his anger, revealing that Qi had been sexually abused by her father since age ten and later assaulted by older boys at school. Sheng felt anger but had no outlet, so he took it out on Shi, blaming her for being "too cute," which he believed led to the sexual abuse.

I was surprised by Sheng's logic, but I also understood it. Many children who have been abused by their parents tend to believe the abuser's words and blame themselves. I invited Sheng to do an imagery rescripting exercise, where he saw that the Qi who was abused at ten years old was not the three-year-old Shi. I asked Sheng to join me in stopping Qi's father's abusive actions. As an adult man, Sheng could channel his anger and use his strength to defeat Qi's father, while I called the police. After this imagery rescripting, Sheng felt as though half of his anger had been released.

In the following sessions, I focused on guiding Sheng into Qi's memories of being abused, helping him confront and repel the abusers. The more Sheng directed his anger toward protecting Qi, the more Qi began to notice Sheng's presence in her daily life. For instance, Qi once mentioned that someone cut in line. She unexpectedly changed her usual gentle and polite tone, firmly telling the man, "I’m standing here in line. What are you doing?" As soon as she spoke, Qi was astonished—it was the first time she heard Sheng's voice without dissociating and directly becoming Sheng. At that moment, I knew the therapy was heading in the right direction.

Only by accessing anger can we establish boundaries and protect ourselves.

I encouraged Sheng to befriend Qi and let him know that he played a crucial role in Qi's life, helping her become assertive when needed. I praised Sheng for casually appearing to reprimand the man who cut in line. Sheng looked proud, and I took the opportunity to ask him to articulate what made him angry and why, recording the conversation. After Sheng left, I played the recording for Qi, who was amazed to recognize that it was her own voice speaking assertively.

Shi and Shan are both children, but since Sheng became less angry, Shi appeared less frequently. Previously, when Shi appeared, Qi wouldn’t necessarily dissociate, but her behaviour would involve uncontrollable crying and complete inability to speak, which justified her diagnosis of depression. However, Shi is only three years old and cannot speak. I taught Qi how to comfort Shi: hugging herself (sometimes using her favourite stuffed dog for comfort), singing lullabies her mother used to sing, or cuddling the neighbour’s dog. These were methods Qi gradually learned to care for Shi.

When Qi dissociated and only Shan appeared, outsiders would see Qi as a child—speaking in a sweet, childish voice and gesturing animatedly. I found that this sometimes-caused problems, such as at work. Although Qi’s job was a part-time cashier role, such behaviours often led people to doubt her abilities. I spent considerable time teaching Qi how to manage Shan, such as setting rules before work and telling her, "I’m going to work now. It’s an adult environment, not suitable for children." Shan was displeased, so I had to help persuade her in therapy.

"Shan, you know, we’re all like this. We can’t let our happy inner child appear in the workplace. For example, if a client compliments my outfit today, my inner happy child might want to jump up and down. But do you think I would jump up and down in front of a client?" I used myself as an example, which made it easier for her to accept.

"Qi, you can reward Shan’s cooperation after a day of work, like buying her favourite snacks." Shan nodded in satisfaction.

John is another relatively healthy part of Qi, but unfortunately, when John is present, Qi is not always aware of his actions. As a result, Qi doesn’t always know what John has said or done. We agreed with John that he would record his promises and actions on his phone for Qi to know. John’s strengths include being adventurous and socially adept, but he has impulsive tendencies, sometimes agreeing to things that embarrass Qi. For example, John once agreed to pretend to be a male classmate’s girlfriend to meet his parents. Qi was very unwilling and feared that if the classmate touched her body, such as her hand or shoulder, she would dissociate. When Qi learned about this from John’s recording, she panicked and came to me because she couldn’t reconcile with John.

In therapy, I invited John to discuss the situation.

"Qi, thank you for telling me about this. I’m also worried for you. Can you bring John out to talk to me?"

Qi adjusted her posture, sitting upright with a steadier gaze. I knew John had appeared because Qi always looked confident when he was present. I said, "John, you’re here."

‘Well, you called me. What can I do for you?’

‘First of all, I'd like to thank you for your willingness to use my suggestion of recording your promises, so that different parts of you can know about your promise to others. This time you promised to be the girlfriend of a male student, right? You're obviously a boy, why do you want to be his girlfriend?’ I asked with a curious smile.

‘Haha......’ John laughed out loud, his voice was very loud and confident, ’It's fun! I've never tried to pretend to be a woman before!

John was a curious, adventures part of Qi, as if to compensate for Qi's introversion and shyness, John was mischievous, playful and impulsive. As he was not always present and could not control when he shows up, he and Qi often cannot reach an understanding with one another. Therefore, one of my tasks was to make John more respectful of Qi's wishes and to get Qi's consent before he could agree on anything.

‘I can do whatever I like, why do I need her permission?’

I suddenly understood John's role in Qi's life. He rationalised what was happening to Qi, and I even suspected that he would come out and ‘play’ when Qi was being sexually violated, so that Qi (or Yi) would not be farmed. I asked John, ‘Do you remember when you first appeared in Qi's body?’

‘No.’

‘I think when you were playing, you might have been the memory that Qi lost ......’.

‘I don't know what you're talking about.’ John looked unconcerned and annoyed.

‘Why don't you tell me what you like to play?’

‘Whatever fun to play ......’ John started to talk to me slowly and asked me for food. Luckily, I always carry peanuts with me when I see Qi, so I started by saying, ’Shan, now that we are talking about adult topics, I'm going to ask you to stay in Qi's body and play with the puppy. If you don't come out, I'll reward you with a whole bag of peanuts at the end of the day.’ After Shan showed up and said yes in a dainty voice, I dared to take out the peanuts and put them on a small plate, and then told John, ‘Well, John, if you want to eat, all I have is peanuts .......’

John was really comfortable with himself, direct and unobtrusive. He took a big bite. It was like we were talking in a bar, and I slowly learnt that John was playing a lot of different games, including teasing his classmates (no wonder Qi said that she didn't know why a certain classmate suddenly ignored her), making nonsense comments on the internet (Qi had been blamed for cyberbullying people before), and playing all kinds of erotic games with the boys (I thought to myself, ‘I think Qi's comment that she was troubled by some of the male classmates who were suddenly looking at her weirdly was due to the fact that John is coming out to play!)

‘John, you do like boys, don't you?’

John suddenly stopped grabbing the peanuts and squinted his eyes at me, ‘How do you know?’

‘I'm curious, you've been into those erotic games with boys for a long time.’

John used a little bit more serious voice, ‘Yeah, well, Qi and Yi don't like it anyway, so I joined in to play.’

‘Thank you for protecting Qi and Yi, because your presence has made their experience of being violated less painful.’ I said, looking at John's no longer smiling face.

‘I don't care. I like boys.’ John said, a little pleased with the compliment.

‘That's okay, but I want you to know that Qi and Yi are no longer in that abusive situation. You don't have to protect them the way you did before, they're safe.’ I looked at John's dumbfounded face, ‘If you continue to protect them in this way, you'll be hurting them. It's like how Qi would feel if you suddenly agreed to go home with a guy as his girlfriend. Now that you're flirting with a guy, you could get Qi in trouble, like this time.’

John listened and nodded.

‘I need you, John, to protect Qi in another way, do you understand?’

John was a bit of a playboy after all, and his presence made the experience of being violated seem like a game of ‘wishful thinking’, adding to Qi's fictional sense of control. Fortunately, John does not hate Qi and has no intention to embarrass her. My job is to integrate John’s strengths to Qi, to make good use of his personal traits, such as being adventurous, sociable, outgoing, playful, etc., to make up for her fearfulness and over-submissiveness.  Therefore, the cooperation between John and Qi is prominent.

Treatment of Dissociative Identity Disorder often takes a long time, and it is important to think about the various parts of the individual and create a safe space for all the parts to show up in the therapy session, before implementing any Schema Therapy experiential interventions.  The therapist needs to help them (All parts) work together rather than hurt or cancel each other out. In fact, there are a lot of similarities between Dissociative Identity Disorder and the different modes of Schema Therapy. The same goal of treatment is to ‘satisfy the unmet needs of childhood’. The use of imagery rescripting is very useful in this type of case, but we need to adjust it creatively, for example open-eyes imagery rescripting, to suit the clients in order to keep the relevant parts staying present.  Honestly, there is a lot of nuance in handing DID clients that’s outside of the Schema Therapy core mode. 

From the Chinese book 'Schema Therapy is published in Hong Kong. Link: 花千樹出版 | 基模治療——療癒童年創傷，重建內心平衡 | HKTVmall 香港最大網購平台

Beatrice Ng-Kessler

Registered Clinical Psychologist (HK and UK)

Advance Certified Schema Therapist, Supervisor/Trainer (ISST)

Certified Mindfulness Trainer from Canada

ISST accredited Schema Therapy Foundation Course (Level I - Cantonese)

11 June 2026 at 9:00 am – 13 June 2026 at 5:00 pm HKT

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