Dreams in Dissociative Disorders

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Dreaming, Vol. 4, No.3, 1994
Dreams in Dissociative Disorders

Deirdre Barrett!
This article reports on a survey of dream characteristics of 48 patients with a variety

of dissociative disorders. For most of these disorders, recovery of repressed memories
was the most frequent distinctive dream event. For patients with Multiple Personality
Disorder, many other phenomena occurred including alters appearing as dream
characters, alters who could orchestrate dream content, and even, rarely, integration
occurring within a dream. The strong potential of these dream characteristics to
facilitate the therapy of dissociative disorders is discussed.
KEY WORDS: dreams; trauma; dissociation; multiple personality.
The distinctive symptoms of dissociative disorders and their origin in trauma

were well known by the turn of the century (Janet, 1889). Almost as early, examples
of distinctive dreams linked to these disorders began to appear. (Fere, 1887, Jones,
1911).
Despite this early notice, the references to dreams in the dissociative disorder
literature remained rare, anecdotal, and usually brief. When dreams are mentioned,
however, it is usually to state that they are invaluable tools in the therapy of dissociation. Putnam (1989) writes:
Although nightmares, night terrors, hypnogogic and hypnopompic phenomena, and other
evidence of sleep disturbances are common in multiple and other victims of trauma, little
has been written about the role of dreams in the dissociative disorders ... My experience
with dream material from MPD patients suggests that it can provide access to deeply
hidden trauma . . . MPD patients seem more willing to share and work with dream
material than with other forms of memory for trauma. (p. 201-2)
KIuft states that "dreams often monitor integration" and may represent "some
sort of healing process in which the mind mayor may not be assuming a new configuration" but he warns the published accounts have been too few so far to justify
clear conclusions about them. (Sizemore, 1979, p. 123)
Thigpen and Cleckley's (1957) The Three Faces of Eve and their patient's three
autobiographical books (Sizemore, 1973, 1989; Sizemore & Pittillo, 1977) all contain
IPlease address all correspondence concerning this article to Dr. Barrett at Harvard Medical School,
Behavioral Medicine Program, 1493 Cambridge St., Cambridge, MA 02139.
165
10530797/94/0900-0165$07.00/1 1994 Association for the Study of Dreams
Barrett
166
dreams, including a dramatic account (Sizemore, 1989) of her final integration occurring in a dream. Schreiber (1974) describes several of Sybil's dreams from early
in therapy as providing vivid metaphors for her multiple personalities. Jeans (1976)
describes a patients "host" personality (the one in control the majority of the time)
experiencing an alter (an auxiliary personality out less) as a character in the host's
dream. Gruenewald (1971) and Salley (1988) note that there are sometimes alters
who communicate with the host personality mainly in dreams and/or can create
dreams for the host. Marmer (1980) presents 15 dreams in which the host is experiencing perspectives of various alters. Paley (1993) describes a series of dreams
from an MPD (multiple personality disorder) patient that are both reflective and
facilitative of the host gaining control over the behavior of a persecuting alter. Terr
(1992) describes how a variety of dissociative disordered patients have retrieved
suppressed trauma memories in dreams.
SURVEY
The author conducted a survey of therapists who treat dissociative disorders

about their patients' dreams. About a third of the questionnaires were distributed
by three leading dissociative disorders specialists to colleagues they knew to be
working with appropriate patients. Another third were distributed at a national hypnosis conference to clinicians who volunteered that they had such patients in their
case loads - therefore patients in hypnotherapy may be disproportionately represented. The final third were distributed to clinicians personally known to the author,
resulting in a heavy loading in the Boston area. Seventy-five questionnaires were
distributed and 48 were returned, however some clinicians made duplicates to report on additional patients so it was not possible to calculate an exact response
rate. See Table 1 for the content of the questionnaire.
Questionnaires yielded data on 48 patients from 16 therapists in 7 states. The
survey asked about patient demographics, specific DSM-III-R dissociative disorder
diagnoses, dream characteristics already described in the previous literature, other
dream characteristics, and examples of dreams. Table 2 summarizes patient characteristics.
PSYCHOGENIC FUGUE, PSYCHOGENIC AMNESIA, AND DD-NOS
For all dissociative disorders except MPD, the survey inquired specifically
about dreams recovering memories, either recent ones or those from childhood,
and also about any other dream phenomena that had been observed to be related
to the patients' dissociative disorder.
In Psychogenic Fugue, Psychogenic Amnesia, and Dissociative Disorder Not
Otherwise Specified, the majority of responses did report some dream-related memory recovery-it should be noted that "memory recovery" is being used in the
subjective sense here. Childhood and recent memories were recovered with similar
167

Table 1. Dreams and Dissociation Questionnaire
Please complete one page for each patient with a dissociative disorder.
Pt age
gender M F
Optional Therapist Information:
-therapist name: _ _ _ _ _ _ _ _ _ _ _ _ _ __
If MPD, # of known
address
personalities
check if you would like survey results
Please complete this checklist if it is all you have time for. Check diagnostic category and any dream
phenomena related to the dissociative disorder that you have observed with this patient:
_ _ Multiple Personality:
--
alternate personalit(ies) appear as dream characters

at least one personality can design dreams to be
experienced by others.
personalities experience different aspects or pespectives of the same dream.
a personality gains memories that have belonged
only to another from dream
switch of personalities during a dream
integration of personalities during a dream:
or temporary
permanent
other dream phenomena, please describe, use back
if necessary _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
other Dissociative Disorder, please specify _ _ _---,,..-_ _ _-:-_ _ _ _ _ _ _ _ _ __

dream contains content from recent amnestic
experience
dream contains content from childhood trauma(s)
other dream phenomena, please describe, use back
if necessary _ _ _ _ _ _ _ _ _ _ _ _ _ _ __
Optimal: If you have time, please give any dream examples of above phenomena or any other comments
about how you use dreams in this patient's therapy on back of sheet or attach additional pages. Dreams
to summarize for general statements unless researcher contacts
and other comments will be used
therapist to pursue further permission to quote more directly.
frequencies. No survey forms were returned describing dreams of patients with Depersonalization Disorder. See Table 3.
A few of the dreams were undisguised recreation of real episodes, especially
for recent repressed events. More commonly, the dreams contained some distortions. One woman dreamed of being eight years old, pregnant, and very frightened
-with her mother nearby but not available for help. This led to her first memory
of a sexual assault at that age, the most vivid aspects of her recollection being the
belief that her belly would swell up, confusion about how a baby would get out,
and her inability to seek her mother's help.
168
Table 2. Survey Patients by DSMIH-R Diagnoses
N
Mean
Age
Gender
M/F
Mean
Yes in Rx
MuliipJe Personality Disorder

Psychogenic Fugue
Psychogenic Amnesia
Dissoc. Disorder Not Olh. Spec.
23
4
13
8
28
39
25
27
2/26
2/2
7/18
3/5
4
1
3
1
Total
48
28
14/34
DSMHI-R Diagnosis
T!lble 3. Memory Recovery in Dreams

Dream
Memories
Childhood
Recent
Fugue
Amnesia
DD-NOS
4
13
8
3
11
5
75
85
63
2
7
4
50
54
50
1
9
25
69
Total
25
20
80
13
52
11
Diagnosis
13
44
In addition to memory recovery, other dream phenomena related to dissociative disorders included a hysterical conversion symptom resolving in a dream and
a trauma-related hallucination beginning after a dream of related content. Both of
these phenomena occurred in patients with diagnoses of DD-NOS.
MPD
Although DSMUI-R describes all dissociative disorders as "incidence unknown," other surveys (Putnam, 1989) suggest that MPD comprimises well under
half of all dissociative disorders and is therefore overrrepresented with 23 of 48
responses in the present study. The survey specified more possible categories to
check based on previous literature for MPD than other dissociative disorders.
Therapist survey respondents were especially eager to describe their MPD patients'
dreams and these surveys were longer and filled with three times more (2.5 versus
.8) dream examples on the average. As they are indeed the most interesting data
from any category, the MPD results will be described in greater detail than other
diagnostic categories.
The twenty-three patients with MPD in the survey had a mean age of 28
years old and averaged 17 known alters. Eight types of dream phenomena which
had been noted in the previous literature or observed in the author's practice were
included in survey questions and two more were described by survey respondents
in an "other" category. The frequencies of these ten types of dream phenomena
are presented in Table 4.
169

Table 4. Types of Dream Phenomena Reproted in MPD Patients
Dream Phenomena
1.
2.
3.
4.
5.
6.
7.
8.
9.
10.
Switch during dream

Alter's experience as dream
Multiplicity metaphors
Alters as characters
Views of same dream
Host is alter"
Dreammaker
Retrieving memories
Different dreams'
Integration in dream
N of 23 S's
Percent
3
4
19
13
6
4
6
13
17
83
15
8
2
57
26
17
26
65
35
"Not asked about specifically, compiled from "other" category.
1) Switch During Dream

A switch is defined in the MPD literature as a change between any 2 personalities, all examples in this section involve a switch from the host to an alter. Three
patients or 13% of the sample were reported to have dreams, usually nightmares,
which triggered a switch, much as a waking stressor might. One patient experienced
the majority of switches this way, for the other two it was an occasional phenomena.
The patient who experienced most of her switches this way had a history of
"losing time" a few times a year since her teens before which she had few memories.
She had memories of being violently sexually abused by her much older brother
and there was strong evidence that she had a more extensive history of multiple
abuses by him and her parents dating back to early childhood. At a time when her
brother had moved to the city in which the patient lived and had become the father
of an infant girl within a two week period, the patient began to have vivid nightmares of sexual violence for a period of about a month.
After several weeks of nightmares and insomnia, the patient began a pattern
of sleeping for 3-4 hours, then whimpering in distress as she had in her nightmares,
and waking up in a state where she manifested several personalities, called herself
by other names, wrote poetry with a different handwriting, and interacted in an
uncharacteristically hostile manner with her roommate. After several hours of this
she would go back to sleep and wake up amnestic for these episodes. A sleep lab
evaluation was negative for delta parasomnia or any other physiologic anomaly to
explain these episodes as sleep-related. Hypnotic exploration in therapy led to contact with several aspects of the patient which corresponded to the alters who continued to emerge predominantly from the sleep state.
2) Alter's Experience as Dream
Four in the sample, or 17%, reported what later turned out to be actual waking experiences of their alters as "dreams" which they at first believed had occurred
only in their sleeping psyche.
Barrett
170
One woman who had recurring "nightmares" of catching evil cats by the throat
and stuffing them in garbage cans, awoke from one of these dreams to find the
velour jogging suit in which she slept covered in cat hair. She did not own a cat
and was so disturbed by the implication that she both brought in the top of the
jogging suit to ascertain that her therapist also saw it covered with the hair and
searched trash cans in her neighborhood.
Some patients were not so quickly aware of the nature of these experiences.
One had "dreams" of sitting on the bank of a river at night feeling very soothed
as she stared at it; many months later an alter owned up to these being real nocturnal jaunts.
Obviously this category may have a higher incidence than reproted because
such events could occur without the "dreamer" ever realizing they were real. There
are two previous reports of patients who initially appeared to be sleep walking who
were discovered to have a dissociative disorder when sleep lab polygraphs revealed
the episodes occurred when the patients were physiologically awake (Fleming, 1987;
Schenck et al. 1989).
3) Multiplicity Metaphors
Multiple Personality was symbolically depicted in dreams of 19 patients, or
83%, according to their therapists. This was often reported at a stage in therapy
when the patient was not fully aware of the diagnosis. It may be genuinely the
most frequent dream phenomena for MPD's as it is an issue of concern to all of
them. However, it also may be that as the most subjective of the 10 categories,
multiplicity metaphor estimates are inflated while harder to spot types may be underestimated.
One patient, not yet in therapy, was aware that she "lost time" and was hearing what later proved to be her alters as voices. She was not aware of the nature
of the voices or the blackouts when she recorded: I had a dream. I was sitting in
a photo booth trying to get it to take a picture of me, but all the pictures that
came out showed other people - or at least faint outlines of other people. In the
mirror, where you see what will come out, the face kept changing, like ghosts.
4) Alters as Dream Characters

In the dreams of 13 patients (57%), their alters appeared as dream characters.
One dreamed of a blond little girl begging her repetitively, "Don't let them hurt
me; take me home with you." The patient was not yet in touch with this child alter
but the therapist recognized the description was an alter that had come out in
moments for which the host was amnestic to implore the therapist with exactly
those words. Two patients who had made suicidal gestures which they attributed
to accidents or intoxication had dreams which later played a great role of explaining
them. One had dreamed of a woman determined to commit suicide, the other of
171
one vowing to kill the dreamer. These turned out to be alters responsible for much
cutting and one overdose.
5) Perspectives on the Same Dream

Six patients (26%) have had personalities experience the same dream from
different perspectives. This can be seen as a variation on category 4 above that has
one distinctive difference. In category 4, the alter appearing to the host as a dream
character sometimes has no experience of this, or in other instances experiences
the host as dreaming but the alter as awake. In many cases, the therapist asks only
the host about dreams and it is unclear what the alter might be experiencing. However, for these 26% of patients with dreams in category 5, two or more personalities
reported dreaming at the same time and experiencing each other as characters.
Sometimes one personality also watched and was not observed as a character by
the others. When this happens early in treatment, the host and sometimes the alter
do not recognize each other until the dream experiences are discussed awake, as
in the example below. Further into the therapy process they are likely to recognize
each other as soon as they appear.
The host personality, Sarah, remembered only that her dream from the previous night involved hearing a girl screaming for help. Alter Annie, age four, remembered a nightmare of being tied down naked and unable to cry out as a man
began to cut her vagina. Ann, age nine, dreamed of watching this scene and screaming desperately for help (apparently the voice in the host's dream). Teen-age Jo
dreamed of coming upon this scene and clubbing the little girl's attacker over the
head; in her dream he fell to the ground dead and she left. In the dreams of Ann
and Annie, the teenager with the club appeared, struck the man to the ground but
he arose and renewed his attack again. Four year old Sally dreamed of playing
with her dolls happily and nothing else. Both Annie and Ann reported a little girl
playing obliviously in the corner of the room in their dreams. Although there was
no definite abuser-identified alter manifesting at this time, the presence at times
of a hallucinated voice similar to Sarah's uncle suggested there might be yet another
alter experiencing the dream from the attacker's vantage.
6) Host is Alter
Four (17%) of the patients' host personalities had experienced a dream in

which they were one of their alters, or rarely two as in the following example:
I dreamed there was a corporation that my father ran that sold meal at some kind of
carnival, like an amusement park with rides. He sold these big slabs of meal. They were
gross and bloody and he was trying to fry them up and giving them to people to eat. I'm
a vegetarian anyway, but I discovered that it was human meat and I had to stop him.
There was a big knife that he used for cutting up the meat. I took it and stabbed him
and he fell down dead. Then I knew that I had to kill myself. The scene changed and X
walked out of a building with my brother leading the way. I was a martyr dressed in a
long black robe. We walked through a beautiful garden and down to a room. There were
little boats about 6 feet long and my brother indicated I get in one. I lay down in it and
172
folded my hands over my hear! and began to float downstream. That was death, this was
how it was done.
This dreamer had a child alter who had hallucinatory images of her father,
sometimes with a knife, sometimes cooking meat. Another alter was a would-be
"martyr" who, in her internal variation on Catholicism, intended to achieve martyrdom by suicide. She could communicate with these alters but awake she perceived them as "other." In the dream she experienced being first one and then,
with the scene shift, the other.
7) Dreammaker
Six (26%) of the patients had at least one personality able to design dreams
to be experienced by other personalities. The "dream maker" appears to be frequently
lucid while the host experiences a non-lucid dream. One common reason for designing dreams was to warn or influence the host away from certain people or situations; four patients had an alter who did this. George, one of the few male MPD
patients in the study, had a female alter Mary who trusted no one. Anytime George
was getting to like someone, Mary would orchestrate a dream where that person
would attack or ridicule George - or George would discover some horrible secret
about them. This had resulted in responses ranging from subtle unease to complete
avoidance on George's part after the dream. A female patient had a similar alter
who designed "rapist" dreams about any man the host was getting too friendly with.
The other common category of reasons for designing dreams was to introduce
memories that the alter wanted the host to begin dealing with but knew the host
wouldn't face awake. One "dreammaker" alter reported, "Dreams can test the waters for whether she's ready for a memory." More rarely dream maker alters used
this ability to urge the host toward a positive action or to communicate something
therapeutic. One alter described dreaming as part of a broader influence campaign:
"I show her images a lot, even while she's awake, of memories and things I feel
and want to do. But she sees them best if I show them to her while she's dreaming."
8) Retrieving Memodes
Fifteen (65%) of the patients had experienced one personality, usually the
host, gaining memories from a dream that had previously belonged only to another
personality. In many ways this is just like the dreams that any other trauma survivors
may have except that these memories have been held by the alter rather than being
completely repressed. As already mentioned, this can sometimes overlap category
7 above when the alter presents these memories intentionally. More often it seems
to happen naturally as the patient approaches integration. All but one of the reports
of this category involved an alter's memories being regained by the host; one example was from one alter to another alter with whom he had been in conflict,
resolving the conflict. Examples cited for MPD patients were similar to those already described above for other dissociative disorders.
173
Dreams hi Dissociative Disorders
9) Different Dreams
Eight (35%) of the patients had different personalities who simply experienced
different dreams. This is, of course, quite analogous to their waking experience.
One patient had three alters who recalled dreams from the same night. The
host had a mild anxiety dream about arriving at school unprepared for an exam.
A male alter who had experienced much physical abuse had a fairly realistic posttraumatic nightmare about that abuse. A female child alter, who was usually the
happy one who could respond as if the trauma had not occurred, had a dream with
a castle and cute baby animals - content fairly typical of children' dreams. Another
female child alter who had suffered much of the sexual abuse reported she had
not slept in weeks because of terrible nightmares.
10) Integration in Dream
Very rarely, lasting integration of two personalities seems to take place in a
dream. This was reported to have occurred for two patients (9%) only one and
two times respectively. One dream was of a wedding in which only one person
stood at the altar at the end of the ceremony. Another involved a fairly literal
conversation saying goodbye, after which the alter moved forward toward the host
and "faded into me like mist." The third involved seeing someone who the host
knew to be the alter but who now looked exactly like the host. With both patients,
there had been much recent therapeutic work toward dismantling amnestic boundaries between these personalities. It is hard to say whether the integration truly occurred in the dream or was merely reflected by it.
DISCUSSION
As therapists, we can only experience our patients' dreams as second hand
accounts, with all the ensuing memory loss, censorship, and problems of articulation.
Research reports from subjects are sometimes collected in a sleep lab to lessen
(but not eliminate) memory loss, however they involve most of the same sources
of distortion. In this survey, dreams are experienced third hand: from patient to
therapist to researcher, so yet another filter is introduced. Obviously, the findings
in this study must be taken as preliminary and conclusion about the characteristics
of dream reports in therapy are likelier to be robust and those about the cognitive
processes of sleep in these disorders are more tentative.
For most people, the state of dreaming is characterized by a degree of hallucination, amnesia, discontinuity with normal experience, and projection of aspects
of ourselves onto others such as we experience at no other time. One of the most
striking observations of this survey is that dissociative disordered persons experience
much more of this dreamlike state in their waking life. These similarities of normal
dreaming and dissociative disorders and the implications they may have for the
etiology of MPD have been discussed in detail elsewhere (Barrett, 1994, in press).
As category 2 (alters' experience as dream) results suggest, these subjects may be

reporting some phenomena from a physiologically awake state as well as REM content as "dreams." However, for the psychotherapist as well as the dreamer themself,
the questions of most interest concern characteristics and possible usefulness of the
subjectively remembered dreams.
No characteristic of the dreams of dissociative disordered patients in this survey is so distinctive as to never be found in those of other dreamers. An admittedly
subjective category that nevertheless appears to be higher in the dissociative group
than in the general population is the rate for dreams with metaphors for other
parts of the self. Obviously people without dissociative disorders can have similar
dreams about various aspects of themselves that might be represented this way.
Carl Jung (1916-194511974) and Fritz Perls (1969) have developed entire dream
theories based predominantly on this premise, but the associations of other dreamers do not lead to anything like the ones described by respondents in this survey.
These associations to other selves, forgotten recent experiences, and early traumas are much more distinctive than the actual dream content which varies mostly by
frequency. Nothing in this survey suggests that dreams can be definitive in establishing
the existence of a dissociative disorder, although these associations that arise in discussing them might. The situation in which dreams of dissociative disordered patients
appear to be most helpful is once one knows the patient has dissociative phenomena
and is trying to track down specific content of childhood traumas which played a role
in initiating this defensive style and/or content of recent amnestic periods.
For Multiple Personality Disordered patients, dream content and associations
can be helpful in identifying alters and facilitating communication between them.
In someone with this diagnosis, any dramatic dream character - especially recurring ones, should be explored for whether they represent one of the personalities.
With patients who have identified alters but do not yet have easy communication
with them, it would often be desirable to suggest that they reflect on, and perhaps
lucidly enhance these communications with dream character/alters. Specifically asking if alters have "dream-maker" capacities may open even more direct communication channels and this can also be enormously helpful in controlling the
post-traumatic nightmares which the majority of them suffer.
The extremely different dreams which various alters can report emphasize that
for dreamwork to be most effective with these patients, alters should be queried
rather than just the host personality, as has often been the procedure in the past.
Lastly, although the spontaneous rate for integration within a dream was low, this
technique has great potential to be intentionally cultivated. In situations in which
the patient is very close to integration, it might serve much the same catalytic function as the more commonly used hypnotic rituals described by Kluft (1992).
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488-493.
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Dreaming, Vol. 4, No.3, 1994