DID question

elkpark · Feb 14, 2006

There was an interesting thread on the same topic not too long ago -- you could start by searching and reviewing the older thread.

dreamofnurse · Feb 14, 2006

I was majoring in psych before getting into nursing, and abnormal psych was my favorite class. We watched the movie Sybil(sp) and I know it's a book as well, to illustrate DID/MPD.

I personally found it difficult to take in and it's not something I would want to watch or read for fun, but it might be helpful to your project :)

Thunderwolf, MSN, RN · Feb 14, 2006

Use my PINK search link below to make an quick search.

FYI....it is a very rare disorder.

leslie :-D · Feb 14, 2006

FYI....it is a very rare disorder.

really? :confused:

according to my therapist (whose clients have included those w/DID), it's not as rare as some may think....

leslie

CharlieRN · Feb 14, 2006

I have worked with hundreds of DID patients as primary nurse. One of whom may have been Truddi Chase.

There is contraversy re how common DID is mostly due to its sx pattern overlapping the symptomatology of schizophrenia. If you sometimes are convinced you are a 30 yr old male but you have the body of a 22 yr old female, then you can be discribed as delusional. A delusion is defined as a fixed, false, belief. Delusions are a first rank symptom of psychosis. Similarly, DID pt discribe ghearing their alternate personalities argueing in their head. Hallucinations are also a first rank pyschotic symptom.

Psychosis can be treated with medication but DID is medication resistent and has to be addressed by talk therapies. There is a major disagreement over medical model verses psychiatric model of threatment and of therapy.

There is a good bit of psychiatric politics involved in this. Those who support the higher incidence of DID are affirming a high incidence of profound, usually intra familial, sexual abuse of young children, usually female. This is the causative substrate for DID. They are also affirming the possiblity of repressed memory.

Intra famial sexual abuse is a political hot potato that psychiatry has been shying away from since Freud stumbled acrossed it. Adding to the general discomfort is the presence, in recent years, of the "false Memory" lobby. A group which preports to be composed of falsely accused parents. Their prefered tactic is to sue therapists who diagnose DID. They are very well financed and have funded research to prove that false memories can be induced by asking about them. I have met with their scientist and found her reseach seriously flawed. But their suits are costly and psychiatrists are not heros so the rate of dx of DID has sharply declined. If you diagnos the patient as a treatment resistent schizophrenic she can be kept on meds for the rest of her life. She will never get better but then there is no expectation of cure for that diagnostic catagory. So its a strong temptation to go that route. The down side is that DID is frequently cured or greatly improved by talk therapy.

Needless to say I am not a neutral in this particular war. :)

Thunderwolf, MSN, RN · Feb 14, 2006

There is much debate over this DX. Really, I think that is a good thing. My personal thought on it is that to date it is not as clearly understood...as so many other DXs. In my past, I was an outpt psychiatric counselor (licensed) and have worked with many folks. I have even worked in one city that was often deemed the DID Mecca, much due to one psychiatrist who did abuse that diagnosis for his own pursuits of fame. I no longer work in psych/counseling, needed a change. But, I have more of tendency to view this dx as a much severe form of PTSD, often originating in childhood, stemming out of severe, ritualistic, sexual abuse/physical torture. During this genesis, all norms, rules, boundaries which hold perception of self and environment are rendered meaningless. In order to survive, the person needs to develop unconsciously these fractionated pieces of self into distinct personalities that can function on their own in that environment. Later on, this means to adapt becomes maladaptive for the environment has now changed (no abuse/torture). I guess the closest thing that many a nurse can relate to with regard to DID is burn victims in burn units who are undergoing burn treatment....removal of dead, burned tissue from living tissue. Very painful. These folks often and need to dissociate from their painful bodies. Also, we all dissociate on a daily basis when we day dream, get lost in thought....a normal occurrence and not a disorder. So, in a sense, dissociation is very common. But, to the extreme as a DID, very rare in comparison to other disorders. I personally, 10 years in psych/counseling, have maybe met one genuine DID. The rest were misdiagnosed (dx even changed later on by psych), malingers, BPDs/hystrionics who were DID wannabees for the attention it brings (and is less stigmatizing), or folks with actual physical health problems that were undiagnosed and needed addressed (ie brain tumors). I do not doubt DID exists, but my experience/exposure has found it to be much rarer than what has been sensationalized. Until better, unbiased, research comes along to understand it, I am more apt to believe it is a rare, severe form of PTSD with the genesis in childhood when the core personality is still forming under EXTREME forms of torture/abuse. However, obtaining better, unbiased, research is the crux and the drawback because often research today is funded by pharmaceutical companies...who have their own agenda. DID is not a money maker for them. Also, and however, DID is politically costly/ hot potato in the psychiatric community...not many in the psychiatric community wish to touch it for long in order to understand it better from a personal research perspective (not fame driven). Dissociation is common....but, DID is not...again, this is my perspective...please no flames! Lastly, many psych disorders have dissociative traits which they share or may even have more dissociative loadings than others. Therefore, having ongoing, differential, assessments is very important during the course of treatment....is this DID or something(s) else? Unfortunately, our managed care system does not afford or allow this to happen....and folks get misdiagnosed and given misdirected treatment.

elkpark · Feb 14, 2006

I personally, 10 years in psych/counseling, have maybe met one genuine DID. The rest were misdiagnosed (dx even changed later on by psych), malingers, BPDs/hystrionics who were DID wannabees for the attention it brings (and is less stigmatizing), or folks with actual physical health problems that were undiagnosed and needed addressed (ie brain tumors). I do not doubt DID exists, but my experience/exposure has found it to much rarer than what has been sensationalized.

I agree with Wolfie -- the disorder is definitely out there, but, for a number of reasons, is seriously overdiagnosed. In my >20 years in psych, I've only seen a few cases of legitimate DID.

I also agree with CharlieRN that it's difficult to get a clear handle on what's reallly going on with DID because the entire discusssion has become so polilticized -- too many conflicting personal agendas.

Stdy2BaNurse · Feb 15, 2006

Thanks for the replies. I did search the threads and found a couple, but the info you have presented here really helps. I have forged on into the book and have to admit, it is intriguing. There are parts that make me want to cry, be angry, laugh - the whole bit... I guess what I am having issue with is the fact that she has over 90 documented personalities. I guess I need to finish the book before I come to any conclusions.

The info provided is much appreciated and will definitely help me keep an 'open mind' as I read through this lady's experience.

Thanks to all :)

Traci

spaniel · Feb 15, 2006

As I had once posted, I too have seen only one case of possible true DID, and even that was suspect. The idea of this being a form of severe PTSD with some psychotic overlay makes some sense to me.

On the other hand, I'm curious-what have your experiences been with Depersonalization Disorder? I'm referring to pimary Depersonalization Disorder, not depersonalization secondary to another diagnostic category.

I guess I have to wonder in what way dissociation/depersonalization is truly protective intrapsychically. Yea, surely,one could debate that the "self" is protected from an even "greater" ill, so to speak. I guess what I'm saying here, is that I lean towards a biochemical response that might be seen in cases of extreme stress.

Thunderwolf, MSN, RN · Feb 15, 2006

As I had once posted, I too have seen only one case of possible true DID, and even that was suspect. The idea of this being a form of severe PTSD with some psychotic overlay makes some sense to me.
On the other hand, I'm curious-what have your experiences been with Depersonalization Disorder? I'm referring to pimary Depersonalization Disorder, not depersonalization secondary to another diagnostic category.
I guess I have to wonder in what way dissociation/depersonalization is truly protective intrapsychically. Yea, surely,one could debate that the "self" is protected from an even "greater" ill, so to speak. I guess what I'm saying here, is that I lean towards a biochemical response that might be seen in cases of extreme stress.

Like dissociation vs DID, depersonalization is a common occurrence which can worsen by stress, especially if severe....but in and of itself is not a disorder. Many folks with and without psych disorders experience periods of depersonalization...but, do not have Depersonalization Disorder. Depersonalization Disorder (DD) by definition exists when all other explanations are ruled out, and yet causes significant distress or impairment. In a sense, it is an end of the line differential diagnosis...nothing else as a disorder (psych, medical, substance) can account for it. I agree with you in that there is a biochemical response...this just makes sense...but what kind of biochemical response goes on during dissociation, depersonalization (and derealization), DID, and DD is unclear. And stress worsens them all. Personally, I believe they all fall on the PTSD continuum...with maybe DD less so. Now a primary DD...Hmmm....tis interesting. Something else usually accounts for most depersonalization from what I've experienced, read, and come to understand. In my mind, primary DD seems to me to be more of a lingering residual syndrome after another significant syndrome has since been resolved (like an aftermath of sorts, leaving the person sensitized), and/or after the event of a significant stressor (a subclinical form of PTSD?), and/or a subthreshold syndrome of perceptual disturbance (maybe even a mild subclinical form of psychosis)...but continues in and of itself to cause disruption in that person's life. Depersonalization Disorder as a disorder just needs more study/research to better understand it (in order to tease it out better). To me, as a disorder, it remains too fuzzy and ill defined. However, rarely does persons come into therapy/tx expressing depersonalization as the cause for their visit (if they do, it is often a flag of another diagnosis for me)....it is usually due to feelings of anxiety or depressive symptoms secondary to the depersonalization (but without an actual anxiety/depressive disorder being present). Okey, I'm going to end here. But, this is my take on it. I don't know if I made this clearer or more muddled for you. But, I hope it did answer some of your question.

CharlieRN · Feb 15, 2006

I agree with thunderwolf and elkpark, DID is indeed a severe form of PTSD. It necssarily is formed by severe, usually sexual, intrafamilial torture in early childhood. So you can't have DID without also having PTSD. It is almost always accompanied by the other diagnoses that go with an abuse history, borderline personality d/o and depression. The patients are almost exclusively female. Men certainly can dissociate but usually don't retain dissociation as a primary defence mechanism. I have worked with perhaps 2 or 3 males with significant dissociation but they let it go once they were out of the adversive situation.

The dx is complicated by the mechanism of dissociation, which is essentially self hypnosis. These patients as a class are excellant hypnotic subjects. they are highly suggestable. A careless therapist can easily make things worse. Just being too excited about exploring the rare dx that the pt presents can be counter theraputic.

Also I agree about its rarity. I have worked with hundreds of cases, but I worked on a dedicated women's specialty unit for 5 years. We drew patients from all of the northeastern US and eastern Canada. The unit had about 20 beds and at any given time 50% of those would carry a DID dx. The rest would be PTSD, BPD, and Depression without significant dissociation. The average lenght of stay was 2weeks. So 10 x 26 x 5 = 1300. Reduce that by some factor to account for return customers.

I was one of several male nurses and therapists employed on that program. This was a reasoned theraputic decison made by the (female) physician in charge. She felt that to employ an all female staff would perpetuate and reinforce the false perception of all males as abusers. Try and imagine being male working in that environment. Can we spell "lightening-rod"?

Truddi Chase was not my primary patient at any time. I think she was a patient on that unit. I remember hearing about the book being in process.

As to what good the dissociative defense does the patient. It is hard to imagine a more effective psychological defense. The person can simply, "not be there" to endure the torture. The bad stuff happens to someone else. Once learned, it is hard to get them to give it up. In real world terms it is also useful to the patient. Let me relate a true story, told to me by the patient. The patient was a newly diagnosed young woman who had come into treatment because of a biszarre thing that happened to her. She had been on a date that was rapidly deteriorating into a "date rape" situation. She was terrified as she realized the man had no intension of letting her get out of the situation without sex. Suddenly she found herself a "passenger" in her own body. Someone else, a much tougher, more experienced and manipiulative woman had taken over. This other easily managed to talk her way out of the situation. The patient was saved from the rape, but her entire world view was shattered. She had conveniently forgotten(denied) the abuse that had lead to her having those skills.