Understanding the Dissociative Disorders

sabby & everyone,

I apologize if it seemed like I was debating religion here, b/c that wasn't my intention. I wrote in my post that if religion helps people have the faith to deal with their struggles, then it's a good thing. But when it stigmatizes MI then it isn't. We have been stigmatized long enough. Also, while I feel that it's acceptable for someone here to discuss how religion per se or spirituality is helping them, I strongly oppose anyone citing a specific religion. This is a MENTAL HEALTH site & not a religious site, & IT IS AGAINST THE GUIDELINES OF THIS SITE to do that, which is why there is a SPIRITUALITY forum, where people may discuss their higher power. They may write about their higher power in any forum, but many people do refer to specific religions in many, many posts which I've read but refrained from addressing that. I do not understand why those posts aren't moderated when they clearly go against the guidelines.

I wasn't debating religion, but commenting on demonic possesion, which is conducive to previous posts in this thread & my point was valid. The religious "debate" didn't start until someone made a comment about my being a hypocrite b/c I state Hell as my location, which is obviously a joke.

I hope this clarifies things. Let's carry on with the topic now please.

Thank you I think this slide show helped
Norma

This is really informative.

I just had an experience with this last week for the first time in my life. Very, Very scary!

I hope everyone has a good day!

lots of good info here!

Great info:

http://www.isst-d.org/education/Adul...D-JTD-2005.pdf

I dont find DID fitting under DD but ok I guess I like it better then MPD because it makes us seem less strange. We are not strange we have just had bad things happen to us.

So it cannot develop otherwise?

Because I definitelly have some of these symptoms... memory lapses (I remember after my state exam on Uni, I went for a trip, by myself... I remember being on particular place and the next thing I remember is waking up in my bed... while I took pictures, I even have pictures I took of myself in the train... but i just don't remember it), out-of-body experience, not recognizing myself in the mirror... I even argue with myself... I would not call it alterego, because it is not a complete personality... it's just my lazy, whacky and unreasonable self, I guess.
And I cannot express these feelings in words...

...but to the point. I have not experience any trauma that would induce this.

Ive always wondered what this was

very informative,i was having some trouble and this cleared that up for me, thank you

Thanks so much Orange Blossom

I at last begin to understand why I am like this.

So I a question.... On the chart at the beginning of this thread it listed under Atypical Dissociative Disorder there is Polyfragmented ADD and ADD with features of MPD. What are these things? I've never heard of them. Can someone please shed some light on these things for me? Thanks so much

In the USA ADD stands for Attention Deficit Disorder. I tried to google "Polyfragmented Attention Deficit Disorder" and could not find it. I looked in my Diagnostic Statistical Manual 4th Edition Text Revised and could not find it. Maybe its a listed mental disorder outside the USA either that or maybe the chart is out dated and no longer used for diagnostics here in the USA but was used at one time. in either case I was unable to find anything about Polyfragmented Attention Deficit Disorder. Ive had the same lack of luck in finding anything about Attention Deficit Disorder with features of Multiple Personality disorder there is no diagnostics on this particular label in the DSM IVTR and googling was no help. So again maybe its a diagnosis somewhere outside the USA or the chart is outdated and those diagnostic labels may no longer being used. now Im curious and would love to know more about these too so I will keep looking and will bring it up to my psych classes and see what comes of it.

Hi VioletIcicles

Polyfragmented ADD is having hundreds or more alter personalities along with atypical disscoiative disorder.

I hope that helps. (I've tried to respond but the computer isn't co oerating.

and ADD with features of MPD means atypical dissociative disorder with some of the features of multiple personality disorder (now called dissociative identity disorder)

thanks to calista defining the terms correctly, I was able to find some thing. here in the USA Atypical Dissociative Disorder is now called DDNOS - Dissociative Disorders Not Otherwise Specified. Which basically means you have some dissociative symptoms but not enough to be called any one of the 4 dissociative disorders - dissociative amnesia, dissociative fugue, Dissociative Identity Disorder and depresonalization/derealization disorder. its a mixture of them all but not enough to call it one or the other.

http://emedicine.medscape.com/article/294508-overview
http://www.survivors-treehouse.net/D...20Spectrum.htm

if you google "Dissociative Disorders Not Otherwise Specified" or "DDNOS" you can find lots of info on it.

Thanks amandalouise That is exactly what I was looking for and couldn't find it. At least I know someone's brain works like mine lol

Thank you Calista+12 for clearing that up! I never knew that someone could have hundreds of personalities. I couldn't imagine. And again amandalouise for providing further explanation.

happy to help and happy what I found was what you were looking for. have a great weekend.

thanks for the original poster who posted the difference, and as someone who suffers from both forms of dissociation its interesting and informative to know the difference!!!

Hi Everyone,

My counselor sent this to me via email. It was supposed to be for my family but I thought I would share it with all of you as well. I hope you are doing well.

Cris

Previously known as multiple personality disorder, dissociative identity disorder (DID) is a condition in which a person has more than one distinct identity or personality state. At least two of these personalities repeatedly assert themselves to control the affected person's behavior. Each personality state has a distinct name, past, identity, and self-image.
Psychiatrists and psychologists use a handbook called the Diagnostic and Statistical Manual of Mental Disorders , fourth edition text revision or DSM-IV-TR , to diagnose mental disorders. In this handbook, DID is classified as a dissociative disorder. Other mental disorders in this category include depersonalization disorder , dissociative fugue , and dissociative amnesia . It should be noted, however, that the nature of DID and even its existence is debated by psychiatrists and psychologists.

Description

"Dissociation" describes a state in which the integrated functioning of a person's identity, including consciousness, memory and awareness of surroundings, is disrupted or eliminated. Dissociation is a mechanism that allows the mind to separate or compartmentalize certain memories or thoughts from normal consciousness. These memories are not erased, but are buried and may resurface at a later time. Dissociation is related to hypnosis in that hypnotic trance also involves a temporarily altered state of consciousness. Dissociation occurs along a continuum or spectrum, and may be mild and part of the range of normal experience, or may be severe and pose a problem for the individual experiencing the dissociation. An example of everyday, mild dissociation is when a person is driving for a long period on the highway and takes several exits without remembering them. In severe, impairing dissociation, an individual experiences a lack of awareness of important aspects of his or her identity.
The phrase "dissociative identity disorder" replaced "multiple personality disorder" because the new name emphasizes the disruption of a person's identity that characterizes the disorder. A person with the illness is consciously aware of one aspect of his or her personality or self while being totally unaware of, or dissociated from, other aspects of it. This is a key feature of the disorder. It only takes two distinct identities or personality states to qualify as DID but there have been cases in which 100 distinct alternate personalities, or alters, were reported. Fifty percent of DID patients harbor fewer than 11 identities.
Because the alters alternate in controlling the patient's consciousness and behavior, the affected patient experiences long gaps in memory— gaps that far exceed typical episodes of forgetting that occur in those unaffected by DID.
Despite the presence of distinct personalities, in many cases one primary identity exists. It uses the name the patient was born with and tends to be quiet, dependent, depressed and guilt-ridden. The alters have their own names and unique traits. They are distinguished by different temperaments, likes, dislikes, manners of expression and even physical characteristics such as posture and body language. It is not unusual for patients with DID to have alters of different genders, sexual orientations, ages, or nationalities. Typically, it takes just seconds for one personality to replace another but, in rarer instances, the shift can be gradual. In either case, the emergence of one personality, and the retreat of another, is often triggered by a stressful event.
People with DID tend to have other severe disorders as well, such as depression, substance abuse, borderline personality disorder and eating disorders, among others. The degree of impairment ranges from mild to severe, and complications may include suicide attempts, self-mutilation, violence, or drug abuse.
Left untreated, DID can last a lifetime. Treatment for the disorder consists primarily of individual psychotherapy .

Causes and symptoms

Causes

The severe dissociation that characterizes patients with DID is currently understood to result from a set of causes:

• an innate ability to dissociate easily
• repeated episodes of severe physical or sexual abuse in childhood
• lack of a supportive or comforting person to counteract abusive relative(s)
• influence of other relatives with dissociative symptoms or disorders

The primary cause of DID appears to be severe and prolonged trauma experienced during childhood. This trauma can be associated with emotional, physical or sexual abuse, or some combination. One theory is that young children, faced with a routine of torture, sexual abuse or neglect , dissociate themselves from their trauma by creating separate identities or personality states. A manufactured alter may suffer while the primary identity "escapes" the unbearable experience. Dissociation, which is easy for a young child to achieve, thus becomes a useful defense. This strategy displaces the suffering onto another identity. Over time, the child, who on average is around six years old at the time of the appearance of the first alter, may create many more.
As stated, there is considerable controversy about the nature, and even the existence, of dissociative identity disorder. One cause for the skepticism is the alarming increase in reports of the disorder since the 1980s. An area of contention is the notion of suppressed memories, a crucial component in DID. Many experts in memory research say that it is nearly impossible for anyone to remember things that happened before the age three, the age when some DID patients supposedly experience abuse, but the brain's storage, retrieval, and interpretation of childhood memories are still not fully understood. The relationship of dissociative disorders to childhood abuse has led to intense controversy and lawsuits concerning the accuracy of childhood memories. Because childhood trauma is a factor in the development of DID, some doctors think it may be a variation of post-traumatic stress disorder (PTSD). In both DID and PTSD, dissociation is a prominent mechanism.

Symptoms

The major dissociative symptoms experienced by DID patients are amnesia , depersonalization , derealization, and identity disturbances.
AMNESIA. Amnesia in DID is marked by gaps in the patient's memory for long periods of their past, and, in some cases, their entire childhood. Most DID patients have amnesia, or "lose time," for periods when another personality is "out." They may report finding items in their house that they can't remember having purchased, finding notes written in different handwriting, or other evidence of unexplained activity.
DEPERSONALIZATION. Depersonalization is a dissociative symptom in which the patient feels that his or her body is unreal, is changing, or is dissolving. Some DID patients experience depersonalization as feeling to be outside of their body, or as watching a movie of themselves.
DEREALIZATION. Derealization is a dissociative symptom in which the patient perceives the external environment as unreal. Patients may see walls, buildings, or other objects as changing in shape, size, or color. DID patients may fail to recognize relatives or close friends.
IDENTITY DISTURBANCES. Persons suffering from DID usually have a main personality that psychiatrists refer to as the "host." This is generally not the person's original personality, but is rather one developed in response to childhood trauma. It is usually this personality that seeks psychiatric help. DID patients are often frightened by their dissociative experiences, which can include losing awareness of hours or even days, meeting people who claim to know them by another name, or feeling "out of body."
Psychiatrists refer to the phase of transition between alters as the "switch." After a switch, people assume whole new physical postures, voices, and vocabularies. Specific circumstances or stressful situations may bring out particular identities. Some patients have histories of erratic performance in school or in their jobs caused by the emergence of alternate personalities during examinations or other stressful situations. Each alternate identity takes control one at a time, denying control to the others. Patients vary with regard to their alters' awareness of one another. One alter may not acknowledge the existence of others or it may criticize other alters. At times during therapy, one alter may allow another to take control.

Demographics

Studies in North America and Europe indicate that as many as 5% of patients in psychiatric wards have undiagnosed DID. Partially hospitalized and out-patients may have an even higher incidence. For every one man diagnosed with DID, there are eight or nine women. Among children, boys and girls diagnosed with DID are pretty closely matched 1:1. No one is sure why this discrepancy between diagnosed adults and children exists.

Diagnosis

The DSM-IV-TR lists four diagnostic criteria for identifying DID and differentiating it from similar disorders:

• Traumatic stressor: The patient has been exposed to a catastrophic event involving actual or threatened death or injury, or a serious physical threat to him- or herself or others. During exposure to the trauma, the person's emotional response was marked by intense fear, feelings of helplessness, or horror. In general, stressors caused intentionally by human beings (genocide, rape, torture, abuse, etc.) are experienced as more traumatic than accidents, natural disasters, or "acts of God."
• The demonstration of two or more distinct identities or personality states in an individual. Each separate identity must have its own way of thinking about, perceiving, relating to and interacting with the environment and self.
• Two of the identities assume control of the patient's behavior, one at a time and repeatedly.
• Extended periods of forgetfulness lasting too long to be considered ordinary forgetfulness.
• Determination that the above symptoms are not due to drugs, alcohol or other substances and that they can't be attributed to any other general medical condition. It is also necessary to rule out fantasy play or imaginary friends when considering a diagnosis of DID in a child.

Proper diagnosis of DID is complicated because some of the symptoms of DID overlap with symptoms of other mental disorders. Misdiagnoses are common and include depression, schizophrenia , borderline personality disorder, somatization disorder , and panic disorder .
Because the extreme dissociative experiences related to this disorder can be frightening, people with the disorder may go to emergency rooms or clinics because they fear they are going insane.
When a doctor is evaluating a patient for DID, he or she will first rule out physical conditions that sometimes produce amnesia, depersonalization, or derealization. These conditions include head injuries, brain disease (especially seizure disorders), side effects from medications, substance abuse or intoxication, AIDS dementia complex, or recent periods of extreme physical stress and sleeplessness. In some cases, the doctor may give the patient an electroencephalograph (EEG) to exclude epilepsy or other seizure disorders. The physician also must consider whether the patient is malingering and/or offering fictitious complaints.
If the patient appears to be physically healthy, the doctor will next rule out psychotic disturbances, including schizophrenia. Many patients with DID are misdiagnosed as schizophrenic because they may "hear" their alters "talking" inside their heads. If the doctor suspects DID, he or she can use a screening test called the Dissociative Experiences Scale (DES). If the patient has a high score on this test, he or she can be evaluated further with the Dissociative Disorders Interview Schedule (DDIS) or the Structured Clinical Interview for Dissociative Disorders (SCID-D).

Treatments

Treatment of DID may last for five to seven years in adults and usually requires several different treatment methods.

Psychotherapy

Ideally, patients with DID should be treated by a therapist with specialized training in dissociation. This specialized training is important because the patient's personality switches can be confusing or startling. In addition, many patients with DID have hostile or suicidal alter personalities. Most therapists who treat DID patients have rules or contracts for treatment that include such issues as the patient's responsibility for his or her safety. Psychotherapy for DID patients typically has several stages: an initial phase for uncovering and "mapping" the patient's alters; a phase of treating the traumatic memories and "fusing" the alters; and a phase of consolidating the patient's newly integrated personality.
Most therapists who treat multiples, or DID patients, recommend further treatment after personality integration, on the grounds that the patient has not learned the social skills that most people acquire in adolescence and early adult life. In addition, family therapy is often recommended to help the patient's family understand DID and the changes that occur during personality reintegration.
Many DID patients are helped by group therapy as well as individual treatment, provided that the group is limited to people with dissociative disorders. DID patients sometimes have setbacks in mixed therapy groups because other patients are bothered or frightened by their personality switches.

Medications

Some doctors will prescribe tranquilizers or antidepressants for DID patients because their alter personalities may have anxiety or mood disorders. However, other therapists who treat DID patients prefer to keep medications to a minimum because these patients can easily become psychologically dependent on drugs. In addition, many DID patients have at least one alter who abuses drugs or alcohol, substances which are dangerous in combination with most tranquilizers.

Hypnosis

While not always necessary, hypnosis (or hypnotherapy ) is a standard method of treatment for DID patients. Hypnosis may help patients recover repressed ideas and memories. Further, hypnosis can also be used to control problematic behaviors that many DID patients exhibit, such as self-mutilation, or eating disorders like bulimia nervosa . In the later stages of treatment, the therapist may use hypnosis to "fuse" the alters as part of the patient's personality integration process.

Prognosis

Unfortunately, no systematic studies of the long-term outcome of DID currently exist. Some therapists believe that the prognosis for recovery is excellent for children and good for most adults. Although treatment takes several years, it is often ultimately effective. As a general rule, the earlier the patient is diagnosed and properly treated, the better the prognosis. Patients may find they are bothered less by symptoms as they advance into middle age, with some relief beginning to appear in the late 40s. Stress or substance abuse, however, can cause a relapse of symptoms at any time.

Prevention

Prevention of DID requires intervention in abusive families and treating children with dissociative symptoms as early as possible.

See also Dissociation and dissociative disorders

Resources

BOOKS

Acocella, Joan. Creating Hysteria: Women and Multiple Personality Disorder. San Francisco, CA: Jossey-Bass Publishers, 1999.
Alderman, Tracy, and Karen Marshall. Amongst Ourselves, A Self-Help Guide to Living with Dissociative Identity Disorder. Oakland, CA: New Harbinger Publications, 1998.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th edition, text revised. Washington, DC: American Psychiatric Association, 2000.
Saks, Elyn R., with Stephen H. Behnke. Jekyll on Trial, Multipersonality Disorder and Criminal Law. New York, NY: New York University Press, 1997.

PERIODICALS

Gleaves, D. H., M. C. May, and E. Cardena. "An examination of the diagnostic validity of dissociative identity disorder." Clinical Psychology Review 21, no. 4 (June 2001): 577-608.
Lalonde, J. K., J. I. Hudson, R. A. Gigante, H. G. Pope, Jr. "Canadian and American psychiatrists' attitudes toward dissociative disorders diagnoses." Canadian Journal of Psychiatry 46, no. 5 (June 2001): 407-12.

ORGANIZATIONS

International Society for the Study of Dissociation, 60 Revere Dr., Suite 500, Northbrook, IL 60062. <http://www.issd.org/> .
National Alliance for the Mentally Ill. Colonial Place Three, 2107 Wilson Blvd., Suite 300, Arlington,VA 22021. <http://www.nami.org/helpline/did.html> .

Rebecca J. Frey, Ph.D.
Dean A. Haycock, Ph.D.

Thank you Sunnygirl1uk,

I have been thinking about your statement since I read it and wanted to respond.

Since we are learning all the time about this intensely personal journey/pathway to truth it is not surprising to me that you found affirmation. Me too. Your statement reminded me that so far it is not all 'exact' and it can be as varied as each of us is.

You said: "thanks for the original poster who posted the difference, and as someone who suffers from both forms of dissociation its interesting and informative to know the difference!!!"

we have hundreds of alters but didnt know there was another name for us

Wow! I've just joined this site and my mind is absolutely blown by the amount of information and understanding there is of dissociation here. I never fit under the typical dissociation headings and so I was told for years I didn't have it as a 'disorder'- until one brilliant psych who finally listened and has told me I am his most severe case. Thankyou for spreading the word on the continuum and aspects so others might find the answers they're looking for.

Hi *waves*

I'm new... I dissociate quite a bit, not sure if I have a disorder by itself or if its part of my BPD... But still. I have alters, they're not fully formed personalities but rather voices in my head that sometimes take over and stuff but I know they're there.

Just thought I'd pop in.

[quote=January;503796]UNDERSTANDING THE DISSOCIATIVE DISORDERS
Depersonalization/Derealization Disorder
The distinguishing characteristic of depersonalization disorder is the feeling that one is disconnected or unreal. Mind or body may be perceived as unattached, seen from a distance, existing in a dream, or mechanical.

Chronic depersonalization is commonly accompanied by "derealization," the feeling that features of the environment are illusory.

...Severe depersonalization is considered to be present only if the sense of detachment associated with the disorder is recurrent and predominant.[/quote]

I just happened to read this right before a scheduled pdoc appointment. I printed it out and wrote my own feelings that fit this exactly!!! All these years I didn't know this is what this was. So I told him. I was truthful for the first time about the "hurt" that happened years ago, and I got this diagnosis.

Ohhhh, I broke down like a baby! I could barely talk, but I got it out to tell him: this is "me". He explained it to me and what I need to do next to begin to heal.

A member here told me that people come into our lives for a reason and I believe this is why I found this place and I had already started being curious about people here with DID. Although that didn't fit, I knew I was close to the answer. And then found this. And there it was!

Oh thank you so much PsychCentral, for your commitment to helping others and providing all this information so we can understand and begin to heal. Bless you.