Since the 1980s, therapists have reported encountering clients or patients who had experienced extreme abuses featuring physical, sexual, emotional, spiritual, and cognitive aspects, along with a premeditated structure of torture-enforced lessons. The phenomena was first labeled "ritual abuse," and, later, as our understanding developed, "mind control.

Punishments include such things as flashbacks, flooding of unbearable emotions, painful body memories, flooding of memories in which the survivor perpetrated against others, self-harm, and suicide attempts.

Also, look for “floating alters.” These are not deliberately created parts of the system, but alters that were accidentally split off at the same time as others.

It appears that DDNOS is the intentional goal of these abusers, but DID sometimes results from a failure of programming. In DDNOS, the ANP is always present, even when another part is in control of the behavior and feelings.

It is important to learn about being multiple, and what works for their healing, from your client. To work with the alters, rather than trying to get the ANP to control the rest of the personality system.

Programming is the act of installing internal, pre-established reactions to external stimuli so that a person will automatically react in a predetermined manner to things like an auditory, visual or tactile signal or perform a specific set of actions according to a date and/or time.