This is the void I scream into about schizoid personality disorder, dissociation, trauma, and other mental health related things. I mainly post to try to correct misinformation and provide access to scientific resources within these communities. Feel free to ask questions or request resources on specific topics.
Tags include: #haze posts for original posts, #asks for answered asks, #info for informational posts, #resources for links and excerpts of psych resources, studies, reviews, etc. #quotes and #images are self-explanatory.
Stances and such under the cut. I have no DNI (especially not for informational posts), just know that these stances are non-negotiable and I do not want you to try to convert me. I can guarantee I've already heard whatever argument you think will change my mind before anyways, I've been around mental health discourse for a long time.
Anti-endo
Alters are highly complex dissociative compartmentalizations of traumatic memory; they are dependent on PTSD to exist on a neuropsychological level. Endogenic ideology comes from pseudoscientific anti-DID hate groups, and the things people label as "endogenic" are either explained by normal human experiences or other mental disorders. There is no proof that alters (or any form of "self states" that are distinct, autonomous and non-transient) can exist without trauma, and there is over a century's worth of proof that they cannot.
More details: 1, 2, 3, 4, 5
Pro-recovery and Anti-misinformation
If you view alters as "multiple people in one body" or "friends in your head", oppose integration (including fusion, source separation and alters becoming less distinct), and/or treat DID like a fun game or quirky lifestyle instead of a serious trauma disorder, you probably won't like much of what I have to say here.
Psych critical
I am critical of the mental healthcare system, but still pro-science, pro-diagnosis, pro-psych medication, pro-psych hospitalization, etc. I don't like misinformation or demonization of mental healthcare under the guise of "criticism", which tends to be unfortunately common in full on anti-psych spaces. It does way more harm than good, and you can address the problems within the system without playing into mental health denialism and anti-intellectualism.
Anti-demonization
I have zero tolerance for the demonization of trauma-based disorders and symptoms such as avoidant attachment, empathy deficits, NPD, ASPD or whatever else people have decided the "evil" mental health condition is. You're not going to find sympathy for those viewpoints with me, so don't even bother.
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Hello! I hope you are doing well.
I was wondering if you happened to know any references that explain if the experience of limb weakness / loss of muscle memory during certain skill based activities can be a symptom of any conditions unrelated to CDDs? Or, lower tiers of structural dissociation? I do have OCD and C-PTSD, and I'm in therapy for those -- currently trying to figure out if its something worth bringing up in a dissociative context with my therapist.
Thank you so, so much for any insight / references. Your blog and the effort you've put in to gathering science-based resources here have been a huge help + comfort. Wishing you the best!
Loss of muscle memory could be explained by skill regression in CDDs, which is a relatively common experience. It can also be benign (such as a response to regular stress) or a part of some physical health conditions. It also can potentially occur on the lower levels of structural dissociation such as C-PTSD.
From the DSM-V section on DID:
"Dissociative amnesia (Criterion B) manifests in several major domains: 1) gaps in any aspect of autobiographical memory (e.g., important life events like getting married or giving birth, lack of recall of all school experiences before high school); 2) lapses in memory of recent events or well-learned skills (e.g., how to do oneâs job, use a computer, cook or drive); and 3) discovery of possessions that the individual has no recollection of ever owning (e.g., clothing, weapons, tools, writings or drawings that he or she must have created)."
From The Haunted Self (theory of structural dissociation):
"Loss of skills not only involves the absence of certain mental actions, but also of behavioral actions. When EP has complete executive control, the daily life skills of ANP are often missing. Thus, survivors as EP commonly report that they have no idea how to cook, take care of children, or perform work duties, and generally feel inadequate and overwhelmed with the tasks of daily life because they do not have access to needed skills for periods of time."
As for limb weakness, that may have something to do with functional neurological symptoms, which can be associated with trauma and dissociation (which used to called "conversion symptoms" and is now commonly called "somatoform dissociation"). It can be an associated feature of CDDs but it's not exclusive to them.
From the DSM-V section on DID comorbidity:
"The most common forms of functional neurological symptom disorder include nonepileptic seizures, gait disturbances, and paralyses. Most commonly, nonepileptic seizures resemble grand mal seizures or complex partial seizures with temporal lobe foci; others may mimic absence or partial seizures."
And from The Haunted Self again:
"Temporary or more permanent loss of motor control includes partial or total paralysis of limbs or the entire body, contractures, physical lack of coordination, cataplexy (i.e., a sudden and general loss of muscle tension)... These symptoms are often dissociative in nature and can be trauma related...
With regard to freezing, patients report being unable to move while still feeling extremely fearful and hypervigilant...In this condition survivorsâ muscles become flaccid and sometimes they temporarily may remain in fixed positions."
So while these things can be a part of CDDs, they can also appear in less complex structural dissociation and also other health conditions. I'd say it's worth bringing up to a medical professional.
Some studies that may be helpful:
Dissociation and its biological and clinical associations in functional neurological disorder: systematic review and meta-analysis
Dissociation and interoception in functional neurological disorder
Cortical thickness alterations linked to somatoform and psychological dissociation in functional neurological disorders
Toward a possible trauma subtype of functional neurological disorder: impact on symptom severity and physical health
Somatoform Dissociation: Major Symptoms of Dissociative Disorders
Degree of somatoform and psychological dissociation in dissociative disorder is correlated with reported trauma
Somatoform Dissociation, Psychological Dissociation, and Specific Forms of Trauma
Somatoform dissociative symptoms as related to animal defensive reactions to predatory imminence and injury
Glad you've found the blog helpful, wishing you the best with your recovery
Reminder that alters can only split from trauma. Alters are highly complex dissociative compartmentalizations of traumatic memory that are reliant on PTSD in order to exist on a neuropsychological level. Your brain cannot compartmentalize a trauma memory if there is no trauma memory to compartmentalize.
Alters and the self-states that make up PTSD develop from the same process, just on different levels of complexity. If it were possible to split alters without trauma it would also have to be possible to develop PTSD without trauma, which it obviously isn't.
And importantly, splitting because of stress is not an exception to this.
The development of alters and PTSD is tied to a person's integrative capacity, which is made up of their mental energy and mental efficacy (ability to use that energy effectively).
When both of these are high, the person will easily be able to integrate their experiences even if those experiences are stressful or frightening. When both are low, the person will lose their ability to engage in more high level integrative actions, making them more vulnerable to structural dissociation until their integrative capacity recovers.
Chronic stress lowers a person's integrative capacity and prevents it from regenerating, and as a result people who have experienced complex trauma (which is required for the development of DID) tend to be stuck in a constant state of low mental energy and efficacy.
As such, if you have already been severely traumatized over and over, you are much more vulnerable to being traumatized again, even in response to things that a non-traumatized person would likely be able to cope with. This is what people commonly refer to as the "window of tolerance".
However, when that threshold is crossed, it is still a trauma response even if we wouldn't traditionally call the event that caused it "trauma". Neuropsychologically speaking, the exact same process of developing PTSD for the first time is happening when you split because of stress. Trauma is still trauma to your body and mind even if you're choosing not to label it that way.
Saying that alters can split without trauma because of stress is misinformation, because the entire point of the window of tolerance is that it is easier to become traumatized when in a state of chronic stress.
So how many times did we get traumatized if we have fragments in the billions just hanging out here
Iâm wondering if this means splitting a new identified alter or if this has anything to do with fragmentation of if itâs a different thing entirely
Because I donât know, it was OEA so many we did split billions of times. Makes sense to me.
I saw someone say in a study dissociation causes it too. How is dissociation traumatizing? Isnât that the coping mechanism? So Iâm curious on your thoughts on that
In short: a single traumatic event can cause a person to split more than once if the event is severe enough and the person's distress tolerance is low.
The majority of parts in people with high fragment counts are what's called parallel and sequential parts. These develop when a traumatic event is so distressing and overwhelming that a single EP cannot contain all aspects of the event, and so multiple form instead.
Parallel parts refer to multiple EPs that hold different "sides" of the same traumatic event. The most common form of this are observing and experiencing EPs, where one part remembers the visual and auditory components of the event but is severely emotional disconnected from it, and another part vividly remembers the physical sensations and emotions of the event but lacks logical understanding of the event.
Parallel structural dissociation can be more complex than this as well, such as splitting one part for the sights, one for the sounds, one for the physical sensations and one for the emotions. Potentially even more if these different "sub-aspects" of the event are traumatic enough.
In addition to this, there is also sequential parts that hold different "stages" of the event. For example one part for the beginning, one for the "peak" of the trauma, and one for recovering after the fact. You can also have parallel and sequential structural dissociation occurring at the same time, and therefore split multiple sets of EPs for different aspects of the event at multiple different stages of the event.
People with high fragment counts also tend to have a higher number of ANPs as well, due them to the traumatic nature of their lives leading to them compartmentalizing the functions of daily life into much smaller fragments. This occurs in a similar to fashion to what's described above, with multiple ANP fragments fronting at the same time or in quick succession.
As for "dissociation causing it", dissociation is the mechanism behind splitting if that's what you mean. You can't split if you don't dissociate. Dissociation also makes a person more vulnerable to being traumatized, due to it involving constantly low levels of mental energy and efficacy that prevents otherwise allow healthy processing of distressing events.
The chronic flashbacks and internal conflicts experienced by those with structural dissociation may also build up to trauma in some cases, especially combined when with other stressors.
You know, I really don't like how much of "syscourse" is actually just grown adults intentionally misrepresenting scientific literature and making fallacious arguments to teenagers who are too young to realize that's what they're doing.
Are you "owning the anti-endos" or are you just trying to publicly humiliate a literal child with arguments that would be get you laughed at if you made them in an actual academic setting?
Honestly, if you're a minor you should probably just block any adult who comes onto your blog unprompted to debate you about this stuff. An adult who's looking for a productive conversation won't seek out a child for that. An adult who's looking for an inexperienced target to embarrass in order to make the opposing viewpoint look stupid will, though.
You know, I really don't like how much of "syscourse" is actually just grown adults intentionally misrepresenting scientific literature and making fallacious arguments to teenagers who are too young to realize that's what they're doing.
Are you "owning the anti-endos" or are you just trying to publicly humiliate a literal child with arguments that would be get you laughed at if you made them in an actual academic setting?
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I tend to avoid online spaces but this specific thing has been bothering me for a long time.
OSDDID spaces online present their experiences very identity-first and everyone always seems to have personal relationships with their alters, like they are their friends or family.
I don't feel connected to them at all, spare for two. Not only this but I don't see them as people either. Just me in different forms stuck in different periods. They still have different "selves": different interests, dislikes, mannerisms, behaviors, and so on, but I still don't see them as "people". I think when it comes down to it I see them purely as symptoms and nothing else. It's taken me a long time to even call them alters at all.
Knowing I have DID at all terrified me, but to see online OSDDID spaces not represent how I experience this makes it all the more lonely.
Yeah, it's pretty common to experience DID in the way you've described. Not to say that alters having relationships with each other or viewing themselves as "separate people" isn't possible, because it definitely does happen. But people online have a tendency to only discuss DID in terms of its most distinct and obvious forms, when in actuality the majority of DID cases present as more subtle and covert.
It's actually healthier not to view alters as separate people, because objectively speaking they aren't and those feelings of separation only reinforce the disorder. It's why the theory of structural dissociation mentions several times that clinicians should not treat alters as separate people and needs to emphasize them as parts of a whole, otherwise the person won't be able to achieve any degree of integration.
I don't mind people acknowledging the fact that alters can believe themselves to be very separate, I take issue with how this presentation is treated as if it's the one true way to experience DID. And with how people insist that such heavy dissociation is actually healthy and doesn't need to be worked on. It very much crosses the line into treating DID like an identity label instead of a serious mental illness, which isn't conducive to anyone's recovery.
And the end result of all of this is that people with the most common presentations of DID do not feel understood within what is supposed to be their own community, which is a shame.
Hey Anon! I just wanted to offer a somewhat different perspective, as someone whoâs made a lot of progress in recovery.
When I started therapy, I was firmly treating my parts as solely parts of one whole. They had distinct selves, but they were also just symptoms of my trauma â nothing more. The end goal was for them to solidify into one identity, which was scary since I didnât know anything else, but isnât that what being parts of a whole meant?
It worked for us for awhile, but distinctly, we hit a barrier when it came to distancing those parts from their trauma. The ones who viewed themselves more as people had a far easier time, because they were people, capable of growth and change. Not just a symptom or a brain chemistry issue â real breathing people with lives of their own, desires, wants, etc. They just happened to share their body.
One of the parts who struggled the most was our protector, who was stuck distinctly in the mentality that he had to anticipate everything in order to protect us. What helped him grow from that mentality was treating himself with more personhood, acknowledging he could be a person. He developed hobbies and desires separate from the others, as well as hobbies along with the others.
The ISSTD guidelines impress upon therapists and mental healthcare professionals that, while itâs essential that patients donât believe themselves to be fully separate people â people as in bodies that have no impact on the others â itâs equally essential to use the terminology that the patient most relates to. This is to help improve dissociation and build trust with the therapist, which is required for stabilization before the trauma-processing and integration phases.
As someone in the integration phase of therapy, I think itâs vital for you to develop your own outlook on your system and what labels you use. Maybe being parts of a whole suits you the best!! Maybe seeing them as people will help instead. Thereâs no harm in trying what you can to help lessen the barriers between your parts. Whatever works, works.
Anon, I would also love to see more people sharing experiences like yours.
But Haze , no one can say it is healthier to treats alters as parts OR separate individuals. Neither is more healthy than the other. It is going to depend on the person/system and what they need and what benefits them best in order to heal without causing distress and roadblocks.
As Sonnet said, professionals are encouraged to use the terminology their patients use. If they see their alters as separate people they should be respecting this and adapting their approach. The reminder to professionals about alters not being individuals is to make sure they understand they need to push home to their patient that they share a singular body and in turn a singular life. The actions, relationships, and choices of one will affect the others. That is what it is saying.
Maybe at one point the idea of alters being only parts and final fusion was the only way you could treat CDDs was the staple at the time. But as more time has passed, and more cases worked with (and people with CDDs have also entered the medical field) it became very apparent that this was faulty and a new approach was encouraged.
Integration is a lot of things, and it can happen in many ways. For some it is seeing themselves as all parts to one whole and not as separate people. Breaking down the divisions between the parts so everything flows together as one with no interuptions. For others it is staying as individuals who work as a team and collaborate to get to the same seamless flow and functionality. It could be something in-between or something else entirely. This is also why I have started to view final fusion and thriving multiplicity as a sliding bar and not an all or nothing end to living with a CDD.
While I agree there is often misunderstandings and misinformation of what dissociation and CDDs are within the community, stating there is only one healthy way be to a system or one proper way towards recovery is also spreading misunderstanding about the disorder. I also agree some people may be pushing themselves further into trouble, but that is ONLY because they do not always see other options available to them. They may not have a reliable support system or a professional to help them when things go overboard. It isn't the choice of being individuals, or the dissociation that sometimes comes with it, that is necessarily the bad thing in this scenario. It is that they do not understand themselves, their system, or their mental health enough to take all factors into play (and as an outside party neither can we). And truthfully, everyone is allowed to take that risk. That is their choice, their means of finding out what works or doesn't.
As a community it isn't our job to say what someone should or shouldn't do just because we think its best or has been personally beneficial. The reason I would love to see more pwCDDs that do not see themselves, or work, as individuals share their experiences is because then more of us would understand both sides of the coin (plus you deserve the chance to share your experiences). We could see someone struggling and suggest a different route. People encourage and support their own experiences, and as a community I think it is important to understand that our way of existing and healing isnt going to work for everyone. What is safe for us isn't guaranteed to be safe for another. What we do to integrate, handle dissociation, dysphoria, trauma, etc isn't going to be the same for everyone.
A lot of professionals keep to what they know. Sometimes this means they will not adapt to their patient's needs. But just because they stick to one way of doing something does not mean that is the right or only way.
"The reminder to professionals about alters not being individuals is to make sure they understand they need to push home to their patient that they share a singular body and in turn a singular life."
This is literally exactly what I'm saying.
And I'm aware professionals are encouraged to use the languages their clients use, I'm not saying you literally have to call them "parts" if you don't want to. What I'm saying is that the core of the disorder is dissociating away from parts yourself and disavowing them as different people or entities, and you are never going to heal from a disorder if you are just constantly reinforcing the core of what makes you sick.
You have to strike a balance with DID treatment. Alters need to be acknowledged and engaged with as they are, you should not be ignoring them or trying to "get rid" of them. But as I've said, doing the complete opposite of that is harmful as well.
Integration refers to processing your memories, personality and identity as all being part of one cohesive whole. Dissociation refers to the separation of these parts and the disavowal of them as being part of the same whole. There is no way to achieve integration while still dissociating at the same time, they are opposite processes.
I'm not saying there is only one way to recover from DID, because as you said how integration presents exactly can vary from person to person. But all integration involves processing dissociative parts as being parts of a whole. That is quite literally the definition.
Claiming that pointing that out is to say there's only one way to heal from DID, is like claiming that "you need to eat to recover from a restrictive ED" is also saying there's one way to heal. There is variation in recovery, but you always need to address what's at the core of the disorder.
A few excerpts from the Haunted Self that I was referring to here:
"Even though dissociative parts have a sense of self, no matter
how rudimentary, they are not separate entities, but rather are
different, more or less divided psychobiological systems that are not sufficiently cohesive or coordinated within an individualâs
personality...These systems are part of a single human being, so we have chosen to refer to the entire individual when he or she is directed by one of those unintegrated systems."
The degree of emancipation of parts varies. Some have a
depersonalized awareness that they are part of a larger personality: âI know Iâm part of him, but it doesnât feel like it.â Others realize this
only vaguely, and a few regard themselves as an entirely separate
person, even when confronted with obvious evidence to the contrary. This can lead to serious problems for survivors.
Various ANPs and EPs may have a strong investment in the
belief that they are separate persons. This substitute belief must be
met with gentle but consistent challenges by the therapist. If parts
insist on being called by another name, the therapist may do so, but
also should regularly refer to such parts as aspects of a whole person.
I hope this better illustrates what I'm talking about, because I really don't think we disagree.
Reminder that alters can only split from trauma. Alters are highly complex dissociative compartmentalizations of traumatic memory that are reliant on PTSD in order to exist on a neuropsychological level. Your brain cannot compartmentalize a trauma memory if there is no trauma memory to compartmentalize.
Alters and the self-states that make up PTSD develop from the same process, just on different levels of complexity. If it were possible to split alters without trauma it would also have to be possible to develop PTSD without trauma, which it obviously isn't.
And importantly, splitting because of stress is not an exception to this.
The development of alters and PTSD is tied to a person's integrative capacity, which is made up of their mental energy and mental efficacy (ability to use that energy effectively).
When both of these are high, the person will easily be able to integrate their experiences even if those experiences are stressful or frightening. When both are low, the person will lose their ability to engage in more high level integrative actions, making them more vulnerable to structural dissociation until their integrative capacity recovers.
Chronic stress lowers a person's integrative capacity and prevents it from regenerating, and as a result people who have experienced complex trauma (which is required for the development of DID) tend to be stuck in a constant state of low mental energy and efficacy.
As such, if you have already been severely traumatized over and over, you are much more vulnerable to being traumatized again, even in response to things that a non-traumatized person would likely be able to cope with. This is what people commonly refer to as the "window of tolerance".
However, when that threshold is crossed, it is still a trauma response even if we wouldn't traditionally call the event that caused it "trauma". Neuropsychologically speaking, the exact same process of developing PTSD for the first time is happening when you split because of stress. Trauma is still trauma to your body and mind even if you're choosing not to label it that way.
Saying that alters can split without trauma because of stress is misinformation, because the entire point of the window of tolerance is that it is easier to become traumatized when in a state of chronic stress.
I tend to avoid online spaces but this specific thing has been bothering me for a long time.
OSDDID spaces online present their experiences very identity-first and everyone always seems to have personal relationships with their alters, like they are their friends or family.
I don't feel connected to them at all, spare for two. Not only this but I don't see them as people either. Just me in different forms stuck in different periods. They still have different "selves": different interests, dislikes, mannerisms, behaviors, and so on, but I still don't see them as "people". I think when it comes down to it I see them purely as symptoms and nothing else. It's taken me a long time to even call them alters at all.
Knowing I have DID at all terrified me, but to see online OSDDID spaces not represent how I experience this makes it all the more lonely.
Yeah, it's pretty common to experience DID in the way you've described. Not to say that alters having relationships with each other or viewing themselves as "separate people" isn't possible, because it definitely does happen. But people online have a tendency to only discuss DID in terms of its most distinct and obvious forms, when in actuality the majority of DID cases present as more subtle and covert.
It's actually healthier not to view alters as separate people, because objectively speaking they aren't and those feelings of separation only reinforce the disorder. It's why the theory of structural dissociation mentions several times that clinicians should not treat alters as separate people and needs to emphasize them as parts of a whole, otherwise the person won't be able to achieve any degree of integration.
I don't mind people acknowledging the fact that alters can believe themselves to be very separate, I take issue with how this presentation is treated as if it's the one true way to experience DID. And with how people insist that such heavy dissociation is actually healthy and doesn't need to be worked on. It very much crosses the line into treating DID like an identity label instead of a serious mental illness, which isn't conducive to anyone's recovery.
And the end result of all of this is that people with the most common presentations of DID do not feel understood within what is supposed to be their own community, which is a shame.
Hello, i am pro-endo, would you be ok if i tell you what my arguments are? I would love to known what you think about them.
I'm not necessarily opposed to just stating what I think about certain arguments, but if your goal is to try to convince me to be pro-endo then you really just shouldn't bother.
A problem I have with trying to explain SzPD to people is that it always seems to come off as more hostile and cruel then it actually is. There's just no way to explain being completely emotionally apathetic to other people's feelings, viewing them as invasive and unnecessary, and honestly having trouble conceptualizing other people as living beings; without people interpreting that as aggression or hatred.
I don't enjoy seeing people suffer. I'm not incapable of understanding morality. I don't hate the people in my life. I'm not intentionally trying to hurt people's feelings when I withdraw from them or don't react to them. I just do not care about anyone, and for some reason people keep assigning more stuff to that that isn't a part of the condition at all.
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The amount of people who are unaware that blackouts are not that common - even for full DID systems - especially out of a specific situation; and as a result minimalize their own very much problematic amnesia, or apologize before they complain about their own amnesia, is geniunely saddening. Regardless of how many people black out or not, if it's disrupting your daily life on a regular basis YES you have amnesia.
Links to studies about different presentations of DID, including different alter types, childhood and adolescent DID, and DID across different cultures.
General DID Presentations
Formation and Functions of Alter Personalities in Dissociative Identity Disorder: A Theoretical and Clinical Elaboration
Lived experiences of men with dissociative identity disorderÂ
The Phenomenology and Treatment of Extremely Complex MPDÂ
Symptom patterns in dissociative identity disorder patients and the general population
Differences Between Men and Women With Multiple Personality Disorder (not open access)Â
The clinical phenomenology of males with MPD: A report of 21 casesÂ
Analysis of demographic and clinical characteristics of patients with dissociative identity disorderÂ
Possession experiences in dissociative identity disorder: a preliminary study (not open access)Â
Alter Types
Therapeutic Hazards of Treating Child Alters as Real Children in Dissociative Identity DisorderÂ
Therapeutic Alliance with Abuser Alters in Dissociative Identity DisorderÂ
Internal self helpers of persons with multiple personality disorderÂ
Issues in consultation for treatments with distressed activated abuser/protector self-states in dissociative identity disorder (not open access)Â
Animal alters: case reports
Introjection and dissociative identity disorder: a case reportÂ
Introject and identity: Structural-interpersonal analysis and psychological assessment of multiple personality disorder (not open access)Â
Opposite-gender identity states in Dissociative Identity Disorder: psychodynamic insights into a subset of same-sex behavior and attractions (not open access)Â
Childhood & Adolescent DID
Outpatient Treatment of Dissociative Identity Disorder and Allied forms of Dissociative Disorder not Otherwise Specified in Children and AdolescentsÂ
Dissociative Identity Disorder Among Adolescents: Prevalence in a University Psychiatric Outpatient UnitÂ
The Scientific Status of Childhood Dissociative Identity Disorder: A Review of Published Research (not open access but you can find a PDF of it if you look it up on Google Scholar)Â
Child abuse and dissociative identity disorder/multiple personality disorder: the documentation of childhood maltreatment and the corroboration of symptomsÂ
Held in mind, out of awareness. Perspectives on the continuum of dissociated experience, culminating in dissociative identity disorder in children (not open access)Â
Dissociative disorders in children: Behavioral profiles and problems (not open access)Â
Diagnostic evaluation of the child with dissociative identity disorder/multiple personality disorderÂ
Clinical phenomenology of child and adolescent dissociative disordersÂ
Confirmation of childhood abuse in child and adolescent cases of multiple personality disorder and dissociative disorder not otherwise specifiedÂ
High psychiatric comorbidity in adolescents with dissociative disorders
Long-term outcome and prognosis of dissociative disorder with onset in childhood or adolescenceÂ
Treatment for childhood and adolescent dissociation: A systematic reviewÂ
Adolescent inpatients' history of abuse and dissociative identity disorder (not open access)Â
DID Across Cultures
Gender and Racial Variability of Dissociative Identity Disorder Symptoms in an International Sample
Prevalence of dissociative identity disorder among psychiatric outpatients in different cultural groups
A Schema Therapy approach to complex dissociative disorder in a cross-cultural setting: a single case study
The Scope of Dissociative Disorders: An International Perspective
Structured interview data on 35 cases of dissociative identity disorder in Turkey (not open access)
Dissociative Identity Disorders in Korea: Two Recent Cases
Trauma and dissociation in a Chinese-American sample
Working with Chinese trauma survivors with dissociation: Lessons from two cases in Macao (not open access)
Current status of multiple personality disorder in India (not open access)
Multiple personality disorder - A case report from Northern India
Multiple personality disorder in the Netherlands: A clinical investigation of 71 patients
Dissociative disorders in black South Africans: A report on five cases
Dissociative disorders in Japan: A pilot study with the dissociative experience scale and a semi-structured interview
Multiple personality disorder in Puerto Rico: analysis of fifteen cases
I think one thing that really seals the deal when it comes to "endos" is how they will try to prove their claims by citing...writings on completely normal human experiences of identity and personality.
I've seen so many pro-endos claim that IFS therapy, or the multiple selves theory, or the authors of the theory of structural dissociation's writings on what an integrated personality looks like, are proof of endogenic systems.
But the fact of the matter is that those resources aren't describing "plurality" or "systemhood" at all. They're describing how a normal, healthy human personality functions, which is applicable to every single person on the planet except people with DID or OSDD-1.
The human personality is made up of multiple parts that become active in different situations. They are responsible for different functions, such as exploration, attachment, defense, self-care, etc, and the subfunctions within those functions.
This what gives the human personality the flexibility that allows it to respond to different situations, and explains why people can have different "versions" of themselves in different situations (such as at work rather than with friends). These parts are all integrated together, meaning they can function fluidly and cohesively, and they create the basis for a consistent identity to form on top of. This is the kind of thing those resources are discussing.
However, that is explicitly not what happens when a person has alters. That is the opposite of being a system.
Systems occur when these parts of self become chronically dissociated from each other due to the abnormal compartmentalization of traumatic memory. This division of self is the same base neuropsychological process that is responsible for the development of PTSD and C-PTSD, just at a much more complex level.
The highly complex dissociative compartmentalization that occurs before the personality has reached the previously described state of integration, is what allows for divisions of self that are autonomous and have elaborated identity states.
If you were to argue that the aforementioned resources are proof of endogenic systemhood, that would mean that every single person on the planet would be a system. At which point, the word would lose all meaning. Even in that case, it would remain true that the only way to experience parts of self that are significant and distinct from the normal human experience, would be through DID and OSDD-1.
If you look at descriptions of what the regular experience of human personality and identity is, and you think "that's how I experience my systemhood, that's proof of my plurality!", then that should be the biggest wake-up call on the planet.
Do you have a PDF copy of The Haunted Self? I'm struggling to find one
I'm not sure about a permanent online link or anything, but @/hauntedselves has one for download in their resource drive, plus a bunch of other books and such about DID, OSDD, C-PTSD, etc. It's also common in most DID research drives but I'm blanking on names right now. Otherwise you can go to sketchy websites in the depths of Google if you so wish
today I saw someone talking about hearing voices in their head, and people suggested they "look into plurality"
Anyway if voices suddenly appear in your head, it could be caused by a schizoaffective disorder, by a mold infestation, by medication, by a BRAIN TUMOR, and without any other information, it may be this thing called "thinking"
hearing voices in your head is a vaguer symptom than coughing
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Let's talk about longitudinal studies on dissociation!
First off, what is a longitudinal study? This is a type of academic experiment where researchers study the same group of volunteers over a long period of time, usually several years. It's very effective for seeing how the same things change over time, such as how people might develop dissociative disorders.
The longitudinal study I want to share is "Development and the fragmented self: longitudinal study of dissociative symptomatology in a nonclinical sample" by researchers Ogawa, Sroufe, Weinfield, Carlson, and Egeland. This was a longitudinal study over the span of 19 years, looking to investigate the emergence of pathological dissociation in a person.
Experiencing dissociation is normal to some extent! But pathological dissociation is described as severe & abnormal dissociation such as amnesia, identity confusion, identity fragmentation, and depersonalization & derealization.
Okay, now let's talk about the study. The study followed 168 children from birth to 19 years old. They were in "at-risk" families which experienced things like poverty or a teenage parent. Here's what the study discovered after 19 years:
Trauma is necessary but not sufficient for pathological dissociation. Not every child who experienced trauma ended up dissociative. Every child who did develop pathological dissociation, however, experienced trauma.
Pathological dissociation is predicted by trauma occurring at 0-24 months of age. The older the children got, the less likely pathological dissociation was to develop.
Pathological dissociation is also predicted by trauma that is severe and chronic.
Pathological dissociation is predicted by attachment style. Children with disorganized attachment to their mothers had the highest dissociation scores. Children who had anxious/avoidant attachment with their mothers had higher dissociation scores than children with secure or anxious/ambivalent attachment.
The more integrated a child's sense of self is, the less likely they will develop pathological dissociation.
The environments that produced the most severe trauma also produced the most chronic trauma, while environments that produced the least severe trauma also produced the least chronic trauma. Likewise, the children who experienced the most severe & chronic traumas also experienced them at the earliest ages. "If children are living in chaotic, traumatic environments when they are infants, then it is likely that they will continue to live in such environments as they grow older. All three of these aspects of trauma may be highly related in our society, and are probably not separable in either an analytic sense or a theoretical sense."
Their findings support that pathological dissociation is not a more severe version of normal dissociation. Pathological dissociation actually "represents an extreme deviation from normal development."
asking this here since iâm having trouble finding a a scientific paper that says anything about this and also anon because iâm nervous
along with this whole system bullshit i got going on i also have psychosis (what i suspect to be schizoaffective and several docs have agreed with it being a strong possibility.) i know 100% that the psychosis is real. iâm on antipsychotics that work really well and treat the psychosis, but none of the DID symptoms have gone away or been lessened. i still have huge periods of time missing, messages i donât remember sending, identity issues, friends i only vaguely know about, notes written to myself in an attempt to communicate etc etc
does my psychosis disqualify a DID diagnosis? can this be comorbid? the professionals iâve spoken to have agreed that itâs highly likely iâve got some kind of CDD but they also said my case was too complex for them and they werenât really that knowledgeable on CDDs so idrk if they are reliable for this
Psychosis doesn't disqualify a DID diagnosis, but it would make the process a lot more complicated and professionals may hesitate to diagnose you with it. It needs to be determined that the potential DID symptoms cannot be explained by psychosis first, as giving DID treatment to psychotic symptoms will play into them and make them worse. This is pretty simple to do for people who do not experience psychosis at all, but is obviously more complicated for people who do.
Checking how the client responds to antipsychotic medication is the main way they do this. If their psychotic symptoms improve drastically but the potential DID symptoms are left untouched, that's a pretty clear sign those symptoms are not psychotic. They might still question if this could be explained by residual psychotic symptoms, but they would have to be pretty mild symptoms for that to suffice as an explanation.
Generally it is believed that there is a relationship between dissociation and psychosis despite them being distinct conditions, which is why dissociation can be experienced in schizophrenia spectrum disorders and why transient psychotic symptoms can be experienced in dissociative disorders (including DID). Additionally, DID and schizophrenia/schizoaffective disorder can be comorbid, although this appears to be rather rare as both conditions are pretty uncommon.
Here are some resources on the topic:
Trauma and dissociation among inpatients diagnosed with schizophrenia spectrum disorders in Taiwan
Association Between Psychotic and Dissociative Symptoms: Further Investigation Using Network Analysis
Dissociation and Psychosis in Dissociative Identity Disorder and Schizophrenia (not open access)
Dissociative Identity Disorder and Schizophrenia: Differential Diagnosis and Theoretical Issues
Dissociative Disorders: Between Neurosis and Psychosis
Psychotic symptoms in complex dissociative disorders
Dissociation, Dissociative Disorders and Partial Psychosis
Auditory hallucinations in dissociative identity disorder and schizophrenia with and without a childhood trauma history: similarities and differences (not open access)
Voices: Are They Dissociative or Psychotic? (not open access)
Delusional beliefs and their characteristics: A comparative study between dissociative identity disorder and schizophrenia spectrum disorders (not open access)
The Relationship Between Dissociation and Symptoms of Psychosis: A Meta-analysis
Wishing you the best with getting the help you need for whatever it is you're experiencing