What Causes Dissociative Identity Disorder?

What Causes Dissociative Identity Disorder?I’ve talked about the diagnostic criteria for dissociative identity disorder (DID), identity disruption and amnesia. What causes DID? How is it related to trauma? These are the topics I’d like to tackle next. If you are questioning whether DID is true for you or are in the early phases of your treatment process this may be information you do not have access to and maybe you are not ready for it.  It is okay if you decide that this post is not for you (of course that applies to all my posts)! Your system may help you manage when you are ready for more information.

The dissociative disorders in general frequently occur in the aftermath of trauma. Many theorists agree that DID develops in response to severe trauma in early childhood, most typically extreme, repeated physical, sexual, and/or emotional abuse. In their Guidelines for Treating Dissociative Identity Disorder in Adults the International Society for the Study of Trauma and Dissociation provides an overview of theories that are developmental, trauma-related, and acknowledge the importance of the relational environment before and after trauma:

In short, these developmental models posit that DID does not arise from a previously mature, unified mind or “core personality” that becomes shattered or fractured. Rather, DID results from a failure of normal developmental integration caused by overwhelming experiences and disturbed caregiver–child interactions (including neglect and the failure to respond) during critical early developmental periods. This, in turn, leads some traumatized children to develop relatively discrete, personified behavioral states that ultimately evolve into the DID alternate identities.

One theory stresses that trauma interferes with normal developmental tasks. The traumatized child is not able to develop a unified sense of self, especially when the trauma begins before age five. These developmental theorists also address the relational and attachment context in which abuse occurs. DID develops throughout the course of childhood and beyond, and may involve elaboration on the  number of parts, their complexity, and their sense of separateness. DID is not thought to occur in response to traumatic events in adulthood, unless the person  had already experienced childhood trauma and resulting identity fragmentation (For more information about these theories see Loewenstein & Putnam, 2004, and Putnam, 1997).

Another model says the following four factors must be present for DID to develop:

  1. the capacity for dissociation
  2. experiences that overwhelm the child’s nondissociative coping capacity
  3. secondary structuring of DID alternate identities with individualized characteristics such as names, ages, genders
  4. a lack of soothing and restorative experiences, which renders the child isolated or abandoned and needing to find his or her own ways of moderating distress (for more information see R. P. Kluft, 1984).

Criteria 4 is related to the relational and attachment context discussed above. When a child does not have caretakers who provide protection and soothing, the child must turn inward in order to survive.

A third theory, structural dissociation, is based on the work of Pierre Janet. It says that we all create our personality and that this requires integrating all our experiences, even very aversive ones. When this is not possible (due to exposure to severe, acute traumatic events), the personality is divided into two parts: one part that attempts to avoid all reminders of the traumatic event (called the ANP for “apparently normal part”) and another that is re-experiencing and attempting to defend against the trauma (called the EP for “emotional part”). There may be more than one part of the self functioning as APs and EPs.

An interesting area of study involves looking at early attachment styles and the development of DID. There is considerable research about infant attachment that points clearly to a pattern of attachment called Type D attachment (or insecure, disorganized) as predicting adult dissociation. Attachment in general and as it relates to dissociation is too big a topic to fully address here. Look for an upcoming post about this!

Understanding DID as a response to and creative strategy for surviving trauma is crucial to healing. Having DID does not mean you are “crazy”. It is not your fault, or the fault of any part of you. Accepting and honoring that all of you together have overcome a great deal already may help pave the way for working together now to create the life you want going forward.

Posted in Abuse, Childhood Abuse, Dissociation, Emotional Abuse, Health, Mental Health, Physical Abuse, Psychologist, Sexual Abuse, Therapy, Trauma | Tagged , , , , , , , , , , , , , , | Leave a comment

Mindful Monday: Change

Mindful Monday: ChangesFocusing on something in nature, big or small, is a way to practice mindfulness. It can also be a part of a practice of accepting change. Who else besides me resists change? What good does that do us? Change happens anyway. Accepting this brings peace.

How have you changed in your healing process? It’s hard to recognize growth when you are still in the midst of pain and struggle!  What if you thought of yourself as transforming, like the butterfly? What if you could find something to value each step of the way? Me, I dig caterpillars as much as butterflies!

May we find time to notice and honor something as it is and appreciate that it has and will change.

Posted in Health, Mental Health, Mindfulness, Psychologist, Therapy, Trauma | Tagged , , | Leave a comment

Dissociative Identity Disorder and Identity Disruption

Identity DisruptionWhat is identity disruption? How is it experienced by someone with dissociative identity disorder? How is identity disrupted?

In the past, it was thought that traumatic events, especially repetitive ones, caused a child’s personality to fragment or split into different parts. Now many theorists instead conceptualize that trauma impairs the ability of integration of the self to begin with. This leads to the experience of having separate parts of the self, or personality states, each with their own independent way of relating, perceiving, thinking and remembering about themselves and their life.  They may experience themselves as people, with or without any awareness of each other. They may serve distinct roles in coping with problem areas or in holding traumatic memories and associated affect. In DID, these parts have not yet learned how to function together in a cohesive and flexible way. One task of therapy is to help all understand that they are actually connected, that all parts together make up a whole person and that they can learn to work together as a collaborative team.

Just like with amnesia, the way a person with DID experiences identity disruption varies greatly. Sometimes it is very subtle and sometimes it is very obvious to an observer, although the person with DID may not be aware that it is happening at all. They may just have a sense of losing time but no awareness of what happens during that lost time. The awareness of each other also varies across parts. There may be a part of you (sometimes referred to as the host or ANP) who does not know about the existence of any others. Other parts may know and communicate easily with at least some of the inner system. Some people may have parts that assume executive control, meaning that they are in control of the person’s body and behavior for a period of time. Other systems have parts that operate more behind the scenes. Some parts present with different names, mannerisms, gender identity, sense of age, etc. Even before you are aware of other parts, you may have glimpses or experiences that hint at their existence.

Those experiences can include things like:

  • Being a depersonalized observer of what you are saying and doing, feeling unable to stop or control what “you” are doing. Some clients describe this as floating above or watching from a distance.
  • Hearing voices, identified as coming from within. These voices may be unintelligible or  clearly understood. Sometimes instead of hearing a voice, a person with DID may experience intrusive thoughts that are experienced as “not mine”. The voices or thoughts can be experienced one at a time, or more often, many talking all at once.
  • Having strong impulses, feelings, speech, or behavior that seemingly come out of the blue. They are often described as confusing and ego-dystonic. You may have the sense that you did not chose to do something but could not control it happening anyway.
  • Feeling like your body is “not mine”. Different parts of the self may also report that their bodies feel and look different ( in size, age, gender).

Many different terms have been used to describe the separate parts of the self: parts, parts of the self, selves, identities, personalities, personality states, self-states, alter personalities, alters, alternate identities (see Van der Hart & Dorahy, 2009). This list is not exhaustive! In therapy, I want to know about the language a particular client uses. When necessary I may help them find language that acknowledges or moves us a bit closer to understanding the connection and interrelatedness of all parts.

Why does language matter? I see it as playing a role in how we approach the treatment of identity disruption that has resulted in dissociated parts of the self. If you understand that you are all in this together, that you are the sum of all your parts, you will be more apt commit to working as a team and cooperating. If you instead believe that you are each separate personalities or people a “every man/woman for him/herself” attitude may prevail with much chaos ensuing, or continuing.

References
American Psychiatric Association: Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. Arlington, VA, American Psychiatric Association, 2013. Web. [access date: 1 June 2013]. dsm.psychiatryonline.org
Van der Hart, O., & Dorahy, M. J. (2009). History of the concept of dissociation. In P. F. Dell & J. A. O’Neil (Eds.), Dissociation and the dissociative disorders : DSM-V and beyond (pp. 3–26). New York: Routledge
Posted in Dissociation, Mental Health, Psychologist, Trauma | Tagged , , , , , | 3 Comments

#TBT: 7 Things You Can Do Right Now To Start Feeling Better

It’s Thursday, and that means time to revisit a post from the past. For this Throwback Thursday (#TBT) I decided to share with you some coping skills for immediate distress relief. , and comments here.

7 Things You Can Do Right Now To Start Feeling Better

Anxious? Depressed? Stressed? Overwhelmed by trauma memories? You will want to do things to help yourself feel better as quickly as possible, without doing anything that has negative consequences. It takes time to recover but there are simple things you can do right now.

  1. Get enough sleep. Sleep deprivation has a profound impact on mood. Are you getting enough restful sleep? If not, consider these basic sleep hygiene guidelines
  2. Practice deep breathing, relaxation or guided imageryDeep breathing can be practiced anywhere and can immediately shift your mood,  help decrease anxiety.  I like Belleruth Naparstek’s guided imagery.  She even has a free audio spa treatment .  An Internet search can help you find other options that works for you.
  3. Smell something.  Our sense of smell can evoke emotions and connect us vividly to past experiences.  Choose  a scent that conjures up positive associations, happiness, well-being. Many find lavender to be calming, for example.
  4. Connect to nature. Being in nature can help people get out of themselves, connect with something larger or feel more grounded.  Exposure to natural light helps mood as well. Live in the city? You can still do it: watch birds,  feed squirrels,  plant a container garden, notice the sunset or sunrise.  Do you have a pet?  Can you spend time with a friend’s? Animals are a great source of unconditional love and companionship.
  5. Do something physical. Research shows that physical activity relieves symptoms of depression and anxiety while also helping with insomnia. You don’t have to think of it as “exercise”,  just move in a way you enjoy. Walking your dog, dancing, biking, gardening, yoga are all options. Join a team and also accomplish #6.
  6. Connect to others. We all need human connection.  Do you have supportive friends you can reach out to? If not, explore in-person or online support groups, classes, activities.
  7. Seek professional help. Sometimes the ideas above are not enough or there are reasons you cannot put them into practice.  Even taking the first step towards seeking help can be a relief. You do not have to struggle alone.  Contact me and I can help you with the next steps.

Kathleen Young, Psy.D.

Posted in Dissociation, Mental Health, Psychologist, Self-care, Therapy, Trauma | Tagged , , , , , , , , , , | 4 Comments

Dissociative Identity Disorder and Amnesia

Dissociative AmnesiaI am continuing the conversation about dissociative identity disorder (DID) and characteristics that make up the diagnosis. I want to address amnesia,  what it looks like in DID, and the function it serves. Of course,  not everyone with amnesia has dissociative identity disorder. Remember, the first two criteria, different self states and amnesia, must exist together for a DID diagnosis to be made.

According to the DSM-5, there are three primary ways amnesia present in people with dissociative identity disorder:

1) gaps in remote memory of personal life events (e.g., periods of childhood or adolescence; some important life events, such as the death of a grandparent, getting married, giving birth); 2) lapses in dependable memory (e.g., of what happened today, of well-learned skills such as how to do their job, use a computer, read, drive); and 3) discovery of evidence of their everyday actions and tasks that they do not recollect doing (e.g., finding unexplained objects in their shopping bags or among their possessions; finding perplexing writings or drawings that they must have created; discovering injuries; “coming to” in the midst of doing something) (Dell 2006; Spiegel et al. 2011).

Many other trauma survivors also experience the first type of amnesia. In fact, about 10 percent of people with trauma histories have extensive memory loss for trauma that they later remember. Some trauma survivors dissociate and “forget” traumatic events, life experiences, even years of their life as a coping mechanism. The second two examples of forms of amnesia are related to the existence of separate parts of the self.

Why would lapses in dependable memory (things like doing work tasks, driving, reading) occur and what would that look like? It also is important to clarify if we are talking about how this is experienced by the person with DID or by others in their life. How you experience this (or if you experience it at all) depends upon how much awareness you have of other parts. In systems that are very separate, you may not even know that there are other parts, let alone the specifics of their abilities and roles. You may, in a sense,  have amnesia for amnesia! This is one reason DID can be difficult to identify and diagnose.

From the other perspective, people in your life may notice that in some occasions you are not able to do things you usually do with ease (like the above mentioned work tasks, driving, reading). Or they may notice that you do not remember something they saw you do or say. This type of amnesia can also include not answering to your legal name (because the part that is present has another name) or  not recognizing a spouse, children, or close friends. Many people with DID have inner safe guards to prevent things like this from being observed. However, systems do not function as well under stress or when there are unexpected triggers. It has also been my experience that for many with DID the functioning of their systems deteriorates at some point. Hearing feedback from others, that you usually do something different, or have a skill you are unaware of, may be your first introduction to the possibility that you experience this form of amnesia.

What about the third form of amnesia? This clearly relates to the other diagnostic criteria, the existence of separate parts of the self. You may be aware that you are experiencing dissociation: spacing out, losing time, feeling numb. What you may not realize is that “you”, some part of you, is continuing to live life during that lost time! Finding writings, things you don’t remember buying, even noticing that you are wearing clothes you don’t remember putting on are all clues that there are parts of you beyond your current awareness.

Every person, and inner system is different! The level of awareness of amnesia varies. Some systems are quite walled off from each other. Some may be more aware of each other but not share all historical information about childhood events. Some parts might hold painful emotions like shame, fear, or anger so that others do not have to. Some parts of your system may not know that others exist and may avoid seeing the symptoms of dissociation. Have you gotten good at making excuses (to yourself and others) for the things you don’t remember and the evidence you find or hear about? If this is all you have known, how can you know that not everyone has these experiences?

The goal of therapy is to first help you accept what is, all the ways you experience dissociative amnesia, so that you can then work together within yourself to lessen it. It is also important to acknowledge the protective function of amnesia: as a child you needed to not know things, to separate yourself and your experiences, in order to survive. As an adult, with the help of your inner system and a therapist with expertise in treating DID, you can develop different coping skills and capacities. You can help each other learn to face the past and thrive!

 

Posted in Dissociation, Mental Health, Psychologist, Trauma | Tagged , , , , , , | 11 Comments
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