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Dissociative survivors’ experiences
Treating dissociation
Dissociation FAQs
Getting help and a diagnosis
Crisis care and grounding
Explaining dissociation and DID
Child sexual abuse
Impact on the body
‘I’m not seeing a doctor!’ I insisted with a look on my face that was intended to end the debate once and for all. As far as I was concerned, it was simple: I wasn’t going to the hospital, walk-in centre or GP surgery, because I couldn’t go. I couldn’t cope with...
All I did was walk into the kitchen and pick up a cloth. But the sudden waft of bleach flung me far, far back into some childhood memory. I switched to a traumatised part of myself. I had been ‘triggered’.
My therapist is retiring next year. I’ve worked with her for nearly five years and I’m not ready to finish therapy yet, so this is a difficult issue for me. Having spoken to PODS, I’ve realised that many other people face the same or similar situations, so I thought I’d write about how it’s impacting me and how I’m dealing with it. But I have DID, so I have a variety of responses…
I was abused by my dad, and also my grandad. And in many ways, I want to just leave it there and not say any more, because every time I say it a huge cloud of fear comes up and a voice screams in my ear that none of it really happened. It’s like, for a moment, my...
It might have been ‘just a routine blood test’ but that didn’t stop me passing out. Again. From a teenager through into adulthood, even the word ‘medical’ could render me light-headed. I couldn’t bear the sight of blood, I couldn’t even hear descriptions of blood;...
Dissociative survivors face a range of challenges and here, in their own words, they describe the things they find hardest about life with dissociative identity disorder.
How do you go about getting a diagnosis for dissociative identity disorder? One client describes her long struggle for treatment on the NHS and the path to the Clinic for Dissociative Survivors.
What do you do when the worst thing you think could happen to you does happen? Do you fall back into old habits, ways of coping that you’ve worked so hard to reform? Or do you work the problem? … In this searingly honest and vulnerable piece, Carolyn Spring talks about how she coped with a double loss of attachment figures and how what she had feared the most actually became a springboard towards new growth.
Pauline Rachael talks about her experience of working towards recovery from trauma.
It was the last week in May 2014. I had packed up all my belongings in my flat, got my affairs in order, and decided that I needed ‘to be dead’. I didn’t want anyone else to have to clear my flat, so I took some stuff to the tip, packed my remaining belongings into labelled boxes, and wrote detailed instructions.
‘Can we heal?’ she asked, quivering with the significance of what she was saying, as if her very life depended on it. ‘Can we really heal?’I could well understood the agony in her eyes. I lived for many years overwhelmed by trauma, the symptoms of unhealed suffering. And if recovery is impossible, then why are we even trying?
There’s no denying it: everyone likes a superhero. From the Greek gods to the current comic book heroes, the human race appears to be endlessly fascinated by the notion of power and ability that exceeds our natural levels of physical prowess and mental dexterity … And here, Xanthe Wells talks about how Avengers Assemble became a metaphor for her of dissociative identity disorder.
I exist as a phantom. I ache to be connected, to be able to express what life is like for me. Me, as a dissociative we. But I don’t have the words to become connected, I don’t have the words to become real. Words fail me.
Recovery from trauma is a difficult process but what are the specific things that can get in the way?
After sexual abuse, it’s very common to have difficulties in your sexual relationship. But is that just the way that it is and we have to just accept it? Or is there a way towards a fulfilling sex life after trauma?
When I first started therapy in 2006, I didn’t know much about trauma and nothing about ‘the three phase approach’. My counsellor didn’t know much more. So although I’d like to say that we started by carefully doing the Phase 1 work of safety and stabilisation, the reality was a great deal messier than that.
Is recovery possible? That’s the question that everyone is asking, even when they’re not asking it. After a breakdown, perhaps after years in the mental health system, do we have to simply accept that we’re broken and that we’ll always be broken, or is it possible to live a life where we’re back in control again, where we’re living as we want to live, where life has purpose and meaning?
Recent years have seen an influx of numerous studies providing an undeniable link between childhood/chronic trauma and psychotic states. Although many researchers (i.e., Richard Bentall, Anthony Morrison, John Read) have been publishing and speaking at events around...
I could cope with it no longer. Every part of me—eyelids, throat, bowels—everything was clenched tight in a ball of furious unbearability. This feeling—such a feeling!—loomed up over me like some prehistoric sea-monster, ready to snap me up and devour me, ready to pilfer my bones and pick apart my brain. This feeling was too much.
Part 9 of the Cathy Le Roux Chronicles, a sardonic look at life with dissociative identity disorder.
When I was an in-patient in a locked rehab unit, a secure facility with an airlock as standard, the local taxi firm would not collect people from the unit. They judged without any real information. Ignorance, I guess, led people to hold a view that was without foundation and based upon stigma.
Understanding the dynamics around child sexual abuse, who the perpetrators are, how they achieve their ends, the impacts of abuse on us—all of this knowledge, this ‘psycho-education’ has aided my recovery. And so these are ten of the many things that I have learned about child sexual abuse, some of the insights that have begun to heal my shame.
Although I am fiercely independent and repeatedly declare that I don’t need anyone to help, lately it seems that some parts of me don’t agree. Their cries for help come mainly at night. I can hear them inside, begging for someone to help them, and it’s relentless.
Being on benefits wasn’t a choice I’d made and certainly not something I did willingly. From before the age of fourteen I’d always had a job, pausing only for maternity leave. But when my dissociated trauma burst onto the scene three years ago it became a massive achievement simply to stay alive.
When I first started to see visions, I believed that they were monsters. More than that, I believed that I was a monster. Aged seven, I was sure that buried deep inside me was a monster that only revealed itself when I glanced towards a mirror. By wearing a ‘little-girl-suit’ and walking amongst the real humans I felt like a fraud.
I had no idea where I was, except—rather obviously—that I was on a beach. It was raining and I was soaking wet. My legs were drenched up to the knees, indicating that perhaps I’d been in the sea. It was dark and late and freezing cold. I put my hands in my pockets and felt sea-shells. The policewoman told me where I was but it didn’t make any sense.
Part 8 of the Cathy Le Roux Chronicles, a sardonic look at life with dissociative identity disorder.
Of all the things that are painful; of all the abuses of my body, my mind, my emotions; of all the effects I live with in my attempts to ‘be fine’ and seem normal: this one, this wound of ‘un-motheredness’ is one of the most difficult.
Tears were streaming down my face as I tried to explain to the teacher – this angry, spiteful, menacing teacher – that I hadn’t stolen anything. It wasn’t me. I didn’t know why she was accusing me, but she was, and here I was – in trouble, again, and not understanding why.
Part 7 of the Cathy Le Roux Chronicles, a sardonic look at life with dissociative identity disorder.
It has been hard to accept that there was no justice for me. My father was killed 8 years ago, so that robbed me of the possibility that he might ever apologise to me for what he had done. It’s unlikely that he would ever have done so anyway, but now there is no chance. Such have been my family fortunes.
Part 6 of the Cathy Le Roux Chronicles, a sardonic look at life with dissociative identity disorder.
Members of the PODS Forum talk about the kinds of things they wish they could educate other people about living with dissociative identity disorder.
When I first read the statement “It’s never too late to have a happy childhood”, I thought rather crossly, “Yeah, right!” But when I had thought about it for a while, I changed it to an enthusiastic “Yeah, right!”
In primary school we had learned about ‘myths’ – Greek gods and Aesop’s Fables and Robin Hood. What I didn’t realise was that ‘child protection’ professionals in England in 1989 clung more fiercely to myths about child abuse than they did to the truth.
I have been a victim both of childhood abuse and abuses within the mental health system of the NHS. As someone said to me recently, the fact that I was abused as a child is appalling, but to be reabused again as an adult by the people who were supposed to be caring for me is equally unacceptable.
I was born 35 years ago. With this body. This body that is a little too short and a little too plump. This body that sags in all the wrong places and looks the age it is, not the age I feel. This body that has produced two healthy children and enabled me to watch them grow. This body has been with me my entire life.
Dissociative survivor ‘Recovering Insomniac’ details ten helpful things that her therapist does.
Users of the PODS forum talk about what is hardest for them in living with dissociative identity disorder.
Denial and dissociation are two sides of the same coin. In employing dissociation, we are employing denial: “This isn’t happening” or “This isn’t happening to me.” We create alter personalities to whom it happened, so that it didn’t happen to me.
Members of the PODS forum talk about the battles in their head that they endure as they live with dissociative identity disorder.
My smoke alarm was going off in the swimming pool even when there was no real risk. There was risk and danger when I was a child, and that has affected my brain’s ability in the here-and-now to assess when there really is danger and when I really need an adrenaline rush so that I can escape or protect myself. This is what is happening when I am triggered: I am responding to a danger that is not really here now.
It’s okay. You can come out now. Honestly, it’s all over! Whichever survival strategies you’ve used (could be an article in that …), whatever your own quirky (aka dysfunctional) individual coping mechanisms have been, it is now officially safe to emerge from the...
I wake up abruptly as you do on days like these. My mouth is almost indescribably dry. Unless of course you take amitriptyline, or any of the other tricyclics – then you’ll know exactly how dry ‘dry’ can be without me having to try to explain. Usually anticholinergic...
I have dissociative identity disorder. I have many separate, distinct and unique ‘parts’ of my personality. My ‘parts’ or ‘alters’ collectively add up to the total person that is me. I am the sum of all my parts. They are each a letter, and I am a sentence.At times,...
I spent the whole of my childhood having to play the game and say that these things weren’t happening. They were and they hurt. The world should have known then, and the world should know now. But it still doesn’t.
Physical symptoms are a big part of life for me with DID. Yes, I have ‘multiple personalities’, the “two or more distinct identities that recurrently take control of the body” and I’m not for one moment denying the significance of that or the impact it has on my day-to-day life. But I would say that physical symptoms such as chronic, unexplained pain, headaches and nausea have been and still remain far more distressing and life-impacting for me than the presence of parts.
Part 3 of the Cathy Le Roux Chronicles, a sardonic look at life with dissociative identity disorder.
All the signs were there that I did in fact have feelings, but initially I could not link these physical events with having an emotion, and I certainly could not put a name to them. Frequently my counsellor would gently remind me to notice what was happening in my body.
Samantha Russell, a survivor of child sexual abuse, talks about her experience of childbirth after trauma.
The work of therapy can bring up strong feelings inside us of wanting to be cared for, wanting to be rescued, and wanting all the trauma and all our ‘parts’ to go away. It can be a very confusing time. As a dissociative survivor, I realised that there are things that I want people to say to me, and then there are things that would be more helpful for them to say to enable me in the long-term to recover.
Four men all talk about their experiences and life with dissociative identity disorder.
No matter how logically illogical it apparently is, I know I choose to listen to barbed words and vindictive self-beliefs about me: I am a subhuman being. I wrap the heavy chainmail-blanket of blame tightly around me. That is my fall-back position.
It is not about diagnostic labels. It is not so much about dissociation, parts, losing time – although all of those add to the constant sickening sense of being different. For me it is about being me. The reality of everyday living with myself. ME.
I feel ‘shame’ that I have emotions, while desperately seeking out those very emotions. Feeling shame for not owning them. Feeling shame for feeling them. Paradox.
I’ve just had my heart broken and I’m struggling to accept it; or accept it again, I should say. I haven’t attempted many relationships in my life and this one ended some time ago. But when I realised I still loved her, or parts of me did, I attempted a reunion. But she’s moved on and unfortunately for me, loss still equals death.
Part 2 of the Cathy Le Roux Chronicles, a sardonic look at life with dissociative identity disorder.
I look up and I am in my therapist’s room. I look up and I am in the cafe area of the shopping mall. I look up and I am in bed in the dark. I look up and I don’t know if I am I. There is no thread of continuity between these places, these experiences. Who am I now, writing this, re-reading this, re-writing this?
Powerlessness is such a core experience for victims of abuse that often we don’t even notice that it’s there. It is played out in the way that we interact with people and the world – it’s the shadow cast by the sun, rather than the sunlight itself.
You ask me how I feel … I feel panic, nothingness, panic, more nothingness. Laced into the panic is sadness, guilt, doubt, paranoia, then dreadful nothingness. And worst of all, shame. Always here, I feel the shame.
Dissociative survivor Kitty talks about her experience of getting to know the various parts of her personality and how similar the process has to been to taking on a rescue dog.
Part 1 of the Cathy Le Roux Chronicles, a sardonic look at life with dissociative identity disorder.
I knew a lot about pain, but I didn’t know very much at all about pleasure. I asked myself: what do I like doing? For weeks I couldn’t answer that question, not with anything tangible or concrete.
Each day me – tip-toeing through life (your life, your world, your complex unknowable system of rules and experiences), a desperate yet futile quest to hide my oddness.
I hate my body. It was there, always there, during the abuse. My mind went away but my body could not. My mind could forget. We parcelled up little chunks of our mind, bit by bit, and sent them off into dim little rooms where they could be forgotten and not heard.
PODS ran a survey in 2016 in association with One in Four (www.oneinfour.org.uk) with the aim of assessing the degree to which counsellors and psychotherapists have received training to work with survivors of child sexual abuse (CSA) and child sexual exploitation...
I had worked as a counsellor for about twelve years before I went on my first PODS training course on dissociation. I had so many lightbulb moments that day, it felt like my brain was burning.
The issue of boundaries had always been a non-issue for me: I saw my clients for 50 minutes; there was no contact between sessions (no need for contact between sessions, surely?); it was a purely professional relationship. No dramas, no big deal. And then I started work with my first really traumatised client, and everything was called into question
Many survivors get in touch with us simply because they need to talk to someone who understands what they’re going through, and to reassure them that they are not going ‘mad’.
I came to be a therapist quite late in life after a successful but ultimately unrewarding career in business. I always felt that there should be something more to life than making money, and it struck me repeatedly how mental health difficulties disrupted the lives of so many of my staff.
… it has really struck me how many people with a history of complex and severe trauma cannot get any help whatsoever via the NHS. Many are passed from pillar to post, either being told that they do not meet the criteria to receive services (they are not quite suicidal/traumatised/distressed/non-functioning enough) or that they exceed the criteria (they are too complex/suicidal/traumatised). This leaves people feeling understandably ashamed, powerless and frustrated…
Dr Nick Read, a retired medical professor and now a psychotherapist, explains the link between trauma and irritable bowel syndrome – and what can be done about it.
We often see therapy – treatment for trauma – as the holy grail, and put an extraordinary amount of effort into obtaining it. But do we make the most of it when we get it? Carolyn Spring shares her thoughts about how to maximise this rare and valuable resource.
The beginning of understanding was really just that—a beginning. Little did I know how much I had to learn and how much I really didn’t know. When my peer supervisor mentioned to me this strange word ‘dissociation’, it was an entirely new concept to me. Now I wonder how that can be.
Should we talk to parts? Or does that make things worse? When someone switches, is this attention-seeking behaviour? And is talking to a ‘part’ in some way dangerous—does it reinforce pathological behaviour? What should you do?
Suddenly, like a party popper, out came her words. ‘It happens all the time. People will be talking to me and I can’t remember what they’ve been saying. I used to think I was just forgetful. But it’s not that. It’s like they can be talking to me and I know rationally who they are but it’s as if I’ve never met them before in my life
Much has been written about the work in therapy in stages I and II of the phase-oriented approach to treating trauma, but less so about the third stage. The work in phase III aims to consolidate the gains acquired in the early stages and to apply these to everyday life in order to develop ‘a life worth living’.
Andrea, a client of mine, cupped her hands, as if around a big cabbage. ‘People think that shame is contained, out there, somewhere, an extra.’ She then swept her hands all over, from top to toe. ‘It’s everywhere.’ She was showing me that shame seemed to be a part of her, transcending time and space.
I used to struggle to understand what phase III could possibly be about, because my life was so consumed with just surviving, and then so consumed with working through traumatic material to neutralise it, that I imagined that therapy would always be like that, and that once it was no longer happening, there would be no more need for therapy.
My role as a psychosexual therapist is to help a client understand what ‘language’ their body or their behaviours are speaking. Once people understand their triggers and behaviours, they are more likely to allow a change, if that’s what they want.
The ‘trauma traffic light’ represents three physiological states that the body can shift gear between, depending on levels of threat or security in the world: the green zone, the amber zone or the red zone. Carolyn Spring explains this concept she developed based on Stephen Porges’ polyvagal therory.
Phase 2 of the three-phase approach is the aspect of trauma therapy that is most geared towards facing and resolving the intrusive traumatic memories that plague a trauma survivor’s life and manifest in forms such as flashbacks, physiological dysregulation, avoidance, numbing and re-experiencing.
When I first started therapy in 2006, I didn’t know much about trauma and nothing about ‘the three phase approach’. My counsellor didn’t know much more. So although I’d like to say that we started by carefully doing the Phase 1 work of safety and stabilisation, the reality was a great deal messier than that.
WHAT IS EMDR? EMDR stands for Eye Movement Desensitisation and Reprocessing and was developed in 1989 by Dr Francine Shapiro, an American Psychologist and Educator. It is a comprehensive, integrative psychotherapy approach which has been recognised as an effective...
In 2000 I met my first client with dissociative identity disorder (DID). I was completely unprepared for the onslaught of love and horror. We worked with her internal chaos with mutual bewilderment and devotion. I kept meeting someone different: another age, another gender, another language. More and more parts.
‘Dissociative parts of the personality’ grabbed the headlines, but my inability to set boundaries was the silent assassin destroying me from the inside… I said yes to everyone else, and no to myself. Other people mattered; I did not. And so, breakdown.
EXPERTS OR SKILLED HUMAN BEINGS? Over the last few years it has become very clear to us in PODS how difficult it is for so many people with complex trauma histories to find anyone willing to provide therapy to them. Many therapists haven’t heard of dissociative...
1. ACCEPT THAT DISSOCIATIVE IDENTITY DISORDER IS REAL So the psychiatrist says it doesn’t exist, it’s an American fad, or it’s attention-seeking hyper-imagination. The GP doesn’t have a ‘READ’ code for it (“Computer says no”) and it falls between the cracks in this...
This article was based on an interview carried out by Rob Spring and edited by Carolyn Spring. It was first published in the Trauma and Abuse Group journal ‘Interact’ in September 2011 and is reprinted with the kind permission of TAG. My original training was as a...
Once we understand dissociation as a logical response to overwhelming trauma, it stops being so dramatic and different, and the person suffering dissociation stops being ‘complex’ and ‘bizarre’ too. There is nothing bizarre about dissociative disorders—what is bizarre is how some people can be so badly mistreated that they end up with a dissociative disorder.
How should dissociative identity disorder be treated? This brief article provides a summary of the generally accepted approaches.
I don’t think there was ever any teaching on trauma in the counselling training I did. But when I was doing my student placement during my diploma, it was mentioned that there was a person who was losing time, and they wondered if this person might actually be...
BASIS OF GUIDELINES There are no National Institute of Health and Clinical Excellence (NICE) guidelines for the treatment of dissociative identity disorder (DID) and so the best available treatment guidelines are those supplied by the International Society for the...
1. I LIKE PINEAPPLE I don't suppose it's unusual to like pineapple, but here was a person who liked pineapple and blueberries, who ate breakfast, who was real: alive and different and existing in her own right, someone who ate pineapple, not just someone who wanted to...
‘I’m not seeing a doctor!’ I insisted with a look on my face that was intended to end the debate once and for all. As far as I was concerned, it was simple: I wasn’t going to the hospital, walk-in centre or GP surgery, because I couldn’t go. I couldn’t cope with...
I applied, with Emmott Snell’s assistance, for CICA. This is the compensation that the government pays out to victims of crime, administrated by the Criminal Injuries Compensation Authority. In the end I was unsuccessful, but the experience was full of learning that...
PODS ran a survey in 2016 in association with One in Four (www.oneinfour.org.uk) with the aim of assessing the degree to which counsellors and psychotherapists have received training to work with survivors of child sexual abuse (CSA) and child sexual exploitation...
Speaking out for the first time about your abuse is hard enough, but when you feel compelled to do something about it, it can be difficult to know where to start. Considering taking legal action is daunting for many people. You will want to know what your options are...
… it has really struck me how many people with a history of complex and severe trauma cannot get any help whatsoever via the NHS. Many are passed from pillar to post, either being told that they do not meet the criteria to receive services (they are not quite suicidal/traumatised/distressed/non-functioning enough) or that they exceed the criteria (they are too complex/suicidal/traumatised). This leaves people feeling understandably ashamed, powerless and frustrated…
DDNOS is seen by many people as a ‘not yet’ or ‘a not quite’ version of dissociative identity disorder and although it is supposed to be a ‘residual category’ and only given to a few people, in fact the vast majority of people diagnosed with a dissociative disorder fall into this category.
What medications should be used in the treatment of dissociative identity disorder? This fact sheet takes guidance from the ISSTD’s Treatment Guidelines for DID.
The way we respond to trauma is not a matter of choice – it is a biologically preprogrammed set of responses which happen in a predictable sequence. Here we look at the five ‘F’ responses to trauma.
Trauma is an event or series of events that are so overwhelming and threatening to life or sanity that a person cannot cope. The mind may switch off (dissociate) during the event or, at the very least, it will not be able to hold together the different elements of the event afterwards and ‘integrate’ them or join them together.
Dissociative identity disorder does not happen in a vacuum: it does not result from a chemical imbalance in the brain, and is not caused by faulty genes. There may be biological, social and environmental factors which increase people’s vulnerability to developing a dissociative disorder. But more than anything, DID develops as a result of trauma and disorganised attachment.
Dissociative identity disorder is a creative survival mechanism for coping with overwhelming and chronic childhood trauma.
How should dissociative identity disorder be treated? This brief article provides a summary of the generally accepted approaches.
Dissociation is a very common experience and can range from the normal to the pathological. Chronic, problematic, ‘pathological’ dissociation develops when there is repeated threat or trauma, especially when it starts at a young age, and when there is inadequate support or soothing from an attachment figure.
Diagnosis of dissociative disorders is by no means straightforward, mainly due to a lack of training and knowledge. The main diagnostic criteria can be found in the DSM-5 and this article explains how diagnosis is made.
There are a number of diagnostic tools available for assessing dissociative disorders. This article lists the principle ones.
Dissociative disorders appear as diagnostic categorisations in both the American-based DSM-5 produced by the American Psychological Association (APA, 2013), and the other ‘diagnostic’ bible used more widely in Europe, the World Health Organisation’s ICD-10.
The anxiety in her voice was unmistakeable. “I had to go out and look for her,” she explained. “She doesn’t know where she is or what she is doing when she’s like that. I had to go.” This was not an unusual conversation. Many supporters and partners, as well as...
I find myself in a unique situation: I have Dissociative Identity Disorder, and so do my kids. I grew up in a family where child sexual abuse was the norm, and because of my husband this unfortunately played out into my children’s lives until I cut loose and we left....
‘I’m not seeing a doctor!’ I insisted with a look on my face that was intended to end the debate once and for all. As far as I was concerned, it was simple: I wasn’t going to the hospital, walk-in centre or GP surgery, because I couldn’t go. I couldn’t cope with...
I applied, with Emmott Snell’s assistance, for CICA. This is the compensation that the government pays out to victims of crime, administrated by the Criminal Injuries Compensation Authority. In the end I was unsuccessful, but the experience was full of learning that...
Speaking out for the first time about your abuse is hard enough, but when you feel compelled to do something about it, it can be difficult to know where to start. Considering taking legal action is daunting for many people. You will want to know what your options are...
Many survivors get in touch with us simply because they need to talk to someone who understands what they’re going through, and to reassure them that they are not going ‘mad’.
… it has really struck me how many people with a history of complex and severe trauma cannot get any help whatsoever via the NHS. Many are passed from pillar to post, either being told that they do not meet the criteria to receive services (they are not quite suicidal/traumatised/distressed/non-functioning enough) or that they exceed the criteria (they are too complex/suicidal/traumatised). This leaves people feeling understandably ashamed, powerless and frustrated…
What are the most frequently asked questions on the PODS helpline? Client Services Manager reveals the main questions – and her answers.
How do you go about getting a diagnosis for dissociative identity disorder? One client describes her long struggle for treatment on the NHS and the path to the Clinic for Dissociative Survivors.
DDNOS is a strange-sounding diagnosis and seen by many as a ‘not yet’ or ‘not quite’ version of dissociative identity disorder. This article explores the differences between the two diagnoses and whether that difference matters or is arbitrary.
The DSM is the principle psychiatric diagnostic textbook for assessing and diagnosing dissociative disorders. In 2013 there was an update from DSM-IV to DSM-5 and as a result the criteria changed. This article explores and explains those changes.
Once we understand dissociation as a logical response to overwhelming trauma, it stops being so dramatic and different, and the person suffering dissociation stops being ‘complex’ and ‘bizarre’ too. There is nothing bizarre about dissociative disorders—what is bizarre is how some people can be so badly mistreated that they end up with a dissociative disorder.
How should dissociative identity disorder be treated? This brief article provides a summary of the generally accepted approaches.
Diagnosis of dissociative disorders is by no means straightforward, mainly due to a lack of training and knowledge. The main diagnostic criteria can be found in the DSM-5 and this article explains how diagnosis is made.
There are a number of diagnostic tools available for assessing dissociative disorders. This article lists the principle ones.
Dissociative disorders appear as diagnostic categorisations in both the American-based DSM-5 produced by the American Psychological Association (APA, 2013), and the other ‘diagnostic’ bible used more widely in Europe, the World Health Organisation’s ICD-10.
The recommended treatment for dissociative disorders is psychotherapy, but how do you go about finding a therapist or counsellor? This article guides you through the process, either via the NHS or privately.
Who should pay for treatment for survivors of abuse who have gone on to develop a dissociative disorder? For many conditions the expectation would be that help would be available on the NHS, but this is rarely the case for conditions arising from trauma.
All I did was walk into the kitchen and pick up a cloth. But the sudden waft of bleach flung me far, far back into some childhood memory. I switched to a traumatised part of myself. I had been ‘triggered’.
Rather than engaging with mental health services because we trust that they will be helpful, many of us—rightly or wrongly—fear any involvement with them partly because we fear losing further control by being ‘sectioned’. We fear losing our liberty, losing the right to make decisions about our life, and losing the right to choose the kind of treatment we receive.
If you don’t have an LPA, many decisions will be taken on your behalf either by medical professionals or your next of kin or relatives. In situations where you have a domestically violent partner or spouse, or abusive parents, this could put you in a very worrying situation.
Coming to terms with flashbacks—understanding what they are, learning how to manage them, and eventually figuring out how to reduce them—is a cornerstone of recovery. Carolyn Spring explains what goes in the brain during a flashback and how to learn to manage them.
I could cope with it no longer. Every part of me—eyelids, throat, bowels—everything was clenched tight in a ball of furious unbearability. This feeling—such a feeling!—loomed up over me like some prehistoric sea-monster, ready to snap me up and devour me, ready to pilfer my bones and pick apart my brain. This feeling was too much.
I had no idea where I was, except—rather obviously—that I was on a beach. It was raining and I was soaking wet. My legs were drenched up to the knees, indicating that perhaps I’d been in the sea. It was dark and late and freezing cold. I put my hands in my pockets and felt sea-shells. The policewoman told me where I was but it didn’t make any sense.
After trauma our brains are sensitised to threat and our amygdala – our brain’s ‘smoke alarm’ – tends to react to burnt toast as if the house is on fire. In this article Carolyn Spring shows how to turn down the sensitivity of our smoke alarm – and overcome the impacts of trauma.
One of the hardest things I found in dealing with triggers was the aftermath: the shame, the self-blame, the sense of failure and powerlessness that once again something had happened that I’d had no sense of control over.
Crisis makes sense. The adrenaline of it can become addictive, or be all we’ve known. Life doesn’t feel right if things aren’t frantic, if relationships aren’t disastrous. Crisis can be an attachment cry. Crisis is the language of emotions that we don’t know how to regulate.
For a long time, therapy sessions would end with a fairly typical exchange. I would express frustration at myself for not doing enough, and gently but firmly the response from my therapist would go, ‘Be kind to yourself.’
Many survivors get in touch with us simply because they need to talk to someone who understands what they’re going through, and to reassure them that they are not going ‘mad’.
Most people have heard the term ‘ritual abuse’, in particular ‘satanic ritual abuse’ but the reality is that ritual abuse can exist with or without a belief system linked to religion. Many survivors report that any belief system was secondary to the group’s desire to severely abuse, control and frighten others
DDNOS is a strange-sounding diagnosis and seen by many as a ‘not yet’ or ‘not quite’ version of dissociative identity disorder. This article explores the differences between the two diagnoses and whether that difference matters or is arbitrary.
The DSM is the principle psychiatric diagnostic textbook for assessing and diagnosing dissociative disorders. In 2013 there was an update from DSM-IV to DSM-5 and as a result the criteria changed. This article explores and explains those changes.
DDNOS is seen by many people as a ‘not yet’ or ‘a not quite’ version of dissociative identity disorder and although it is supposed to be a ‘residual category’ and only given to a few people, in fact the vast majority of people diagnosed with a dissociative disorder fall into this category.
What medications should be used in the treatment of dissociative identity disorder? This fact sheet takes guidance from the ISSTD’s Treatment Guidelines for DID.
The way we respond to trauma is not a matter of choice – it is a biologically preprogrammed set of responses which happen in a predictable sequence. Here we look at the five ‘F’ responses to trauma.
Trauma is an event or series of events that are so overwhelming and threatening to life or sanity that a person cannot cope. The mind may switch off (dissociate) during the event or, at the very least, it will not be able to hold together the different elements of the event afterwards and ‘integrate’ them or join them together.
Dissociative identity disorder does not happen in a vacuum: it does not result from a chemical imbalance in the brain, and is not caused by faulty genes. There may be biological, social and environmental factors which increase people’s vulnerability to developing a dissociative disorder. But more than anything, DID develops as a result of trauma and disorganised attachment.
Dissociative identity disorder is a creative survival mechanism for coping with overwhelming and chronic childhood trauma.
Dissociation is a very common experience and can range from the normal to the pathological. Chronic, problematic, ‘pathological’ dissociation develops when there is repeated threat or trauma, especially when it starts at a young age, and when there is inadequate support or soothing from an attachment figure.
One of the major difficulties of dissociative identity disorder is that it is so often a ‘disorder of hiddenness’. So what are the principle signs of symptoms?
So I’m curious. On what do you base your belief in dissociative identity disorder? This was a tweet I received from a fellow twit based in the US a few months ago. The more I use social media, the more I realise how controversial dissociative identity disorder is. For...
Dissociative identity disorder … incredibly rare or as common in fact as the hedgehog? This article looks at the studies into how prevalent it really is and some of the complications inherent in such studies.
BASIS OF GUIDELINES There are no National Institute of Health and Clinical Excellence (NICE) guidelines for the treatment of dissociative identity disorder (DID) and so the best available treatment guidelines are those supplied by the International Society for the...
Someone who has dissociative identity disorder may have distinct, coherent identities within themselves that are able to assume control of their behaviour and thought.
After sexual abuse, it’s very common to have difficulties in your sexual relationship. But is that just the way that it is and we have to just accept it? Or is there a way towards a fulfilling sex life after trauma?
‘Child grooming’ refers to a series of actions deliberately undertaken in order to develop an emotional bond with a child in order to sexually abuse them. Grooming increases the availability of the victim for abuse whilst decreasing the likelihood of detection for the abuser.
Understanding the dynamics around child sexual abuse, who the perpetrators are, how they achieve their ends, the impacts of abuse on us—all of this knowledge, this ‘psycho-education’ has aided my recovery. And so these are ten of the many things that I have learned about child sexual abuse, some of the insights that have begun to heal my shame.
It feels a long time ago now, the time when my abuse sat silent within me. It’s been over ten years. Back then, I didn’t understand any of the dynamics of abuse. The things that had happened, the things that had been done to me, the things I had been made to do—they sat silently within me as heavy weights on my soul, fetid non-reminders of my badness, this toxic mush that I thought was me.
Duncan Craig is the founder of Survivors Manchester and talks here about the impact of sexual abuse on men.
Samantha Russell, a survivor of child sexual abuse, talks about her experience of childbirth after trauma.
To experience sexual abuse as a child, as I did, is to experience an act or indeed many acts of powerlessness. This can have a devastating impact on relationships that continues into adulthood, and it often manifests itself in two extremes – being controlling, or remaining a victim.
It’s not a definition or some bullet-points on a page, a menu of things that were done or could have been done, or might yet be done. It’s something to do with me as a person, the me that I’m so scared to show you, that I’m so scared to be, because of what happened …
Dr Nick Read, a retired medical professor and now a psychotherapist, explains the link between trauma and irritable bowel syndrome – and what can be done about it.
The ‘trauma traffic light’ represents three physiological states that the body can shift gear between, depending on levels of threat or security in the world: the green zone, the amber zone or the red zone. Carolyn Spring explains this concept she developed based on Stephen Porges’ polyvagal therory.
I was born 35 years ago. With this body. This body that is a little too short and a little too plump. This body that sags in all the wrong places and looks the age it is, not the age I feel. This body that has produced two healthy children and enabled me to watch them grow. This body has been with me my entire life.
What medications should be used in the treatment of dissociative identity disorder? This fact sheet takes guidance from the ISSTD’s Treatment Guidelines for DID.
Physical symptoms are a big part of life for me with DID. Yes, I have ‘multiple personalities’, the “two or more distinct identities that recurrently take control of the body” and I’m not for one moment denying the significance of that or the impact it has on my day-to-day life. But I would say that physical symptoms such as chronic, unexplained pain, headaches and nausea have been and still remain far more distressing and life-impacting for me than the presence of parts.
I hate my body. It was there, always there, during the abuse. My mind went away but my body could not. My mind could forget. We parcelled up little chunks of our mind, bit by bit, and sent them off into dim little rooms where they could be forgotten and not heard.