Fear and anxiety affect decision making in the direction of more caution and risk aversion... Traumatized individuals pay more attention to cues of threat than other experiences, and they interpret ambiguous stimuli and situations as threatening (Eyesenck, 1992), leading to more fear-driven decisions. In people with a dissociative disorder, certain parts are compelled to focus on the perception of danger. Living in trauma-time, these dissociative parts immediately perceive the present as being "just like" the past and "emergency" emotions such as fear, rage, or terror are immediately evoked, which compel impulsive decisions to engage in defensive behaviors (freeze, flight, fight, or collapse). When parts of you are triggered, more rational and grounded parts may be overwhelmed and unable to make effective decisions.

My client who has only three alter personalities besides the ANP was unaware of her multiplicity until she encountered a work-related trauma at age sixty. She became symptomatic as the hidden parts emerged to deal with the recent trauma.

Shortly after I began work with Teresa, I acquired another MPD client, a supposedly schizophrenic young man I will call Tony. He called in to the clinic on a day I was on telephone duty, saying he was having flashbacks of "ritual abuse.” I did not yet know what that was. Tony became my client. He could be quite entertaining. I have a vivid memory of him as a three-year-old, "Tiny Tony,” standing on his head on my office couch, and running down the hall to try unsuccessfully to make it to the bathroom. He had in his head the entire rock band of Guns’n’Roses, and I got to know Axl, the band leader, quite well. I remember the time Tony was in hospital and I went to visit him; Axl popped out and said, "Remember, we’re schizophrenic in here!

Although Dissociative Disorders have been observed from the beginnings of psychiatry, the Structured Clinical Interview for DSM-III-R Dissociative Disorders (Steinberg 1985) was the first diagnostic instrument for the comprehensive evaluation of dissociative symptoms and to diagnose the presence of Dissociative Disorders.

Due to previous lack of systematic assessment of dissociative symptoms, many subjects experience the SCID-D as their first opportunity to describe their symptoms in their own words to a receptive listener.

In my view, the spurning of DID is highly connected with knowing and not knowing about child sexual abuse. Side by side with denial of childhood trauma and of severe dissociation, is an unmistakable cognizance of dissociative processes as they are embedded in our language. We regularly say things such as, "pull yourself together", "he is coming unglued", "she was beside herself", "don't fall apart", "he's not all there", "she was shattered", and so on.