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Dissociative Identity Disorder
Biology 202
1998 Second Web Reports
On Serendip
Dissociative Identity Disorder
Rachel Kaplan
Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder (MPD) is considered by the American Psychiatric Association to be one of 4 main kinds of dissociative disorders (DSM-IV): "The essential feature of dissociative disorders is a disturbance or alteration in the normally integrative functions of identity, memory, or consciousness" (8). If identity is the main function affected, the person is said to have DID.Most non-DID people have one identity comprised of many parts that work harmoniously together. They have only one I-function which consists of a conglomeration of thoughts and feelings formed from connections between many different brain areas. People with MPD, however, have a decentralized, internal network of 2 or more I- functions or "alters," each with its own physiology, behavior, and cognitions.
Dissociation often enables victims to maintain a relatively healthy level of functioning because traumatic memories are disconnected from other information in their minds. A multiple presents her view of DID: "We do not SUFFER FROM MPD. We SURVIVE because of MPD" (6). Living with this disorder is often an extremely lonely, confusing experience. Luckily, there has been much success in treating this disorder thanks to the extensive research conducted into DID etiology.
The etiology may be explained by the diathesis-stress model. There appears to be a biological component given the fact that most people with DID have a family history of the disorder. It has also been found that people who are easily hypnotized are more susceptible to DID (5). The stress is known to come from severe physical, emotional, and/or sexual abuse at a developmentally sensitive stage in childhood (3).
When a person experiences extreme stress "endogenous, stress-responsive neurohormones, such as cortisol, epinephrine and norepinephrine (NE), vasopressin, oxytocin and endogenous opioids" are released (10). These substances induce glucose release and activate the immune system, enabling the organism to effectively deal with the stress. Chronic stress, however, such as repeated sexual abuse, decreases the effectiveness of this system. It has been hypothesized that when the system is bombarded with chronic stress, there is a malfunction in the negative feedback loop which goes from the neurohormones back to the hypothalamus and pituitary gland. As a result, the system begins operating in positive feedback mode; increased cortisol release, for example, leads to increased cortisol production. The desensitization of the system causes the person to have an intense stress reaction in the presence of even the smallest trigger. Abnormalities in the limbic system have also been implicated in this condition.
This desensitized state exacerbates the dissociative process. In order to survive extreme stress, many children psychologically separate "thoughts, feelings, memories, and perceptions of traumatic experiences" (2). This coping method becomes increasingly ingrained the more frequent the abuse. The resulting highly conditioned, hypersensitive survival technique leads to impaired functioning. A person with a young child as one of his alters might bring out that child whenever there is even the slightest threat of an anxiety-provoking situation. In this way, if a traumatic event occurs, the pain gets isolated to one faction, a storage space, of the overall personality.
Memories from traumatic experiences are encoded in a unique way. Pierre Janet has suggested that the emotional impact of the trauma prevents the victim from translating the experience into the words and symbols which would be stored in the semantic memory. Instead, the experience gets stored in a "somatosensory or iconic level" form which makes for vivid and accurate recall (10). For example, 4-5 months after witnessing a murder, subjects showed excellent recall for details about the event (Cutshall 1989) (11). Neuroimaging studies have shown that during the stimulation of traumatic memories, there is decreased activity in Broca's area, the part of the brain most concerned with the translation of experience into words, and increased activity in the right hemisphere areas, parts which are involved in the processing of emotional and visual information. (Rauch et al., 1995) (11). A person with DID has stored these emotional and visual representations of traumatic incidents in a whole identity that is as stunted as the memories themselves.
Storage in semantic memory is easier on the ego because experiences are tempered through their translation. Also, because semantic memory integrates input into existing mental schemata, the information is subject to learning effects (10). When recalled, these memories are subject to distortion because of their emergence in a new context. There is debate, however, about whether traumatic memories can ever be changed. It has been found that with time sensorimotor and iconic memories tend to become restored as words and symbols which can be processed in connection with existing mental schemes (10). LeDoux, on the other hand, has postulated that "once formed, the subcortical traces of the conditioned fear response are indelible, and that 'emotional memory may be forever'" (10). LeDoux's theory does not bode well for the ability of trauma victims to unload their burdensome memories. There is definitive evidence, at least, that memories may be recovered.
Research has shown that memory retrieval is "state dependent (10): "physiological arousal in general can trigger trauma-related memories, while, conversely, trauma-related memories precipitate generalized physiological arousal (10). This phenomenon might explain why the presence of a trigger for a traumatic memory may induce a "switching" of alters. The memory may induce a stress reaction which would ultimately produce a different physiological state. It seems possible, given that alters have been shown to have different physiologies, that a specific physiological state might correspond with a specific alter. The concept of corollary discharge may be used to explain why the actions of one alter may affect the mind-set of others despite the psychological separation of these entities.
People with DID are reluctant to integrate their separate identities because they use them to cope; however, patients' quality of life has been shown to increase following treatment. Therapy should involve a nursing, medical, and primary therapist component. Therapists may direct patients to increase the strength of the entire system through increased internal communication and cooperation, the build up of ego strength, and the increased taking of responsibility for internal actions (7). It is very important that the patient gain a sense of control over his current cognitions and past memories. The multiple may gain control by recognizing the abused child's thoughts and feelings and by altering negative self-images (8). It is also vital that both the therapist and the patient show equal respect to all the alters.
Hypnotherapy and nonverbal therapy are commonly used in the treatment of DID. Hypnotherapy is commonly used in treating DID because of its facilitation of memory retrieval, "calming, soothing, containment, and ego strengthening" qualities (4). It can be used to increase communication between the alters and between the alters and the therapist. This method may also help in "fusion rituals (when previous psychotherapeutic work has cause a particular separateness to no longer serve a meaningful function for the patient's intrapsychic and environmental adaptation and when the patient is no longer narcissistically invested in maintaining the particular separateness)" (4). This is interesting because it indicates that a patient's pride might serve as an obstacle to his convalescence. The danger to hypnotherapy is that it may cause a patient to believe in a fantasy which he creates while under hypnosis.
Nonverbal treatment methods such as art and play therapy have also been proven useful in treating DID. Art therapy seems to be a freer expression of thoughts and feelings than verbal methods. The right side of the brain is more involved with creativity and the imagination; whereas, the left side is more concerned with language. Stimulating the right hemisphere might bring up "sensorimotor and iconic" memories more readily than if the person needed to filter input through the left hemisphere (10).
In general, most people respond fairly well to treatment depending on their baseline comorbidity (9). It has been shown that 60% of patients who undergo treatment maintain stable integration, which is defined by Kluft as "3 stable months of continuity of contemporary memory, with the absence of behaviorally evident separate identities (9).
DID research raises a lot of questions about the nature of the I-function. What are the implications of its being able to be fragmented? Perhaps the other I-functions, or separate identities, are merely different centers of connections with some of the same and some of their own links to other brain areas. Maybe the mechanism of the "fusion rituals" during hypnosis involves the solidification of links between the most dominant I-function and the alters such that when one is activated, the whole system becomes activated. Another possibility is that everyone possesses different centers of connections and somehow after repeated dissociation episodes, some people's links become severed.
Findings from DID research may be helpful for DID and non-DID sufferers alike. Research into this area has shed a lot of light into what kinds of cognitions lead to healthy functioning, among the most important of which are the need for a sense of control and self-love and respect. The research also highlights the interconnectedness of the mind and body: the fact that the psychological has a very real affect on the physiological and vice versa.
Works Cited
1) Re: Multiple Personality Disorders "NOSSCR Online"
2) The Effects of DID on Children of Trauma Survivors "Sidran"
3) Dissociative Identity Disorder (Multiple Personality Disorder) "Sidran"
4) Guidelines for Treatment "ISSD"
5) About Multiple Personality Disorder and Dissociation
7) Clinical Case Study #2: "Hardscrabble Communications"
8) An Overview of Diagnosis and Treatment
9) Two-Year Follow-Up of Inpatients With Dissociative Identity Disorder
10) The Body Keeps the Score: Memory and the evolving psychobiology of post traumatic stress
11) Dissociation and the Fragmentary Nature of Traumatic memories: Overview and Exploratory Study
|
Continuing conversation
(to contribute your own observations/thoughts, write Serendip) 11/28/2005, from a Reader on the Web Excellent resource about the topic. |
1) What are some of the day-to-day concerns or issues people with the disorder face or people they live with face.
2) also, what are the percentage of cases in the U.S. of the people who have this disorder ... Evan Norrgard, 8 May 2006
I was diagnosed with DID. I see alot of pictures and visuals in my mind. I take these and work with what I see. If I see a house that has has a storm come throught I talk to myself and the alters about the storm. I also talk to THe Holy Spirit and see his help. I will ask the parts if they want to come an be integrated into me. They ususally do after some talk. I always feel relieve after such a talk.
I function well and work and enjoy a full life now, But I know there is more for me and I want travel the world and experience more goodness in life.
A hard part of this is that my mother and sisters do not except that anything traumatic ever happened to me and talk as though nothing ever happened. It is really strange.
Thank you for you imput. I wish I could come for some treatment, however I do not think that your prices are within my price range ... Lena, 3 December 2006
I suffer with DID and now after years of therapy, I seem to be going backward instead opf forward. There are so many stressors in my life right now I cant cope...any suggestions to help? ... Sam, 28 April 2007
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| This paper reflects the research and thoughts of a student at the time the paper was written for a course at Bryn Mawr College. Like other materials on Serendip, it is not intended to be "authoritative" but rather to help others further develop their own explorations. Web links were active as of the time the paper was posted but are not updated. |
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Comments
w mh
Thank you soooo much! I have never been more thankful in my life.
I have put the pieces together. I know now why I do the things I do - without knowing why.
Lately I have made a system of who I am.
I have tried, a part of me, to admit how it was. How I don't have a childhood at all. Or youth. Or grown up.
I know I am DID. Is it ok to say I am? I don't want to say anymore about it.
Its like I have believed what others have said to me in years, but now I know I'm not depressed or whatever. I am the I that doesn't know who I am.
I know. Dont want to scare. But pleae believe me!!! Its true... I am so ruined. My whode life is falling apart. I have never been a child, not a youht, not even an adult.
My therapist (my new one) claims she understand. She believe me.
I am not english or from any other part of the world where english is the language. And, afaid: Sorry!
i KNOW I am IDI and it freaka mw out. But still. Are someone here willing to help me? I want to be whole....
DID
Dear L.
I'm glad that making sense of a diagnosis is comforting to you in some way. I know we are dealing with language differences here, but I think it is important not to think of yourself as BEING DID, but of HAVING DID. DID is not your identity. It is a condition you are dealing with. I think it is good that you are making a system of who you are, and I understand what you are saying when you say "I am the I who doesn't know who I am."
I know you say you are ruined and your life is falling apart, but it sounds to me like you are starting to heal. Healing will be a long journey. You wouldn't want it any other way. Too much too fast would overwhelm you. If you do have DID that means you have a history of past trauma. A big part of your healing will be facing and processing some of the trauma of your past. If you don't remember trauma, you may find that some memories come to you in flashbacks or dreams. If you do any art work, some may come out in your art work. Invite other parts of you to leave you notes or do art work for you when you have "missing time."
If you really feel like you are falling apart, try hanging onto anything that you know is real and start from there in building the stability. The most important thing will be the relationship you form with your therapist. I am glad you have found this website. There are other good websites for support and blogging regarding DID too.
There will be times that you feel like you are falling apart, but believe me that you will not really be falling apart. You will just be experience new things inside you that can be very confusing and evoke a lot of emotions. Some of the emotions might be things that you don't like feeling. Really let your therapist help you with this. There is a path to wholeness, but take it one step at a time.
confusion
It does sound to me like you are definetly dealing with DID. I don't know where you are located, but try to find a therapist who has worked with AND is comfortable with working with this diagnosis.
Does anyone know
Does anyone know how to email a particular person posting, in private?
what resources would anyone
what resources would anyone suggest across the country and in indiana
would be interested specifically in faith (christian) based resources
dealing with dissociative disorders-various including tho not limited to did
DID
What do you mean by resources? Are you talking about information to learn more, or mental health services to treat conditions? I am in Indiana.
Elaine in Indiana -
Hello Elaine. If you return to this web page, I would like to make contact. I live in Indiana and am currently looking for a therapist who specializes in trauma and dissociation. They are not easy to find! I've been making phone calls today and came upon this page through a Google search. I've requested that the system notify me when new comments are posted. I am in Indianapolis but am willing to drive to see the right therapist.
DID
Hello Cathy-
I also get notified when new comments are posted, so I got your message. I really don't know what this website allows in terms of giving personal contact information. I can tell you that my website is www.light-awakening.com. That website will give my contact information. If for some reason the mediators of this website don't allow me to tell you my website I guess they will delete this message. In that case I would request that the mediators somehow tell me the approved way for us to communicate personally.
By the way, I am about 35 miles from Indianapolis.
Hi Elaine. This is exactly
Hi Elaine. This is exactly what I hoped would happen, that you'd be alerted and return with a means of contacting you. I have a full afternoon ahead, but I will touch base in the next few days. The drive is no problem. I'm doing as much research as possible at this time to find the best fit possible in a therapist. Many thanks for your reply!
DID
Hi Cathy B-
I'm doing some work with the local school system, so I am gone a lot during the day, but it is not always every day. A lot of my counseling is done evenings and weekends. I actually do home-based too, so there is the potential of me coming to you. It is just a little more complicated now that I am working at a school too. I don't remember which of my phone numbers is listed on the website, but either way I will get a message. Or my email is also listed on that website.
Alone
Hello, I am 68 years old, and presumably have DID. I have known one other person exhisted since i was 14, and wrote a little about what I knew, but didn't know about the others, mostly suicidal children, until, while working with a therapist, they came out and took over. I have been hospitalized 10 times over my lifetime for this, most of the times being told they didn't know what was wrong with me. I live in an area of Wa , where very few therapists deal with this problem, and no support groups exhist. The cause of my DID problem does not fit in with most others who have the same diagnosis, and I feel extremally alone. Social relationships are almost impossible for me, and friends i have none. Because of many problems in my life, extreme stress is ongoing. I do have a good therapist who is familiar with DID, and has worked with it (no hypnosis), but I still feel extremally isolated, lonely and close to hopeless.
You are not alone..
I understand what you are going through and id like to talk to you about it, can i have your email??
email
Shay, Thank you for responding- I was thinking no one would. I don't know how to give my email address to you without putting it out for everyone. Sandy (509Sparklingstarrs)
Without a friend or support
I am hoping against all odds to have some help in my options at this time. I am a 64 year old woman whom has been diagnosed with PTSD and DID about 20 years after many years of all kinds of slightly to extremely off target diagnosis. I lived in Hawaii most of my adult life where I raised 4 children -successfully- and had 2 excellent psychologists. In between the two different doctors, I had a psychiatrist for less than a year who within the first 2 visits diagnosed the D.I.D. I have always had a streak of optimism and capacity for enjoyment. After going through 20 years of severe abuse (Birth to 20 years old) years of therapy, good support and my own tremendous willingness to LIVE well, versus be a survivor...I did manage a fairly good life..with episodes of crisis here and there. 7 years ago I moved to Seattle to help my daughter raise her children. A series of misfortunes, bad dentistry lead to an infection of my pericardium..then embolism..and from there, the mostly non existent mental health support went down hill. No records were ever asked from my HI doctors. No therapy and when the 1st crisis happened, when an incredibly insensitive Social worker (who was also:"the therapist") didn't have the courage to tell me that after I became 60, I would get no treatment at all. She altered my records to reflect the use of heroine. As unusual as it seems, I had never used or wanted drugs...(A profound spiritual focus may have been my best friend!)..from there it has escalated down to where I hardly recognize the person in my records as myself. There are good people who can vouch for my "innocence". Because now. when I am facing major surgery for cancer< a "Copes" aid has accused me of "coming to her with a threatening attitude and knife on hand" It is so preposterous I am speechless!..DSHS Social workers have taken this as true without even meeting the aid, who happens to be an aggressive young woman. I have gone through hell in my life, but I have never been so close to want to end it. And I am alone. Completely alone.
I hope there is some help for me.
Diana
Dissociative Identity Disorder
Diana- Yes, there is hope. I am very confused about the process of being "railroaded" that you describe. I certainly know how hard it is for many people with DID or any kind of trauma recovery to find accurate diagnosis and therapy at times. -But I have never heard of anyone being told they won't receive treatment after age 60, or of falsifying diagnoses.
I am a mental health therapy who has sort of ended up specializing in trauma recovery, personality disorders and DID. Seattle is a big city, I'm surprised you haven't found adequate resources. Had you checked out the Sidran Institute website to see if you can find someone in your area that specializes in issues like yours? I would be glad to help you in anyway I can, but I live in Indiana. I do have a friend in Seattle who may be able to put me in touch with more resources that would help you.
Can you name what you need first? I hear that you feel very alone. What about your family there? If you need support websites such as this, there are several good ones around to help find support and information. Are you currently "trapped" in some kind of situation because of this social worker that you are needing help extricating yourself from. If I can make better sense of your situation, perhaps myself and others on this website can at least help you figure out how to navigate your way through the system.
My Little Warrior Women
I am a 56 year old white woman. I was sexually abused by male relatives from age 2 1/2 to 7 or so; molested by hospital personnel at age 5 or 6. I grew up in a sexist rigid gender-role patriarchal home. I had no memory of this until I entered rehab for substance abuse in my 38th year. Though I was voted the "brilliant" child of the family, I was also the "crazy" one. The day I entered public school, and every year after, I was referred to counselors and was included in group therapy. I had periods of lost time and "blank outs" for as long as I can recall. As a very small child, my father designed a crash helmet for me out of a plastic soup bowl padded with foam that tied under my chin with ribbon, to keep me from cracking my head when I fell over.
I paid good money and precious time on counselors and psychiatrists to figure out why I was a drunk and a druggie. Went to treatment at age 39 - got clean and sober. . .but got beaten up with flashbacks of childhood sexual abuse.
I continued with the MD's, the PhD's, and the rest of the alphabet soup because I wanted to know why I found myself in bed with strange people I didn't know, why I found child-like drawings on my walls that my daughters denied, why I was in Kentucky when I lived in Illinois. Why my life did not improve no matter how many antidepressants I took or how much alcohol I didn't drink.
Finally, in 2003, I was diagnosed with PTSD and bi-polar D/O, and received appropriate treatment. I found yet another counselor and had a breakthrough: one of my alters ratted me out. I normally don't refer to my alters as alters. I call them my me's.
I am not what they term "fully integrated" but we live in peace. My me's are my warrior women who protected and sustained me, without whom, I would not have survived. I live today, because of their creativity and vigilance.
I remember the dark days as I struggled for breath at the bottom of the black sea, terrorized, my soul burning with hunger for breath and light. My husband would come home and find me in the fetal position in the closet. I would wander home two hours late with a black eye and no skin on my cheek. My warrior women sustained me. I knew that if living through it didn't kill me, remembering it would not.
Today, most days, I float upon the soft white foam of that same dark sea and my soul knows freedom and light.
I pray all who tread this journey come to know the joy of the truth. You survived that you might know a joy equal to the pain you once bore.
Hello, I wanted to thank
Hello,
I wanted to thank you for sharing your story. I to have DID and it has been a little rough getting the understanding I have now. I found an incredible place that handles trauma differently. Their approach is different then the traditional approach. This has been so incredible for me and my people. I hope you continue to be healed.
trees
treatment
Can you share the place you found that was so helpful to you? Thank you
a question for trees
Can you tell me what kind of different treatment you found?
DID
I have been living with DID since I was 6 years old. It was the way I survived being raped by my father over and over. It became problematic when I was of the age where my children were born. I have been in psychiatric hospitals many more times than I like to remember. I was even treated with ECT as I was mis diagnosed with severe depression. Thank goodness I was fortunate to have been hooked up with my current therapist of the last 11 years. He has been exceptionally kind, understanding and educated in the treatment of DID. Without him I probably would have been dead a long time ago. Our relationship is based on kindness, honesty and trust. I have been on and off many different types of medication over the years, but have found that there really is no medication specifically for this disorder-- it's all symptom based treatment.
My husband has been very good with "us" over the years. I know it has been hard for him, but I give him much credit that he has stuck with me- extremely supportive. It is not often that a person with DID can claim that. If you think one of your relatives or friends has DID- get them to a competent therapist as quickly as possible- and offer them your complete support-- that is the best "medicine" anyone can give them-- thanks for listening-- Fran, liz, Nikki, Sara, Sue, Susie, Jenny, and Peter
DID
Hi Fran, liz, Nikki, Sara, Sue,Susie, Jenny & Peter :)
My name is Eddie, I live in Australia and I have a very dear friend who has DID. I want to be the best friend that I can be to her so can you give me some advice as to how to do that. I give her someone to talk to which I know helps but i also know that she only goes so far with what she tells me. I'm very privelaged to be one of very few people that she's openned up to at all but I want to be more and do more for her. Is it just to be there when required? I try to nudge her to see a therapist again but fear that in me nudging her like this too often that she will close of to me totally.
CASE STUDY
HI MY A COLLEGE STUDENT STUDY PASYCHOLOGY AND IM DOING A RESEARCH PAPER ON DID AND I WAS WONDERING IF IT WAS POSSIBLE IF WE CAN TALK?
I have d.i.d. if you have
I have d.i.d. if you have questions. I am a victim of sexual abuse and ritual abuse.
sure...
If you eant to talk thats fine...just to tell you, Idon't even remember what I said on here and when I did it...just to say it might be a while when I "talk" to you.
Confused or just thinking too hard.
Hello I am a male of 18 years. I'm very confused if I have D.I.D or not, but I believe I do have this disorder or it could either also be that I'm thinking too hard to think I have it. My eldest brother said that people who has disorders do not even realize they have a disorder. I find that really hard to be true. The reason why I believe I have D.I.D is because I see like four total different people in myself, or rather say I have four personalities. Each having our own names of course and how we contribute to our life, having different aspects of life and much more. I'm unsure if any more will develop, because on the other hand I think I have five personalities, but the fifth one I'm so unsure about... GAH! It's so complicated to try to explain. I haven't really told anyone about this, so I haven't really asked anyone to tell me if I behave different. But I do have some of, or most of the symptoms. I have sleeping disorders, sometimes I get no sleep at all or too much sleep in one day. Eating disorders, I barely eat and I find it hard to know if I'm hungry or not, and when I eat a whole meal, I get hungry in like 2 hours. I weigh about 125 pounds for a 5'8 male, that's really underweight too. I often get amnesia! Sometimes when people tell me something, even it's a stupid conversation or it could be an important conversation, I may instantly forget what they just said and my mind jumps to one thing totally different from the topic. I don't remember everything, but like after three hours or so I would remember, or never at all. I hear voices in my own head, I sometimes talk to my "other" people or whoever they are in my own head and they would respond, or it could just be me talking to myself, GRR... yet again, very complicated to explain! Everytime I try to talk about something, my head can't focus! It literally feels like my brain is rushing with so much thoughts and it could be about random things... I can't concetrate... If you were me (or us) you would have a hard time trying to explain something... you just get this awkward feeling. I don'tknow if I should see a doctor, I could just be thinking too much and I don't know, I don't know who's really thinking that right this moment...
reply; confused or just thinking to hard?
Hi there! Im 16 and 6 months ago i was diagnosed with DID, and from what youve said, I think its safe to say that your diagnosis is dead on, mainly because what you wrote sounds exactley like me! I think that maybe you should see a therapist about all of this and get it straightened out. Good luck!!
DID Partner
Hello. My partner (who now has DID) and I have been seeing each other for about half a year now and don't know how people can be 'unsure if they have DID'. It's really obvious for us. He has 6 MP's;
Daphne who is a woodnymph/nymphomaniac(?) type character, whom I had to teach about cars and building to. She has since gained some of his common knowledge and the ability to read.
Jack, an 8 year old who loves playing Nintendo DS (Pokemon and Drawn to Life), pretending to be a cat and drawing.
Uriel, the mother figure, who is partner to Vandiel/Winston and helps me keep the house running.
Vandiel, the trickster. He had a horrible habit of rearranging food at the supermarket and books at the library. Once he toilet papered the house after my partner spend a day cleaning.
Winston, the animalistic(?) man. He's got mayjor reaction to the fight or flight thing. He's also Vandiel's Alter Ego. Yes,, an alter ego's alter ego. I shit you not.
Emmanuel, the 23 year old laywer who does drugs and drinks lots to cope with his life in my partners head. He's since fallen in love with me and promised never to do so again, so longs as I stay with him/them.
I believe, both Emmanuel and Daphne had suspended realities in my partners head to keep them unaware of the real world; as their awareness would have jepardised my partner's survival. He went out to do the shopping and woke up in a pet store holding a cat coller two days ago. Jack keeps asking if we can a cat. I have noticed also, MP's come out more at night and in shopping centers than anywhere else in our case.
Hope this helps. I'd love some messages from others with simillar happy memories.
DP/DR
I have been having a time of it for the last 6 months. I have had a great deal of trauma in my life and have a diagnosis of PTSD.
My sleep has been interrupted and I have been having vivid, maybe even lucid dreams. During my waking hours, I have been having panic attacks and triggers that find me remembering or finding new meanings to past events.
In the past, I lived my life within a script running through my mind. There were always people in my script who had very high expectations of my abilities. I would go about my life trying to perform well infront of these (mind) people.
After my first trigger, several years ago, I have stopped allow this script to run. I wanted to be more aware of what the real people around me were doing and saying.
life after DID
I guess my question comes from a different perspective and I am hoping that someone can help me understand. I am a mental health therapist who often works with clients with DID. I just finished a many year long work with a client with whom I had grown very close, and I've gone through hell and high water with her. I did this because I wanted to help her knowing she had been through all kinds of misunderstanding and abuse by the mental health system. She has successfully integrated at this point, but oddly enough I find I have become public enemy number one in her eyes. Now she is angry with me, and blames me for the things I did to help her get well. I may be a therapist, but I am also human. Can anyone explain to me where she may be coming from with all this. I always assumed that we would transition once she became well, but I never expected the rage and distance from me. It is hard from the therapists perspective too to have cared so much and worked with someone so long, to then start being verbally abused to the person you worked to help for so long.
Re: life after DID
You may have taken away her internal support system. I have DID and I am studying to be a professional counselor. To be honest, I am not much impressed with the so-called "therapeutic techniques" I have read about for "curing" DID. Being a multiple is very much a personal journey and integration absolutely is. You have to be ready to integrate, it's not something a therapist can force on you. My alters have been telling me for years that they would have no problem integrating, ALL of them, if they were confident that I could be safe on my own. We are working toward that goal and when we get there, we will achieve unity. Maybe you pushed your client too fast? Or maybe she just misses having her alters around. I couldn't imagine life without mine. Life is lonely enough without being TRULY alone.
Or, you know, hate to say it, but your client's uncharacteristic rage could very well be a sign that she's NOT fully integrated. Could be a sign of another alter coming out that you have never met before. In my experience when you see extreme emotions and behavior that are very uncharacteristic of the main person, you are often looking at the emergence of a new alter who has yet to be acknowledged.
DID
I appreciate your comments. In the case of this person who had been my client, integration was not even a goal for our treatment, because it was not something she wanted. When whatever level integration did happen, she/they chose it on their own because they were having a lot of medical symptoms that were debilitating, and they decided that the only way to heal the body was to come together. Her/their decision to do this was not known to me, and it happened separately from me. She informed me of it later. So I certainly never pushed for integration. Her goal was to be functionally multiple- like not losing time- so she developed co-consciousness. Really she did whatever level of healing she did on her own, I just accompanied her on the path by believing in her and supporting her decision making. Although we had met when she was my client, she had not officially been my client for many years, and I sort of just remained a supportive presence in her life. The issue of her turning against me happened within days of her integration, and this is what was so confusing to me. I know at the time I was going through a lot myself, and having her suddenly become cruel to me just hit me so hard, and she saw me cry and feel hurt. I felt badly that that happened, but I been at the end of my rope myself, and having the person I had stood by so long, and honestly fought for her wellness with start becoming cruel to me was just a last straw for me. I've gone through my head so many times trying to understand psychologically what may have happened inside her that led to this. I can't come up with anything that would outweigh the years of love and giving i gave just because i believed in her enough to want her to get well (it wasn't just the DID, it was the PTSD, and depression). It has been a year since this happened and I am still shaken by this because it has led me to doubt all my hard work and commitment to her wellness, but also because I felt like I knew this woman (all 30 of her), and would never have seen her becoming cruel to me, and never even being willing to talk about it. I have given up thinking I can understand. I hope some day we can have peace between us again. Our working together was an amazing thing. and because I am a highly spiritual person, I believe that God was a big part of our work together- because it all worked so well. We developed a very caring and trusting relationship. So I was blindsided by her turning against me in such a vicious way, and me never knowing why. It's led me to doubt God too- because so much of what I did was also a way of serving God by standing by someone that so many other people had given up on. I also have my own history of PTSD from many years ago, and that got triggered again through all of this. that is why I have struggled so much. I agree with you that her learning to live as one person could be such a hard adjustment for her- even though it was her choice. I also know that her choice was not necessarily based on all the alters being ready psychologically to come together, but because it seemed necessary to "save the body." I know it is also possible that there isn't full integration, and what I am experiencing from her is from a different part of her that what I knew. I thought it might even be huge transference. I know she would have experienced a huge amount of rage once she remembered much of what had happened in her life- and perhaps it all got directed at me because I was the one who was the closest at the time. I just don't know. AT this point I just pray for her continued healing, as well as my own, and for their to eventually be a peace between us.
yep I can i have DID and
yep I can i have DID and remember we all function from the victim, perpetrator, rescuer triangle..in my case it is difficult for me to integrate since all parts are designed to protect me by assiging one or another of those functions to either, the world, the person I amin a relationship with, the new project or deadline Im on. true I have not fully processed all of the traumas and my life was appalling and alters still behave so reflexively but I can tell you that I believe my therapist that if you dont do the cognitive work in each parta nd the system and actually become willing and take the risk to act and view the world, people and relationships differently you will end up knowing what happende to you , integrated, but still approaching the world victimized and relating that way.. my guess she transferred her vicitimization rage to you. its very easy for any of us to do since most of us have suprisingly deep complex ways of attaching and protecting.. have you read beverly james work? maybe it can help. my guess, as a person whose system went under cover mid therapy for 15 years and later resurfaced to do this deeper altering work which required a whole new way to trust my therapist and begin to make peace with most rageful parts of myself and the most hurt, we had to work down through layers to find this dynamic and admit it and try hard in these parts to trust her very differently than my people pleasing, logical, intellectual, emotional seemingly higher functioning arrangements of self could pull off. we can be so subtle that we can fool ourselves. i was fully convinced I was no longer DID and everyone-kids, spouse, coworkers, clients even thought so--even therapy got derailed without either of us catching it because I was so terrified and not ready to go here. But in those years I gained a sense of safety and knowledge about the world that I wouldnt have otherwise. now I am more able to process the deep pain. hope this helps. My guess is its not you and some part is still operating , possibly without her consent.. looking for rescue somewhere else
DID
I don't know if the person who wrote this will get this message or not, but I was very interested in understanding more about what you came to learn and how you learned it in that time you chose not to deal with deeper issues.
DID
Well I was just writing a long response to what you said because it intrigued me a great deal, but it disappeared while I was still typing so I don't know if it will end up showing up or not. I will just try to address the couple things I didn't get to in that response. If the first part of the response doesn't show up, I will try to recreate the main points later.
I am very interested in what you said about having your DID going into hiding for 15 years because you weren't ready to do the deeper work yet, although it doesn't seem that you turned your rage on your therapist. I do believe that this is a big part of what is going on with this former client. I am just not sure how I ended up having all the rage and fear turned toward me. I think it is possible that her family and friends only see the ways in which she is better, and don't recognizd that other things are going on still. I think it is possible that all the rage and fear got turned at me because I do recognize that something is still not OK, and she wants to keep me as far away as possible for fear I might want her to go deeper, or is mearly afraid of the fact I know so much about her. She has gotten sort of paranoid in believing somehow I would use what I know against her. I understand what you said about those 15 years when your DID went into hiding were still beneficial to you because it helped you see the world in a new way. I hope that happens for her too. I'm not sure she has 15 years to wait though because of age.
I am interested in what you said about the perpetrator, victim, rescuer triangle. It has been my understanding that all alters start out as some kind of protector, although it often doesn't end up looking that way. I did recognize all of her alters to fit in one of those roles. What I wasn't thinking about though was that without having all the alters to play those roles that those roles would also get assigned externally. I can't say that I was ever her rescuer. At times I was a protector because of the advocacy I did for her, but she sure did flip me into a perpetrator role very quickly- and that is what totally left my head reeling.
Something else I have wondered about, and don't know if you have any insights on because I don't know how other people's internal systems may work. This client had a whole system of justice and democracy set up in her internal system, and it was possible for the alters to get together and decide to exile one of the alters if they were creating harm in the system. For her it was referred to as putting them "outside the circle." -They still existed, but were just in exile. It was always possible for an alter in exile to be allowed back in if they agreed to certain changes. Anyway my reason for going into this is because there was one alter that I had known that got put outside the circle during the time I was working with her. I have wondered what happened to him when some integration took place. He would not have liked me at all. I had very good relationships with all the other alters, but never had the chance to establish that with this particular one because he got put outside the circle before we ever developed a working relationship. I have wondered if he jumped into the integration and took on a dominant role, or if perhaps he didn't integrate and remains an alter that influences her in other ways.
Obviously I have had months to think about this now, and still haven't really made much sense of it. I still wish so much for her to continue on her path toward a more full healing. I am greatly saddened that if she has placed me in a perpetrator role, she may only remember me as one more person who hurt her, when my whole agenda was to always create a safe space for her. -And I still worry that in some way I inadvertantly did or said something that actually hurt her when that is the last thing I would have ever wanted to do.
I am a person with DID and
I am a person with DID and have been through the therapy roller coaster. I completely understand how close a therapist and client can get in this kind of traumatic and lengthy process. A couple of things come to mind as reasons for her actions. Number one- you integrated her so now she's pushing you away cause she figures you fixed her and you won't need to see her anymore so she's pushing you away first cause she thinks she won't get hurt that way. She may look at what you did to help her as traumatizing due to now learning about boundaries and may now think you were wrong. I really think it's the fear of losing you though. hope this helps. feel free to email me if u need
DID
I didn't really integrate her. It was a choice she sort of made spontaneously on her own, but it is true that all the work up to that point led to her and the alters being able to make that decision. It was sort of a surprise to me that she chose to integrate. I think it might have to do with fear of losing me. See we were both aware that over the years we had developed a very close relationship (it was still highly ethical and with her needs always put first), but we talked about how at some time we needed to transition her to another therapist, but i would still remain a support person in her life. These talks though would lead to so much chaos in her internal system that it just didn't seem like the time. When she integrated, that did seem like a time we might think about that transition because now that there weren't 30 of her to deal with, she didn't need me in the same way. I had no intention of "leaving her," just letting someone else transition into the primary therapy role with her. I know that even before she integrated, she got some weird paranoia things that would get going about me. Actually during our entire time working together, I worked to increase her support network. It wasn't healthy for either one of us, for it to just be me. I fully planned to continue offering my support, and being there for her. But my duty was for her to establish a normal life, and that meant expanding to new people and pursuing her own talents and interests.
I do understand at a personal level that fear that comes from fear of rejection- that says, "I'll reject you before you can reject me." I've done that in my own life when healing from some of my own issues. - But I never implied to her that I was leaving her, and after this whole thing got started, I made several attempts to bring healing between us. All of which were rejected.
What you say about boundaries is particularly interesting. We spent lots of time talking about maintaining appropriate boundaries between us. There was a sense of friendship between us, but my role was as her therapist and case manager, and if she ever felt like the fact we had developed a sense of closeness got in the way of our relationship being therapuetic, then we needed to adjust really fast. she always expressed finding great therapuetic value in our continuing to work together, and I have to believe that was true because I saw one healing after another taking place in her. It seems odd that when the issues of boundaries was something I was constantly checking out with her, and she always affirmed that the relationship was therapuetic to her, and I wasn't involved in any way that wasn't beneficial to her or what she wanted, that boundaries would become an issue. But I know there would have been such a huge change in her perspective one she had integrated, that I do wonder if this played a role. I somehow feel like I was put in a no win situation. I gave at the level of her need which helped her get better, but once she was better and her need changed, she questioned the way that I gave. Nothing was inappropriate between us or anything, but i did serve as a strong advocate for her at times. That is how i work though. I've had other people advocate for me in my times of need. It just always seemed like a gift I could give back.
It feels like I've tried to address with her all those things that may have caused her current state of upset, and it only made her more angry. So i just stopped thinking anything I could do would make it better.
her angry alter is probably
her angry alter is probably mad that you're trying to destroy her or she may be angry that she has recovered memories she wish she never did. she may be testing you as well
You've heard the old cleche,
You've heard the old cleche, "Don't kill the messenger"?
Sometimes we blame the one who diagnoses us. For me, it felt like an internal betrayal. I projected that onto the ones who were trying to help me with my mental health. I am a medical professional and my first comment was, "I'm NOT crazy!"
Of course understanding our diagnosis and understanding why we have had certain behaviors can be very comforting, yet our parts are how we deal with stress and trauma. We feel threatened due to the exposure a diagnosis brings.
Shame on you. Your patients therapy is, nor ever was about you. Get over your personal investment with this woman. Other than your fees, She owes you nothing. Perhaps you do not realize that you have expectations of this person...because you 'are human too'. She and her parts are aware of this. You have put your personality into "helping" her. I suggest you send her to another qualified therapist.
Your obsession with this patient borders on malpractice and may already be classified as such. Discuss these feelings with your peers. Get some unbiased professional insight into your dilemma.
DID
Her anger at me wouldn't be due to diagnosing her. I didn't do that diagnosis- that was many years before from a psychiatrist who was an expert in the field. Although I understand that at the time she reacted much as you described about the diagnosis. She was over that by the time I met her. Actually she was much relieved that I would believe the diagnosis, because she had many therapists in between the psychiatrist that I mentioned and myself who would not believe the diagnosis and kept saying she was paranoid schizophrenic and putting her on a lot of psychotropic meds that only made her worse, etc.
The "uniqueness" of our work together is that we both realized early on that it was such a good fit. There was good rapport in all kinds of areas. There was a sense of out interactions being synchronized no matter which alter was out, and there was just the true amazement of the work and watching all kind of levels of healing take place. I don't think I am odd as a therapist to say that I actually care about my clients. I am a pstoral counselor and it is not just a cold clinical situation. I choose to walk a path with them- and that means whether they can pay or can't pay, whether my employment situations changes or whatever. As long as I am useful to them, then still have access to me.
Of course this client didn't "owe" me anything. Common decency would have been nice. To go from a close trusting productive relationship to one of anger and cruelty within a matter of hours with nothing happening in between though I think is enough to brain boggle most people.
There was the initial struggle for me to come to some sense of peace with something like this that came out of the blue. Then there are the continuing disruptions to my life by phone calls to say hurtful things to me or my family. As far as malpractice- my focus on working with her was always on her and what was best for her in any particular situation, even if that was not always best for me. But after the works together ended, it is simply my own feelings that I have sought to deal with. I have done that through lots of supervision and consultation. I have done this by consulting with some in the "DID community" such as this forum to see if I could make any kind of sense of this.
None of my dealing with this has been within her awarness. This is simply about having given my very best to someone for a very long time, very intensely at times, then having that person turn in me in a way that I have never experiened and would never have expected. That is where the "I'm human too" comment came from. Therapists aren't cold hard objects. We feel. We get hurt. -And that is the peice I have been trying to deal with in my own life. I will always wish this woman well. I will always believe in her capacity to finish the healing process. I simply am experiencing a sense of loss and hurt too, and that is my peice to deal with, and that is what I am doing.
hi therapist, it sounds
hi therapist,
it sounds almost as if you've contacted another "layer" of alters and a protector is keeping you at bay?
Maybe there's a whole new layer of awful memories she doesn't want to get to and you're the scapegoat
so you cop all the anger?
Just a thought. I'm currently very angry with my therapist (who did nothing) because of the chaos in my life
after a whole new lot of memories came up
therapist
Random thoughts: How you handle this anger is critical to recovery. Often one part will not like being in therapy and another not want the relationship to end. Like a surly teenager, you must set clear boundaries on the verbal abuse. The rage may be a part that feels the need to protect for some reason or a part with borderline tendencies. ;-)
D.I.D.
I obviously cannot do anything about her anger since she immediately cut me out of her life. I would have wanted to work with her on this. I do have concerns whether she will be able to work herself through this place to work toward further healing. But I am also trying to work out my own healing because of parts of this feeling personally injuring by someone I genuinely loved and invested so much care in. I expected her to have a lot of anger. I didn't expect it to all be directed at me.
DID therapy
Dear Anonymous therapist,
Sounds like you are going too fast, and you are missing some pieces of the "how things work" puzzle particularly in understanding of the spiritual dimension. Integration is not a goal that should be pursued quickly.
Each of the parts needs to be healed of each and every trauma so that they can become co-conscious. Then each needs to get to the point of being unstuck in their emotional development. Each of the parts needs opportunity to fully express themselves doing things that are appropriate to their emotional age. As the parts have new experiences they grow up emotionally. As the parts share experiences they become more integrated at a natural rate.
By encouraging parts to integrate prematurely, they combine their unresolved problems and this is potentially overwhelming, and you may well be cast as the villain.
A second option is that a bunch of memories which you have not yet looked at in therapy have suddenly been triggered, and one part has taken over and gone into a protective mode. When this happens all the other parts are hidden, and the protective part does not let them out. The protective part probably has limited knowledge of all the good you have done, you have to start from scratch. The past bad emotions get superimposed on the the present situation, and this may lead you to be erroneously perceived as a perpetrator.
Bare in mind that you may have found less than a third of the parts that are really there. The level of healing, safety and trust required for the most scared and small parts to come forward is very extreme.
In my experience you will not succeed in this work without God's help to learn how to do it well and plan in meticulous detail the process of recovery and support. This work is difficult enough even with God helping at every step of the way, without his knowledge and insight, you don't stand a chance.
My final comment is that you do not seem aware of the presence and involvement of spirits. Each memory and each bad emotion may optionally include the presence of one or more spirits. The DID sufferers are typically very aware of the spiritual dimension, you can probably ask them "are there any spirits present, and what do they look like". The presence of a spirit simply makes an existing problem worse, and they add a malicious dimension to the whole scenario. You will need to learn how to identify spirits, and remove them simply and efficiently. I would expect there to be more than 1000 in total. Let's say you have had more than 200 successful therapy sessions and have not dealt with the spirits present, there could be up to 400 spirits hanging around, with nothing better to do than to stir up unpleasantness and to plant lies about you in their mind.
best regards
Keith
thanks
hey Keith,
I diden't even relize I posted anything on here, like you...
yes I know I'm a bad speller...thats me...thankyou for your comments.
Rose
response
I actually had not remembered writing to this website, so i was confused when I started getting responses. Now that I re-read my initial email I remember what I was thinking about at the time. Actually integration was never the goal for the client or for me. We were dealing with all the PTSD- of course through that I came to know the alters well and had positive relationships with them. I am a pastoral counselor, so we were often addressing spiritual issues too. I have learned more about the nature of how threatening it can be to the client once there is some integration and they realize there is someone out there who knows so much about them. As far as the integration it was something the client decided on their own- and only told me about it later. I believe there are other factors that contributed to the reaction that are not nearly so mysterious. Apparently there was someone else involved who was telling her lies about me, and me lies about her. Although i would have preferred to have talked and worked it out, since that is not she wants, there just isn't any contact at all. My hurt was truly caring about this client, and agreeing to walk a path with her toward healing even though at times I was judged for it too (not everyone believes in DID). I will always miss the client and with them well, but I cannot do anything to fix this situation.
Lost a battle, win the war
Fair enough, your explanation makes sense, the involvement of a third party messing things up sounds very unfortunate and fairly typical.
I once lost more than 3 years as a result of a similar situation. Sometimes I think it is a wonder that anyone with DID gets healed at all.
However, when the dust settles, at the end of the day God knows the truth, and will point them to the best place for their healing journey. All that work developing that deep level of trust and relationship will be needed for the next steps in healing when they eventually come back on track.
You do not have time to get hurt, you need this time to re-group, strengthen your position, finances, and emotional resolve. Try to see it in a bigger perspective, you may have lost a battle, but you have not lost the war.
best regards
Keith
She is borderline
Your patient is borderline (BPD) and you treated the DID part. Now she resents the control you had over her and devalued your relationship. She may cut you off completely.
I get it. I have DID and
I get it. I have DID and have worked with a therapist who thought integration was the therapeutic goal. After integrating one alter and suffering from the loss, I can't imagine going any further. The most personal thing people have is their innermost thoughts. Therapists who don't have DID can't imagine the richness of the internal thought process of the DID patient. Patients can explain it but you'll never experience having it or losing it. Now the person who has integrated, who bought into the idea that integration is good, has to deal with internal silence and loneliness. She may not have realized how hard that was going to be. My experience is that integration is permanent, and you can't get your old thought patterns back. It's really a cruelty performed by the therapeutic community based on outdated research and an inherent lack of understanding of "what is good". Better to learn love and acceptance, those old basic therapy goals, than to try integration. My advice is not what you want to hear. Refer her to another therapist who can help her understand that you were trying to help, and who can help her cope with the new thought structure she's going to have to live with for the rest of her life.
integration is permanent
I have to disagree. I went through the integration process and experienced that silence of thought for over 2 years. i was in a relationship that became progressively more adventurist. It was constantly stretching all my previously held limits and beliefs about everything, educational, spiritual, emotional and sexual. I tried to terminate the relationship but when that was unsuccessful believe that triggered the resulting crisis I am facing now.
This is nothing like I experienced before, as I felt some consistency and stability within my old system. I feel myself switching constantly and I am in and out of consciousness and while I don't recognize my old system, some of what I see feels familiar. I have been accused of playing a cruel form of mind fuck but I don't like this experience any better then they seem to.
Moment by moment I feel angry, remorseful, calm, irritated, irresponsible, intelligent, immature, prophetic, and a dozen other things like someone shuffling a deck of emotion cards and not only does it seem not based on anything external but I am finding any consistency of thought impossible. Stability while crucial to my existence, seems to be outside my capability right now.
God is tending to my needs and I know that I will be stronger and more able to function when this is over but this is another of those periods of my life that is nearly unbearably uncomfortable.
I am reacting instead of thinking things out and making rational decisions. I believe that I am capable of them...unfortunately I will make and re make them over an over again from every new point of reference in this crazy brain of mine. If I can't stop the switching I can't move forward.
I am reaching for a man as if my life depends on it. I feel functional within a relationship. It's like I am actress and only exist in the rolls I play. I have everything I need to be fine in any of them but can't stay in any of them with out the supporting structures of set and expectation. I NEED THAT OUTSIDE STRUCTURE. The problem with relationships is that they fall apart the second stress applied. JUST STOP FUCKING FEELING SORRY FOR YOURSELF AND FIGURE OUT WHAT IT IS THAT HE GAVE YOU AND GIVE IT TO YOURSELF!!!! That doesn't work. This spinning is bad...the depressed overwhelmed and suicidal tendencies have far to much power with no outside forces to pull me out. It may be a fine concept for normies but I need structure outside myself to maintain any stability. StoP stop!!!. You have everything you need. Feelings are feelings ... they aren't real. You can always feel differently in the same circumstance... pull from a new place...its there..ITS NOT ... I HAVE NEVER BEEN ALONE so its time. You're in a safe place for it. Your needs are taken care of and there are built in limits on how long you have to endure it. Now is the time. LEARN HOW. You can do this ...you can. JUST DO IT.
I have alienated everyone. People are afraid of me. It doesn't help that every movie of the week, soap or series that shows anyone with DID gives them homicidal tendencies! My overwhelming response to all of these things is withdrawal not confrontation. I seem both unfeeling, and emotional and coming close to giving up hope that I will ever be anything close to functional on a long term basis.
Integration wasn't the perfect solution to my brain dysfunction and it wasn't permanent.
D.I.D.
Although I understand the change she would be experiencing in her inner world is immense. The problem with you theory in this case is that I never had the goal of integration for her. Neither did she. I always work according to what my client wants, and integration was never a goal. We worked with the PTSD, the depression and becoming more functional. She made the choice on her own that she needed to integrate due to health problems over the course of one night, and then told me about what had happened later. Her rage with me errrupted after that point with no explaination. It is not an issue of referring her to someone else or anything like that because she immediately cut connections with me, except to occasionally call me and rage at me, and threaten. When this happens it all throws me for a loop again. My writing to this forum, although trying to understand what might be happening inside her head, didn't have anything to do with trying to figure out what to do with her (since she cut connections, all I can do is pray for her), it was about me trying to deal with the feelings I am left with that knows I spent many years focusing only on how to help her see that I would not hurt her, and to never do anything to harm her, and then have her dumping all this on me, while refusing to process it. The phone calls have been more like a "hit and run." She says cruel things then hangs up. Although I am finally coming to the point of realizing this has to be some huge transference or something, I am only human, and our relationship was very deep and trusting, and I have simply felt very hurt and confused about a visciousness aimed toward me that is so contrary to our entire relationship.