An Outlet to Find Out Shit

From the point of view of the side of academia that’s all about social constructivism, saying “DID is a social construction” is kinda a matter of “whoaaa no shit?”. But somehow, these psychologists have latched onto the idea of socially constructed disorders only in this specific context. So like, the shifting demographics of DID or the way its diagnosis responds to popular media is Evidence! that DID isn’t quite as worthwhile or solid a disorder as, say, schizophrenia.

But schizophrenia has sure as hell gone through its own demographic shifts: from being a diagnosis of white women to one of Black men, from including those psychology now considers autistic or DID to separating out those labels, etc. Hearing voices differs phenomenologically across groups. Delusions differ massively. The general course of schizophrenia diffferrrrrs.

There needs to be a sociocognitive model for every disorder. So the sociocognitive model of DID just pisses me ooffff.

These are from the DSM-5

Myth: people with DID only forget their abuse and/or childhood

Fact: “Amnesia in individuals with dissociative identity disorder is not limited to stressful or traumatic events; these individuals often cannot recall everyday events as well.” -page 293, paragraph 2, last sentence

Myth: DID only forms in children

Fact: “The full disorder may first manifest at almost any age (from earliest childhood to late life)” -page 294, second paragraph under Development and Course

Myth: people with DID can’t/don’t have any other mental problems

How do so many other DID systems know so much about their alters?  Is there something wrong with me?  I mean, you know, something else wrong with me?

I see people writing personal histories and back-stories for each of their alters, and I wouldn’t be able to do that if I tried.  I don’t know anything about their personal histories other than their histories in relation to my own.  

I see people talking about drawing sketches of their alters, and while I have a basic idea of the appearances of some of mine, I certainly wouldn’t know them well enough to give a full-out description or make an accurate drawing.  Maybe of one or two, but for the most part I have no idea what they would look like.

I see people whose alters write entries in their blogs, and I can’t ever see mine ever doing anything like that.  Mine very rarely present “publicly” and really only interact with myself and each other.  Sometimes out loud, sometimes internally, sometimes a mix of both.  It’s always the most frustrating when everyone wants to say their piece using the vocal chords, and then people start losing their train of thought while they wait for their turn to use the mouth.  Like, seriously, I can hear them either way so I don’t know why they sometimes insist on using the mouth.  But… These things never happen in front of other people.  

I almost always remember it when one of them takes the wheel, which I have been told is not how it’s supposed to work.  You’re supposed to have “black-out” times.  I do have black-out times, too, but not very often.  Usually I am quite present when someone else is at the wheel.  I just have little to no control over what they say or do… I can only watch helplessly as they do it.

I don’t get it.  Is my experience unique to DID, or is it possible that I’ve been misdiagnosed?

1. Every DID system is different. The disorder can present itself in many ways. Any of the following could be reasons someone knows a lot about their alters: > they have made efforts to increase communication, such as journaling, keeping logs, using recordings, apps, etc > they have been in therapy and working towards knowing each other and functioning together > they happen to be more integrated than your system > something else I haven’t listed There is nothing wrong with you, your system, or your diagnosis. Your experiences are completely real and valid.

2. It’s okay to know about your alters’ appearances and actions and histories. It’s also okay to know absolutely nothing about them other than that they exist. DID is a complex disorder and our brains are very strange. A lot of things can be possible. Not being able to write about, draw, or introduce your alters is actually very common; it just may not seem that way when the systems who know a lot about each other speak the most and loudest. As for alters having personal histories not related to your own, this seems to be a strange phenomenon that is definitely not a constant across systems. Not everyone has alters who have their own back-stories. It is okay to have or not have this experience.

3. It only seems common/typical for alters to be writing blog entries because this site is a blogging platform, and the loudest members of the DID community here are those whose alters seem to be more aware and active. Your alters may not be openly communicating in public because really, DID is a coping mechanism with emphasis on hiding, avoiding, and protecting. Your situation is perfectly normal. In fact, it sounds like your system is focused on safety in this respect.

4. It’s okay to know about or remember when an alter “takes the wheel”. It’s also okay to only have some black-outs and to be watching what an alter does when they’re fronting. This is normal for many systems! This even happens to me sometimes. I will be “watching through a window” as someone does something I can’t control.

The DDIS (dissociative disorder interview schedule) has a few questions about this. I forget exaaactly what some of the questions are or where the cut-off is, but things that push it towards DID include: different names, referring to other system members/the body in the third person, and clear episodes of “that was X headmate doing that – that wasn’t me”. But mostly it’s just on a scale – check off 8 symptoms, you have DID – only 7, it’s OSDD-1a if you have amnesia, OSDD-1b if you don’t.

I think for the most part, it really depends on the doctor. OSDD diagnoses are infamous for sometimes being placed on folks who do “technically have DID”, but who haven’t shown enough symptoms to their doctors (in the DSM-IV, the doctor actually had to view a switch personally, which should be pretty obviously problematic) or who have doctors who are just hesitant to give the big D-I-D diagnosis.

Like, the MID (Multidimensional Inventory of Dissociation) is by Dell, who has a lot of problems with the DID-OSDD distinction, and so doesn’t even have an OSDD-1a category – just DID and OSDD-1b. (fun fact: our experiences sort of break the calculations on the official excel sheet. OOPS.)

(tbh I agree with Dell, that the distinction isn’t entirely tenable, like DID vs OSDD-1b is a ‘either you have amnesia or you don’t’ thing, while DID vs OSDD-1a is way more of a scalar thing. (although it’d make more sense to me to have amnesia be a specifier of DID, mostly because then maybe 'DID without amnesia’ would get some research, whereas -NOS categories basically never get properly researched. Plus it might stop the tendency to talk about “DID and OSDD”, because OSDD-1 is such a big part of all OSDD diagnoses, and would leave some room for non-1 OSDD diagnoses.))

Is it possible that it has something to do with breaking routines, sensory issues, or anxiety preventing you from being able to clean when you’re more connected to your emotions or body? It could also be that the depression makes it difficult for you to clean normally but dissociating gives you some mental distance from the depression’s effects. I personally tend to always be at least mildly dissociated, but I’ve noticed that slightly heavier levels of dissociation can protect me from being as overwhelmed by novel situations or crowds (though too much dissociation can also make everything worse- go figure!).

Do any of our followers have any input?

So after preliminary research, here’s what I found:

1. Dissociative disorders, and DID in particular, are a raging inferno of controversy in both the psychological and legal worlds.

2. This is partly due to some patients faking symptoms to try to escape consequences for their actions. This is also due to a heavy overlap of symptoms with depression, anxiety disorders, and severe stress disorders.

3. These disorders may even be brought on by the therapists themselves. Some recent research shows that these dissociative states may be brought on by old and faulty therapies and treatments. This is mostly due to the idea of dissociative disorders relying on the Freudian concept of repression.

4. The previous entries in no way meant to imply that the psychological world even agrees that these disorders exist. Due to the disorders relying on the Freudian concept of repression, many psychologists say that these disorders are old explanations for the previously mentioned disorders that they overlap with. This is due to most of Freud’s theories having since been discredited.

I also found that the only dissociative disorder that even involves alters is DID. So to answer your question, we need to presuppose three things:

1. Dissociative disorders are real

2. They are not the product of old and faulty therapies and treatments

3. There is a dissociative disorder that involves alters and is not DID

While it’s true that the physical structure of the brain is constant between alters, the way that the brain and body responds to different alters, particularly trauma-oriented versus non-trauma-oriented alters, is known to change. (x x x) It should be noted that individuals without DID fail to match these differences.

Only 2-14% of all presentations of dissociative disorders can be attributed to either factitious disorder or malingering with higher rates being found within specialty dissociative disorder units and within referrals to expert consultants. (x) These rates are very similar to rates found in the respective populations for other disorders and diseases (for example, one study placed the prevalence of factitious disorders in tertiary care settings such as specialized treatment for cancer at 9% (x)). It should also be noted that DID is not actually a commonly used defense in court, though PTSD is.

In regards to the overlap of symptoms, DID is often viewed as the most extreme disorder on a spectrum that includes PTSD (a trauma- and stressor- related disorder; I assume this is what you would call a “severe stress disorder”). This fits the theory of structural dissociation (addressed below) and also matches the fact that both disorders involve dissociative symptoms (flashbacks are often described as dissociative intrusions) and are the result of trauma or extreme stress. Despite this, it’s clear that the phenomena experienced by those with co-morbid PTSD and DID goes beyond that experienced by those with only PTSD. As well, because of the origin of DID, it, like PTSD, does have high co-morbidity rates with anxiety and depressive disorders. However, I’ve never seen any suggestions that DID could actually be either an anxiety or depressive disorder because the criteria between these categories of disorders are vastly different. May I ask how you came to such a unique conclusion?

While iatrogenic DID is possible, neither iatrogenic nor sociocognitive sources can explain the majority of cases of DID. One study found that 73% of individuals with DID have corroboration for having experienced dissociative symptoms prior to receiving a diagnosis of DID and 67% for dissociative symptoms prior to therapy. (x) Other studies have found treatment for DID to be highly effective at lowering self-injurious behaviors and the number of necessary hospitalizations; increasing adaptive functioning; lowering levels of dissociation, PTSD, and distress; improving  Schneiderian first rank symptoms, mood and anxiety disorder symptoms, and somatization symptoms; and decreasing the number of psychiatric medications prescribed. Integration was associated with more significant improvements. (x x) It’s highly unlikely that treatment that led the fabrication of a previously non-existent syndrome would lead to such drastic improvements. Finally, it’s been shown that individuals with DID consistently show symptoms that are not widely, popularly, or even always clinically associated with DID. (x)

In addition to the above evidence that DID is not iatrogenic, there is strong evidence that DID is traumagenic. Part of this evidence lies in the differences between trauma-oriented and non-trauma-oriented parts as was discussed in the second paragraph of this response.The theory of structural dissociation also strongly links DID with childhood trauma, as does the extremely high rate of co-morbidity between DID and PTSD. One study confirmed reported cases of child abuse in eight out of nine cases of DID and all twelve cases of DDNOS (now OSDD) studied. (x) There are many also similarities between the brains of individuals with PTSD and DID, though there are also unique differences, some of which can be correlated to the level of dissociation experienced by the individual. (x x)

Dissociative disorders do not rely on the Freudian concept of repression. Not even DID or dissociative amnesia rely on the Freudian concept of repression, and depersonalization/derealization disorder certainly has nothing to do with it! (On that note, I’ve also never seen depersonalization/derealization disorder contested despite it being a dissociative disorder.) I highly suggest that you research the theory of structural dissociation in order to better understand current theories on the formation of DID. I’ve briefly explained the theory below, but a cursory overview really isn’t enough to convey the theory correctly.

The theory of structural dissociation centers around two main points. The first is that children are not born with a stable sense of self but instead develop one under normal conditions by integrating loose collections of ego states. The second is that trauma can disrupt the natural integration of information. Adults who survive traumatic situations develop PTSD when they fail to integrate the trauma into their sense of self and personal history. This leads to the existence of an “emotional part” (EP) that contains all of the dissociated, or non-integrated, traumatic materials. The apparently normal part (ANP), or the part of the individual that survives after the rejection of the traumatic material, experiences the negative symptoms of PTSD (dissociation, amnesia, emotional numbing) in attempts to avoid activating the EP which is associated with positive PTSD symptoms (dissociative intrusions in the form of flashbacks, intense emotions, ego-dystonic reactions, and so on).

When the trauma is more complex, varied, or long lasting or when it begins at a younger age, the individual may develop C-PTSD, BPD, or OSDD-1. According to the theory of structural dissociation, these disorders are characterized by the presence of one ANP and multiple EP. This results when different EP are needed to hold different aspects of the trauma. For example, an individual with C-PTSD may have an EP that, when activated, responds with a strong flight action path, an EP that responds with a strong fight action path, and an EP that experiences a loss of bodily sensation and submits to perceived threats. An individual with BPD may have an EP that attaches to authority figures and an EP that reacts negatively to attachment and is overwhelmed by fear of abandonment. An individual with OSDD-1 may have an EP that holds the visual memories of being abused, another that holds the emotions associated with the abuse, and yet another that acts out as a way to express these dissociated emotions.

Finally, the theory of structural dissociation postulates that individuals develop DID when they experience severe, repeated, or long-term trauma at such a young age that their personality never had the chance to fully integrate. Individuals with DID have not just multiple EP but also multiple ANP that handle different aspects of daily life. Each ANP not only avoids anything that could trigger the activation of an EP and so cause symptoms that might interfere with their functioning but also experience some degree of amnesia in regards to other ANP. Alters are often highly phobic of each other because they learned at a very young age that to acknowledge the trauma that they experienced when not permitted to do so could be lead to worsened or increased abuse, neglect, abandonment, or even threats of death. (x)

Dissociative amnesia as a disorder or as part of DID has nothing to do with repression as described by Freud. Please keep in mind that rejecting the existence of dissociative amnesia not only rejects the experiences of abuse survivors but also of war veterans (x x x) and Holocaust survivors. (x) Finally, keep in mind that many cases of repressed memories of childhood abuse have been proven to be accurate. (x)

This is an actual psychological disorder which causes an individual to waste huge amounts of time in daydreaming or fantasising. It is clearly problematic and disruptive for the person. Below are some facts and some general guidelines to help you better understand and manage the disorder.

1. It is still a relatively new disorder hence doctors may not even know that is exists. However, there is plenty of data available online. For more information, check out sites like: daydreamingdisorder.webs.com/

2. Be aware of the warning signs. These include wasting hours on daydreaming; engaging in fantasy planning (thinking through potential courses of action in unrealistic, fantasy situations); also, compulsive body movements and activities such as pacing the floor, rocking in a chair or foot tapping.

3. Pay specific attention if your daydreams have a highly complex plot - rather than being a vague stream of consciousness, or lots of unrelated thoughts that change frequently and randomly.

4. Related to Point 3, often maladaptive daydreaming is triggered by traumas (such as sexual abuse) or chronic feelings of anxiety. Hence, the maladaptive daydreaming may point to the fact that a deep rooted problem now needs to be addressed (as it cannot be successfully repressed any more).  

5. There is a difference between maladaptive daydreaming and schizophrenia. In the former the person is able to distinguish between daydreaming and reality. In the latter, the person hallucinates, and believes their fantasies are real.

6. Notice situations, people and environments that act as triggers for maladaptive daydreaming. If possible, limit your exposure to these – and think about the reason why these act as a trigger.

7. Decide on small goals such as scheduling set tasks that need to be done at certain times of the day – so they interrupt daydreaming and help to break the pattern.

The DSM-5 changed all -NOS (Not Otherwise Specified) diagnoses to OS- (Other Specified) and US- (Unspecified) diagnoses. The APA has this to say about that change:

“I see that “Not Otherwise Specified” (NOS) diagnoses from DSM-5 have been replaced with“Other” and “Unspecified” conditions. How will this change impact diagnoses?”

An important clinical tool in the Fifth Edition of the Diagnostic and Statistical Manual of MentalDisorders" (DSM-5) is the revised diagnoses of “other specified” and “unspecified” mentaldisorders. Revised from DSM-IV’s “Not Otherwise Specified” categories, these diagnoses giveclinicians the flexibility necessary in some settings to provide patients with the best care. Forexample, if a patient comes into an emergency department and is acutely psychotic, it might notbe immediately clear if this is due to schizophrenia, bipolar disorder, drug use or severehyperthyroidism. These diagnoses allow a clinician to be as specific as possible, without needingto declare that all criteria are met for a more definitive diagnosis.

The changes also bring DSM more in line with the World Health Organization’s InternationalClassification of Diseases. Every section of the ICD-9-CM, including those for diabetes,pulmonary disease and other physical illnesses, require mandatory codes for disorders that don’tprecisely fit current definitions of major disorders. To help clinicians make an appropriatediagnosis we have maintained a requirement for individuals with these diagnoses to haveclinically significant distress or impairment in social, occupational, or other important areas offunctioning.

As for a change in criteria, OSDD-1 is equivalent to DDNOS-1. It technically is the label for all individuals who have a mixture of dissociative symptoms that don’t fit the criteria for any other dissociative disorder, but in practice it’s still most often applied to individuals with presentations similar to those found in individuals with DID except for a lack of amnesia between alters and/or a lack of sufficiently differentiated alters. As well, the new OSDD-2 is very similar to the old DDNOS-3 and refers to identity alterations that result from the kind of coercion found in brainwashing, t*rture, or c*lt recruitment.

The old DDNOS-2, or derealization without depersonalization, has been collapsed into depersonalization/derealization disorder. OSDD-3, or acute dissociative reactions to stressful events, was not covered by the DDNOS diagnosis. The new OSDD-4 and old DDNOS-4 are similar, but while DDNOS-4 referred to both dissociative trance disorder and possession trance, OSDD-4 refers only to dissociative trance disorder because experiences of possession now fit under the criteria for DID. On the other hand, OSDD-4 may include DDNOS-5, a loss of consciousness not attributable to a general medical condition. Finally, the old DDNOS-6, or Ganser Syndrome, is no longer acknowledged under the DSM-5 and may be treated as a factitious disorder.

Other specified dissociative disorder is a category used for symptom clusters that are clearly dissociative in nature but that don’t meet the criteria for another dissociative disorder. This category is used when it is known that another dissociative disorder is not present and what the symptoms are. In contrast, a diagnosis of unspecified dissociative disorder is only made when the exact diagnosis is unknown or when it cannot be said that or why the symptoms present do not qualify for another dissociative disorder. This diagnosis is usually made when there is not time or opportunity for a more specific diagnosis to be made.

I hope that this answers your question!

pt 2. insult eadh other regularly. yet I’ve never felt a full switch. im dissociative, with depersonalization and unreality issues, so I feel unwelcome or strange in the body. yet, with no amnesia, ive no idea of im actually two people. any thoughts? 

Yes. OSDD (previously DDNOS) can either wind up being extremely similar to DID without the amnesia bit or it can also be more fluid and in-between. if you already deal with dissociation and depersonalization issues then it’s very possible that this also impacts your ability to develop a solid state of identity. experiences don’t have to be strict DID to still be very much valid. do you have someone you can work with  to help with fleshing out what you’re experiencing?