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Dissociation is humanities most creative survival dynamic. It is not born out of pathology rather it is born out of an instinct for survival. For those who have survived unbearable trauma using their dissociative ability, they have reason to celebrate dissociation. However, if the same coping mechanism is still being used years after the trauma has ceased, then the dissociation may have become pathology. If the trauma survivor is unable to progress in their life, the impact of adapted dissociation may well be the answer.

"Understanding...traumatic dissociation, as a result of extreme stress, is fundamental to understanding Post Traumatic Stress" (disorder)" Delphi Centre.
 

The essential feature of the Dissociative Disorders is a disruption in the usually integrated flow of consciousness including thinking, feeling, actions, memory, identity, or perception of the environment. The disturbance may be sudden or gradual, transient or chronic.

Dissociation is experienced on a continuum from the common everyday experience of day dreaming or driving in the car and experiencing 'highway hypnosis' to the farthest end of the continuum which is experienced as
poly-fragmented D.I.D. i.e. no constant part of self at all.

Diagnostic criteria for 300.14 Dissociative Identity Disorder. (D.I.D)

  1. The presence of two or more distinct identities or personality states (each with its own relativity enduring pattern of perceiving, relating to, and thinking about the environment and self.)
     

  2. At least two of these identities or personality states recurrently take control of the person's behaviour.
     

  3. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
     

  4. The disturbance is not due to the direct physiological effect of a substance (e.g. blackouts or chaotic behaviour 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.

Some  Indicators of a client dissociating
  • Body becomes suddenly still or rigid

  • Slow responses

  • Experiencing events in 'slow motion'

  • Emotions numb or flat

  • Numbing –high pain threshold.

  • Out of touch with environment (derealization)

  • Drifts off, spacey, stares off in space

  • Zones out, loses track of what's happening around them

  • Unresponsive blank stare

  • Down-turned  stare, tuned out

  • Rapidly blinking eyes

  • Eyes darting anxiously or rolled up

  • Not in the present

  • Inattentive, memory lapses

  • Listening to ‘inside voices’

  • Rubbing or adjusting eyes 

  • Fantasies, excessive daydreaming

  • Robotic, autopilot

  • Overactivity or withdrawal

  • Falling asleep, yawning, disoriented

  • Conversation drop out

  • External observer of self

  • Different experience of life, e.g. sounds louder or softer, colour brighter or muted, wide angle view etc.

  • Actions out of sync. with scenario.

  • Dramatic change of personality

  • Cloudy, foggy, inability to focus

  • Attempts to remain grounded – stroking, tapping, jiggling,

  • Self-soothing, rocking

  • Twitching or grimacing

  • Amnesia for past life experiences.

  • Rubbing nose or adjusting glasses

Adapted from Schiraldi,G.R

 

DISSOCIATION : FREQUENTLY ASKED QUESTIONS

There is a great deal of overlap of symptoms and experiences among the several Dissociative Disorders, including DID. Some people who may not qualify for a specific diagnosis may, nevertheless, have problems with dissociation. For ease of reading, we use “Dissociative Disorders” as a general term for all of the diagnoses. Individuals should seek help from qualified mental health providers to answer questions about their own particular circumstances and diagnoses.

 

Q: What Does Trauma Have to Do with DID?

Post traumatic Stress Disorder (PTSD) is a trauma-related mental illness affecting 8% of Americans. PTSD is closely related to Dissociative Disorders. In fact, most people with a Dissociative Disorder also have PTSD. The cost of trauma disorders is extremely high to individuals, families, and society. Recent research suggests that people with trauma disorders may attempt suicide more often than people who have major depression. Research also shows that people with trauma disorders have more serious medical illnesses, substance use, and self-harming       behaviors.    
     
Adapted from Sidran      
          

Q: What Is Dissociation?

Dissociation is a disconnection between a person's thoughts, memories, feelings, actions, or sense of who he or she is. This is a normal process that everyone has experienced. Examples of mild, common dissociation include daydreaming, highway hypnosis, or "getting lost" in a book or movie, all of which involve "losing touch" with awareness of one's immediate surroundings.
 

Q: What Is connection to Infant Attachment Style:

Babies who experience an insecure disorganized attachment with their primary carer are predisposed to experience complex Post traumatic stress disorder if they encounter any successive trauma in their lives and thus exhibit a complex stress response including the previously leaned capacity to dissociate.

 

Q: When Is Dissociation Helpful?

During a traumatic experience such as an accident, disaster, or crime victimization, dissociation can help a person tolerate what might otherwise be too difficult to bear. In situations like these, a person may dissociate the memory of the place, circumstances, or feelings about of the overwhelming event, mentally escaping from the fear, pain, and horror. This may make it difficult to later remember the details of the experience, as reported by many disaster and accident survivors.

 

Q: When Is Dissociation Helpful?

During a traumatic experience such as an accident, disaster, or crime victimization, dissociation can help a person tolerate what might otherwise be too difficult to bear. In situations like these, a person may dissociate the memory of the place, circumstances, or feelings about of the overwhelming event, mentally escaping from the fear, pain, and horror. This may make it difficult to later remember the details of the experience, as reported by many disaster and accident survivors.

 

Q: Who Gets Dissociative Disorders?

As many as 99% of people who develop Dissociative Disorders have documented histories of repetitive, overwhelming, and often life-threatening trauma at a sensitive developmental stage of childhood (usually before the age of nine). They may also have inherited a biological predisposition for dissociation. In our culture, the most frequent cause of Dissociative Disorders is extreme physical, emotional, and sexual abuse in childhood. Survivors of other kinds of childhood trauma (such as natural disasters, invasive medical procedures, war, kidnapping, and torture) have also reacted by developing Dissociative Disorders.

 

Q: Who Gets Dissociative Disorders?

As many as 99% of people who develop Dissociative Disorders have documented histories of repetitive, overwhelming, and often life-threatening trauma at a sensitive developmental stage of childhood (usually before the age of nine). They may also have inherited a biological predisposition for dissociation. In our culture, the most frequent cause of Dissociative Disorders is extreme physical, emotional, and sexual abuse in childhood. Survivors of other kinds of childhood trauma (such as natural disasters, invasive medical procedures, war, kidnapping, and torture) have also reacted by developing Dissociative Disorders.

 

Q: Does DID Affect Both Women and Men?

Most current literature shows that Dissociative Disorders are recognized primarily among women. The latest research, however, indicates that the disorders may be equally prevalent (but less frequently diagnosed) among men. Men with Dissociative Disorders are most likely to be in treatment for other mental illnesses or drug and alcohol abuse, or they may be incarcerated.

 

Q: How Does a Dissociative Disorder Develop?

When faced with an overwhelming situation from which there is no physical escape, a child may learn to "go away" in his or her head. Children typically use this ability as a defense against physical and emotional pain, or fear of that pain. By dissociating, thoughts, feelings, memories, and perceptions of the trauma can be separated off in the mind.  This allows the child to function normally. This often happens when no parent or trusted adult is available to stop the hurt, soothe, and care for the child at the time of traumatic crisis. The parent/caregiver may be the source of the trauma, may neglect the child’s needs, may be a co-victim, or may be unaware of the situation.





 

Q: If It’s a Survival Technique, What’s the Down Side?

Because it is so effective, children who are very practiced at dissociating may automatically use it whenever they feel threatened--even if the anxiety-producing situation is not extreme or abusive. Even after the traumatic circumstances are long past, the left-over pattern of defensive dissociation sometimes remains into adulthood. Habitual defensive dissociation may lead to serious dysfunction in school, work, social, and daily activities.

 

Q: How Do the Identities of DID Develop?

Until about the age of eight or nine years, children are developmentally primed for fantasy play, such as when they create and interact with imaginary “friends.” When under extreme stress, young children may call on this special ability to develop a “character” or “role” into which they can escape when feeling threatened. One therapist described this as nothing more than a little girl imagining herself on a swing in the sunshine instead of at the hands of her abuser. Repeated dissociation can result in a series of separate entities, or mental states, which may eventually take on identities of their own. These entities can become the internal "personality states" of DID. Changing between these states of consciousness is often described as "switching."

 

Q: Do People Actually Have more than one 'self'?

Yes, and no. One of the reasons for the decision to change the disorder's name from MPD to DID is that "multiple personalities" is a misleading term. A person with DID feels as if she has within her two or more 'selves', each with its own way of thinking and remembering about his or herself and their  life. These 'selves' previously were often called "personalities," even though the term did not accurately reflect the common definition of the word. Other terms often used by therapists and survivors to describe these selves are: "alternate personalities," "alters," "parts," "states of consciousness," "ego states," and "identities." It is important to keep in mind that although these alternate states may feel or appear to be very different, they are all manifestations of a single, whole person.

 

Q: Is it Obvious when a Person Switches Personalities?

Unlike popular portrayals of dissociation in books and movies, most people with Dissociative Disorders work hard to hide their dissociation. They can often function so well, especially under controlled circumstances, that family members, coworkers, neighbors, and others with whom they interact daily may not know that they are chronically dissociative.  People with Dissociative Disorders can hold highly responsible jobs, contributing to society in a variety of professions, the arts, and public service.


 

 

Q:  What Are the Symptoms of a Dissociative Disorder?

People with Dissociative Disorders may experience any of the following: depression, mood swings, suicidal thoughts or attempts, sleep disorders (insomnia, night terrors, and sleep walking), panic attacks and phobias (flashbacks, reactions to reminders of the trauma), alcohol and drug abuse, compulsions and rituals, psychotic-like symptoms, and eating disorders. In addition, individuals can experience headaches, amnesias, time loss, trances, and "out-of-body experiences." Some people with Dissociative Disorders have a tendency toward self-persecution, self-sabotage, and even violence (both self-inflicted and outwardly directed).

 

Q: Why Are Dissociative Disorders Often Misdiagnosed?

Dissociative Disorders survivors often spend years living with the wrong diagnosis. They change from therapist to therapist and from medication to medication, getting treatment for symptoms but making little or no actual progress. Research shows that people with Dissociative Disorders spend an average of seven years in the mental health system before getting the correct diagnosis. This is common because the symptoms that drive a person with a Dissociative Disorder to treatment are very similar to those of many other psychiatric diagnoses.

 

Q: What Are Some Common Misdiagnoses?

Common misdiagnoses include attention deficit disorder (especially among children), because of difficulties in concentration and memory; bipolar disorder, because “switching” can look like rapid-cycling mood swings; schizophrenia or psychoses, because flashbacks can cause auditory and visual hallucinations; and addictions, because alcohol and drugs are frequently used to self medicate or to numb the psychic pain.

 

Q: What Other Mental Health Problems Are People with DID Likely to Have?

In addition, people with Dissociative Disorders can have other diagnosable mental health problems at the same time. Typically these include depression, post traumatic stress disorder, panic attacks, obsessive compulsive symptoms, phobias, and self-harming behavior such as cutting, eating disorders, and high-risk sexual behaviors. Although they may get expert treatment for the more common secondary issue, if the dissociative disorder is not addressed, recovery is generally short lived.

Adapted from Sidran

 

Q: Can Dissociative Disorders Be Cured? 

Yes. Dissociative Disorders respond well to individual psychotherapy, or "talk therapy," trauma theory education and to a range of other treatment modalities, including medications, sensorimotor therapies and art or movement therapy, mindfulness.

E.M.D.R is particularly useful for managing and processing memory flashbacks (senses: sight, sound, smell, taste, touch,) body feelings, visceral feelings,  making meaning and putting words to the experience enabling a true 'healing'.

Coalescent Psyche Therapy: Accelerated Trauma Recover Mandala (Bearup, L) based upon trauma theory, right brain creative art therapy principles, development and learning theory and structural dissociation theory is particularly helpful.

 Compared to other severe psychiatric disorders, Dissociative Disorders may carry the best prognosis, if proper treatment is undertaken and completed. The course of treatment is long-term, intensive, and at times painful, as it generally involves learning to stay mindfully aware in the present taking ownership of the past experiences and the protective and defensive adaptions of the years, living a victim/survivor, remembering and reclaiming the dissociated traumatic experiences. Ultimately, the “alters” or “parts” can merge or coalesce as  whole functioning self. Integrating  the awareness, identity, and history previously held by the individual parts.

Individuals with Dissociative Disorders have been most successfully treated by therapists of all professional backgrounds, generally with considerable experience and specialized training, working in a variety of settings.

 

 

Peri-Traumatic Dissociation.

The peri-traumatic dissociative experience is an example of survival instinct at its best. It is the experience of dissociation during the actual trauma to lessen the emotional, physical, psychological pain eg: a numbing of sensation, a slowing down of time etc

 Peri-Traumatic Dissociative Questionaire.

  1. Did you ever lose track of what is going on around you. Did you 'black out', or feel 'spaced out' and didn't feel part of what is going on?

  2. Did you lose time?

  3. Did you do things that you didn't actively decide to do?

  4. Did you experience any change from the way you usually experience yourself in the world?, i.e.,. Did your sense of time ever change? e.g. Slow motion

  5. Did you feel as though you are a spectator, watching what was happening to you as if you were an outsider?

  6. Did you feel as though you are disoriented, as though you were uncertain about where you were, what was happening or what time it was?

If you client endorses the above statements it is likely that he / she experienced peri-traumatic dissociation.

Source:  Adapted from Marmar CR, Weiss DS, Metzler TJ (1997)

If these peri-traumatic symptoms continue after the traumatic incident for any significant time then it is likely that the individual is experiencing PTSD or CPTSD.

 

 

Lindy Bearup lindybearup@gmail.com
 

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but today well lived - makes every yesterday a dream of happiness and every tomorrow a vision of hope"
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