last edit on
6/16/2020 10:39:02 AM
i relate to all of this.
Lmao me
but keep in mind dissociation can be experienced as a result of trauma, not saying you have DID. And there are many dissociative disorders- or it can be experienced as a symptom of a trauma disorder
I relate to all of this.
@4:00 the video really starts
he talks about / describes *some* personal experiences he’s had with:
amnesia,
depersonalization
and derealization
and yeah I’ve experienced all of these things he’s describing
but i like the disclaimer he says, about dissociation not being always pointing to DID. Just keep that in mind folks.
last edit on
6/16/2020 1:34:56 PM
There’s so many symptoms to describe and talk about- and so much, that goes into, the experience of it, as a whole- that it would takes volumes... to really, explain all of it in detail.
But one of the things I do want to say that I haven’t talked about before is, I’ve had the experience that time was moving too slow- or that *I* was moving in slow motion, since I was a *very* young child
so that kind of freaks me out because, I guess, that means that this has been going on pretty much my entire life. And uh, that something happened in early childhood that I just don’t remember.
Which I mean- I was *guessing* based on some hints I’ve gotten that was a *possibility* but, yeah...
I was poking around in some early childhood memories and then I actually had something resurface from early childhood that was so painful that... hah, it made me kind of want to back off from it.
But yeah, they come back to me randomly and then, I forget them again and- then I remember them again. It’s patchy basically.
So it makes sense to want to write them down. I’ve written down a few already here, somewhere lol, and that helps solidify my ability remember consciously like- permanently, rather than- whenever my brain feels like showing me.
At least that was the hope. Lol I don’t know if it works.
But yeah uh, another memory I had flasH in my head yesterday, I wanted to write down to add to the arsenal-
I was, god, I want to say fucking 3 or 4. There was orange and brown leaves all over, and pine needles. Just as far as the eye could see. On the ground, and on the trees- tall tall tall trees, a semi dense forest. It was a beautiful memory, and, I was walking along this dirt path with some wooden logs in it that were square.
When you stepped on them it made a kind of hollow clunk sound, that was satisfying to me.
And I was just walking along this path, in this, forest in- god knows where.
I want to say it was up north in the mountains like. I have no idea what the fuck I was there for though or what I was doing in this memory.
It’s just a flash, like, all the rest.
They’re all very disjointed and I can’t really draw the dots between them at all so. But yeah, that’s- that.
Exposure to multiple types of trauma over multiple developmental epochs is associated with a wide range of clinical problems including emotion dysregulation (numbness, dissociation alternating with hyperarousal and emotional flooding); behavioral dysregulation (impulsive, self-destructive and aggressive behavior); identity problems including difficulties with body image and eating disorders; disruption in meaning (e.g., feeling life has no purpose); interpersonal problems; and somatization and medical problems including chronic fatigue, heart disease and autoimmune disorders [13, 20–23]. Many DD patients struggle with these difficulties e.g., [23]. Epidemiological studies have found that mood, somatoform, anxiety disorders, and substance abuse are commonly associated with antecedent trauma, as well as PTSD [24, 25]. These disorders are also common co-morbidities of patients with chronic complex DD e.g., [23, 26]. For example, in a prospective treatment study of DID and dissociative disorder not otherwise specified (DDNOS) patients, 89% also had PTSD (n = 242), 83% had a mood disorder (n = 226), 50% had an anxiety disorder other than PTSD (n = 136), 30% had an eating disorder (n = 81), 22% had a substance abuse/dependence disorder (n = 61), and 22% had a somatoform disorder (n = 59) [26].
Most DDNOS/OSDD patients are similar in presenting symptoms, history, clinical course, and treatment response to DID patients, so DDNOS/OSDD is combined with DID here (reviewed in [23]). DID is conceptualized as a childhood onset, posttraumatic developmental disorder in which the child is unable to consolidate a unified sense of self due to severe, chronic childhood abuse, often involving a caretaker [13]. Dissociation during and after the repeated episodes of abuse allows the child to psychologically detach from the emotional and physical pain, in turn potentially resulting in alterations in memory encoding and retrieval [58]. Over time, this leads to fragmentation and compartmentalization of memory, as well as difficulty retrieving memory [13, 23, 59]. Exposure to early, typically chronic, trauma results in the elaboration of discrete physiological, psychological, and behavioral states that can persist and, over later development, become increasingly developed, ultimately resulting in dissociative emotional/behavioral/memory self-states [13].
Clinical presentation and comorbidity
Many clinicians and lay people believe that DID presents with dramatic, florid personality states with obvious state transitions (switching). These florid presentations are likely based on media stereotypes, but actually occur in only about 5% of DID patients [60]. The vast majority of DID patients have subtle presentations characterized by a mixture of dissociative and PTSD symptoms embedded with other symptoms such as posttraumatic depression, substance abuse, somatoform symptoms, eating disorders, personality disorders, and self-destructive and impulsive behaviors [23, 61]. A classic presentation includes a history of multiple treatment providers, numerous serious suicide attempts resulting in repeated hospitalizations, and good medication trials typically with limited or no benefit
Although the media and public are often overly fascinated with DID dissociated self-states, the complex symptomatic presentation of DID receives more clinical attention from trained clinicians [62–64]. Under-recognition of DID is common because the most obvious and pressing aspect of a patient’s clinical presentation may be one of the many comorbid disorders (e.g., severe mood disorders, posttraumatic stress disorder [PTSD], eating disorder, substance abuse, BPD), or the pseudopsychotic symptoms related to the overlap and intrusions of self-states into consciousness. This overlapping influence of self-states causes “passive influence” phenomena or Schneiderian first rank symptoms, which are more common in DID than overt, obvious “switching” of states.
...cluster of symptoms in “impairment in identity”, both “unstable self-image” and “dissociative states under stress” are DSM-5 criterion symptoms...
Neurobiology of dissociation: common underlying neural pathways in PTSD and chronic complex DDs
Two subtypes of acute trauma response have been found in a range of neurobiological studies, one primarily involving dissociative symptoms and the other predominantly intrusive, hyperaroused symptoms; these symptoms may underlie some forms of emotion dysregulation in trauma-related disorders, including PTSD and chronic complex DDs. These two subtypes of dissociation have been described as primary and secondary dissociation [16]. Primary dissociation refers to the re-experiencing/hyperaroused type of dissociation and includes the classic PTSD symptoms including intrusive recall, flashbacks, and nightmares. In contrast, secondary dissociation is characterized by such symptoms as numbness, depersonalization, derealization, and analgesia responses
last edit on
6/16/2020 2:32:41 PM
cardinal symptoms of dissociation (e.g., daydreaming; feeling numb; gaps in memory; feeling unreal),
Although DD are associated with tremendous suffering including the loss of a continuous sense of one’s self and one’s memory, theorists suggest that dissociation provides some protection from the overwhelming danger and tumultuous emotions...
...with research showing that dissociation preserves attachment even in the face of betrayal and abuse by caregivers
Studies indicate DD patients have difficulties with affect regulation, which they attempt to regulate through self-harm, suicidal thoughts and behaviors, and dissociation.
The psychological profiles of DD patients are consistent with neurobiological findings: DD patients show difficulties with emotion regulation, with a resultant tendency to vacillate between hypoarousal and dissociative states, and emotional flooding including profound depression and intense anxiety.
Studies of individuals with PTSD, both with and without borderline personality disorder, have found that higher dissociation levels predict poor response to standard treatments, such as eye movement desensitization and reprocessing (EMDR) and dialectical behavior therapy (DBT; Bae, Kim, & Park, 2016; Kleindienst et al., 2011). Despite these data, most psychiatric and psychology textbooks fail to present empirical research about DDs, or they provide inaccurate or sensationalized information about diagnosis and treatment of DDs
Expert consensus treatment guidelines are available for DID in children and adults (International Society for the Study of Trauma and Dissociation [ISSTD], 2004, 2011). These guidelines recommend a phasic treatment model that, consistent with a survey of international DD experts (Brand et al., 2012), emphasizes patient safety and stabilization. Due to the severity and complexity of DD symptoms and impairment, the first stage explicitly focuses on safety and stabilization; DD patients often decompensate if there is a premature attempt to process traumatic memories before behavioral stabilization and acquisition of emotion and symptom management skills (ISSTD et al., 2011). The symptoms of these chronic complex DDs have been conceptualized as reflective of emotional dysregulation related to trauma (Brand & Lanius, 2014), and emotional dysregulation and posttraumatic stress have been found to predict increased dissociation and tension reduction actions (Briere, Hodges, & Godbout, 2010). Conceptualizing NSSI and suicidal behaviors as attempts at self‐regulation, Stage 1 treatment is recommended to utilize a multimodal, present‐centered approach that emphasizes psychoeducation and cognitive‐behavioral interventions while conceptualizing relationship dynamics through psychodynamic and attachment theories (Brand, 2001). Patients are taught healthy coping skills to manage dysregulation, including grounding to reduce dissociation; emotion regulation skills to replace reliance on unhealthy behaviors (e.g., NSSI, substance abuse) to reduce overwhelming emotions; containment of intrusive PTSD symptoms; and methods for managing unsafe behaviors. When patients demonstrate improved awareness and tolerance of emotions, decreased dissociation, mastery of basic symptom management skills, and improved safety, they may (optionally) progress to Stage 2, which adds carefully paced processing of trauma memories. A survey of 36 international experts (Brand et al., 2012) indicated that experts remain attentive to safety and stability until the third phase of treatment. In Stage 3, patients are able to devote more energy to increasing social and occupational activities and may completely or partially integrate self‐states (Loewenstein et al., 2017).
last edit on
6/16/2020 3:17:58 PM
Our clinical experience and the expert guidelines suggest that premature focus on trauma memory frequently causes DID patients to develop acute symptom exacerbations with increased suicidal and self-destructive behaviour, sometimes requiring inpatient hospitalization (ISSTD, 2011). Often, this results from unmodified use of exposure-based treatments such as EMDR and Prolonged Exposure or insufficient stabilization.
Other Specified Dissociative Disorder 300.15 (F44.89 -DSM V)
“This category applies to presentations in which symptoms characteristic of a dissociative disorder that causes clinically significant distress or impairment in social, occupational or other important areas of functioning predominate but do not meet the full criteria for any of the disorders in the dissociative disorders diagnostic class. The Other Specified Dissociative Disorder category is used in situations in which the clinician chooses to communicate the specific reason that the presentation does not meet the criteria for any specific dissociative disorder. This is done by recording "Other Specified Dissociative Disorder" followed by the specific reason (e.g. "Dissociative Trance")
Examples of presentations that can be specified using the "other specified" designation include the following:
1. Chronic and recurrent syndromes of mixed dissociative symptoms: This category includes identity disturbance associated with less-than-marked discontinuities in sense of self and agency, or alterations of identity or episodes of possession in an individual who reports no dissociative amnesia.
2. Identity disturbance due to prolonged and intensive coercive persuasion: individuals who have been subjected to intensive coercive persuasion (e.g. brainwashing, thought reform, indoctrination while captive torture, long term political imprisonment, recruitment by sects/cults or by terror organizations) may present with prolonged changes in or conscious questioning of, their identity.
3. Acute Dissociative reactions to stressful events: this category is for acute transient conditions that typically last less than 1 month and sometimes only a few hours or days. These conditions are characterized by constriction of consciousness, depersonalization, derealization,perceptual disturbances (e.g. time slowing, macropsia) micro-amnesias, transient stupor; and or alterations in sensory-motor functioning (e.g. analgesia, paralysis)
4 Dissociative Trance: This condition is characterized by an acute narrowing or complete loss of awareness of immediate surroundings that manifests as profound unresponsiveness or insensitivity to environmental stimuli. the unresponsiveness may be accompanied by minor stereotyped behaviors (e.g. finger movements) of which the individual is unaware and/or that he or she can not control, as well as transient paralysis or loss of consciousness. The dissociative trance is not a normal part of a broadly accepted collective cultural or religious practice.”
_____
Descriptions of known presentations of Other Specified Dissociative Disorder
Macropsia: objects feel like they are getting smaller and or farther away
Tachypsychia: feeling like time is moving too slow or fast
Analgesia: not feeling any pain while dissociating
Microamnesia: short term memory problems due to dissociation
Transient Stupor: Mary involve short term paralysis and or mobility problems
Dissociative Trance: (described above at point #4)
last edit on
6/16/2020 3:47:17 PM
last edit on
6/16/2020 3:55:22 PM