How to Manage Your Response to Physical Pain When You Have DID


No one wants to be in physical pain.

No one.

Parts who think you deserve pain often believe the terrible things they were told in childhood about you, or hope that by feeling bad now you will avoid even worse things later.  Sometimes they simply feel that being in physical pain is familiar to them, and “familiar” is easier to handle than something new and different.

If these reasons sound illogical, immature, or even ridiculous to you, then the current self-state in control of your thoughts is mature and logical.  Parts are born from trauma, and do not have the skills to handle physical pain in the way an adult can.  They might resort to desperate measures because they see every event as a dangerous crisis, even now.  They are not acting or reacting as if they knew about the inherent power of being a competent and compassionate adult.


Managing pain from illness or injury can be difficult for trauma survivors who se brains associate any current pain anywhere in the body with past abuse or neglect.  This doesn’t have to be a conscious thought to happen to a survivor.  And it can happen remarkably fast.

One of the “stickiest” problems with trauma disorders is the speed with which these responses occur.  This makes sense; children must quickly sense danger and act.  Their habitual reactions will sometimes prevent more abuse or allow them to switch before it begins.  If this is successful, that pattern will be used the next time something bad happens.  And with people who have DID, there were a lot of “next times”.  The nervous system will refine fear or defense responses until the neurological pathway is almost reflexive.  A bad experience in childhood is now an adult neurological response without conscious control.

This makes over-reactions to physical pain and the search for substances or dangerous actions in adulthood very “sticky”. Stopping it is like stopping a freight train on the tracks.

train tracks

One solution is quite similar to dealing with that freight train on the tracks:  Create warning signals and mechanisms to re-route.

To continue with the analogy, this makes YOU the part of the system that is driving this train.  The train is not driving you.  Nobody drives a freight train independently from the first day on the job.  There is a learning period, and you take easier routes at first.  You work up to the trickiest towns and cities during rush hours.

With pain management, the same thing applies.  Everyone gets a bump or a bruise, a headache, a cold, or a hangnail.  Use these minor episodes of pain for practicing more effective responses.  When you have a bunch of effective and familiar ways of thinking, and actual physical tools to deal with pain, you will be a better driver when the route gets hard to navigate (see how I wove this site’s name into this post)?

This isn’t some woo-woo suggestion that the agony of a major injury or dental procedure can be eliminated with your positive outlook.  Far from it.  You will need actual medical or dental intervention.  Dealing effectively with pain requires calm thought so that you can get good care, advocate for what you need, and avoid excessive fear and anger.  Those emotions are well-understood to…you guessed it…increase pain!

What does this look like?

  • Gather your pain intervention tools at home or at the office for quick access.  Store them for easy access, know how to use them, and practice using them so that you know when and how ice, heat, pain gel, NSAID meds, pain pads, etc. are each optimal for you.
  • Experiment with different safe choices.  This means that you can learn about what things could harm you and avoid those.  If you are not sure what is safe and what could harm you, find a healthcare provider to help you.  Ask before you use something that can harm you.  Your system will not trust you if you prove to be untrustworthy.  Make it easy for them to trust you.
  • Show them to your system so that they know what you know:  we have stuff that works.
  • Use imagery or visualizations that you have refined for its calming but also energizing effects.  This isn’t time to sit back, because you probably have to be able to get care or take care of the body.
  • Make a list of your resources and have it available on paper, on screens, or with your therapist.  In DID, stuff can get lost or forgotten.  Parts can erase what they fear.  Be aware of this and act accordingly.  You may have to make the list decorative for parts that are calmed down or convinced by how nice things look.  If they need your therapist’s stamp of approval, get it.  In writing if necessary.
  • If your therapist is trained in DBT and CBT principles, learn a few useful skills that can help you think clearly when you are in pain.
  • If thinking clearly is the problem when you are in pain, you need better stabilization techniques first.  Nobody remembers to think of red and blue things in an appointment once they have switched.  Ask to be taught a wide variety of techniques and practice them in low-stress situations to get skilled at using them when you are in pain.

Need more information on dealing with pain, appointments, doctors, and dentists?

I wrote a book for you!


“Staying in the Room” is available as a paperback on Amazon .  Get a copy today and start learning how to make life easier when you have DID!

Published by Cathy Collyer

I am a licensed occupational therapist and a licensed massage therapist, in private practice in the NYC area. I have over 25 years of professional experience in adult and pediatric treatment, with a focus on sensory processing issues and treating the consequences of complex trauma. I am the author of four books, including "Staying In The Room: Managing Medical And Dental Care When You Have DID" and "The Practical Guide To Toilet Training Your Child With Low Muscle Tone". Over the years I have lectured about trauma treatment and pediatric development.

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