I am a pre-nursing student awaiting 'the letter' for fall admission. In the meantime, I have to take classes this spring to prevent repaying my student loans. I have enjoyed the Psych classes I have had to take thus far, so I jumped right in to Abnormal Psych. 5 weeks into the semester and we are just now getting to disorders - one we covered today is DID. In addition, we must do a written and oral book report on a psych related book. I was given "When Rabbit Howls", by The Troops for Truddi Chase. After listening to our lecture today about DID and hearing my prof's opinions, I am having a hard time getting into my book with an open mind.
I thought some of you here might be able to give me your opinions - for or against the dx of DID.
Specializes in Med-Surg, Geriatric, Behavioral Health.
I agree with CharlieRN. Folks with both DID and DD are highly suggestible and hypnotizable. This realm of disorders is not for the new/naive therapist to play around with. Having clinical supervision really needs to be a part of the therapeutic framework when working with this population. A careless therapist can make things so much worse....or having a careless therapist diagnose DID all over the place. I agree with CharlieRN about the issue of coping mechanisms gone awry. I did not include this previously too much...trying not to sound too Freudian. But, coping mechanisms is largely a part of what we are talking about.
Wonderful input, CharlieRN, as always.
Thank you.
Like to see you start more threads in the future...you bring much to the table, always valuable.
I wrote a post when I saw it come up in my Inbox, but somehow it disappeared. My fault I'm sure. Oh well... since a few minutes elapsed I'll try to recreate it.
Thanks Wolfie and Charlie. Nope-I wasn't really confused regarding the differentiation between Depersonalization Disorder,primary and co-morbid dxs.
And I too believe there surely is a component of PTSD in primary depersonalization disorder. Frankly I'd have to see the comorbid anxiety as protective in the sense that the person would "call out" for help. (But I guess as you sorta indicated, if the anxiety were a signficant component,then it might not be classified as primary Depersonalization. Still and all, I have to wonder why it is a separate diagnostic category. Perhaps because the element of the depersonalization predominates in SOME way. )
But I want to go back to my query regarding the typical use of defense.It's easy for me to see the defensive use of dissociation . It's less easy for me to see the defense in depersonalization,except to say that in some way it "saves something more important than the feeling of the self". In depersonalization, the person often feels disembodied, "not real" and things don't look real (technically derealization). But reality testing is intact,etc. so a "sane" person would/should feel anxiety. The anxiety feeds and escalates.
So as Charlie pointed out in the DID, a very serious situation (rape) ends up NOT being "the" threat as the expense of the world view. So- I'm thinking out loud here. In Depersonalization Disorder, the feeling of the self is lost to protect from_____. Yet the anxiety exists to perhaps rescue the feeling of the self, in a way. Any thoughts?
Oh boy- now I can see why I continued to work CCU while in psych grad school!
Specializes in Med-Surg, Geriatric, Behavioral Health.
oh, spaniel...you naughty pup...you make it so difficult. :chuckle
maybe, one way to view some of the difference is:
dissociation-removal of self in order to escape the environment/stimuli to a more pleasant one...self is elsewhere/removed/shut off..."i'm not here, but some where else"...did takes it to the nth degree and removes self from self and from the environment. we often experience dissociation when we listen to music, watch movies/sports, have sex, or when driving.
depersonalization-change of perceived self toself yet fully present within the environment/stimuli...self is present but perceived foreign/odd/changed, but world feels normal..."my body/mind is acting or feels strange/different (the change is noticeable to the person)". "i feel like a stranger to myself...my body has a mind of its own". common experiences: we can experience this when in high emotional states, such as anger or fear. "i was frozen to the spot and couldn't move" "i was so angry, i didn't feel the pain". "i felt numb after i heard the news". "i hit him without thinking...that's not like me". "why am i thinking this way?!...this is not like me!" in depersonalization disorder, the change is unwelcome and generates its own distress.
derealization-self is present but the environmental stimuli is skewed or changed..."the world seems like a dream (movie; the matrix)". common experiences...developing tunnel vision during stress (accident lawyers know this), misperception of environmental cues aka illusions(magicians/illusionists take advantage of this...we are easily fooled), when suddenly awakened after a hard sleep and need a few minutes to adjust, or having dreams.
ptsd-self is presentbut the current, perceived environment is changed/replaced by a one that was past experienced, caused perceived/actual harm, and has been avoided since-reliving the moment(s)
in this brief capsulet, you can easily see why periods of depersonalization (numbing, detachment, physiological reactivity, intrusive thoughts/memories), derealization (flashbacks, nightmares, triggers, distraction), and dissociation (limited recall/memory disturbances, avoidance) are often present in ptsd. they are common in our every day experiences!...but jacked up to the nth degree in ptsd.
so, really....no big mystery...when you look at the big picture.
when viewed this way, does depersonalization make a little bit more sense? when faced with a significant stressor, the mind has to adapt and change to it. this can be perceptual or structural. the body often has to change as well....often below our perceptual ability. when changes do occur (mind/body) and are perceived and viewed as beneficial, they are often welcomed. however, when they are not perceived and viewed in a positive way, the change becomes a stressor of its own and generates its own discomfort. in depersonalization disorder, this added discomfort by the perceived and unwelcomed change ("this is so foreign and removed from me") often self generates its own symptoms of anxiety and depression. this is what usually brings the person in....the anxiety and/or depressive symptoms (but not enough to generate a full blown anxiety/depressive disorder). so, the person is definitely uncomfortable about the whole process and how it has impacted their functioning in daily living.
due to the commonality of dissociation, depersonalization, and derealization in our every day experiences, we hardly notice it when it occurs. but, when it becomes a life of its own and causes impairment in functioning, it is often very distressful. when this occurs at this level, the feeling/sense of a loss of control of oneself/environment often becomes universal.
in summary:
ptsd most common. did most rare. either one...it is no picnic.
dd...probably more common than what we realize....but, it still needs better defined as a free standing disorder.
to pull it all together, see the movie, altered states...yeah, a severe "hollywood" case...but actually, it is a lot of what we are talking about here....and a lot more fun and entertaining.
I think of all of those as disorders as being disorders of repressed intolerable memory. The problem being that we have a wonderful brain designed to remember. So the repression is never total. This results in varing degrees of discomfort, anxiety, depression etc. This is a nice explanation except it is a touch too neat.
It always seems that the successfull dissociation in DID pts starts to break down when the dissociative defense is no longer needed for the survival of the person. Of course I was only seeing clients who's dissociative defenses held up till they were out of danger. Those who's defenses failed did not survive. None the less, I came to believe that there was a controling "watch dog' or "manager" personality fragment present most of the time. Not necessarily a particular mature fragment since the decisions are not necessarily too logical. Sometimes it seemed that the "who's turn is it to drive" decisions were being made by a committee, rather than a single entity, but they were being made. It is, I think, this semi controled quality to DID that many therapists sense and which may lead to disbelief in the diagnosis. It does share the same substrate as BPD and can feel and be manipulative.
Another point is that the therapist can never assume that because the part of the patient's system of personality fragments, that is presenting at the moment, is cooperative and wants to heal, that the entire system shares this view. It is not safe to assume that the other aspects are unconscious because they are not active. They can be and often are wide awake and listening.
I'll tell another story. I went to check in with one of my primarys one day. She greated me cheerily with the anouncement that she had decided she was not a multiple. I asked, "How do the others feel about that?" She answered immediately, "Oh, they are really mad at me."
This is all so fascinating. I am trying to take it all in. As my reading progresses, I am seeing how these different personalities have developed - in reaction to a need or another event. Here are a couple of concerns that I have:
1) the doctor's foreward in the book states that there can be medical issues evident with some personalities and not others - ie. tumors, pregnancy symptoms, etc.
2) when describing her fluid changes into other personalities, he describes facial changes that seem impossible...physical changes. Maybe I'm reading too much into it.
Specializes in Med-Surg, Geriatric, Behavioral Health.
Interesting exposition Wolfie.
I think of all of those as disorders as being disorders of repressed intolerable memory. The problem being that we have a wonderful brain designed to remember. So the repression is never total. This results in varing degrees of discomfort, anxiety, depression etc. This is a nice explanation except it is a touch too neat.
Yes, a little too neat...but this stuff can be a little complex for a lot of folks. I thought that a little time out in order to expand upon terms, to discuss commonality vs rarity, and to simplify a little was in order here. This stuff can get way too heady for many or sound too esoterical when not explaining it carefully. So, yeah, a little neat...I agree. Also, I was trying not to sound too psychodynamic/freudian in discussing it...which for some folks can sound like mumbo jumbo/less scientific. However, I do agree with you regarding repression. The mind never forgets...neither does the body. When the memories begin to surface into awareness (in a trickle or in a flood), tension results producing the various symptoms. I'm with you on that, no problem. In fact, I alluded to this:
When changes do occur (mind/body) and are perceived and viewed as beneficial, they are often welcomed. However, when they are not perceived and viewed in a positive way, the change becomes a stressor of its own and generates its own discomfort.
Charlie, my friend, I appreciate much what you bring to the plate...your experience and your knowledge base...so members may learn or become better informed. Please continue. Maybe, now is the time for you to expand a little on the relevant psychodynamics or on psychodynamic terms often used here on these disorders. Maybe starting with Study2BaNurse's most recent post could be a place to begin. The podium is yours. I'll go off to mod my other forums for awhile. Thanks, my friend. This has become a most excellent thread.
Specializes in Med-Surg, Geriatric, Behavioral Health.
I'll tell another story. I went to check in with one of my primarys one day. She greated me cheerily with the anouncement that she had decided she was not a multiple. I asked, "How do the others feel about that?" She answered immediately, "Oh, they are really mad at me."
wonderful topic! My experience is limited with DID. I do recall one gal who was allergic to strawberries,but loved & ate them,then would "leave" when the hives began to show. This was also one of the more self injurious/high risk taking alters who tended to put the whole system at risk when she was decompensating,drugs,different types of roulette. We did see markedly changed lab values in observed situations as well. I fully agree about this not being territory for the inexperienced or easily drawn in therapist.
What stood out in the post was "the body doesn't forget".. or words to that effect. I think there is a whole slew of dyamics that may play into some of the odd perceptual/bodily sensations in Depersonalization disorder.My thinking on this is that some (or much) of the original damage may be preverbal.Again, as Thunderwolf notes, the elements of depersonalization/derealization are part and parcel of normative experience to some extent (i.e. sleep deprivation .) What I'd be interested in is identifying sources of resilience in the population of people who have been diagnosed with DID,DD, and for that matter PTSD.
Fascinating thread. and thank you for best discussion I have read on this BB. I haven't had any experience with this group therefore can't comment, but I have been enlightened by what I have read so far, and will continue to watch this space.
This is all so fascinating. I am trying to take it all in. As my reading progresses, I am seeing how these different personalities have developed - in reaction to a need or another event. Here are a couple of concerns that I have:
1) the doctor's foreward in the book states that there can be medical issues evident with some personalities and not others - ie. tumors, pregnancy symptoms, etc.
2) when describing her fluid changes into other personalities, he describes facial changes that seem impossible...physical changes. Maybe I'm reading too much into it.
What are your thoughts/opinions?
Thanks for the wonderful information!!
Responding to Wolfie's invite I will coment on your post.
Both of these symptoms can be addressed by reference to the first DID client I ever delt with. She was a 29 yo, single, caucasion female. Lets talk about #2, first. Her presentation when admitted and for most of the time she was on our unit, was that of a mentally retarded 12 year old. That is she appeared mentally dull, she moved slowly in a dazed state. She had a bland personality and a "blunted" affect. She never wore even minimal makeup and seemed to be sexually undeveloped, flat chested and narrow hipped. She displayed poverty of thought content to the point that I assumed her to be illiterate, based on her presentation.
Then one day I walked into her room and found a sexually mature, young woman reclining on her bed! She most definately had breasts and curves. She had an interested and alert expression. I almost did not recognize her. She carried on a alert friendly, and oriented adult conversation with me. I delivered the message I had come with and went to find her therapist. (At no time did I get closer than 15 feet to her.) Later her therapist told me I had met "Suzanne", who existed for the purpose of seducing male staff. My caution and professionalism were just the right response and I never met "Suzanne" again but I did get to meet some of her other more adult alters later on.
Which brings me to #1. She told me that some of her alters were photosensitive while taking thorozine but others were not. Which confirms the biochemical changes from one alter to another.
I theorize that the various alters habitualy use different groups of facial and skeletal muscles, in varing combinations. There is a certain, cartoon or sketch like, presentation to an "alter", compared to the integrated personality of the same person. Unfortunately you only see this after years of successful therapy. The alters look plenty real at the time but in retrospect you can see that they lacked the range and vitality of an integrated personality.
Thunderwolf, MSN, RN
3 Articles; 6,621 Posts
I agree with CharlieRN. Folks with both DID and DD are highly suggestible and hypnotizable. This realm of disorders is not for the new/naive therapist to play around with. Having clinical supervision really needs to be a part of the therapeutic framework when working with this population. A careless therapist can make things so much worse....or having a careless therapist diagnose DID all over the place. I agree with CharlieRN about the issue of coping mechanisms gone awry. I did not include this previously too much...trying not to sound too Freudian.
But, coping mechanisms is largely a part of what we are talking about.
Wonderful input, CharlieRN, as always.
Thank you.
Like to see you start more threads in the future...you bring much to the table, always valuable.