I suffered severe sexual and emotional abuse with neglect when younger. I have symptoms of borderline PD, ptsd and am highly dissociative under stress. I am aware of separate parts of my identity, but we communicate so are not really split. No condition seems to really fit. I am not aggressive, enjoy being alone and can usually manage emotions well - except under stress. It's later on that events affect me. Patterns of behaviour are repeated, but are not pervasive in all areas of my life. Self-harm is linked to punishment and I hardly ever tell anyone. I do lose time sometimes. I have flashbacks and central nervous system overloads where eveything is bright and loud and painful. Are these comorbid or am I missing something else? In the end, it is all trauma-related, but I'm only being treated for PD and it feels like the other symptoms are being missed. Just to make it clear, I in no way think of myself as a victim - that's another label other people put on me. My concern is that when i'm n crisis, which doesn't happen very often but is still horrendous, that i cannot access appropriate help because people are caught up with the borderline issue and ignore the other stuff like not knowing where I am or what I'm doing. I do feel that simply saying someone is being a victim is another way of saying "just get over it". That's really not helpful. I have a full life and I contribute to help others overcome things where I can. Also, there is considerable evidence that trauma affects the way the brain is wired - it determines personality traits. In that case, you might as well tell someone with schizophrenia to just stop being a victim. Great question! Thank you for the additional detail. The time loss is the key feature that really confirms the diagnosis of DID, although it sounds as though you have a good degree of co-consciousness. The other disorders that you list really do not constitute separate diagnoses in themselves as the features of each one are really subsumed under DID and you are correct in assuming that the whole picture is being overlooked if people are attempting to treat only those certain symptoms with which they are familiar. It is extremely common for the DID diagnosis to be missed and even when it is identified, many therapists are unfamiliar with how to treat it and so they focus on the more common features that the disorder shares with others that you named. You really need to find a therapist with some real experience in DID, or failing that (as it is hard to find) at least a therapist who has some extensive training and expertise in trauma and dissociation.
Here's an excerpt from some of my previous posts regarding DID that I hope will be helpful to you-it illustrates how DID is often misdiagnosed and outlines stages of treatment:
DID is the existence of two or more separate personalities or personality states within one person, with each alter having distinctly different ways of thinking, feeling, behaving and relating to the world and distinctly different memories, each part having amnesia for the other parts' memories. It is born from repeated and severe abuse and involves the defense mechanism of dissociation and generally develops before the age of 10 as children are far more likely to dissociate.
DID is often misdiagnosed and it is very common for a person to have had multiple different psychiatric diagnoses before it is definitively identified as DID. The symptoms frequently overlap with symptoms of schizophrenia, Bipolar Disorder, Depression, Anxiety Disorders (all), PTSD, other Dissociative Disorders and Somatoform Disorders as well as Borderline Personality. It requires extremely careful assessment and a high level of trust by the patient before alters reveal themselves. The diagnosis cannot be finalized before a therapist has actually made contact with another alter and observed the switch between alters.
The hallmark symptom is amnesia, which can be partial or complete depending on the level co-consciousness that exists between alters. Folks with the disorder describe the amnesia as "missing time" or blank periods, often daily or weekly, where they cannot account for their whereabouts or behavior. It is this amnesic barrier between parts that often leads to the most bizarre and distinctive signs and symptoms: not recognizing familiar people; not remembering highly significant events in their lives (like the birth of their first child, for example); finding purchases or articles of clothing/possessions, writings or drawings that they have no recollection of having bought or created. They are frequently accused of lying because they disavow their own behavior which is remembered by one part, while the amnestic part is completely unaware of it. Other unusual symptoms include: an exceptionally high tolerance for physical pain (they split off physical sensation which becomes encapsulated in one or several alters without others feeling it); not recognizing themselves in a mirror; using different names; having dramatically different skills and abilities that seem to be alternately present and then vanish (one alter may be able to drive a car while the sudden emergence of a child alter results in complete loss of this ability until the adult alter re-emerges); completely different opinions and behaviors (leading to the mislabeling of Bipolar or Borderline Personality.
Often communication across between separate alters takes place in the form of hearing voices, hence these folks frequently get misdiagnosed as schizophrenic. The key distinction here is whether the voices are experienced as coming from inside the person's head (DID) or outside one's head (Schizophrenia/Bipolar Disorder).
The separate identities develop in response to traumatic experiences which the child is unable to integrate and so they become "split off" from awareness and begin to take on a life of their own.
Folks with DID often self-injure, frequently a result of internal battles between persecutor alters and weaker alters and there are continual battles for control of the body and "time out" in the body between competing alters.
Symptoms of depression and anxiety are frequent and common and the picture is further complicated by the fact that one alter can meet all clinical criteria for Depression, while another part experiences no symptoms whatsoever. One part can be psychotic and experience no side effects from meds while another non-psychotic part has all the side effects and will stop taking meds. You can imagine that attempting to medicate such a disorder becomes an absolute nightmare.
Other symptoms include flashbacks and nightmares, hence the confusion with PTSD. Sometimes there are fugue states and clients will switch and "come to" in the body and have no idea how they arrived in the situation they are in, not know the people they are with and be completely disoriented. I had one client call me from another state after being away for a few days and having no idea how she got there or how to get home. Depersonalization and trance states are common and hence the overlap with other Dissociative disorders.
Folks with DID frequently experience multiple somatic symptoms for which there is no organic basis. They experience partial body memories of abuse without the actual memory of the event and thus exhibit strange physiological symptoms and are often labeled as Somatoform disorders or hypochondriacs.
I could go on and on, but suffice it to say that virtually any symptom of any disorder can be found at some point in a person with DID. Treatment is almost exclusively through psychotherapy as medication is merely palliative and an adjunct during periods of acute anxiety or depression. Treatment aims at initially contracting against suicidal and self-destructive behavior and attempts to establish safety first. Many DID folks enter treatment in horrendous circumstances where they are frequently in highly abusive relationships or are themselves abusive. Given the multiple alters, they may be both victim and perpetrator both within themselves alone and in the context of their relationships. The second primary goal is establishing communication and negotiation among alters to decrease amnesia and contradictory, self-defeating behavior. Ultimately the goal becomes integration of alters into one cohesive whole which involves sharing of memories and feelings across alters and a merging, where all parts continue to be present, but constant.
Treatment stages:
I do believe that integration is the eventual goal in therapy with folks for DID as I see anything less than that as settling for less than a person deserves, though I respect the choices people make as to how far they wish to go in therapy. But integration most certainly is possible.
Initially I focus on contracting to decrease overtly self-destructive behavior in order to allow therapy to proceed. This contracting can take weeks or months before all parts are willing to get on board and suspend overtly self-destructive behavior as there is usually a lack of understanding by each part that what they do effects all parts. Safety of the body has to come first before other work takes place in order to avoid hospitalization or injury which will only delay and interfere with therapy.
The first step in therapy then is always establishing communication between alter parts. Sometimes this happens initially through a journal where each part can write or post comments to a question. Once there has been some initial communication and awareness of other parts, communication is fostered through developing co-consciousness which is the ability for one part to stay "present" while another part or parts are dominant. Mainly, this involves a willingness to stay and resist the desire to dissociate. The greater the degree of co-consciousness, the less amnesia there is and the less confusion the person experiences.
The next step is to facilitate cooperation between parts and decrease the internal struggles and battles for control which lead to disorganized behavior and inconsistency in relationships. This often is somewhat like family therapy and the basic tenet is to encourage openness to understanding the perspectives and needs of other parts within the system. The most important thing here is to encourage respect for other parts-it is also one of the most difficult aspects of the therapy as negative attitudes by the host personality toward other parts is generally the source of most conflict. The other parts' behaviors are interpreted out of context and are often perceived by the host as destructive or persecutory. Other parts often are angry with the host and see the host as weak and dependent. It's my experience that persecutor alters are every bit as valuable and important and necessary to the system and are really protector parts in disguise, no matter how horrendous or destructive their behavior may appear at first on the surface. This step is crucial, as communication will shut down and no further work will take place without establishing respect between alters and a willingness and desire to learn from one another. Each alter offers unique coping strategies and needs to be honored for the role they played in the system's survival. Initial cooperation and collaboration among alters may begin with simply negotiating things like who has time out in the body and when. Clearly, a degree of respect needs to precede this in order to facilitate the trust necessary to allow alters to voluntarily take control. This also diminishes the severe headaches which usually result from switching struggles.
Once there has been a level of communication and cooperation established, the next step is to facilitate sharing of memories across alters which further reduces the amnesia barrier. It also results in the transfer of skills between parts and a dramatic increase in empathy for what each part experienced and the contribution they made to survival. The greatest roadblock to accomplishing this step is usually host resistance, as the host is reluctant to accept the dissociated memories and the attendant emotional pain and they must become committed to the goal of accepting the other parts of themselves and owning the experiences and the pain. This leads to integration.
When alters integrate by sharing the emotions and the memory, they never actually leave or disappear-they simply cease to exist as separate. This is key as no part is ever eliminated (which sometimes is what the host personality strives to do-trying to destroy or suppress a part is a negative barrier and not possible either) as each is equally crucial to the person's evolving sense of self. Other alters fear loss of independence and uniqueness and their role and often resist too at this stage until the concept is fully understood. Acceptance of all parts directly results in integration. All of these fears of loss of separateness, loss of coping by dissociation need to be processed to facilitate this stage.
The last stage is usually grieving with all the anger, sadness and feelings that come with owning the experiences of horrific abuse, and sometimes worse, the emotional neglect. Grieving the loss of the parents you never had is the most apt phrase I've ever heard and is credited to Colin Ross, the guru in treatment of DID.
Finally there is a resolution phase, where as clients call it, they adjust to being a "monomind" and coping with new experiences without the use of dissociation or other ways of avoiding affect (like alcohol, drugs, self-mutilation, rage episodes or other forms of acting out) and they practice and solidify the coping mechanisms they have been learning throughout therapy.
I will star this question in case you decide to post further details or have additional questions regarding this-Good Luck!!! Do explore links to Sidran Foundation and ISSD as there is some valuable free information there. Also databases for finding trauma therapists-just use your judgment with any that you find, as there is no verification that info those folks submit is accurate! Report It
Thanks Opester. I talked with t about some of this and she didn't freak so it seems good. My instincts are still telling me to hide the other parts, but I need help with the one who is using SI.
Don't like this. Report It
You could be all those things at the same time, or nothing.
Think about it this way- no matter what label they put on you, you'll have the same symptoms, the same problems, the same coping skills you are working on or trying to lose. You are not the label people put on you.
In psychiatry it is such a vague science, and people are so variable that it's common for someone to be diagnosed with one thing and have issues with others. Your caregivers should be talking to you about the issues that are interfering in your life the most, and prioritizing. Not so much with defining exactly what label fits and treating that and expecting everything to be fixed.
In my life someone has described me as being pretty much every diagnosis in the DSM (OK maybe only 70% of them). I've decided to thrive on being unique. So long as I can support myself and don't hurt anyone what's the harm. Work on what bothers YOU, not what the shrinks say is wrong. I can kind of relate to what you are saying. I was eventually diagnosed with issues related to a head injury that responded really well to Seroquel and Trazadone, but that's just me and every person is a unique individual.
But I really started to recover when I started rational emotive therapy with a qualified psychologist. I learned that my thoughts really do make a difference in how I feel. There are things I can do in my life to make my life better all other medications aside. With all due respect, you sound like you have something of a victim mentality. Of course. You were abused and neglected. I know what you mean. I was tortured, raped, and sodomized by my grandfather for a time. I was even a "victim" of hurricane Andrew which hit Florida in 1992. The problem is that I can be a victim and a martyr or a survivor. I wasn't a victim of my childhood. Hey, I'm alive right now! I'm a survivor! That kind of thinking changes the way you feel - about yourself and about others so that a diagnosis makes no difference. See what I mean.
I wish you the best and I hope my answer helped you. Don't stop asking questions. And good luck! the importance is not so much in the actual diagnosis, but rather treating the symptoms that are bothering you. in clinical social work and now in psychiatry there is an effort to avoid unnecessary labeling and focus on helping the person in the here and now.
please feel free to e-mail me with any further questions or comments You should be treated for your symptoms, not just your diagnosis. Borderline PD is overdiagnosed, and even if you have symptoms, once you get that "label" it is an unfortunate fact that many mental health professionals won't see what is really going on with you.
However, there are good professionals out there -- you just may have to go through a few to get to one. A word of advice: don't tell any new doctor or therapist about your previous diagnoses, because of the problem with labeling. People assume tha you have all the characteristics of that diagnosis, and little else. As you probably know, Borderline PD has nine possible criteria, and you only need to meet 5 of them -- but many professionals will just automatically assume that you have an anger problem, fear of abandonment, and engage in high-risk behavior, whether you do or not. So don't tell them what you've been disgnosed with. Let them give you the right tests and ask the right questions, and figure it out for themselves.
Also, people will, unfortunately, automatically slap a Borderline PD diagnosis on anyone who self-injures, even though the behavior is not limited to that condition.
Comorbidity is high between the three conditions. But remember, all behavior is on a continuum, and whether or not you meet enough criteria in the DSM-IV to warrant a diagnosis doesn't mean you don't need treatment. Which brings me back to having the right doctor and the right therapist -- if the people treating you aren't treating your symptoms but just your "diagnosis" (especially when that diagnosis doesn't seem to fit all that well), find someone who will.
Unless your behavior is life-threatening, usually the symptoms that are most distressing to you should be treated first. THis may sound obvious, but a lot of practitioners place their own values and priorities onto you. That is not to say that, often, there are a few things that are underlying other problems, and if you treat those underlying problems, the rest will be easier to deal with -- knowing those issues is just professional competence. But it sounds like you're caught up in that label they stuck on you, and need to find someone who will treat you as an entire person. I asked my friend who has DID. She was originally diagnosed with depression. She also have a very abusive childhood and first marriage. When she said she was hearing voices she was diagnosed with schizo-affective disorder. Then she was diagnosed with Borderline Personality Disorder. It took many years and she saw lots of therapists. No medications could make the voices stop. No therapy made the voices stop. It turned out that her alters were talking to each other. Her diagnosis was changed to depression, ptsd and did. These days she seldom switches but she talks to the alters and listens to them talk to each other. She says they often give good advice. The voices never stopped and she does not want them to stop. I鈥檓 no expert, but this is what my friend said. I looked up some more information as well.
Dissociative identity disorder
From Wikipedia, the free encyclopedia
http://en.wikipedia.org/wiki/Dissociativ...
Controversy
http://en.wikipedia.org/wiki/Multiple_pe...
Sybil
http://en.wikipedia.org/wiki/Shirley_Ard...
Eve
http://en.wikipedia.org/wiki/Chris_Costn...
Psychology Today
http://psychologytoday.com/conditions/di...
Symptoms
鈥?The individual experiences from 2 to more than 100 different identities. Half of the recorded cases, however, report 10 or fewer.
鈥?The various personality states exhibit distinct histories, behaviors and even physical characteristics.
鈥?Transitions from one identity to another are often triggered by psychosocial stress.
鈥?Frequent gaps are found in memories of personal history, including people, places, and events, for both the distant and recent past. Different alters may remember different events, but passive identities tend to have more limited memories than hostile, controlling or protective identities.
鈥?Symptoms of depression or anxiety may be present.
鈥?In childhood, problem behavior and an inability to focus in school are common.
鈥?Self-mutilation and suicidal and/or aggressive behavior may take place.
鈥?Visual or auditory hallucinations may occur.
鈥?The average time that elapses from the first symptom to diagnosis is six to seven years.
http://www.behavenet.com/capsules/disord...
Diagnostic criteria for 300.14 Dissociative Identity Disorder
(cautionary statement) 聽
A. The presence of two or more distinct identities or personality states (each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self).聽
B. At least two of these identities or personality states recurrently take control of the person's behavior.聽
C. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.聽
D. The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during Alcohol Intoxication) or a general medical condition (e.g., complex partial seizures). Note: In children, the symptoms are not attributable to imaginary playmates or other fantasy play.
Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision.聽 Copyright 2000 American Psychiatric Association
NAMI factsheet
http://www.nami.org/Content/ContentGroup...
Mayo Clinic
http://www.mayoclinic.com/health/dissoci...
PsycCentral
http://psychcentral.com/disorders/sx18t....
Merck Manual
http://www.merck.com/mmhe/sec07/ch106/ch... I too suffer fromn a lot of the symptoms you talk about - dissociation is reagular (the longest i was 'out' for has been a couple of hours in a very, very stressful situation). I also am aware of sererate parts of me, and like you am not a 'spilt' but able to know - most of the time - which part of me is trying to be in control (I used to think that there was only 1 'other' - now i know that there are 2, and am genadually becoming more convinced that theres at least another 1 hiding in the background somewhere!)
Repeated behaviours, flashbacks and overload (mine presents as mind blanks - not knowing my own date of birth, or home telephone number, being unable to cook - thats a biggy for me as i'm a qualified chef! The list goes on.)
Panic attacks, anxiety, not wanting company but being afraid to be alone, not being able to go out alone, my list of symptoms extends beyond yours. But that doesn't matter in the slightest.
What does matter is the reason that we both, and many, many other men and women out there will read this and nod - being able to identify with what we are both saying.
The reason we all feel like this is because we were abused as cildren.
The sepreate parts are the 'inner children' - the parts of us that have been unable to grow up emotionally. These are possibly at the age the abuse started, got worse, changed, whatever - but whatever the reason that they are there, they all need to be acknowledged, taken care of properly, parented and loved. Not always an easy task, but possible. Doing this job properly will mean that they will be able to grow up and then re-integrate once more so you (and I!) become the one person, rather than several personalities fighting for attention.
I don't know if this will help or not - but everything you have said in your post is 'normal'.
My feeling is for you to try and shake the PD 'label' that is not the problem - it is a consequence of the the real issue!
I would strongly recommend that you seek specialist services in your area - there are some out there!
It is very hard (as both I and my partner know all to well) to deal with issues around sexual abuse, but with the right help and support, all these issues CAN be dealt with.
Another important point - you are not a victim - you, we, are survivors of one of the most heinous crimes around, one that is often treated with the 'forget it' attitude, that is neither helpful nor useful!
So those reading this who have been lucky enough not to have to go through this trauma - remember that if someone tells you of their abuse, it has taken a huge amount of courage to open up, we understand that you propably won't know what to say and often all we need is someone to talk to who will not blame us or make us feel that is was our fault - because the child is NEVER to blame!
Here are some websites that may be able to point you in the direction of a more local group:
America - http://www.snapnetwork.org
UK - http://www.oneinfour.org.uk
http://www.napac.org.uk/
http://www.thesurvivorstrust.org/
http://www.napac.org.uk
I can apperciate where you are coming from, so if you want to contact me, please do. See BPD at the foot of page 1, at http://www.ezy-build.net.nz/~shaneris and PTSD on page 6. Practise daily, and when needed, one of the relaxation methods on page 2; read that page, and note the tips at the mental-health-abc and conquering stress websites. Forgiveness, not only of those others who wronged you, but the actions of the other sub-personalities too, is an important step on the path to getting better: not to do so would be to hold yourself(selves) back. Also, understanding, acceptance, tolerance, and the willingness to negotiate have their place. I only know a little about dissociative identity disorder, but it seems to me that the aim is to reintegrate those sub-personalities into a functional whole, with the "adult", or "probability estimator" in overall charge, which is sensible. I suggest using the WebFerret search engine, or your own, and the Google and Wikipedia websites to research it further, since you appear to have done a certain amount already. If you learn effective techniques for coping with stress, like those relaxation methods, EFT, Tai Chi, yoga, or the guided meditations on page 3, they should be of considerable benefit to you. Try them all, and use whichever works best for you. It may be a good idea to always carry two pairs of sunglasses (medium, and dark: if indoors, put on the medium, only when it becomes necessary:- if outdoors, change from the medium to the dark, preferably with your eyes closed). Also carry earplugs, and investigate purchasing "Bose" noise cancelling headphones, as well. There is a section on self harm on page 4. The answer by Opester was excellent, and fully deserving of best answer: I can only hope to add a little to it, since she is an experienced professional therapist, and more mainstream, where I tend to be more in the alternative style. Although I don't always defer to her, especially concerning depression treatments, in this instance, I strongly suggest going with her advice, and use pages 1 and 2, (particularly the 1800 therapist website) of "ezy-build" to locate, and evaluate the relative competence of the therapists you manage to locate nearby. I know that, in your position, I would be prepared to travel far, even relocating for the period of time necessary to accomplish that reintegration, with the most able therapist I could find with a proven track record in this field: question your potential therapists closely on this, and have a prepared written list. Include such questions as: "How long have you been treating people suffering from Dissociative Identity Disorder?", and "How many such people have you treated?", and "What proportion of those treated managed successful reintegration?", and "How do you propose treating my D.I.D.?". Everything else in my life would be subservient to that end, of getting the best available therapy, so highly in importance would I rank it. Until such time as successful reintegration is achieved, "your" life is not really your own. Personally, I would find such a state of affairs to be not only unacceptable, but extremely intolerable, (e.g., suffering the aftereffects of self harm, or financial mismanagement for acts which I didn't remember committing) and I sincerely hope your condition improves, soon. |
