Q: How is DID treated? What about children who have DID? - Peter
A: The International Society for the Study of Trauma and Dissociation have created treatment guidelines for Adults and Children with Dissociative Identity Disorder. These documents which cover diagnosis, assessment, and treatment information can be attained here.
Additional books that may be useful include:
Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality by Colin A. Ross
Not Trauma Alone: Therapy for Child Abuse Survivors in Family and Social Context by Steven Gold
Rebuilding Shattered Lives: The Responsible Treatment of Complex Post-Traumatic and Dissociative Disorders by James A. Chu
Peace,
TWCrew
Friday, May 09, 2008
Monday, May 05, 2008
Diagnosis from MMPI?
Q: Can you diagnose DID from an MMPI? - Anna
A: Dissociative Identity Disorder can not be diagnosed from an MMPI.
The MMPI was originally designed to measure the following symptoms/disorders:
1 Hs - Hypochondriasis
2 D - Depression
3 Hy - Hysteria
4 Pd - Psychopathic Deviate
5 Mf - Masculinity–Femininity
6 Pa - Paranoia
7 Pt - Psychasthenia
8 Sc - Schizophrenia
9 Ma - Hypomania
0 Si - Social Introversion
Over the years, people have found that they can measure other symptoms/functioning using the same questions, and have created other scales (measuring protocols). They are too numerous to list here, but you can see them all here. Post-Traumatic Stress Disorder is one of these additional scales, so it may be diagnosed from the MMPI.
Peace,
TWCrew
A: Dissociative Identity Disorder can not be diagnosed from an MMPI.
The MMPI was originally designed to measure the following symptoms/disorders:
1 Hs - Hypochondriasis
2 D - Depression
3 Hy - Hysteria
4 Pd - Psychopathic Deviate
5 Mf - Masculinity–Femininity
6 Pa - Paranoia
7 Pt - Psychasthenia
8 Sc - Schizophrenia
9 Ma - Hypomania
0 Si - Social Introversion
Over the years, people have found that they can measure other symptoms/functioning using the same questions, and have created other scales (measuring protocols). They are too numerous to list here, but you can see them all here. Post-Traumatic Stress Disorder is one of these additional scales, so it may be diagnosed from the MMPI.
Peace,
TWCrew
Saturday, May 03, 2008
Do all memories need to be recovered?
Q: Do all our memories need to be recovered and processed to heal? - Tom
A: No, not at all. If that was the case, you'd probably spend a VERY long time in counseling and miss out on a lot of the life you could be living NOW! You have to remember enough to know what happened, why you have parts, and what needs to be done to feel safe again. Most Multiples have gone through repeated abuse events, sometimes with more than one abuser. Each abuser has to be addressed in counseling, but many of the types of abuse events were repeated. As you deal with a few memories related to one abuser and one type of abuse event, you'll also be dealing indirectly with the other similar events (and usually the same alters). Some memories stand out as major turning points, major traumas, or other life-changing events which tend to require a lot of processing in therapy so not all memories are created equal!
Peace,
TWCrew
A: No, not at all. If that was the case, you'd probably spend a VERY long time in counseling and miss out on a lot of the life you could be living NOW! You have to remember enough to know what happened, why you have parts, and what needs to be done to feel safe again. Most Multiples have gone through repeated abuse events, sometimes with more than one abuser. Each abuser has to be addressed in counseling, but many of the types of abuse events were repeated. As you deal with a few memories related to one abuser and one type of abuse event, you'll also be dealing indirectly with the other similar events (and usually the same alters). Some memories stand out as major turning points, major traumas, or other life-changing events which tend to require a lot of processing in therapy so not all memories are created equal!
Peace,
TWCrew
Are my memories true?
Q: How do I know if my memories are true? - Jane
A: That is a question survivors ask themselves and their counselors over and over again. Unfortunately, there isn't an easy answer. No one can be totally sure of the accuracy of all of their memories unless they have been followed by video cameras their entire lives! So save yourself the torture and accept that your memories, and the memories that your alters have, are true... but they may not be accurate.
What that means is they are true to the personality that has them, but they may contain inaccuracies such as:
1. Symbolic material that helps convey emotions, memories, fears, and other information,
2. Combination of more than one similar event into an amalgam that appears to be one memory,
3. Deception or misinformation purposely added by the perpetrators of abuse to further scare, manipulate, discredit and silence the victim,
4. Merging of real events with internal imagery used to dissociate (for example, being abused by the child imaging they were really somewhere else taking a hot air balloon could create a memory of being abused while in a hot air balloon,
5. Blocking of information or denial which removes some of the events, emotions, or sensations involved in the original event.
The key is using therapy, internal dialogue, journaling, and other methods to help distill the truth of the memory, the emotional content of the memory, and how the information needs to be handled in order to help heal from the damage. Therapy should not be seen as an arena to gather memory evidence to use in court against your perpetrators, but rather a place to let every part of yourself be heard, validated, and thanked for helping you get through difficult times and confusing emotions.
Peace,
TWCrew
A: That is a question survivors ask themselves and their counselors over and over again. Unfortunately, there isn't an easy answer. No one can be totally sure of the accuracy of all of their memories unless they have been followed by video cameras their entire lives! So save yourself the torture and accept that your memories, and the memories that your alters have, are true... but they may not be accurate.
What that means is they are true to the personality that has them, but they may contain inaccuracies such as:
1. Symbolic material that helps convey emotions, memories, fears, and other information,
2. Combination of more than one similar event into an amalgam that appears to be one memory,
3. Deception or misinformation purposely added by the perpetrators of abuse to further scare, manipulate, discredit and silence the victim,
4. Merging of real events with internal imagery used to dissociate (for example, being abused by the child imaging they were really somewhere else taking a hot air balloon could create a memory of being abused while in a hot air balloon,
5. Blocking of information or denial which removes some of the events, emotions, or sensations involved in the original event.
The key is using therapy, internal dialogue, journaling, and other methods to help distill the truth of the memory, the emotional content of the memory, and how the information needs to be handled in order to help heal from the damage. Therapy should not be seen as an arena to gather memory evidence to use in court against your perpetrators, but rather a place to let every part of yourself be heard, validated, and thanked for helping you get through difficult times and confusing emotions.
Peace,
TWCrew
Sunday, April 27, 2008
What medications are used in treating DID?
Q: What medications are used in treating DID? - Emily
A: There are no medications specific for treating DID. Many symptoms related to sleep problems, depression, anxiety, and PTSD hyperarousal can be managed with medications specific for those issues.
Anti-depressants are commonly used, especially those in the selective serotonin reuptake inhibitors (SSRIs) family, to help regulate symptoms of depression and anxiety. Effexor, an anti-depressant that is not in the SSRI family, is often used because it has been shown to be effective in treating PTSD symptoms in addition to depression. Caution should be used with Effexor because of it's withdrawal syndrome.
Anti-anxiety medications such as Klonopin can be used to help with sleep issues, panic attacks, and flashbacks. These are best limited to as low dose as possible and only as needed due to risk of abuse and dependency.
Sleep aids include over-the-counter options such as Benadryl or Tylenol PM (same active sleep-causing ingredient in both), herbal supplements such as Melatonin (which is a substance that naturally occurs in the body and helps regulate our sleep cycle/internal clock), and prescription options. Many prescription options also have a risk of abuse, dependency, and withdrawal and are usually recommended to be taken for a short time (7-14 days) such as Ambien and Lunesta. Newer forms are allowed to be taken longer, such as Ambien CR and Rozerem (which is the only prescription sleep aid to work on the melatonin system). Any medication used for sleep on a regular basis can create psychologically dependence, which is basically the psychological belief that you need the medication to get to sleep and may become frustrated when sleep fails to come as quickly without the medication. Many doctors recommend that you limit your sleep aid use to 3-4 nights per week to avoid dependence issues. Your doctor will best be able to address these issues with you.
Other medications which are sometimes used with Dissociative Identity Disorder include anti-psychotics and mood stabilizers. These are controversial and should probably only be used for emergency situations or if Bipolar Disorder is thought to co-exist with the DID.
Peace,
TWCrew
A: There are no medications specific for treating DID. Many symptoms related to sleep problems, depression, anxiety, and PTSD hyperarousal can be managed with medications specific for those issues.
Anti-depressants are commonly used, especially those in the selective serotonin reuptake inhibitors (SSRIs) family, to help regulate symptoms of depression and anxiety. Effexor, an anti-depressant that is not in the SSRI family, is often used because it has been shown to be effective in treating PTSD symptoms in addition to depression. Caution should be used with Effexor because of it's withdrawal syndrome.
Anti-anxiety medications such as Klonopin can be used to help with sleep issues, panic attacks, and flashbacks. These are best limited to as low dose as possible and only as needed due to risk of abuse and dependency.
Sleep aids include over-the-counter options such as Benadryl or Tylenol PM (same active sleep-causing ingredient in both), herbal supplements such as Melatonin (which is a substance that naturally occurs in the body and helps regulate our sleep cycle/internal clock), and prescription options. Many prescription options also have a risk of abuse, dependency, and withdrawal and are usually recommended to be taken for a short time (7-14 days) such as Ambien and Lunesta. Newer forms are allowed to be taken longer, such as Ambien CR and Rozerem (which is the only prescription sleep aid to work on the melatonin system). Any medication used for sleep on a regular basis can create psychologically dependence, which is basically the psychological belief that you need the medication to get to sleep and may become frustrated when sleep fails to come as quickly without the medication. Many doctors recommend that you limit your sleep aid use to 3-4 nights per week to avoid dependence issues. Your doctor will best be able to address these issues with you.
Other medications which are sometimes used with Dissociative Identity Disorder include anti-psychotics and mood stabilizers. These are controversial and should probably only be used for emergency situations or if Bipolar Disorder is thought to co-exist with the DID.
Peace,
TWCrew
Is DID a neurological disorder?
Q: Is DID a neurological disorder? - Anon
A: At this time DID does not appear to be caused by neurological damage (such as brain injury), nor does it appear to cause neurological damage/changes (such as lesions or tumors). As new advances in neurological imaging, such as SPECT scans, continue to evolve it may become possible to differentiate alters or to differentiate dissociatives from non-dissociatives. For the most part, the brain has a preferred mapping for where it stores general abilities/task centers, and this is not expected to vary due to DID. Therefore, DID is a psychological disorder because it appears to be caused by psychological trauma.
Peace,
TWCrew
A: At this time DID does not appear to be caused by neurological damage (such as brain injury), nor does it appear to cause neurological damage/changes (such as lesions or tumors). As new advances in neurological imaging, such as SPECT scans, continue to evolve it may become possible to differentiate alters or to differentiate dissociatives from non-dissociatives. For the most part, the brain has a preferred mapping for where it stores general abilities/task centers, and this is not expected to vary due to DID. Therefore, DID is a psychological disorder because it appears to be caused by psychological trauma.
Peace,
TWCrew
Saturday, April 26, 2008
Is DID a personality disorder or thought disorder?
Q: I've seen news articles referring to MPD as either a thought disorder or a personality disorder. What is it? - Anon
A: Multiple Personality Disorder seems like it would fall under the category of a "personality disorder" because of the name, but it is not. Rather, it is grouped with other disorders under a subtype called "dissociative disorders", which fits the newer name Dissociative Identity Disorder. It is also not classified as a "thought disorder".
The handbook used to diagnose mental health issues is called the Diagnostic and Statistical Manual of Mental Disorders (DSM).
There are five axis in a diagnosis:
- Axis I: Clinical Disorders (mental illnesses, substance abuse, etc.) including developmental and learning disorders
- Axis II: Personality Disorder and Mental Retardation
- Axis III: Medical conditions and physical disorders (such as brain injury/post-concussive syndrome, menopause, chronic pain, etc.)
- Axis IV: Psychosocial and environmental/support system stressors contributing to the disorder/symptoms (typically issues that are making things worse psychologically or could be barriers to recovery)
- Axis V: Global Assessment of Functioning (a rating scale on 0 - 100 of how well the person is functioning in interpersonal, vocational, and self-care areas)
Thought disorders are usually symptoms of an Axis I disorder, typically in the Schizophrenia-type disorders and Autism. Read here for more about common thought disorders such as pressured speech, tangential speech, word salad, and echolalia.
Personality disorders are pervasive (they happen in relation to most situations/people) and enduring (life-long) patterns of thinking, reacting, and interacting with others. Common examples include antisocial, borderline, schizoid, narcissistic, and dependent.
Dissociative Identity Disorder is an Axis I diagnosis as part of the subgroup called Dissociative Disorders (which includes DID, fugue, depersonalization, and dissociative amnesia).
It is possible for specific alters to have characteristics of a thought disorder or personality disorder. Some people may be diagnosed with MPD/DID and borderline personality disorder, but this would not be clinically appropriate if only a few of the alters have borderline characteristics because it would fail to meet the full criteria of pervasive and long-term.
Peace,
TWCrew
A: Multiple Personality Disorder seems like it would fall under the category of a "personality disorder" because of the name, but it is not. Rather, it is grouped with other disorders under a subtype called "dissociative disorders", which fits the newer name Dissociative Identity Disorder. It is also not classified as a "thought disorder".
The handbook used to diagnose mental health issues is called the Diagnostic and Statistical Manual of Mental Disorders (DSM).
There are five axis in a diagnosis:
- Axis I: Clinical Disorders (mental illnesses, substance abuse, etc.) including developmental and learning disorders
- Axis II: Personality Disorder and Mental Retardation
- Axis III: Medical conditions and physical disorders (such as brain injury/post-concussive syndrome, menopause, chronic pain, etc.)
- Axis IV: Psychosocial and environmental/support system stressors contributing to the disorder/symptoms (typically issues that are making things worse psychologically or could be barriers to recovery)
- Axis V: Global Assessment of Functioning (a rating scale on 0 - 100 of how well the person is functioning in interpersonal, vocational, and self-care areas)
Thought disorders are usually symptoms of an Axis I disorder, typically in the Schizophrenia-type disorders and Autism. Read here for more about common thought disorders such as pressured speech, tangential speech, word salad, and echolalia.
Personality disorders are pervasive (they happen in relation to most situations/people) and enduring (life-long) patterns of thinking, reacting, and interacting with others. Common examples include antisocial, borderline, schizoid, narcissistic, and dependent.
Dissociative Identity Disorder is an Axis I diagnosis as part of the subgroup called Dissociative Disorders (which includes DID, fugue, depersonalization, and dissociative amnesia).
It is possible for specific alters to have characteristics of a thought disorder or personality disorder. Some people may be diagnosed with MPD/DID and borderline personality disorder, but this would not be clinically appropriate if only a few of the alters have borderline characteristics because it would fail to meet the full criteria of pervasive and long-term.
Peace,
TWCrew
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