We are searching data for your request:
Upon completion, a link will appear to access the found materials.
For people without DID, dream experiences include having other characters in one's dreams behave in ways one can't predict or control, sometimes there can be a "switch" into lucid dreaming where more control can be exhibited.
Since people with DID already have alters in waking life (ie, identities the host can't directly control and switch amongst), how does this manifest in dream states? That is, are in-dream characters the same as alters, or different ones?
- How often do perspective-switches happen for people with DID?
- How does communication between alters take place in the dream world?
Unfortunately, I was not able to find empirical literature on this question, as it does not appear to have been studied much - for example:
References to dreams in the multiple personality literature are rare and tend to be brief.
So we are limited to clinical reports. In 1994, Deirdre Barrett collected 3rd-hand accounts of dreams from 23 DID (MPD) patients. The study method that she used is not very good quality however, so any conclusions would be premature, but it does provide some possible hypotheses as to the nature of these patients' dreams, as summarized in this table:
In particular, alters appear as characters in dreams (4) of more than half of the patients in this survey. Item (5) lists a few patients reporting dreams experienced from multiple perspectives (ie, multiple alters) simultaneously:
… 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.
Another interesting item (9) lists patients who reported experiencing multiple different dreams by different alters. Note that some of the dream reports (2) were not actually dreams, but were perceived as such by the alter recounting them.
More case reports are reviewed in another paper, and Barrett has written extensively on this subject. She summarizes:
These included memories of childhood traumas and content of recent fugue episodes. A few of the dreams were undisguised recreations of actual episodes, especially for recent repressed events.
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.
Empirical data (based on mentation) would be more reliable for drawing conclusions. Barrett and others have hypothesized that rather than alters appearing in dreams, characters in dreams may be used as inspiration (prototypes) for dissociated identities.
Traumatic Memory Retrieval in Dissociative Identity Disorder
Suddenly beginning to remember traumatic events from childhood is a hallmark of dissociative identity disorder. Have you ever researched to find out why this is so? I have, and my findings thus far are intriguing. This piece is another branch of the research I have already done on the corpus callosum, the wiring of our brains, but it goes a bit farther.
Please remember, I do not and do not claim to have earned a college degree above that of Associate in Psychology. I am merely a person living with dissociative identity disorder trying hard to understand herself, and in doing so to hopefully help herself and others.
I have long noticed that many of the people I have met, with a few exceptions, report beginning to experience the flooding back of the terrible memories of childhood trauma in their mid-20s to early 30s. The sudden remembering of trauma always baffled me until I started to read the research available online. I postulated that there was a correlation between brain maturity and this phenomenon, but now I have a sneaking feeling I have found even more evidence that proves I may be right.
As I mentioned in a previous post, I have been taking some exciting classes on the brain in college. I have learned a tremendous amount and am happy to have made some inferences from the things taught in my classes.
The Corpus Callosum
One of these things is the importance of the corpus callosum in the regulation, overall function, and health of the brain. This a region deep in the brain that consists of bundles of nerves that acts like wiring connecting the two sides of our minds. Without going too deeply, these wires cannot work correctly if the myelin, a fatty substance that coats them, is damaged or does not form properly.
There are many reasons and diseases associated with damage to the corpus callosum including and most important for our purposes here, chronic traumatic stress. When a child’s brain is flooded with the hormones that are secreted to make the body ready for the fight, flight or freeze response when danger is perceived have horrible side effects if the child can never return to baseline levels. In other words, if the child continues to feel threatened 24/7 and year after year their little brains are incapable of getting a rest from these vital substances. Over time many of the structures of the brain are damaged including the amygdala, hippocampus and corpus callosum.
There is a significant substance that coats the “wiring” of the corpus callosum called myelin that acts like insulation. Just like with electrical wiring in your home, if the insulation is broken or missing the wiring cannot propagate a signal correctly or may short out. Chronic stress in early childhood prevents the brain from achieving full myelination, decreasing the connectiveness between the two hemispheres of the brain.
Hang Onto Your Hats
What follows next in this piece will put together many of the pieces of the puzzle I have been missing for so long.
I have uncovered research that explains why people who live with DID or any other dissociative or severe mental illness report they cannot remember their childhood abuse until later in life. This research is scattered here and there among the many scientific papers on the Internet, and that is probably why no one until now has pulled it all together.
Brain Structures Called Ventricles
There are structures in the brain known as ventricles which contain cerebral spinal fluid (CSF). Made up of four primary structures, the lateral ventricle is the one which caught my attention. It is here (and a few other places as well) in the choroid plexus that the cerebral spinal fluid is manufactured.
CFS is vital to the working of our brains, as it circulates and removes the waste products produced in metabolism by the brain cells kind of like the way our intestinal system and kidneys remove waste products from our body. Without this circulation, our brains would become overwhelmed with waste and would die. Interestingly what has many structures of the brain that can be affected, the corpus callosum is one of the first to be changed. A breakdown of the circulation of CFS will cause it to thin and shrink.
Thinning and shrinking of the corpus callosum means that the wiring between the two hemispheres becomes inefficient and thus there is a breakdown of communication between them.
I believe this is the basis of many major psychiatric disorders such as borderline personality disorder, bipolar disorder, schizophrenia and major depression.
What’s That Got To Do With Anything?
Okay, you may be thinking, but what about suddenly remembering traumatic memories from childhood?
The number of fibers (wires) in the corpus callosum are fixed at birth. However, they grow thicker and thinner in different stages of life. These changes occur because of myelination (adding new insulation) and pruning (getting rid of the extra connections we do not need).
Now please be patient with me, and I promise I will get to the point.
The posterior (back) of the corpus callosum changes in size with age as the myelination and pruning activities of the brain change. On average, they increase with increased myelination and decrease with pruning.
Check out the following breakdown of how our brains change over time from birth to old age. The ages are approximate as every human’s brain matures at a different rate dependent heavily upon genetics.
A Breakdown of Brain Maturity
Birth to 6 years—Humans are born with more neurons (wiring) than we will ever need to help us interpret the world we have just been born. The first three years of life are when we experience the most increase in brain activity as we learn to survive outside the womb.
Age 7-16 years—Our brains experience more significant growth in the anterior (front) region of the corpus callosum in a wave of development. This development could be because of a growing ability to use language and speech.
Age 17-20+ years— Although our brains have been cutting away unused and unneeded brain cells for many years, pruning of excess neurons (brain cells) begins in earnest and increases.
Age 20- 40+ years—a plateau of pruning and growth is reached. Our brains have reached a point where they are most fully developed. Brain maturity in most people is achieved here, and It is at this stage that connectiveness between neurons and the hemispheres of the brain become fully developed and rich.
During this stage is the point where I believe many who live with dissociative identity disorder begin to remember the severe trauma they experienced as children.
Let Me Ask You to be Patient With Me Just a Little Longer!
I have stated in a previous post that the left hemisphere is responsible for interpreting the world about us, and the right for understanding what is being explained. The left hemisphere is the spokesman for the brain and right acts like its silent partner.
So, the left hemisphere is called the interpreter. (Duh)
As I have said before, they have done experiments with people who have had their corpus callosum (wiring) cut between the two hemispheres of their brain to help end severe seizure activity. The results were stunning.
In one experiment they used headphones and told the person in their right ear (the right hemisphere because they have no communication to the left) to stand up, walk across the room and pick up a pencil. Immediately the person did as they were told. When the scientist asked this subject why he had done so, he reported feeling the need to walk, and he wanted a pencil.
The right brain heard the order and carried it out, but the left hemisphere had no idea that order had been given. To make sense of what the subject had just done, (i.e., standing up and going to get the pencil), the left hemisphere made up a scenario to explain what had just occurred.
The person who had just lied was unaware they had told a fib. To them, the answer they gave was the correct one without a doubt.
The Effects of Severe Childhood Trauma
Severe childhood trauma shuts down the left hemisphere (interpreter) and forces the brain to encode the memories of the event into the right (silent partner) hemisphere. As you may have surmised, if only the right hemisphere holds the memories, the person who experienced them cannot know about their existence, and they are “forgotten.”
In this way life goes on, that is until the person reaches brain maturity when suddenly a new stage of development is reached, and the connections that had been lost due to the trauma are suddenly established. The result is a flood of memories from the trauma the person had experienced in childhood.
The Memories Aren’t Lost
The memories aren’t repressed, they aren’t forgotten and then suddenly remembered. The new connections made between the two hemispheres of the brain have formed.
I think in children who have experienced horrendous and repeated trauma at an early stage in their brain development experience this effect to an even greater extent than do other adults.
The stress hormones that flood their little bodies and are never allowed to return to baseline cause an uptick in loss of connectedness between the two hemispheres of the brain. The reason is that there is a significant dip in the formation of myelin (insulation) surrounding the fibers in their corpus callosum (wiring) at the point (age birth to 6 years) when our brains are just learning how to encode memories and how to survive outside the womb. It is easy to see how traumatic memories can be lost to the “waking self” as they are encoded on the right hemisphere, and the child simply moves on with life not even knowing those events had occurred.
Then when the child who had now developed dissociative identity disorder reaches adulthood (ages 20 – 40) and the connectiveness of the two hemispheres enters a new stage of development. Then these memories that have been filed away in the silent hemisphere of the brain suddenly burst into the consciousness of the left, and we are left scratching our heads and thinking we are crazy.
I know this is new information to many of us in the DID community, but I have included the links to the research I’ve been using to put this together. There is far more to the story to explore, but I wanted to bring you up to date on what I have found so far.
“We are our memories. That’s all we are. That’s what makes us the person we are. The sum of all our memories from the day we were born. If you took a person and replaced his set of memories with another set, he’d be a different person. He’d think, act, and feel things differently.” Brian Falkner
At What Age Is the Brain Fully Developed? (2015). Mental Health Daily. Retrieved from:
Blood Supply, Meninges, and Cerebrospinal Fluid Circulation. The Human Central
Luders, E., Thompson, Paul M., Toga Arthur W. (2010). The Development of the Corpus
Callosum in the Healthy Human Brain. Journal of Neuroscience, (30), 30-33
McEwen, B. S., & Morrison, J. H. (2013). Brain On Stress: Vulnerability and Plasticity of the
Prefrontal Cortex Over the Life Course. Neuron, 79(1), 16–29.
Thank you for all your hard work, Shirley. I follow your posts with great interest. Best – TS
Thank you very much! Shirley
Thank you for this article, it helps understanding how memories got back…At the age of 33 I suddenly ‘ remembered’ very much after being severely triggered. However, now I’m 56 and these memories are still covered up, waiting to be processed. They did not come out properly and have been covered up again in absence of any right therapy. Meanwhile DID continues and you wait for help, I hope to get another sudden memory recovery, as this is living very strange” knowing there is very much wrong but not knowing what it is”. Maybe you are not forgotten about what happened, but it remains all in the context of comprehension of the age you were in. So memories could be deformed and changed by age you had during trauma, I believe.
I’m sorry you haven’t been able to find a good therapist. We desperately need more therapists who are trained in DID care. We are working on that very hard.
The memories of your past are still there, but your system is hiding them for you, just like they always have. What I was trying to explain in this article was an answer to the people who pooh-pooh at repressed memories. Somehow folks have gotten in their heads that we have pushed back these memories or that they have been temporarily forgotten. That isn’t true. The memories have been, well, for lack of better words misfiled. They were encoded and stored in the right hemisphere which is the side that is mute when it comes to expressing what it remembers and how it interprets the world. The left hemisphere is totally unaware these events took place because the memories have been stored in silence.
Then suddenly our brains reach maturity and make new connections, including between the left and right hemispheres.
Pow! We remember things that happened years before.
This puts to rest the false memory syndrome people who claim that memories cannot be so easily forgotten, and thus these memories are false.
I hope you are able to find the help you deserve soon. It is horrible to be without guidance like that. I’ve been where you are. Peace to you my friend. And thank you for reading my blog. It means the world to me. Shirley
I must admit that I do not fully comprehend the going ons.
(how to blog/respond/ internetbut also read twice and understand 62 % of ..post??fk idk)
I am a 27 year old female, ,
Was diagnosed early years with adhd,
As a young child, once again as an teenager after imagrating, but thirdly while in waiting room at counseling self diagnosed reading a pamphlet, (which is the first and only recolection I have of even the this horrid acronym adh)
There are many blurs from then till now and i must add that I have abused all sorts substances over the years and very aware of the retardation of brain development from ..drugs both street and pharmaceutical and their circumstantial traumas (comparitively)
Chicken or egg fk idk
A few months back While in hospital for a night through hardest stint of a daring self iflicted detox I noticed on my records: borderline personality disorder. Once again never recall any discussion of this diagnoses but there it was. Like the pamflet all over again but worse cause my name was attached to it.
In the last year have been doing stints of clean and sober (currently 1 month for second time) but struggling with the memories that flood back/ dreams that reoccur then somehow turn to memories.
Apologies not trying to sob,sulk or show pony,
I’m very much dont label me, dont pity me kind of person but heard disassociation disorder first time this week an it’s been brought up twice thereafter.
I stumbled upon this post among a few others but something resonated with me,
I am hesitant to say “yeah sounds like what I got”
Cause whatever my brain has done has kept me safe and has only started affecting me as of late.
Now aware of this possibility I call my “awakening ”
For example walking out a shop yesterday I knew I wasn’t “myself” I was like ina state… remember saying in high school “autopilot”
Or the “secretary assistant”
( guess my spirit desperate to unseperate myleft and right brain to work in unicen)
Memories come at the most inconvenient times. And I “disappear “slot because I want to vallidate/ resolve memories instead of sending them back to the dontevergotherebox.
But part of me doesn’t feel safe to do transition
Why this whole rant of mine you ask:
Yes the correlation in this post in my
( guess my spirit desperately yurns to unseperate myleft and right brain so to work in unicen)
opinion is onto something
*2nd curious about percentages of these people self medicating purely for an excuse for the “forgetfulness” and the void lack of memories cause??
*3 what treatment available
How do I know?
* if I do have this what difference can it make knowing? (Wouldent it be safer with the walls up I spent so long building)
But in same breath need help to navigate out of …herenow
Dissociative Identity Disorder: A Case Study
In the following paper, I will present a young woman who I believe is suffering from Dissociative Identity Disorder (DID). In addition, I will give a description of DID, its etiology, and its epidemiology. Lastly, I will present information which I believe supports the diagnosis of DID.
DID is, perhaps, the most misunderstood and controversial of all mental disorders. It is both fascinating and tragic at the same time. Perhaps, no disorder has garnered more attention from the media or more disdain from the skeptics.
There is no denying that those with DID experience a myriad of symptoms, and have a very high rate of co-occurring mental disorders. Furthermore, one cannot easily refute that most people presenting with symptoms of DID have suffered physical and/or sexual abuse, as well as other traumatic experiences as children. Although it is generally believed that DID is a rare mental disorder, one study indicates that it has a lifetime prevalence of 1% in the general population (Millon, Blaney, & Davis, 1999).
The young woman described below exhibits many symptoms of DID. I believe she may have a history that would predispose her to develop DID. In addition, she has experienced factors known to precipitate the onset of DID.
The Client/Patient is an 18-year-old female from Germany. She has been living in the U.S. for the last three years. Her mother died four years ago (cause of death unknown). Client witnessed mother's death. Client's mother was never very involved in her life. She was raised by her grandmother. She has no prior history of mental illness or any other medical problems.
The client appeared under nourished at the time of the interview. Client fainted during the clinical interview when her hand was placed in cold water. Otherwise, she exhibited good physical strength for her size. Client had a pleasant disposition, is responsive, and seems oriented to time and place.
Client was brought in by her father and grandmother. Father and grandmother complained that client steals and lies, frequently. For example, father reported that she will take money from his pocket and then deny that she had done so. Father stated that client stole a pocketknife from her teacher. Client claimed that she did not steal it, but rather found it. Father and grandmother claimed that client steals money to buy candy from the store. Client will often assert that it was another little girl who actually bought the candy.
Client often behaves like a child much younger than 18. Father reported that client came to him stating that she wanted to be loved and be his baby like the other little girl. Client went on to say "I'm a good girl now, ain't I? I don't steal anymore, do I?" Father said she had a peculiar look on her face during this time. Father claimed that the client will change behaviors frequently. For example, client once ran away and claimed that she was whipped excessively at home. However, on other occasions, as stated above, client will seek out father's love and affection.
Although father claimed that she is not whipped excessively, he does admit to whipping her when she returned home after she ran away. I am not convinced that the client is not physically abused. Family did not seem to be very fond of client. For example, client’s grandmother called her "a terrible little liar."
Client is frequently interested in things that one would associate with a young child, not an 18-year-old. For example, she reported stealing money from teacher in order to buy candy, ice cream, and rollerskates. Client appeared more gullible than one would expect for an 18-year-old. For example, client stole items and called people "wicked" names when told to by a boy (15) who lives on her street.
During the interview the client talked about her interaction with the aforementioned boy and another girl (11). Client described how the boy tried to get the other girl to go into the bushes with him. Client said that she did not know what this meant, and that the other girl would not tell her. Client said that the boy will say bad names to her and try to get her to steal, but that he is nice to the other girl. Later in the interview, however, client talked about how the boy tries to get her to go out into the bushes with her (after having said that he never tried to get her to do that). Client also stated that the boy had knocked down the other girl and tried to take her clothes off (after having said that he was nice to her). Client went on to say that the other girl told her lots of bad names that that boy taught her (after having stated that the girl does not say bad words).
From the interview provided, I get the impression that the interviewer is having a conversation with two different people. It appears as though the client switches from herself to "the other girl," about whom she was talking. The other girl then appears to be talking about the "client." I believe this is why the girl contradicts herself, as described above. Furthermore, I believe this is why the client (18) buys candy, ice cream, and rollerskates (interests more characteristic of an 11-year-old) with the money she steals. This may also explain why she claims not to remember stealing certain items. It is my opinion that the client is suffering from Dissociative Identity Disorder (DID). The so-called other girl (11) is actually an alternate personality/identity.
300.14 Dissociative Identity Disorder
- The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).
- At least two of these identities or personality states recurrently take control of the person's behavior.
- Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
- The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play (American Psychiatric Association, 2000).
Dissociative Identity Disorder (DID)
DID, formerly multiple personality disorder, is characterized by the presence of two more distinct personalities residing in an individual (American Psychiatric Association, 2000). “The quiet, careful guy at the lab who is a ‘wild man’ at parties may look to others like a multiple personality, but he sees these ways of being as different aspects of his identity and does not suffer from Dissociative identity disorder” (Maxmen & Ward, 1995). According to the DSM-IV-TR, DID "reflects a failure to integrate various aspects of identity, memory, and consciousness" (American Psychiatric Association, 2000).
The different personalities or identities may vary in age, sex, personal history, and temperament. They usually have different names, as well. The various identities may not have knowledge of one another. They may emerge (i.e., take control of the person) gradually or within seconds. When a new identity takes control, the person’s facial expression may change or rapid eye blinking may occur (American Psychiatric Association, 2000).
Those who have witnessed a person with DID alternate or transition between personalities may report that it is “spooky” or strange to witness, as the newly emerged identity may speak and walk differently. The person’s facial expression may change so dramatically, the person may become unrecognizable to those witnessing the “transformation.” For some, it is an unnerving experience to say the least (Maxmen & Ward, 1995).
People with DID experience frequent gaps in memory. They may disavow behavior witnessed by others. Psychosocial stresses may precipitate the onset of DID (American Psychiatric Association, 2000).
Individuals with DID often report a history of physical and/or sexual abuse (American Psychiatric Association, 2000). People with DID have learned to dissociate as a way to escape from a traumatic reality. Some argue that DID is a coping mechanism or simply a means of survival, as the trauma people with DID have experience is so psychologically and emotionally painful, it could easily lead to psychosis or suicide (Middleton, 2005). Even so, “untreated patients with DID have very high suicide rates, in the order of several thousandfold in excess of the American national average” (Middleton, 2005).
The abusers may deny or distort their abusive behavior, in an attempt to trivialize real abuse as proper punishment (Middleton, 2005). The psychological motivation of abusers time and again is
to evoke protectively in the child the unwanted negative images of the self—to make the abused one feel utterly helpless, humiliated, shamed, violated and abject—and to bring about a near annihilation of the true self of the abused (Middleton, 2005).
It is no wonder then that abuse leads to a damaged sense of self. Abuse perpetuated on children by a caregiver (as is usually the case) is especially traumatic. In order to maintain a bond with their abusive caregivers (as they remain dependent on the very people who abuse them), abused children may learn to block out or dissociate themselves from the abuse, as a means of coping with their emotionally and psychologically conflicting reality (Middleton, 2005).
Psychologically sound and healthy individuals may take the notion of selfhood for granted, but it is an essential aspect of healthy human functioning, without which one’s daily functioning would be severely hindered. Selfhood allows one to differentiate him- or herself from others and the environment. In other words, it serves as boundary between the self and the rest of the world. It serves as a guide for how one represents him- or herself to others and the environment, as well (Middleton, 2005).
Furthermore, a good sense of selfhood allows one to distinguish the past from the present, as well as the capacity to recall one’s life logically and relatively chronologically. Self-hood enables one to live for him- or herself independently and free of toxic, enmeshed relationships. This in turn, allows one to be at peace with him- or herself and to develop self-esteem, as well as an overall sense of wellbeing (which is an essential aspect of an emotionally and psychologically healthy individual (Middleton, 2005). Interestingly enough, Middleton points out that selfhood enables one to cope with traumatic experiences, so that he or she may move on with his or her life (2005).
People with DID lack a true sense of selfhood. They, therefore, lack many or most of the positive aspects of a well-defined sense of self. It is not surprising that people with DID have difficulties in nearly every aspect of their lives (e.g., vocational and financial difficulties, social and familial problems, legal troubles, substance abuse and other mental disorders, etc.) (Middleton, 2005).
Comorbidity is a significant problem of people living with DID. People with DID regularly have had or will develop other mental disorders at some point in their lifetimes. Common cooccuring disorders run the gamut from mood, anxiety, and psychotic disorders to substance abuse, somatoform, and eating disorders (Millon, et al., 1999). “Moreover, borderline personality disorder has been diagnosed in almost 70% of a series of clinically diagnosed DID subjects” (Millon, et al., 1999). Like DID, Borderline personality disorder (BPD) is frequently diagnosed in individuals with a traumatic/abusive childhood. Those dually diagnosed with DID and BPD are more likely to have been more severely abused than those diagnosed with only DID (Millon, et al., 1999).
Clinicians are frequently unaware that they’re treating a [person with DID], since these patients are tough to detect. One psychiatrist reported that seven years had passed before he realized his patient had this disorder. Few enter treatment complaining of multiple personalities, and if they come at all, it’s usually for depression (Maxmen & Ward, 1995).
In short, DID “rarely occurs as an isolated condition” (Millon, et al., 1999). In regards to DID, comorbidity is more often the rule than the exception. Differential diagnose is, therefore, extremely important when considering a diagnosis of DID (Millon, et al., 1999).
People with DID are prone to establishing abusive relationships with others (American Psychiatric Association, 2000). In addition to having real physical ailments (as they are prone to self-mutilation), they may exhibit psychosomatic symptoms (Middleton, 2005).
DID has been found in cultures throughout the world. For example, DID has been documented in Australia, India, New Zealand, North America, South America, Turkey, France, Belgium, Scotland, Scandinavia, England, Japan, the United States, and Germany. Although DID is found all over the world, in may be expressed differently depending on the cultural context. For example, in traditional cultures, alternate personalities often manifest as god, ghost, deceased family members, or nonhuman entities. The manifestation of such alternate personalities is in line with the cultural values of some traditional societies. Although psychopathology may be universal, it always occurs within the context of a culture. One cannot deny the interplay that occurs between culture and nearly every aspect of human life, including psychopathology (Shumaker & Ward, 2001).
DID appears to be more prevalent in individualistic cultures, such as the United States, Germany, and Finland, than collectivistic cultures. Most Western cultures are individualistic in nature, while Eastern cultures are more collectivistic (Shumaker & Ward, 2001). However, a recent study indicated that DID was on the rise in Japan. Between 1919 and 1990 there were only five documented cases of DID. A dramatic increase in DID occurred between 1991 and 1997, with 30 cases being documented (Uchinuma & Sekine, 2000).
In addition, DID is more prevalent in cultures that tend to be relatively more tolerant of child abuse (Middleton, 2005). Although Western cultures typically hold a harsh opinion of child abusers, they are generally not really severely punished. Rates remain high in the West, despite increasing efforts to improve detection and early intervention of physical, sexual, psychological, and emotional abuse of children (Steinberg, 2005).
DID is three to nine times more prevalent in females than males (American Psychiatric Association, 2000). However, this disparity narrows between the sexes among incarcerated individuals—reflecting the greater likelihood that prison inmates were abused as children. DID usually shows up during adolescents and rarely develops after the age of 40 (Maxmen & Ward, 1995). It tends to be chronic and recurrent. DID, “and the proliferation of new identities, often continues for life, making this condition the worst of the dissociative disorders” (Maxmen & Ward, 1995).
Justification for Diagnosis
I would like to point out that after making the initial diagnosis of DID, I would investigate further in order to gain more evidence to substantiate my claim. A fully detailed description of the methods for more thoroughly investigating DID is beyond the scope of this paper, but they include things like semi-structured diagnostic interviews (the Dissociative Disorders Interview Schedule) and screening tests, such as the Dissociative Experiences Scale. A diagnoses of DID is more or less done on an exclusionary basis, meaning that other seemingly similar disorders, such as schizophrenia (for which DID is frequently—albeit wrongly—diagnosed as), must be first systematically ruled out before it is given (Maxmen & Ward, 1995).
If I could not substantiate my claim relatively quickly, one option would be to defer the diagnosis of DID or, perhaps, give a diagnosis of Dissociative Disorder, Not Otherwise Specified (DDNOS). DDNOS is often used by clinicians as an initial diagnosis until they can more thoroughly substantiate a diagnosis of DID (Maxmen & Ward, 1995). That being said, I will now provide justification for why I believe that the young woman described above does, in fact, have DID.
This particular client exhibits many symptoms of DID. For example, the client disavows certain behaviors, apparently having no recollection of pervious events that were witnessed by others. She may claim to have found items that were known by others to have been stolen by her. The client will persistently deny that she stole the items, even in the face of proof that she did, in fact, steal the items.
In addition, the client has stolen money from her father in order to purchase candy. I find that stealing money to buy candy to be rather uncharacteristic of an 18-year-old. It seems to me that an 18-year-old would be more interested in stealing money to purchase more age-appropriate items. At times, the client has claimed that another little girl was actually responsible for purchasing the candy. The family is convinced that she is simply a pathological liar.
People with DID usually have no recollection of events that took place while an alternate personality or identity was in control. I believe that the client has an alternate identity, which takes on the persona of a little girl. I think that this alternate identity is responsible for the thefts witnesses by others. Furthermore, I think this explains why the client apparently buys candy with the money she steals, instead of more age-appropriate items.
Client’s father reported that her behaviors shift dramatically from time to time for no apparent reason. He stated that she once ran away and refused to come home. Upon returning, client told father that she wanted him to love her like he did the other girl. Furthermore, client’s father claimed that she has a strange look about her during these shifts in behavior.
When different identities emerge in people with DID, it usually proceeded by rapid blinking or a change in facial expressions. Witnesses often say that people with DID have an overall strange look about them when they are shifting from one identity to another. I believe that the client’s strange facial expression (described by the father), which co-occurred with a shift in her behavior, is actually the emergence of alternate identity. This would also explain the dramatic shifts in her behavior, as well as her request that her father love her like he does the other girl. I believe the other girl, of whom she spoke, is actually an alternate identity.
On one occasion, when the client ran away, she claimed that she was whipped excessively at home. The father denies that this is the case. However, one would expect him to deny it, as abusers usually do. Although the father claimed that he does not whip her, he admitted to whipping the client after she returned home from running away. This is an obvious contradiction, which, I believe, reveals that he does in fact whip her—perhaps, excessively. Obviously, this suspicion would have to be substantiated before I could make this claim with any level of real confidence.
It would appear that the client has not had an extremely stable childhood. Her mother and apparently her father were not very involved in her life growing up, as she was predominantly raised by her grandmother. It sounds as if the client’s grandmother does not hold her in high regard, as the grandmother commented that the client was “a terrible little liar.” Such a statement may indicate the presence of emotional or psychological abuse.
Furthermore, the client appeared undernourished at the time of the interview. This may be evidence of neglect and/or abuse at home. However, under normal circumstances one would expect an 18-year-old to be capable of attaining nourishment for herself by whatever means necessary (perhaps her alternate identities are stealing for this very reason), though the client’s circumstances appear to be by no means normal. The client’s undernourished appearance could be the result of an eating disorder, which co-occur with DID at a very high rate (Maxmen & Ward, 1995). Of course, these suspicions would have to be further substantiated, as well.
Approximately 90% of people suffering from DID were abused and/or experienced a traumatic childhood (Millon, et al., 1999). A history of abuse appears to be the overwhelmingly consistent feature of those with DID (Okugawa, 2005). Although I cannot yet make this claim unequivocally, I believe there is some reason to expect that the client at the very least experienced a difficult childhood, if not an abusive and/or traumatic one.
Further evidence for a diagnosis of DID appeared during the diagnostic interview. During the interview it seemed as if the clinician was having a conversation with two different people. Although the client appeared to be rambling and contradicting herself, I believe that the interviewer was actually witnessing the emergence of one of the client’s alternate identities.
Furthermore, during the interview, the client claimed not to be aware of the sexual innuendo of the boy who lives on her street. This is rather unusual for most 18-year-olds (especially considering she is of normal intelligence). I believe that when she made this claim, one of her alternate identities was in control, probably the little girl described above.
In regards to the little girl, the client makes reference to interactions between herself, the boy (described above), and the little girl. She seems to intermix and intertwine the actions of the little girl with herself. For example, in one instance stating that she (the client) said bad words and not the other girl, but in another instance say that the other girl said bad words and not her. Perhaps, in the second instance “the other girl” (the little girl) had emerged as the controlling identity and was actually speaking of the client as “the other girl.” This may explain the apparent contradictions the client made during the interview described above.
The client’s father reported that her strange behaviors did not begin until she moved to the United States from Germany, shortly after the death of her mother. The client reportedly witnessed the death of her mother (who “fell over dead next to her”). Psychosocial stressors have been shown to precipitate the onset of DID for those susceptible to the disorder. Moving, especially to a foreign country which speaks a different language and has different customs, is extremely stressful. Moving to a new country, in conjunction with witnessing the death of her mother, may have been enough to push her over the edge—leading to the development of a full-blown case of DID.
Other factors that support the diagnosis of DID are as follows: The client is female, under the age of 40, and comes from a Western culture with previously documented cases of DID. DID is much more prevalent (four to nine times) in females than males. There are few cases in which DID developed in individuals over the age of 40. The client is from Germany and lives in the U.S. They are both Western cultures where child abuse is more or less tolerated, and where DID has been documented relatively frequently.
Lastly, during the interview, when the client’s hand was placed in cold water, she fainted. This may be indicative of psychosomatic symptoms. According to Maxmen and Ward, psychosomatic symptoms are common in people with DID (1995).
DID, also known as multiple personality or split personality disorder, has a notorious and somewhat controversial history. DID has garnered attention from Hollywood, gaining pop culture status in movies like Sybil and Primal Fear. From time to time, DID shows up as the centerpiece in the defense of someone charged with a crime who, as a result of DID, claims to have no recollection of ever committing the crime. Such individuals contend that they are not to blame for the crime, as it was not “them” who committed, but rather one of their alternate identities. Certainly, this may be a legitimate claim for some, but I am just as certain that this defense is abused from time to time. Those who falsely claim to have DID in an attempt to avoid punishment, are surely--in part--responsible for the controversy surrounding this disorder (Kennett & Matthews, 2002).
Although some people may be skeptical of DID, the statistics may speak for themselves. Although relatively rare (when compared with other mental disorders, such as depression), DID is a widespread disorder occurring across the world and throughout history. One study of 1,008 adults living in North Carolina, fond that 10% of them have at least experienced some symptoms of a dissociative disorder at one time or another. Another study found the inpatient prevalence of DID to be between 1% and 10% (Steinberg, 2005).
To dissociate refers to the “splitting off” from normal consciousness. This “splitting off,” though it sounds dramatic, is actually very normal and routine in the human experience. For example, sleeping, meditation, daydreaming, or just “zoning out” are all common experiences which represent a “splitting off” from normal consciousness. Perhaps, one could argue that the experience of dissociation lies on a continuum, with daydreaming being the mildest and least disruptive form and DID being the most severe and malevolent. Although DID is a very extreme version of dissociation, dissociation, in its truest sense, may not be so unusual after all (Maxmen & Ward, 1995). “According to some philosophical and religious stances, to be human IS to live in a dissociated condition” (Krippner & Powers, 1997).
DID is both fascinating and tragically debilitating. While some disregard DID as a hoax or as a creation of those in the mental health field, the data shows that a similar clustering of symptoms surround those with DID across a wide spectrum of individuals (Kennett & Matthews, 2002) (Steinberg, 2005). To be sure, more research is needed in order to gain a more accurate and comprehensive understanding of DID.
Cohen, A. (2004). Dissociative identity disorder: Perspectives and alternatives. Ethical Human Psychology and Psychiatry, 6, 217-230.
Kennett, J., & Matthews, S. (2002). Identity, control and responsibility: The case of dissociative identity disorder. Philosophical Psychology, 15, 509-526.
Humphreys, C.L., et al. (2005). The assimilation of anger in a case of dissociative identity disorder. Counseling Psychology Quarterly, 18, 121-132.
Krippner, S., & Powers, S.M. (Eds.). (1997). Broken Images, Broken Selves: Dissociative Narratives in Clinical Practice. Washington: Brunner/Mazel, Inc.
Maxem, J. S., & Ward, N. G. (1995). Essential Psychopathology and Its Treatment. (2 nd .). New York: W.W. Norton and Company.
Million, T., Blaney, P.H, & Davis, R.D. (Eds.). (1999). Oxford Textbook of Psychopathology. New York: Oxford University Press.
Okugawa, G., et al. (2005). Perospirone for treatment of dissociative identity disorder. Psychiatry and Clinical Neurosciences, 59, 624.
Schumaker, J.F., & Ward, T. (Eds.). (2001). Cultural Cognition and Psychopathology. Westport: Praeger Publishers.
Steinberg, M., et al. (2005). SCL-90 symptom patterns: Indicators of dissociative disorders. Bulletin of the Menninger Clinic, 69, 237-249.
Uchinuma, Y., & Sekine, Y. (2000). Dissociative identity disorder (DID) in Japan: A forensic case report and the recent increase in reports of DID. International Journal of Psychiatry in Clinical Practices, 4, 155-160.
Warwick, M. (2005). Owning the past, claiming the present: Perspectives on the treatment of dissociative patients. Australasian Psychiatry, 13, 40-49.
Cooperation, Integration, and Fusion
Integration i n its most basic form occurs any time that information is processed. When an individual incorporates a fact into their understanding of their self or an event into their understanding of their personal history, that's integration. Dissociation can be seen as a failure of integration. When an individual is struggling with depersonalization or derealization , they're having difficulty processing relevant information about their self or environment in real time. When an individual has dissociative amnesia , their memory of the traumatic or stressful event(s) are kept separate from their other memories and may be accessible only through dissociative flashbacks. When an individual has dissociative identity disorder (DID) or other specified dissociative disorder subtype 1 (OSDD-1) , information is stored in separate dissociated parts, known as alters .
Every individual who has been through trauma must integrate to some extent as part of healing . This means accepting that the trauma occurred, making it part of one's personal narrative, and making it accessible in a way that does not cause intense re-experiencing of trauma elements. In doing so, an individual may have to accept thoughts, feelings, and urges associated with their trauma. For example, an individual with posttraumatic stress disorder (PTSD ) may find that as they integrate their trauma history into their personal narrative, they have to also process feelings of helplessness, betrayal, fear, or anger. In terms of structural dissociation , the individual has to integrate the emotional part(s) associated with their trauma, and that means having to take ownership of everything that the part(s) contained.
For individuals with DID or OSDD-1, however, some or all of their parts are likely to go beyond simple containers of traumatic materials. For individuals with DID, some alters may have strongly developed independent senses of autonomy and self. The individual must then make the choice of to what extent they want to integrate their alters as part of their healing. Again, some degree of integration is inevitable. The individual must integrate traumatic materials in order to heal from PTSD. As well, enough integration between alters must occur to allow for easy communication and a lack of dissociative amnesia between parts . The individual must be able to take responsibility for all of the system's actions, and all alters in the system should work together towards the same goals.
Some systems choose to stop there, at what the ISST-D calls resolution. In this case, they may retain any number of independently acting alters. Reasons for choosing not to fully integrate can include: feeling that full integrate is unnecessary not understanding what integration actually entails and being afraid of "losing" their alters uncertainty over how to navigate the world as one integrated person being used to having alters around for company, entertainment, or support alters having their own unique relationships that they're hesitant to lose alters wanting to remain separate for their own sakes or the individual not wanting to lose attention, support, or a sense of being unique that they feel is associated with remaining dissociated. Unfortunately, even some individuals who might otherwise want to integrate can find it impossible to integrate all of their parts or to maintain one integrated personality over time or when faced with stress. This can occur when an individual is in a highly stressful or unsafe environment, can't bring themself to fully accept their trauma history, can't access treatment from professionals who are knowledgeable about DID, or can't afford to continue treatment or when symptoms from comorbid personality or other disorders interfere. Some question if integration is even permanently possible, and many therapists are less insistent on full integration as the only possible treatment for DID than they were in the past. Even if a therapist tries to push their client to integrate, permanent integration cannot be forced, and an integration that occurs before the system was ready for it is very likely to fall apart.
That said, even individuals with DID who are vocal about their desire not to integrate are likely to spontaneously integrate some alters and fragments as they process and heal, many systems willingly integrate down to a few alters (including well known systems such as Robert Oxnam ), many individuals who are fully integrated are convinced that integration is the best option, and some studies (such as this one ) do suggest that complete integration is the option most likely to result in long-term stability and healing. In order to integrate two or more alters (which the ISST-D refers to as "fusion," with "final fusion" referring to a complete integration of all dissociated parts), the individual needs to take ownership of all thoughts, feelings, memories, urges, skills, and other traits that were previously associated with those parts of the self. Integration is complete when there are no subjective differences between the parts involved only one sense of self remains.
Integration of alters can be experienced in different ways. For fragments, integration may simply entail other alters being able to access what those parts held without a switch being necessary. There may be no major difference in how other alters perceive themselves or the world. Even with more developed alters, one alter may seem to integrate into the other so that the resulting part retains the identity of one of the alters involved but gained some of the skills, traits, preferences, or views of the other. Another possibility is that the integration of two or more alters may lead to the creation of a "new" alter that contains some combination of traits from the parts that integrated. This alter may feel like all or none of the alters involved but is regardless an acknowledgment that what the alters held no longer needs to be kept separate. Finally, an integration may indicate a shift that has already occurred in the system. For example, if an alter primarily held acceptance of same sex desires, that alter may no longer be perceived as separate as the system as a whole moves towards accepting their sexuality.
It must be noted that not every trait that an alter held will be experienced in the resulting part in the exact same way as it was prior to integration. Traits such as gender identity, sexuality, or religion might differ between parts, and the individual will need to figure out for themself how they feel in relation to these and other points of conflict. Some preferences that alters had may be muted when no longer contained in relative isolation for example, the integration of an alter who really loved hard rock is unlikely to completely change the musical preferences of an individual who loves classical music, but the individual might find that the integration results in a greater tolerance for rock music or widens the range of music that they enjoy. Some traits may be lost entirely, such as an alter's unhealthy ability to ignore pain at the expense of respecting one's physical limits. Finally, some skills or abilities that alters excelled at may require additional practice as an integrated individual before they can be fully expressed.
Even when some traits are lost, integration that was not forced or rushed should not feel like a loss. Healthy integrations feel like what they are: an acceptance of aspects of oneself that one wasn't previously able to fully accept. Some individuals do need to take some time to mourn the loss of experiencing an alter as separate, but others experience integration as joyous! Alters especially may want to integrate so that they no longer miss out on so much of the system's life, so that their emotional range is no longer limited, or so that they can consistently contribute to the system's functioning and safety. Overall, integration leads to a more stable and well rounded individual who has consistent access to all parts of themself. As the individual learns to connect with all of their thoughts, feelings, and behaviors, they will learn to rely less on dissociation, and their general dissociative symptoms will decrease. An individual who is fully integrated and has achieved final fusion may be less vulnerable to increased dissociation or splitting into new parts as a result of future stress.
Finally, it must be noted that even if an individual successfully integrates, it is possible for the integration to temporarily dissolve during times of stress or conflict. It's important to keep in mind that this is a normal part of the progression of integration and is not a bad sign or a setback. Before final fusion, integrations might fall apart if the parts involved weren't completely ready yet, if a stressor arises that one alter in particular was created to handle, or if the parts involved need influence from other parts in order to remain stable in their unity. After an attempt at final fusion, it might take some time for the individual to become used to living as one integrated identity. Like everything else, learning a new way of viewing oneself and learning how to rely on responses other than dissociation take practice! Treatment should continue for a while after a system has achieved final fusion in order to support this process, and an individual can also briefly return to therapy at any point in order to address temporary lapses in integration, an increase in dissociation in response to new stressors, or any other problem.
Busting some myths
Something that astonished me was the number of myths surrounding the disorder. In the following segment i will list these myths out and attempt to put out the truth.
1) DID is not real, it is people acting out.
Truth: DID is a very real disorder, it has been identified by both Diagnostic and Statistical Manual (DSM) and International Classification of diseases (ICD).
2) People who have DID are dangerous.
Truth: Unlike the media representation of dissociative identity disorder, people suffering from this disorder are not dangerous. In fact as mentioned earlier in the article you wouldn’t even know that they are suffering from the disorder.
3) The alters are extreme.
Truth: In movies and shows the switch and different alters are extremely exaggerated. This is completely untrue. The portrayal in the media is extremely sensationalized.
4) This disorder is the same as schizophrenia
Truth: They are two separate disorders. While schizophrenia is a psychotic disorder characterized by hallucinations and delusions, Dissociative identity disorder is characterized by separate fully formed personalities.
5) The persecutor alters are always going to harm you.
Truth: The persecutor alters are more likely to harm their own body rather than their environment. These alters often hold the majority of the memories of trauma.
Yes, the movies do get some details correct, but largely they are creating a stigma. The characters are extremely exaggerated and unreal. The overall result isn’t accurate at all.
Its time that we educate ourselves and make a safe environment for everyone suffering from the disorder. Its our moral responsibility, and we must always keep in mind that whatever is in the media isn’t always true.
Dissociative Personality Disorder: How It Really Affects You
What Is Dissociative Identity Disorder?
Dissociative identity disorder (DID)is a mental disorder that affects memory, behavior, emotion, perception, and identity. It was once called multiple personality disorder, and is one of three different dissociative disorders. One of the primary characteristics is the feeling that there are multiple identities in the individual&rsquos head, which is what often leads to the above-named issues.
Types of Dissociative Disorders
People who have dissociative amnesia forget significant events that have happened to them as well as core memories, which is painful to the individual experiencing it. Dissociative amnesia lasts for a varied length of time and could occur at any time with a sudden onset. You never know when it could happen to you, and it could happen more than one time throughout a person's life.
With depersonalization disorder,you may feel separated from the things happening around you, including your own actions, thoughts, and feelings. Some have described it like watching a movie, because you feel detached from what's around you. People tend to notice it earlier than age 16, but it's possible to experience the first episode later. However, it rarely happens after 20. For those who do experience it, it is a pattern that can repeat throughout their life.
Dissociative Identity Disorder
With dissociative identity disorder, you experience separate identities, which can be present only in the mind of the individual, or cantake control of the individual's mind and body. The identitieslikely have distinct names, mannerisms, ways of speaking (including intonation), and idiosyncrasies that are exclusive to each one.
Symptoms Of Dissociative Identity Disorder
There are a number of different symptoms that are related to DID. Here are some common signs of the disorder:
- An individual experiences two or more entitiesor identities. Each onerelates to the world in a different way
- A change from one identityto the other also includes shift in the person's behavior, memory, perception, motor function and/or cognition
- The individual has memory gaps which can include events, places, and people
- The individual experiences distress in their personal or professional life due to these symptoms
When The Change Happens
Hollywood makes DID out to be a person with a "split personality," with a "good side" and a "bad side," when this is often not the case. Dissociative identity disorder does not typically appear as two personalities with entirely separate lives that know nothing of each other. Rather, the personalities may be distinct but in different ways. The secondary identity(or identities) may only be present for short amounts of time, and they are triggered by specific situations or instances.
Those who live with DID report that they're aware that something strange is happening to them. Some feel that they are pushed into the background while someone else is in control of their body. Some feel that they hear voices that have their own stream of consciousness and thought. Some have reported feeling impulses or even emotions that are so strong but that they don't know where they came from. They may even note that they feel a shift in their body, their personality or their attitude that shifts back just as suddenly.
On the other hand, some may not know what is happening to them and realize that they have suddenly arrived somewhere different from where they remembered being and with no recollection of how they got there or what may have happened in between.
Why It Happens
There are a number of different reasons that this disorder may occur, but one of the most common is some type of abuse. Within the United States, Canada, and Europe as many as 90% of people who have been diagnosed with the disorder experiencedsome type of abuse as a child. Those who have a biological relative who has the disorder are also more likely to be diagnosed with it.
Of course, the fact that it tends to occur with a high frequency among these types of individuals doesn't mean that an individual who hasn't gone through any of these traumas in their past is entirely exempt. Anyone could develop dissociative identity disorder, which is definitely something you want to keep an eye on. If you recognize any of the signs or symptoms we've discussed here in yourself or someone else, you should seek out professional help immediately. The sooner you can get started on treatment the better.
Treatment For Dissociative Identity Disorder
Once a diagnosis is made, it's time to start the treatment process. This process generally focuses on the distinct identitiesand how to join them together into one cohesive entity. By breaking down the walls between each one it's possible to slowly start the integration process. With therapy, it is definitely possible to start this process and to eventually bring the individual around to a happy and healthy life that they can live without the other personality there.
Often, it's important to discuss the potential reasons for the development of the entitiesto fully integrate them. Sometimes stressors are a reason that a secondary identityemerges, and it's essential to evaluate the situation and the trauma that happened in the individual's childhood. When the person with DID confronts their abuse, they can begin to heal. However, this isn't something they can do alone. Someone with DID needs to seek professional help in order to process their feelings. A mental health professional can guide them in their journey to wellness.
Medications don't treat or cure DID, but rather aid in curbing the symptoms of the illness, such as depression, anxiety or panic attacks. Psychiatric medications vary and also may include sedatives to calm extreme levels of anxiety during times of distress. With the help of medication and intensive trauma therapy, it is definitely possible for someone with this disorder to continue to improve and to have more positive and healthy functioning throughout their personal life, as well as their professional life. Seeking treatment is essential, however, as integrating the entitiesisnot something that can be accomplished at home.
What A Diagnosis Means For You
So, what does it mean for you if you are diagnosed? Well, it means that you definitely need to start looking at some professional help. A therapist will be able to help you start putting things together so you can figure out what's going on in your life and how to get to the type of life you want to live. If you're not really sure what's going on or whether you might be living with this or any other dissociative disorder, you should still speak to a professional to find out more. They will be able to help diagnose you and figure out a plan for the future.
Getting the help you need and continuing treatmentis extremely important. Even if you think that you have overcome the problem, or if you think you've figured out the root of the problem you should continue to take any medications that are prescribed to you and continue to talk with a professional to make sure you're staying on the right track. Because many people who are diagnosed with this disorder have childhood trauma, it is extremely possible that problems could come back up later that cause additional problems. Make sure you're looking for a professional, whether that's with a therapist in your area or with the help of an online mental health professional.
How Online Therapy Can Help
Recent studies show that online therapy can be a useful method of treating symptoms of trauma&mdashone of the primary causes of dissociative identity disorder. In a study published in Depression and Anxiety, a peer-reviewed journal, researchers examined the effectiveness of online cognitive-behavioral therapy (CBT) when treating individuals with post-traumatic stress disorder (PTSD). The report mentions the high toll trauma can take on those experiencing it, and the treatment gap that exists due to various barriers to care, including perceived stigma, high costs, and lack of trained professionals, particularly in less-populated areas. Online therapyis a way of circumventing those barriers by increasing accessibility and providing remote counseling to those who need it.
As discussed above, online counseling is an accessible, flexible way of managing dissociative disorder-related mental health concerns, such as trauma, panic, or anxiety. With online therapy through BetterHelp, you&rsquoll have access to thoroughly vetted mental health professionals. A licensed online counselor can help you work through a dissociative disorder diagnosis. Read below for reviews of BetterHelp therapists, from those who have sought help in the past.
&ldquoI worked with another counselor for over 6 months before working with Arielle Ballard. In one 30 minute session, I got more accomplished in terms of structuring goals, building coping mechanisms, and recognizing thought patterns, than I had in the 6 months working with the other counselor. I'm pleased with my progress and am very greatful to Arielle.&rdquo
&ldquoI cant speak highly enough about David. I came to BetterHelp about 3 months ago with severe PTSD that was ruining my life and my relationships. In a short time I began to learn better and healthier coping mechanisms, tools to stop and change thought patterns and find a new sense of peace and confidence. What a difference. I would recommend David to anyone that may be seeking help from trauma and anxiety, he is very good.&rdquo
If you&rsquove been diagnosed with dissociative identity disorder, know that there is help available. There are trained counselors and therapists that are skilled at treatingpeople with DID. They can support you on your journey to wellness. Don't lose hope, there is a way to heal from your past, and it starts by seeking treatment.
How do people with DID (Dissociative Identity Disorder) experience dreams? - Psychology
Dissociative identity disorder: Rachel
Dissociative Identity Disorder was once called Multiple Personality Disorder (MPD). Rachel speaks in third person. She does not identify herself as “me”, instead, she says “Rachel thinks she claims this body, but she don’t, Rachel uses this body, and these are Rachel’s clothes”. During the interview Rachel also states that when Rachel is in control and doing her artwork there is a child linked up with her named “Shadow” is there looking through Rachel’s eyes as she does the art work.
According to the DSM-IV diagnostic criteria for DID, Criterion A: “The Presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self)”. Rachel describes having DID like this: “it’s like being half in and half out of the body it’s like running through the catacombs, or the darkness and didn’t know someone else is there”. Rachel also states that there are other people in there looking through her eyes.
Rachel also seems to understand the underlying cause of her disorder as evidence by stating “Is a way of survival mentally ill? People with MPD are being created though abuse and torture. There is a real world conned to the term”. She also describes having DID as looking through a fog, and once in awhile the fog is lifted, but their world is always a little off focus. She states “We possess many realities and I am never alone”.
Axis I: 300.14 Dissociative Identity Disorder
Axis II: V.71.09 Diagnosis Deferred
Axis IV: Possible relationship or occupational problems or concerns
I chose 60 on the multiaxial scale because Rachel appears to be functioning well despite her mental illness however, she states that she is “never alone”, implying that her other identities are always there, and she explains that people with DID are “always a little off focus”. I feel with these two impairments (among others) would at the least moderately affect Rachel’s psychological, social, and occupational functioning. After careful assessment and time with her I would be able to gauge it better.
Ms. M is a 26 year old woman who was hospitalized as a result of a suicide attempt. Ms. M. has a long history which includes: several suicide attempts, several hundred acts of self-mutilation, a history of substance abuse which includes cocaine, LSD, and PCP, and several psychiatric hospitalizations. She has been diagnosed with Borderline Personality disorder and Bipolar Disorder. She states that nothing has worked for her. Ms. M learned about DID from another patient. Ms. M had no mention of other identities before learning about DID. Ms. M found resources about the disorder and read them. It has been suggested that some clients “fake” DID. “It is difficult to answer this because evidence indicates that individuals with DID are suggestible (Bliss, 1984 Kihlstorm, 2005). It is possible that alters are created in response to leading questions from therapists, either during psychotherapy or while the person is in a hypnotic state” (Barlow & Durand, pg 195 2009). In addition some investigators have studied the ability of individuals to fake dissociative experiences (Spanos, Weeks, and Berrand (1985). Research has shown that individuals can sometimes fake DID. Some individuals do this in an attempt to deny responsibility of a crime being committed such as a serial rapist who may claim it was their other identity who committed the crime and that they had no recollection of the crime. The reason why Ms. M would “fake” DID needs to be investigated further. Due to Ms. M’s complex and lengthy psychiatric history, a full medical and psychological and drug assessment and workup is warranted.
I am not totally convinced that Ms. M is experiencing DID. I feel the two case studies are similar, but lack sufficient evidence of DID for Ms. M. however, Rachel appears to have DID as a result of childhood sexual abuse. A differential diagnosis that may apply for Ms. M may be related to substance use. She admits to using “fairly heavily since her teen years”. Diagnostic criteria for DID, Criterion D. States “The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or general medical condition (e.g., complex partial seizures) (Frances & Ross, pg 221, 2009). I would not feel comfortable totally ruling out dissociative fugue related to substance use.
In addition, “some clinicians believe that DID may be misdiagnosed as Bipolar or other psychotic disorder” (Frances & Ross, pg.221, 2009). It is suggested that DID is associated with childhood sexual abuse and extreme physical abuse or torture. Since dissociation can also present in other mental disorders such as Bipolar, psychotic episodes, substance use/blackouts, and posttraumatic stress disorder, it is paramount to do a thorough assessment, and evaluation of the client.
It is believed that DID is higher among females than males. “The ratio is as high as 9:1. This information was collected through case studies, rather than actual research” (Frances & Ross, pg. 197, 2009). DID is identified in as many as 21 different countries, and occurs in many culture around the world. In some cultures the hallucinations or voices that are heard by other identities of the person with DID are often times believed to be possessed in other cultures (Frances & Ross, 2009).
Dissociative Identity Disorder (DID)
We are all familiar with being able to drive a car without paying a lot of attention to our hands, feet, or even details of nearby traffic - or being able to walk down the street without needing to pay attention to our legs. This is possible because the body reorganises itself into functional loosely coupled organisational units for each task, and then "returns home" to a core identity to then reorganise itself for the next task.
This is a very preliminary chapter - and theme - for a book on the somatic aspects of dissociation. Given that loose coupling is a natural phenomenon, and fragmentation/dissociation is caused by a temporary freezing of that normal process - there should be easily accessible pathways out of dissociation to return to a normal state of physiological wholeness.
[AMAZON LINK BELOW TO BOOK ITSELF
-- TOC and book summary in downloadable .pdf]
According to the poet Elias Canetti, "All the things one has forgotten / scream for help in dreams." To the ancient Egyptians they were prophecies, and in world folklore they have often marked visitations from the dead. For Freud they were expressions of "wish fulfillment," and for Jung, symbolic representations of mythical archetypes. Although there is still much disagreement about the significance and function of dreams, they seem to serve as a barometer of current mind and body states.
In this volume, Deirdre Barrett brings together the study of dreams and the psychology of trauma. She has called on a distinguished group of psychiatrists, psychologists, and social workers--among them Rosalind Cartwright, Robert J. Lifton, and Oliver Sacks--to consider how trauma shapes dreaming and what the dreaming mind might reveal about trauma. The book focuses on catastrophic events, such as combat, political torture, natural disasters, and rape. The lasting effects of childhood trauma, such as sexual abuse or severe burns, on personality formation, the nature of memories of early trauma, and the development of defenses related to amnesia and dissociation are all considered. The book also takes up trauma and adult dreams, including Vietnam veterans and Post-Traumatic Stress Disorder, Holocaust survivors and perpetrators, rape victims, and firestorm survivors. Finally, this volume concludes with a look at the potential "traumas of normal life," such as divorce, bereavement, and life-threatening illness, and the role of dreams in working through normal grief and loss.
Taken together, these diverse perspectives illuminate the universal and the particular effects of traumatic experience. For physicians and clinicians, determining the etiology of nightmares offers valuable diagnostic and therapeutic insights for individual treatment. This book provides a way of juxtaposing the research in the separate fields of trauma and dreams, and learning from their discoveries.
Average Brain Anatomy and Function
To understand what goes wrong with the brains of children who are exposed to repeated and horrific trauma, we must first understand a little bit about brain anatomy.
Basically, the brain is divided up into three centers, each controlling a different aspect of who we are and our behavior. They work together to help us interpret and interact with our environment. They are the survival center, the emotional center, and the executive center.
The Survival Center. This part of the brain is also titled the reptilian brain or brainstem and is the most primitive part of the human brain. Fully developed when we are born, it handles all our basic instincts and functions to sustain life and to help us move about in our world. It controls our breathing, digestion, heartbeat, hunger, all the things we do without having to consciously think about it. This part of our brain is also responsible for our fight/flight/or freeze response to perceived danger. When it receives signals that it understands to be dangerous from the senses (sight, smell, sound, touch), it reacts quickly and automatically.
The Emotional Center. This part of the brain is titled the limbic system. Its function is to process memory, emotions, and responses to stress. It is responsible for our ability to nurture and care for others as well as separation anxiety, fear, rage, and bonding. It also regulates control over our hormones. The limbic system is the seat of our emotions, where we process memories that are emotionally charged.
The two structures we will focus on later in this book are the hippocampus and amygdala, two important parts of the brain that, as you will see, are heavily affected by trauma.
The Executive Center. The prefrontal cortex is also known as the thinking brain. It is responsible for our rational thought processes such as problem-solving, planning, creativity, and self-awareness. It also helps us interpret our emotions.
It is important and interesting to note that the things we interpret in our day to day lives flow through our brains in much same order as listed above. First, our senses are activated to tell our brain stem that we need to pay attention, next the limbic system reacts to the new stimuli as dangerous or no. It is the thinking brain that reacts last, perhaps seconds to minutes later. So, we can become afraid of a stimulus, say a spider, and react before we are able to think about our actions.
Dissociative Identity (DID)
Dissociative identity disorder (DID), which was known as multiple personality disorder until the 1994 publication of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders, is defined by the presence of two or more distinct personality states within an individual. This condition is generally understood to be a coping mechanism, in that an individual dissociates in order to avoid facing a situation, or memory of a past incident, that is too traumatic to be dealt with consciously.
DID, and its diagnosis, is an area of controversy among mental health professionals, and the condition is responsible for no small amount of dissent in the field of mental health treatment.