A Polyfragmented System

If you truly support mentally ill people, then you must be able to understand where violence comes from. You must be able to reconcile why you can support people who wish to kill themselves but assume anyone with homicidal ideation is inherently evil. You must be able to recognize incarcerated persons as human and worthy of life and rights. You must be able to see a person through their addiction, whether it is to the socially-acceptable alcohol, or it’s hard drugs.

If trauma was a criteria, many would go undiagnosed due to amnesia, denial, or other common reasons for underreporting trauma like fear or shame. You also really do not want these manuals deciding what "severe trauma" means; Look at PTSD's definition of trauma for diagnosis, or how CPTSD and DTD have been rejected from the DSM.

It's hard enough getting these diagnostic manuals to admit trauma is a thing at all, and when it has happened, it has been extremely narrowed down to include only the most extreme examples of trauma, such as witnessed death. You do not want these manuals deciding what is "bad enough trauma" for a DID diagnosis.

Authors in the field of trauma often say that the DSM would be far shorter if only trauma was more acknowledged as the cause of many DSM disorders. Not even just dissociative disorders, but a huge number of the disorders included in the manual are likely based in trauma.

Saying "it's not in the trauma and stressor disorders section of the manual, so it isn't based in trauma" is silly, because it isn't only DID that's based in trauma but isn't in the trauma and stressor disorders section - Personality disorders are also known to be based in trauma but are not in the trauma and stressor disorders section, to give a big example. You're not only downplaying trauma's role in DID by saying this, but also its role in many, many other disorders which are based in trauma as well.

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Despite what garbage people say

Trauma and stressor related disorders is a new category in the DSM 5 based on short term, single traumatic events, in which the disorder and the symptoms can be clearly traced to the event. Dissociative disorders are placed next to those, but not a part of it, because it’s a category based on symptom grouping. Not because they’re not related– DID is a trauma disorder, categorized by its dissociative symptoms, so they moved the whole damn dissociative section to put it next to trauma and stress disorders.

According to the linked article, “[Trauma and Stressor Related Disorders] is the only diagnostic category in the DSM-5 that is not grouped conceptually by the types of symptoms characteristic of the disorders in it,” and, “A common focus of the disorders in it as relating to adverse events. This diagnostic category is distinctive among psychiatric disorders in the requirement of exposure to a stressful event as a precondition.“ 

As per the DSM 5, “Psychological distress following exposure to a traumatic or stressful event is quite variable. In some cases, symptoms can be well understood within an anxiety or fear-based context. It is clear, however, that many individuals who have been exposed to a traumatic or stressful event exhibit a phenotype in which, rather than anxiety or fear-based symptoms, the most prominent clinical characteristics are anhedonic and dysphoric symptoms, externalizing angry and aggressive symptoms, or dissociative symptoms. Because of these variable expressions of clinical distress following exposure to catastrophic or aversive events, the aforementioned disorders have been grouped under a separate category: trauma- and stressor-related disorders. Furthermore, it is not uncommon for the clinical picture to include some combination of the above symptoms (with or without anxiety- or fear-based symptoms).”

In other words, these are disorders that present in a way that they don’t fit into other categories. It would be more appropriate to call this category “a trauma based trash bin”. It’s a handful of disorders with no set symptoms that don’t really fit into other categories.

Each of the disorders in that section states in the criteria something along the lines of: “The care in Criterion C is presumed to be responsible for the disturbed behavior in Criterion A (e.g., the disturbances in Criterion A began following the lack of adequate care in Criterion C),” or, “symptoms begin and worsen following exposure to an event.” As well, there’s typically a duration in relation to the event listed (for example, “Duration of the disturbance (symptoms in Criterion B) is 3 days to 1 month after trauma exposure.”).

None of that applies to DID– not because it’s not a trauma-based disorder, but because there’s multiple, longterm events, there’s usually amnesia, the symptoms usually aren’t discovered until decades later, and they’re typically lifelong. HELL– PTSD used be under anxiety disorders. Because symptom grouping. This is nothing new, it’s nothing shocking or surprising.

DID and other DDs present with the main symptom of dissociation– so it would make sense to group those, and put them NEXT to the trauma disorders. Because it’s a trauma disorder based on its dissociative symptoms. You literally, actually can’t put “exposure to trauma” as a criteria for DID– it wouldn’t work, and it doesn’t actually make sense to do that and move it to TSRD if you just take the time to read the section on Trauma and Stressor Related Disorders. It doesn’t belong there.

DID is trauma-based, and still a dissociative disorder because of the setup of the DSM and the development and course of DID. Just because clinicians can’t currently tell the difference between trauma-based systems and endos doesn’t mean they won’t soon be able to. And at that point, no, endos can’t have DID. They can have PTSD (and they’d benefit from those resources far more). But not DID. A misdiagnosis (though I’d contend that it’s much more likely they’re actually a trauma based system) doesn’t change that fact, as much as you’d like it to.

It’s absolutely infuriating because the vast majority of the answers given to these questions is yes, which is WILD to me because literally 1) words mean things and no, RAMCOA doesn’t only involve psychological abuse; it is quite literally hands on, and no, it can’t be done with one person because it quite literally is always a form of organized abuse, and 2) it is so fucking irresponsible to tell a person you’ve never met and know nothing about that their alter is having a programmed reaction when what the asker is describing is very likely a common conditioned trauma response. Like sometimes the most likely explanation IS the correct explanation!! And regardless, this is something they should explore with a safe, trusted, experienced irl human, not a stranger on the internet!

Like dude! What the fuck! How did we get here?? Why is everyone craving RAMCOA experiences and wishing for programmed alters?? Why are people desperately trying to jam their experiences into very specific boxes that mean very specific things?? Religious abuse is not RA! Conditioning is not programming! Psychological abuse is not TBMC! Most forms of abuse are not OA! Please for the love of everything, try to accept that you don’t need to try and make your experiences fit into these labels in order for your experiences to be bad! They don’t need to be RAMCOA in order for people to take you seriously! Or to believe that you suffered! Or to agree it was bad enough! I promise!

These words mean things and the meanings were not created by people on tumblr and the meanings have existed for decades and have been in use by professionals in the field for an equal length of time. Stop watering down the experiences of RAMCOA survivors by trying to make xyz random trauma fit into labels that exist to describe and define very specific forms of abuse that result in very specific types of systems and symptoms. It’s really not cool, we can tell that you don’t know what you’re talking about, we know you don’t actually have the experiences you claim to have, and it’s very fucking upsetting and insulting! You don’t need to claim to be like us in order to get the support you deserve!

When I first joined DID tumblr like five years ago, there was nothing in the RA tag, and there wasn’t even really a RAMCOA tag at all. And now the RAMCOA tag has multiple people using it every day and it honestly really just exploded within the past year or so. It has been wild to see! I’m not mad about fellow survivors finding each other and telling their stories. I’m not upset that people are being more open about their experiences and are naming it what it is. But I AM upset about this huge flood of people claiming/wanting to claim certain labels for themselves when they don’t have the experiences that fit within the definitions of those labels, and I am upset about the rampant misinformation about what these forms of abuse actually entail, and I am upset about people saying that randos on tumblr fit these definitions when they can’t possibly know that.

It’s just so fucking invalidating. It’s so insensitive. And it’s also dangerous. This isn’t game. This isn’t a “collect them all” trauma scavenger hunt. This isn’t something to be envied or sought after. This isn’t something that makes you a more valid or legit survivor than someone else. This isn’t something that gives you cool points.

Being a RAMCOA survivor is awful. It means having a horrific time finding a therapist who knows how to help you, because even most DID specialists don’t have enough knowledge in this area to help you without setting off programs or making things worse. It means not being able to use most run of the mill DID recovery guides because none of them address the intricacies of dealing with hierarchies and abuser-loyal parts. It usually means having a polyfragmented system and all the confusion and overwhelm and awfulness that comes from that. It means having survived unspeakable horrors that most people would never even dream of and that many people don’t even believe in.

The link to the paper! http://ow.ly/r40x30mZF79

The paper is Revisiting the etiological aspects of dissociative identity disorder: a biopsychosocial perspective. A very good one that I recommend to anyone interested in the causation of DID! I don't think I can do it justice if I tried to summarize the entire thing, so I'll just write down some bullet points of things I found interesting:

What is DID?: 

DID is a complex, posttraumatic, developmental disorder that is caused by trauma in childhood (usually very early childhood).

What causes DID?:

DID arises when a child’s ability to develop an ordinary sense of self in relation to others is impeded by unintegrated trauma.

Emotional neglect by parents and/or siblings is the strongest predictor of DID (and any other dissociative disorder).

More covert trauma such as dysfunctional communication in families or subtle emotional neglect can lead to milder presentations DID.

DID VS PTSD:

Switching between alters is considered to be a more elaborated version of PTSD intrusions & avoidance.

People with PTSD & DID generally experience the same amount of feeling shame, betrayal, self-blame, anger and fear.

People with DID tend to experience more feelings of alienation, loneliness, and disconnection than people with PTSD.

DID VS normal experiences:

The human mind is naturally made up of multiple interconnected “modes” that make up their whole self.

Trauma & dissociation causes modes to become decoupled and start existing in smaller, isolated pockets.

In DID, the modes have become so disconnected that individual modes start functioning as if they, independently from each other, are the whole self.

In a non-DID brain, new modes are always being created and old modes are always being updated.

Since CEN is about what your parents DIDN’T do rather than DID, it can be hard to identify if you were emotionally neglected as a child. Here are some signs of potential CEN, paraphrased from Jonice Webb’s Running on Empty: Overcome Your Childhood Emotional Neglect.

1. Expressing guilt, discomfort or self-directed anger for having feelings (especially negative feelings)

Apologizing for crying in front of therapists, friends, or loved ones. Preceding statements of emotions with apologies: “I feel terrible saying this,  but I didn’t really want to go to the family reunion.” “I know this is wrong,  but I felt like walking out.” “I know this means I’m a bad person, but I get really angry when she does that.”

2. Fiercely defending parents from negative interpretations (from therapists, friends, or loved ones)

The emotionally neglected are desperate to protect their parents from blame. They tend to view their parents as somewhat ideal, and are naturally driven to blame themselves for their struggles. When others get close to identifying ways in which their parents may have failed them, the emotionally neglected adult is quick to explain that their parents “did the best they could” or “aren’t to blame.”

3. Doubting the substance of their memories from childhood

Many emotionally neglected adults have difficulty recalling specific things about their childhoods. They often report that their childhood feels like a blur that’s hard to differentiate into exact events. furthermore, they often distrust their own emotional read on the childhood memories that they do have. When they’re reporting their mother’s temper, their father’s workaholism, etc. in therapy sessions with me, they often pause to question the reality, importance or validity of their memory. “I feel like I’m probably exaggerating it. It wasn’t really that bad,” one woman said to me while tears were rolling down her cheeks. “Isn’t this boring for you to listen to?” one man said to me while telling me about his parents’ lack of reaction to the death of his dog when he was ten. Or,  “I don’t know why I’m telling you this, it’s probably not important,” another man said while relaying a story about how his cherished stepfather disappeared from his life after divorcing his mother.

4. Lacking understanding of how emotions work; their own as well as others. 

The emotionally neglected are apt to have a low Emotional Intelligence Quotation (EQ). But it is very difficutl for the emotionally neglected to realize that their emotional understanding is poor. They grew up in families in which this was the case, and they’ve lived their lives this way. Here are some signs of this “alexithymia” (inability to identify and describe emotions in the self). You may need the help of a therapist, friends, or loved ones to identify these signs in yourself:

repeated physical discomfort (may be evidenced by squirming or fidgeting) when experiencing an emotion, especially a negative one

telling emotionally intense stories in a way that is completely devoid of emotional content (not talking about how you felt, brushing off your own negative feelings, joking about something that should clearly be emotionally disturbing)

changing the subject quickly or resorting to humor when someone steers a discussion in an emotional direction

showing a repeated inability to give answers to feeling-oriented questions. This may consist of giving intellectualized or avoidant answers.

Intellectual response example: Q: “What did you feel when she told you to leave?” A: “I thought she was being a jerk.” (Questioner asked for a feeling; answerer gave a thought or judgment instead.)

Avoidant response example: Q: “What did you feel when she told you to leave?” A: “I hadn’t realized she was that angry until she said that.” (Questioner asked for a feeling; answerer gave information that did not directly answer the question. A feeling answer might have been, “I felt surprised.”)

5. Counter-dependence

The emotionally neglected feel upset with themselves for needing help, especially help from a therapist, friend, or loved one in dealing with their negative emotions. They may see their need for therapy or emotional help as weak, pathetic, shameful, foolish, or frivolous. “Shouldn’t I be over this by now?” “I’ll bet not many 37-year-olds are still trying to learn how to say no.” “I don’t like feeling that I need you. I want to stop treatment for a while, to make sure I can do it on my own.” They feel ashamed for not being able to handle things by themselves.

6. Memories

It’s hard to glean what didn’t happen from childhood memories. Things to listen for:

Memories of a parent drastically misunderstanding the child’s feelings, needs, or personality. One young woman about to obtain her bachelor’s degree in social work told me about her parents’ pressure upon her all through middle and high school to skip college and take over her father’s brick delivery service. I found myself wondering whether these parents had any idea at all who their daughter was.

Memories that entail the parent negating, ignoring, or over-simplifying the child’s emotions. For example, one neglectful mother said to her son, “Your big sister misses her father” soon after their father suddenly passed away, paying no heed whatsoever to the feelings of her son.

Memories of a parent having a favorite phrase that squelches the child’s emotional expression, like “Don’t be a baby,” “Get over it,” or “Stop crying.” (Not that many mindful parents might use these phrases on occasion; it must be either used extremely inappropriately just once, or used frequently, to indicate that it represents a general philosophy of Emotional Neglect.)

Memories that convey significant feelings of deprivation in some non-physical area that was important to the patient as a child. “I was fascinated with the guitar but my mom insisted that I be a violin player.” “I REALLY wanted to be with my friends in middle school but my parents were really strict.”

Memories that seem unimportant but have a lot of emotion attached to them. On the surface, the event in a memory might seem trivial, but the lack of emotional attunement from parents can make it memorable. Watch for intense but seemingly meaningless memories, because they’re often remembered specifically because they’re loaded with the invisible pain of emotional neglect.