D.I.D. A questionnaire for the presence of D.I.D. may be found at: http://counsellingresource.com/quizzes/cesd/index.html Individuals diagnosed with DID demonstrate a variety of symptoms with wide fluctuations across time; functioning can vary from severe impairment in daily functioning to normal or high abilities. Symptoms can include:[1]
* multiple mannerisms, attitudes and beliefs that are not similar to each other * headaches and other body pains * distortion or loss of subjective time * depersonalization * derealization * amnesia * depression * flashbacks of abuse/trauma * unexplainable phobias * sudden anger without a justified cause * lack of intimacy and personal connections * frequent panic/anxiety attacks * auditory hallucinations of the personalities inside their mind
Patients may experience an extremely broad array of other symptoms that resemble epilepsy, schizophrenia, anxiety disorders, mood disorders, post traumatic stress disorder, personality disorders, and eating disorders.[ Source(s): http://en.wikipedia.org/wiki/Dissociativ…
_____________________________________________________________________________________ Those people who have D.I.D. may experience such things as "coming to" in a place that they don't recognise, or receiving bills for things they don't remember ordering, or, if living alone, finding notes in a different handwriting, or sometimes friends tell them things about themselves, and their behaviour as another "alter". _____________________________________________________________________________________
Sometimes the various "alters", or sub-personalities have different disorders, making prescribing medications a nightmare for therapists. Also, if the person has no awareness of their other alters, different ones may well be seeing different doctors, and therapists, presenting with completely different symptoms. This can delay a correct diagnosis, and I am informed that Dissociative Identity Disorder (formerly Multiple Personality Disorder) has a high rate of misdiagnosis.
If you perform a Google search of the rates of D.I.D. in countries, worldwide, you will notice a disparity of many thousands of percentage points, indicating that it is much overdiagnosed in some countries, and much underdiagnosed in others, probably because doctors, or therapists are either not alert as to the possibility, or even dismissive of the existence of the disorder.
It can be helpful to put the various alters in touch with each other, so that they can arrive at some form of accomodation, sharing control, limiting harm, and perhaps even agreeing on the ultimate desirability of reintegration into a "monomind".
One way that this can be achieved is by "conferencing". That person can hold pens in both hands, and have a series of questions, or issues, in the middle of a sheet of paper, and different boxes around the sides for each alter to write their response in.
Alternatively, hypnosis, or autosuggestion (self hypnosis) can be used, with a voice recording operating, and a recording being made for later playback, analysis, and discussion with a therapist about the best course of action to adopt.
From "Opester", a Licenced Clinical Social Worker: "here's a website that seems very well-organized and protected so as to keep little parts safe from triggering experiences. It is an entire online community for DID and i thought you might wish to check it out: http://www.mosaicminds.org/Community/index.shtml There is even an area exclusively devoted to child alters.
On another note, it is really important to see your therapist regularly as infrequent visits won't allow the necessary depth for integration to occur. Talk with your therapist about more frequent appts. I wanted to share the following excerpt from other questions I have answered on DID and I hope you may find it helpful, though it may not offer you any new information depending on how long you've been in treatment. But here it is anyway:
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. _____________________________________________________________________________________
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.
Hope this helps explain the process. Again, just a reminder-DID and PTSD are among the only psychiatric disorders which can be truly "cured" and also do not depend on meds for management of symptoms". _____________________________________________________________________________________ Multiple Journeys to One: Spiritual Stories of Integrating from Dissociative Identity Disorder by Judy Dragon, Terry Popp "I highly recommend reading this book! It has validated so many things I had told my therapist, things I thought no one would ever be able to believe. It has provided me with hope and courage to continue my healing. I think it will be very beneficial to all who love and care about someone who has survived as well. I think these ladies are an inspiration and I thank them so much for sharing." Amongst Ourselves : A Self-Help Guide to Living With Dissociative Identity Disorder by Tracy, Ph.D. Alderman, Karen Marshall LCSW, "We had read everything we could get our hands on about MPD, hoping to find something we could use both as a therapeutic source for ourselves and a resource to share with important people in our life.This book not only does just that, but most importantly, it consistantly exudes respect for the multiple as a whole as well as for each alter. Rosalee, one of the alters of one of the authors, describes various facets of living with MPD with honesty and candor. We feel that this book should be distributed like World War Two propaganda: out of low-flying airplanes, to the masses." THE STRANGER IN THE MIRROR: Dissociation: The Hidden Epidemic by Marlene Steinberg, Maxine Schnall "This book drags you into it. I found myself going back to it again and again, I was through the first hundred pages and thought the easy reading and understand of this book in unbelievable. I didn't think I would be able to read it norless understand it. I had to take that chance and was I shocked when I realized it was on my level. This is a must read book for all. I found myself all thought this book, and at times we found ourselves. Thank You so much for this information it has given me a better understanding after years of talking with a therapist on some of the insanity that my life has taken me through." Treating Dissociative Identity Disorder (3-Volume Set) by James L. Spira (Editor), Irvin D. Yalom (Editor) "This is the best book to date on the subject of DID/MPD. The authors are the leaders in the field, and they offer concise and detailed information about how to treat patients with multiple personalities in in-patient and out-patient settings. Dr. Spira's introductory chapter is especially helpful and offers a good context for the chapters that follow. There are chapters on psychological assessment, the develop of DID, treatments from a variety of perspectives, and even a chapter of psychotropic medications! This is a great book for anyone who has ever treated someone with MPD, or who want to better understand dissociative disorders." - from Amazon.com ____________________________________________________________________________ DP/DR. Depersonalization/derealization: Opester, a therapist with more than 20 years of experience, specialising in dissociation, and former contributor here, provided a post which is well worth viewing at: http://au.answers.yahoo.com/question/index;_ylt=AjGm6SZeDl.EmP3AKExBq3fh5gt.;_ylv=3?qid=20070729124635AAGBzdb&show=7#profile-info-418bccfb9324deeab3120af8e1ccb6ffaa Regard DP/DR as being purely temporary.
Advice from other therapists, and sufferers: When affected, run your hands under cold water for several minutes. Adapt the following to your situation: Look around and find 5 colours; feel 4 different textures; smell 3 different odours, and taste 2 different things. Focus on your hands for several minutes, multiple times daily. Try snapping a rubber band on your wrist, lightly, at first, then increasingly harder; remove afterwards, and pocket.
Give the EFT a good tryout, to see if it helps you. It is free via the searchbar at http://www.mercola.com "EFT" & "EFT therapists" or http://www.tapping.com (13 free videos) Professional is best. - There is a version for use in public places, (if you want to, you can claim to have a headache, as you employ the acupressure massage/tapping on your temples, but you would then be restricted to subvocalising: [repeating to yourself in your mind] ) "Even though I sometimes suffer from depersonalization/derealization, I deeply and completely accept myself". Use the PMR, at http://www.drcoxconsulting.com/managing-stress.html
DP/DR often results from anxiety/panic attacks, so if this applies in your case, see http://your-mental-health.weebly.com/1.html about anxiety, and/or panic, then pages h, & i. Neo-Reichian therapy has been recommended for DP/DR, but I suggest using the above treatments for at least several weeks, as they may well be all that are required. Also see http://en.wikipedia.org/wiki/Depersonalization about treatment, but TMS (radiation exposure) and naloxone (see www.drugs.com ) should be kept in reserve, due to their relative risks.