Q: How is Dissociative Identity Disorder 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
Friday, May 09, 2008
Monday, May 05, 2008
Diagnosis from MMPI?
Q: Can you diagnose Dissociative Identity Disorder 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.
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.
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!
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!
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.
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.
Sunday, April 27, 2008
What medications are used in treating DID?
Q: What medications are used in treating Dissociative Identity Disorder? - Emily
A: There are no medications specific for treating Dissociative Identity Disorder. 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. In lower doses, these may also be used for medication resistant depression.
A: There are no medications specific for treating Dissociative Identity Disorder. 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. In lower doses, these may also be used for medication resistant depression.
Is DID a neurological disorder?
Q: Is Dissociative Identity Disorder a neurological disorder? - Anon
A: At this time Dissociative Identity Disorder 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, Dissociative Identity Disorder is a psychological disorder because it appears to be caused by psychological trauma.
A: At this time Dissociative Identity Disorder 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, Dissociative Identity Disorder is a psychological disorder because it appears to be caused by psychological trauma.
Saturday, April 26, 2008
Is DID a personality 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.
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.
Friday, April 25, 2008
DID in the news... again...
Well, it seems Dissociative Identity Disorder ends up in the news about once a year either because someone admits to being Multiple, someone makes a bad movie about MPD, or someone thinks a pop star's erratic behavior is really Dissociative Identity Disorder. And we've got the trifecta going on right now!
1. Hollywood
- Big Screen: 04/17/08 per Variety: Halle Berry has announced that she's going to produce and star in a movie called "Frankie and Alice" in which she portraits a woman with two alters, one of which is a white racist. Yippee.
- Little Screen: New TV show by Steven Spielberg called "The United States of Tara"
2. Herschel Walker's new book "Breaking Free" hit the shelves and news outlets this month.
3. Who else is being called "Multiple"?
- Not Famous: Rozita Swinton, aka "Sarah" the tipster that set off the events in a cult compound in Texas
- For Publicity: Miley Cyrus, aka Hannah Montana
- As if we didn't suspect already: Tori Amos, aka American Doll Posse
- Yeah, right, sure...: Britney Spears
Every time it pops up I wonder when I'll have to suffer through a "MPD is fake!" conversation. Or hear people confuse it with Bipolar, Schizophrenia, or a personality disorder. At work I have to smile and ignore the comments about the people "stupid enough" to fall for that rubbish, or the counselors who must has "swindled" them and "implanted" these outrageous ideas. My favorite is when people swear that they could easily spot someone who "truly" had Multiple Personality Disorder. Yeah... right...
So, cheers everyone, we survived another round of stupidity, misinformation, and "experts."
1. Hollywood
- Big Screen: 04/17/08 per Variety: Halle Berry has announced that she's going to produce and star in a movie called "Frankie and Alice" in which she portraits a woman with two alters, one of which is a white racist. Yippee.
- Little Screen: New TV show by Steven Spielberg called "The United States of Tara"
2. Herschel Walker's new book "Breaking Free" hit the shelves and news outlets this month.
3. Who else is being called "Multiple"?
- Not Famous: Rozita Swinton, aka "Sarah" the tipster that set off the events in a cult compound in Texas
- For Publicity: Miley Cyrus, aka Hannah Montana
- As if we didn't suspect already: Tori Amos, aka American Doll Posse
- Yeah, right, sure...: Britney Spears
Every time it pops up I wonder when I'll have to suffer through a "MPD is fake!" conversation. Or hear people confuse it with Bipolar, Schizophrenia, or a personality disorder. At work I have to smile and ignore the comments about the people "stupid enough" to fall for that rubbish, or the counselors who must has "swindled" them and "implanted" these outrageous ideas. My favorite is when people swear that they could easily spot someone who "truly" had Multiple Personality Disorder. Yeah... right...
So, cheers everyone, we survived another round of stupidity, misinformation, and "experts."
Changing levels of internal activity?
Q: Went years and years without losing time... or without losing a lot of time that I was aware of. Then re-entered counseling and WOW the voices are going wild and losing time has jumped to almost daily. Why the skyrocketing increase since entering counseling? Was in and out of counseling for year and years from 11 yrs old to 24 yrs old then nothing for about 13 years... never diagnosed until this real commitment to healing (2 years ago). So the question is.... why the increase in "parts" activity... almost to the point of not being able to function? - R. Kidd
A: It's kind of like a leaky dam. The leak lets out a steady stream of water, but that stream is nothing compared to the amount of water that comes rushing out when the dam breaks. I think the "volume" changes when there is no other choice (major stress or triggers that finally overwhelm the system), or when it's time (alters feel safe or the decision to commit to therapy is made by several parts).
Early on our main hosts (parts who dealt with the outside world on a regular basis) often had little awareness of the internal chatter/activity because they needed to function. It wasn't until we moved away to go to college and had a sense of safety that people began to break down those barriers inside. When we decided to confront our main abuser, and finally ended all ties, then people inside felt strong and safe to come out. That's when the dam broke and we went from chatter to a bustling train station worth of noise!
At first, it was disabling and overwhelming. Everyone seemed to be scrambling for their time out to do what they wanted to do, to make friends, to talk about their memories and needs... all the while work and school seemed to be slipping away from our grasp. I think the "falling apart" process helped us be able to take stock of what was really going on (Dissociative Identity Disorder, self-injury, depression, nightmares, etc), admit the severity (honest assessment of MPD and abuse severity), and take real action (be honest in therapy about internal workings).
It was by falling apart that we crossed the line from being a victim to being a survivor. It was by making a mess of things that we had to face the truth that our abusers were responsible for the damage they did early in our lives, but from that point forward it was us causing any additional damage. We had to choose recovery which is a lot harder and a lot nastier than it sounds. Recovery doesn't just land in your lap, it's a daily (sometimes hourly or even breath by breath) choice to move forward. And we were going to have to do it together.
Encourage people inside to learn when it's okay to communicate and ways in which they can do that. Can they join an online email/support group, draw/paint, play sports, write in a journal, take a walk, or find other ways to let off steam? Can they agree to have "quiet times" (such as work hours) in exchange for you giving them "loud times" (like a set schedule of 9-10 pm you give them time to do the things that let them communicate, let off steam, and enjoy freedom)? Can you introduce them to your counselor and encourage them to write down things they remember during the week that they want to be sure gets talked about in therapy, so they don't have to keep repeating the same information to you over and over again?
Quiet periods and noisy periods still come and go for us. The loud, overwhelming, cascading roar has quieted and will probably never reach that level again. I know that the more stress we're under (or the more people under stress at the same time), the more people inside are feeling ignored/abandoned, and the worse the body feels (like when it is sick), the more likely the noise level will increase. But I also know that when it's too quiet things may not be okay. I may have shut people out (put my head back in the sand?), or they may have shut me off somewhere so I don't know what's really going on inside (so I can keep functioning in the real world). So, a comfortable medium is where we are most of the time now, and it's quite nice.
A: It's kind of like a leaky dam. The leak lets out a steady stream of water, but that stream is nothing compared to the amount of water that comes rushing out when the dam breaks. I think the "volume" changes when there is no other choice (major stress or triggers that finally overwhelm the system), or when it's time (alters feel safe or the decision to commit to therapy is made by several parts).
Early on our main hosts (parts who dealt with the outside world on a regular basis) often had little awareness of the internal chatter/activity because they needed to function. It wasn't until we moved away to go to college and had a sense of safety that people began to break down those barriers inside. When we decided to confront our main abuser, and finally ended all ties, then people inside felt strong and safe to come out. That's when the dam broke and we went from chatter to a bustling train station worth of noise!
At first, it was disabling and overwhelming. Everyone seemed to be scrambling for their time out to do what they wanted to do, to make friends, to talk about their memories and needs... all the while work and school seemed to be slipping away from our grasp. I think the "falling apart" process helped us be able to take stock of what was really going on (Dissociative Identity Disorder, self-injury, depression, nightmares, etc), admit the severity (honest assessment of MPD and abuse severity), and take real action (be honest in therapy about internal workings).
It was by falling apart that we crossed the line from being a victim to being a survivor. It was by making a mess of things that we had to face the truth that our abusers were responsible for the damage they did early in our lives, but from that point forward it was us causing any additional damage. We had to choose recovery which is a lot harder and a lot nastier than it sounds. Recovery doesn't just land in your lap, it's a daily (sometimes hourly or even breath by breath) choice to move forward. And we were going to have to do it together.
Encourage people inside to learn when it's okay to communicate and ways in which they can do that. Can they join an online email/support group, draw/paint, play sports, write in a journal, take a walk, or find other ways to let off steam? Can they agree to have "quiet times" (such as work hours) in exchange for you giving them "loud times" (like a set schedule of 9-10 pm you give them time to do the things that let them communicate, let off steam, and enjoy freedom)? Can you introduce them to your counselor and encourage them to write down things they remember during the week that they want to be sure gets talked about in therapy, so they don't have to keep repeating the same information to you over and over again?
Quiet periods and noisy periods still come and go for us. The loud, overwhelming, cascading roar has quieted and will probably never reach that level again. I know that the more stress we're under (or the more people under stress at the same time), the more people inside are feeling ignored/abandoned, and the worse the body feels (like when it is sick), the more likely the noise level will increase. But I also know that when it's too quiet things may not be okay. I may have shut people out (put my head back in the sand?), or they may have shut me off somewhere so I don't know what's really going on inside (so I can keep functioning in the real world). So, a comfortable medium is where we are most of the time now, and it's quite nice.
Sunday, April 20, 2008
Difference between MPD and DID?
Q: What is the difference between Multiple Personality Disorder (MPD) and Dissociative Identity Disorder (DID)? - Anon
A: Mental disorders are named, classified, and described in a book called the Diagnostic and Statistical Manual of Mental Disorders (called the DSM for short). This book is used by doctors, counselors/therapists, and psychiatrists to diagnose behaviors/symptoms, and the book is updated every decade or so to reflect new research, beliefs, understanding of mental illness.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for Multiple Personality Disorder (MPD) was first established in 1980. The clinical criteria was:
DSM-III Criteria for Multiple Personality Disorder:
A. The existence within the individual of two or most distinct personalities, each of which is dominant at a particular time.
B. The personality that is dominant at any particular time determines the individual's behavior.
C. Each individual personality is complex and integrated with its own unique behavior patterns and social relationships.
D. Two or more alter personalities must exhibit individually distinct and consistent alter personality-specific behavior on at least three occasions.
E. There is evidence of some type of amnesia or combinations of types of amnesia among alter personalities (e.g., one-way amnesia, mutual amnesia, etc.). the amnesia does not have to include all of the alters.
The DSM-IV, which was released in 1994, changed the name of Multiple Personality Disorder to Dissociative Identity Disorder (DID) and changed the criteria to:
DSM-IV Criteria for Dissociative Identity Disorder:
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).
B. At least two of these identities or personality states recurrently take control of the person's behavior.
C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
D. 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.
So, according to the DSM, the name Multiple Personality Disorder has been replaced or renamed Dissociative Identity Disorder. Therefore, they are the same and the newer name should be used.
But...
Many people with the disorder may prefer one name over the other, based on:
1. What the disorder was called when they were diagnosed,
2. What name they believe best fits their experience or system of alters,
3. Their stance on if the name was changed just for political reasons inside the psychology field in an attempt to make it less "sensational" or more "palatable" for professionals to admit they treat it.
4. Their personal beliefs that MPD and DID should be used to describe different levels of severity, different causes, and different expectations for the number and amount of differentiations between personalities. Many people seem to think that MPD better describes a more severe form of dissociation, would tend to be caused by more severe or long-lasting trauma events, and that the alters involved would be better defined/more distinct. For example, imagine a glass vase as being an integrated/normal/non-dissociative personality. If you dropped the vase 3 feet and it cracked in a few places, but still held it's overall shape, it would be DID. If you dropped the vase repeatedly, or from a more drastic height, and it shattered or pieces broke off, then that would be MPD.
P.S. I still prefer the term Multiple Personality Disorder, but have had to move towards using Dissociative Identity Disorder more on my blogs and websites due to how search engines function.
A: Mental disorders are named, classified, and described in a book called the Diagnostic and Statistical Manual of Mental Disorders (called the DSM for short). This book is used by doctors, counselors/therapists, and psychiatrists to diagnose behaviors/symptoms, and the book is updated every decade or so to reflect new research, beliefs, understanding of mental illness.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) criteria for Multiple Personality Disorder (MPD) was first established in 1980. The clinical criteria was:
DSM-III Criteria for Multiple Personality Disorder:
A. The existence within the individual of two or most distinct personalities, each of which is dominant at a particular time.
B. The personality that is dominant at any particular time determines the individual's behavior.
C. Each individual personality is complex and integrated with its own unique behavior patterns and social relationships.
D. Two or more alter personalities must exhibit individually distinct and consistent alter personality-specific behavior on at least three occasions.
E. There is evidence of some type of amnesia or combinations of types of amnesia among alter personalities (e.g., one-way amnesia, mutual amnesia, etc.). the amnesia does not have to include all of the alters.
The DSM-IV, which was released in 1994, changed the name of Multiple Personality Disorder to Dissociative Identity Disorder (DID) and changed the criteria to:
DSM-IV Criteria for Dissociative Identity Disorder:
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).
B. At least two of these identities or personality states recurrently take control of the person's behavior.
C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
D. 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.
So, according to the DSM, the name Multiple Personality Disorder has been replaced or renamed Dissociative Identity Disorder. Therefore, they are the same and the newer name should be used.
But...
Many people with the disorder may prefer one name over the other, based on:
1. What the disorder was called when they were diagnosed,
2. What name they believe best fits their experience or system of alters,
3. Their stance on if the name was changed just for political reasons inside the psychology field in an attempt to make it less "sensational" or more "palatable" for professionals to admit they treat it.
4. Their personal beliefs that MPD and DID should be used to describe different levels of severity, different causes, and different expectations for the number and amount of differentiations between personalities. Many people seem to think that MPD better describes a more severe form of dissociation, would tend to be caused by more severe or long-lasting trauma events, and that the alters involved would be better defined/more distinct. For example, imagine a glass vase as being an integrated/normal/non-dissociative personality. If you dropped the vase 3 feet and it cracked in a few places, but still held it's overall shape, it would be DID. If you dropped the vase repeatedly, or from a more drastic height, and it shattered or pieces broke off, then that would be MPD.
P.S. I still prefer the term Multiple Personality Disorder, but have had to move towards using Dissociative Identity Disorder more on my blogs and websites due to how search engines function.
Saturday, April 19, 2008
Don't want to integrate?
Q: There are so many of us and we all really don't want to merge into One. But our Counselor wants to see us Merge. We are not Merging EVER. Can you tell me what will happened if we don't Merge and my host is still DID for the rest of her life? - Christina
A: Integration is a choice, not a necessity. Being Multiple doesn't become a true "disorder" until it impairs your ability to live your life (hold a job, meet your basic needs, be as social as you want to be, etc.). Many people with Dissociative Identity Disorder choose not to integrate, and they learn how to function in a healthy manner with their parts through communication, cooperation, compromise, and usually a fair amount of co-consciousness. Other choose not to set integration as a goal for therapy (or life in general) but find that over time they have many alters who seem to slowly blend together into a couple or group of like-minded alters. Integration should really only be a goal or requirement of treatment if the system can not function and communicate well due to a high level of animosity or amnesia.
So, you can choose to not merge, and still have a good life. If your therapist demands integration, state your firm belief/desire to not place that as a goal, and continue to work on other issues. If your counselor refuses to honor this because they think integration must be the goal of treatment, it's time to find a new counselor.
A: Integration is a choice, not a necessity. Being Multiple doesn't become a true "disorder" until it impairs your ability to live your life (hold a job, meet your basic needs, be as social as you want to be, etc.). Many people with Dissociative Identity Disorder choose not to integrate, and they learn how to function in a healthy manner with their parts through communication, cooperation, compromise, and usually a fair amount of co-consciousness. Other choose not to set integration as a goal for therapy (or life in general) but find that over time they have many alters who seem to slowly blend together into a couple or group of like-minded alters. Integration should really only be a goal or requirement of treatment if the system can not function and communicate well due to a high level of animosity or amnesia.
So, you can choose to not merge, and still have a good life. If your therapist demands integration, state your firm belief/desire to not place that as a goal, and continue to work on other issues. If your counselor refuses to honor this because they think integration must be the goal of treatment, it's time to find a new counselor.
Can't afford therapy!
Q: My SO is a multiple. I have known him for over 10 years. We have no health insurance and need therapy very bad. - BJ
A: There are a lot of places that offer low cost or free counseling. Contact your local rape crisis center, local church counseling centers, and domestic violence hotlines for referrals. Local mental facilities (hospitals, clinics often called MHMR for Mental Health and Mental Retardation) for information about county programs that you may qualify for. Your family may also qualify for Medicaid health benefits (which includes mental health care) based on income. Many states are also opening up hotlines that can be reached by dialing 211 from a regular telephone to access assistance programs for their area.
A: There are a lot of places that offer low cost or free counseling. Contact your local rape crisis center, local church counseling centers, and domestic violence hotlines for referrals. Local mental facilities (hospitals, clinics often called MHMR for Mental Health and Mental Retardation) for information about county programs that you may qualify for. Your family may also qualify for Medicaid health benefits (which includes mental health care) based on income. Many states are also opening up hotlines that can be reached by dialing 211 from a regular telephone to access assistance programs for their area.
Animal alters?
Q: Have you had any experience with animal alters? I have two inside and am having difficulty in communication. - Rell
A: Non-human alters appear to be fairly common. Most Multiples I know have at least one alter who appears to be an animal, ghost/angel/fairy, or some other creature/being. In our system, we have a cat alter who we late discovered was a child (she calls herself Katt!). I think for some alters, being human is just too scary because of what humans do to other humans (abuse, neglect, torture, etc). Admitting your human can be scary because it means admitting you're at risk of being hurt and used in the same ways the physical body is being harmed. I think some alters also pick out beings that they feel a connection with, either because that other being feels safe, powerful, or representative of how they feel or wish they could feel. Approach these type of alters as you would any small child or non-verbal alter. Use body language, eye contact, and written communication to help reach out to these parts.
A: Non-human alters appear to be fairly common. Most Multiples I know have at least one alter who appears to be an animal, ghost/angel/fairy, or some other creature/being. In our system, we have a cat alter who we late discovered was a child (she calls herself Katt!). I think for some alters, being human is just too scary because of what humans do to other humans (abuse, neglect, torture, etc). Admitting your human can be scary because it means admitting you're at risk of being hurt and used in the same ways the physical body is being harmed. I think some alters also pick out beings that they feel a connection with, either because that other being feels safe, powerful, or representative of how they feel or wish they could feel. Approach these type of alters as you would any small child or non-verbal alter. Use body language, eye contact, and written communication to help reach out to these parts.
Where is the research?
Q: Why isn't there research proving the cause and existence of DID? - Anon
A: I think most experts agree that Dissociative Identity Disorder forms at a very early age (usually agreed to be around 4-6 or younger), and many of these children would have a difficult time verbalizing the abuse, much less the presence of dissociation, following the trauma. If you look at Piaget's Stages of Intellectual Development, it makes sense that DID could form in a child who is abused during the Preoperational Period because of how children try to make sense of their world under normal circumstances - symbolic, magical, creative, parts versus wholes. It's rare that you will ever find a group of 4 - 6 year olds who have lived a life without trauma and then go through a traumatic event together so you can see if DID develops (and it sure wouldn't be ethical to subject healthy children to trauma just to see if DID develops!). Most group-trauma events happen to older people, such as students in a school shooting or bus accident, and by that age Dissociative Identity Disorder isn't expected to develop as a coping technique.
A: I think most experts agree that Dissociative Identity Disorder forms at a very early age (usually agreed to be around 4-6 or younger), and many of these children would have a difficult time verbalizing the abuse, much less the presence of dissociation, following the trauma. If you look at Piaget's Stages of Intellectual Development, it makes sense that DID could form in a child who is abused during the Preoperational Period because of how children try to make sense of their world under normal circumstances - symbolic, magical, creative, parts versus wholes. It's rare that you will ever find a group of 4 - 6 year olds who have lived a life without trauma and then go through a traumatic event together so you can see if DID develops (and it sure wouldn't be ethical to subject healthy children to trauma just to see if DID develops!). Most group-trauma events happen to older people, such as students in a school shooting or bus accident, and by that age Dissociative Identity Disorder isn't expected to develop as a coping technique.
Where is DID now?
Q: Where is Dissociative Identity Disorder now? There was a good deal written about DID in the 1980s and 1990s, then it seemed to die down, and in the last few years, there seems to have been a resurgence, at least in mainstream venues. - Craig
A: I don't think "DID" faded away, it just got divided into subparts: trauma and dissociation. For example, the main organization and journal concerning MPD has changed names numerous times over the years. In 1984 the first major conference on MPD was held in Chicago by the International Society for the Study of Multiple Personality and
Dissociation (ISSMP&D; Journal="Dissociation"). This society continued, and in 1994 was renamed the International Society for the Study of Dissociation (ISSD; Journal:"Journal of Trauma and Dissociation"). In 2006 it changed to the International Society for the Study of Trauma and Dissociation (ISSTD; Journal unchanged).
Nay-sayers have nothing to lose; but those who support the validity of the diagnosis and even dare to treat those who have the disorder face ridicule from peers, scrutiny from insurance companies, and threats of lawsuits from supporters of the False Memory camp. I have known people who have lost careers and the custody of their children because of the DID diagnosis - not because of their actions but because of fear and misunderstanding from employers and the court system. It may be hard to find supporters willing to go public with their belief or even with their own personal history of DID, but that isn't the same as there being no supporters. There is still a strong curtain of silence, shame, and fear.
A: I don't think "DID" faded away, it just got divided into subparts: trauma and dissociation. For example, the main organization and journal concerning MPD has changed names numerous times over the years. In 1984 the first major conference on MPD was held in Chicago by the International Society for the Study of Multiple Personality and
Dissociation (ISSMP&D; Journal="Dissociation"). This society continued, and in 1994 was renamed the International Society for the Study of Dissociation (ISSD; Journal:"Journal of Trauma and Dissociation"). In 2006 it changed to the International Society for the Study of Trauma and Dissociation (ISSTD; Journal unchanged).
Nay-sayers have nothing to lose; but those who support the validity of the diagnosis and even dare to treat those who have the disorder face ridicule from peers, scrutiny from insurance companies, and threats of lawsuits from supporters of the False Memory camp. I have known people who have lost careers and the custody of their children because of the DID diagnosis - not because of their actions but because of fear and misunderstanding from employers and the court system. It may be hard to find supporters willing to go public with their belief or even with their own personal history of DID, but that isn't the same as there being no supporters. There is still a strong curtain of silence, shame, and fear.
Why the controversy?
Q: Why is there so much controversy over this diagnosis? - Anon
A: I think people get confused and disbelieving about Dissociative Identity Disorder because they only see the extreme cases or Hollywood versions of the disorder. I believe there are three types of people with DID:
1. Those who aren't yet aware they have it. They may be in denial, or may be chasing symptoms (such as depression, anxiety, mood swings, substance abuse, etc.) and not realizing it's root cause.
2. Those who know they have it and function very well, so they "pass as normal." They may have periods of time when they need counseling or medication to help deal with stress and symptoms (such as depression, or when dealing with major life stressors such as the death of a significant other, marriage issues), but have probably never been hospitalized. The main alters or hosts who run the body/life may not have much, if any, awareness of what is going on in the rest of their internal world so they erroneously believe they are Singletons.
3. Those who have spent years being misdiagnosed, mismanaged with medication, or have not had access to appropriate therapy. They do not function well most of the time and have frequent hospitalizations. They may be disabled by their condition, or by their lack of appropriate treatment.
I think most people fall into the second category. This is what makes tracking the diagnosis prevalence difficult. Many studies only use hospitalized patients, but if many or even most of the people with the disorder are never entering the hospital then we can not accurately determine how many people have the disorder. The other commonly used method is looking at how therapists bill services and what diagnostic code they utilize. Many therapists will use the code that is related to the chief complaint (such as depression, PTSD, eating disorder, etc.) rather than all the possible codes that fit a client (such as DID, Axis II codes for personality disorder, and other diagnostic codes that may seem overly stigmatizing or difficult to be approved for treatment). This doesn't even begin to measure the number of clinicians who could miss the diagnosis due to lack of training/experience, or due to lack of belief in the Dissociative Identity Disorder diagnosis.
A: I think people get confused and disbelieving about Dissociative Identity Disorder because they only see the extreme cases or Hollywood versions of the disorder. I believe there are three types of people with DID:
1. Those who aren't yet aware they have it. They may be in denial, or may be chasing symptoms (such as depression, anxiety, mood swings, substance abuse, etc.) and not realizing it's root cause.
2. Those who know they have it and function very well, so they "pass as normal." They may have periods of time when they need counseling or medication to help deal with stress and symptoms (such as depression, or when dealing with major life stressors such as the death of a significant other, marriage issues), but have probably never been hospitalized. The main alters or hosts who run the body/life may not have much, if any, awareness of what is going on in the rest of their internal world so they erroneously believe they are Singletons.
3. Those who have spent years being misdiagnosed, mismanaged with medication, or have not had access to appropriate therapy. They do not function well most of the time and have frequent hospitalizations. They may be disabled by their condition, or by their lack of appropriate treatment.
I think most people fall into the second category. This is what makes tracking the diagnosis prevalence difficult. Many studies only use hospitalized patients, but if many or even most of the people with the disorder are never entering the hospital then we can not accurately determine how many people have the disorder. The other commonly used method is looking at how therapists bill services and what diagnostic code they utilize. Many therapists will use the code that is related to the chief complaint (such as depression, PTSD, eating disorder, etc.) rather than all the possible codes that fit a client (such as DID, Axis II codes for personality disorder, and other diagnostic codes that may seem overly stigmatizing or difficult to be approved for treatment). This doesn't even begin to measure the number of clinicians who could miss the diagnosis due to lack of training/experience, or due to lack of belief in the Dissociative Identity Disorder diagnosis.
Switching as a married couple of Multiples?
Q: Have there ever been times, or are there still times now, when you and your husband "split" into one of your alters simultaneously, so it's actually one alter talking to another? I would imagine that if you have two child-alters dealing with each other, that could pose a problem. For example, what if you guys are taking a road trip somewhere, or maybe trying to handle business at a bank or at a store, and these alters come out? If both alters are really young, how would you be able to drive or deposit money or pay for items at a grocery store? - Craig
A: First of all, let's clarify some terminology. Splitting is the creation of new alters, which for the most part takes place in childhood and teenage/young adulthood years. The older you get, typically the harder it is to create new alters. Most Multiples tend to stop being able to create new alters (not fragments) in their teens (unless traumatic events/abuse continue to happen). Switching is the chancing of who is present or in control of the physical body.
Switching alters isn't really that difficult to understand as a singleton. You have an internal mechanism, or conscious, that lets you know when different behaviors are allowed or appropriate. When you can hug certain people, use curse words in front of other people, when you have to be "all business" and when you can "let your hair down." Most people with Dissociative Identity Disorder also have an internal mechanism or group of alters that help control when switching can be allowed or forced. This allows safety and function, so that young alters don't suddenly appear while the body is driving a car but they are more than welcome to come out when watching a kid's movie at home. It also helps ensure that someone is available to deal with crisis situations, such as strong or assertive alters being able to be called into action when other alters feel unsafe or fear that the body is in danger. This system usually works very well, which allows many people with DID to be highly functional and appear normal. But there can be times when internal stress is very high, or when a system of alters hasn't learned to cooperate, that this can fail to happen.
Being a married couple of Multiples means we usually have a good balance of being able to have similar types of alters interact,and also being able to have a supportive or adult alter available when the other person has a scared or young alter out. With any married couple there is a natural fluctuation of roles and care-taking behaviors that help ensure that both partners have turns being supportive and supported; whether that is physically, emotionally, or financially. There are long periods of neutral functioning, but also times when one or the other of us needs extra TLC.
A: First of all, let's clarify some terminology. Splitting is the creation of new alters, which for the most part takes place in childhood and teenage/young adulthood years. The older you get, typically the harder it is to create new alters. Most Multiples tend to stop being able to create new alters (not fragments) in their teens (unless traumatic events/abuse continue to happen). Switching is the chancing of who is present or in control of the physical body.
Switching alters isn't really that difficult to understand as a singleton. You have an internal mechanism, or conscious, that lets you know when different behaviors are allowed or appropriate. When you can hug certain people, use curse words in front of other people, when you have to be "all business" and when you can "let your hair down." Most people with Dissociative Identity Disorder also have an internal mechanism or group of alters that help control when switching can be allowed or forced. This allows safety and function, so that young alters don't suddenly appear while the body is driving a car but they are more than welcome to come out when watching a kid's movie at home. It also helps ensure that someone is available to deal with crisis situations, such as strong or assertive alters being able to be called into action when other alters feel unsafe or fear that the body is in danger. This system usually works very well, which allows many people with DID to be highly functional and appear normal. But there can be times when internal stress is very high, or when a system of alters hasn't learned to cooperate, that this can fail to happen.
Being a married couple of Multiples means we usually have a good balance of being able to have similar types of alters interact,and also being able to have a supportive or adult alter available when the other person has a scared or young alter out. With any married couple there is a natural fluctuation of roles and care-taking behaviors that help ensure that both partners have turns being supportive and supported; whether that is physically, emotionally, or financially. There are long periods of neutral functioning, but also times when one or the other of us needs extra TLC.
Friday, April 18, 2008
How to use this blog
Welcome to the "Living with Multiple Personality (and some Disorder!)" blog.
I have Multiple Personality Disorder (MPD, later renamed Dissociative Identity Disorder, DID). It's an unusual diagnosis, as well as a controversial one. While the experts were arguing over if MPD/DID was real or not, I moved through many phases of recovery, married my soulmate (who is also Multiple), attained a BA in Psychology and completed an MS in Rehabilitation Counseling Psychology. As a counselor, I now help people recover, reclaim parts of their lives, and find the hope that their future is worth surviving and fighting for.
I believe that I have an interesting point of view given that I've "been on both sides of the sofa," so to speak. I have not only been a consumer of mental health services, but now I'm a provider. I have to balance my understanding of my clients from both perspectives: objective/clinical/factual, and emotional/empathetic/been-there-done-that/past experience. Every day is a challenge, a endless list of to-do's, an mountain of paperwork, an obstacle course of bureaucratic red tape... and if I'm lucky... a glimpse of the amazing power, resiliency, hope, and perseverance of the human spirit.
If you have questions, feel free to email me or ask them in a "comment" to *THIS* post.
If you want to leave feedback or your answers to a questions, use the "comment" section.
Use the "search blog" box at the very top of the page to help you find topics/questions that interest you.
I have Multiple Personality Disorder (MPD, later renamed Dissociative Identity Disorder, DID). It's an unusual diagnosis, as well as a controversial one. While the experts were arguing over if MPD/DID was real or not, I moved through many phases of recovery, married my soulmate (who is also Multiple), attained a BA in Psychology and completed an MS in Rehabilitation Counseling Psychology. As a counselor, I now help people recover, reclaim parts of their lives, and find the hope that their future is worth surviving and fighting for.
I believe that I have an interesting point of view given that I've "been on both sides of the sofa," so to speak. I have not only been a consumer of mental health services, but now I'm a provider. I have to balance my understanding of my clients from both perspectives: objective/clinical/factual, and emotional/empathetic/been-there-done-that/past experience. Every day is a challenge, a endless list of to-do's, an mountain of paperwork, an obstacle course of bureaucratic red tape... and if I'm lucky... a glimpse of the amazing power, resiliency, hope, and perseverance of the human spirit.
If you have questions, feel free to email me or ask them in a "comment" to *THIS* post.
If you want to leave feedback or your answers to a questions, use the "comment" section.
Use the "search blog" box at the very top of the page to help you find topics/questions that interest you.
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