The insistence on accepting "non disordered plurality" as an experience adjacent to alters in DID and OSDD (switching and executive control shifts, autonomy, internal communication, sometimes even amnesia) is genuinely dangerous to people with CDDs.
It's extremely common for people with dissociative disorders not to not remember trauma or not view their experiences as traumatic. Like, you ever meet someone who genuinely thinks something horrific that happened to them wasn't traumatic? "Grow a pair, my dad left me out in the cold all night if I misbehaved too!" That denial and emotional distance is common even outside of CDDs.
When you tell someone "your symptoms are not pathology, they are an identity that should not even be medicalized, you don't need to have trauma to have CDD-adjacent experiences. It's not a symptom of trauma, some people are just born like this" you are discouraging them from getting potentially life saving medical treatment and allowing them to believe that there is no risk of destabilization. If it's not trauma, they can safely reach out to their alters and try to catalogue them, they can misrepresent it online as "I'm just built different".
I think a lot of people who claim to be endogenic either have DID and don't remember their trauma or are conflating conscious "headmates" with imaginary companions, self dialogue, ego-states, maladaptive daydreaming, or fantasy play.
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hello. can I ask for some of your knowledge? I know that cptsd has parts too. an anp and eps right? and the eps are when you’re in a flashback and things like that. but when u have did and cptsd, how do u know when what you’re feeling is a cptsd symptom or an alter? sometimes i can talk abt trauma no problem, feel fine. other times, even mention of it makes me cry. and i don’t know who those crying alters are. no name I know of. if they even are alters. what’s the difference between switching between an ep alter that feels the trauma and then one alter that doesn’t.. vs cptsd parts, dissociation, and flashbacks? idk. what are cptsd parts like compared to did alters?
Some context first:
The idea of ANPs (Apparently Normal Parts) and EPs (Emotional Parts) comes from the Theory of Structural Dissociation, which is the current pet favorite model of trauma and dissociative disorders in Western psychiatry. The original model was proposed to explain PTSD, but it's since been extended to explain dissociative disorders (and Borderline Personality Disorder).
Fair warning that this model does not like giving any kind of personhood to anyone in a system. It can feel somewhat dehumanizing because of that. We're going to go over its perspective since you're asking specifically about ANPs and EPs, but keep in mind that this is not the only way that you're "allowed" to understand yourselves. Use it if it helps, ditch it if it doesn't.
Starting simply: let's say that an adult has a single traumatic experience. When that trauma happens, it fails to integrate into the person's existing personality or self because the person lacks the resources to process it. Instead, the Theory of Structural Dissociation says that the raw experiences of the traumatic event stay separated off as an Emotional Part of the personality: a part of the person's overall personality that is stuck in that trauma, holding the feelings, responses, etc. from that moment. This is the part that is experienced in flashbacks and trauma responses.
The part of the person that remains disconnected from the trauma is then the Apparently Normal Part of the personality, which is able to function and live life- however, the Emotional Part (flashbacks, intrusions, etc.) may interfere with this.
The Theory of Structural Dissociation makes a lot of sense for PTSD. What about CPTSD, OSDD, DID, etc.?
The later-extended Theory of Structural Dissociation (and the theory people tend to refer to when talking about it) suggests that all children start out as a collection of relatively unintegrated ego states that handle different situations. The child is in one state when they're angry, one when they're scared, one when they're hungry, etc. There aren't necessarily barriers between these states, but they also don't flow fluidly into each other yet.
In a "normal" childhood, children are supported enough to integrate these states into a single cohesive identity: "me when I'm angry" becomes the same person as "me when I'm scared." The resulting person moves fluidly between these states without any major identity shakeups. It all becomes "me".
In a chronically traumatic or inconsistent childhood (particularly one involving disorganized attachment), these states can't be integrated safely. The child needs to keep information separate or to respond very differently to their caregiver at different times. Because of this, the various ego states grow up separated from each other, and each is shaped by different experiences. As time goes on, they become more differentiated from each other as each state has its own lived experiences and develops its own perspectives.
This is how you get alters according to the Theory of Structural Dissociation: dissociative barriers formed to adapt to an unpredictable or unsafe environment lead to increasingly different experiences of self between separated parts. (The persistent un-personing of alters is part of our gripes with this model, but that's another essay entirely.)
There's a lot of space in between these extremes of "one ANP and one EP from a single traumatic event in adulthood" and "many different parts that grew up separately because of their childhood environment", which is why some people divide structural dissociation into primary, secondary, and tertiary types.
There are a bunch of charts out there that try to show how different disorders correspond to different levels of structural dissociation. We snagged one that's a bit more clear than the rest:
Under this theory, the existence of DID means that you're experiencing multiple ANPs and multiple EPs. Each ANP is one self who lives life outside of traumatic material. Each EP is one self who's stuck in moments of trauma, or who specialized in handling that kind of traumatic situation.
CPTSD would be the same, but with only one ANP- just one self that lives daily life (but who is intruded upon by traumatic material: flashbacks, etc.).
In a comorbidity situation, it's not that you have DID plus CPTSD on top of it- it's that the two are the same on a deeper level because of the structural nature of these diagnoses. (Which, honestly, is another gripe that we personally have with this model- it feels slightly overgeneralized in this respect.)
With all that theory out of the way...
Does it actually help you to sort everything into ANPs and EPs, or would it help more to ask what your brain and/or system members need from you? To work on addressing trauma symptoms, to work on building trust and connections? Do you need to sort by disorder, or are there better ways to make sense of it all (particularly given that from a clinical perspective, these two comorbid diagnoses on a Venn diagram are almost a circle)?
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As a side note: I haven't yet seen the model account for the ICD-11 diagnosis of Partial Dissociative Identity Disorder, which is characterized by little to no switching- I need to look into that and see if anyone's written about it yet, as it raises some interesting questions about ANPs as the defining feature of DID in the Theory of Structural Dissociation.
Childhood dissociation is a strange beast. In ways most who haven’t lived it won’t ever intuitively grasp.
I lived two lives, running alongside each other but never touching.
On one track was the ‘me’ who went to school, did homework, showed up at appointments and playdates.
That version of me didn’t know what was happening. Not really. They were built to keep going, to keep smiling, to stay innocent of what we couldn’t bear.
On the other track, other parts carried everything.
Why we woke screaming in the night, sweating through sheets.
Why we knew closets and mirrors weren’t safe.
Why we knew what adults did.
That was the one who curled on the floor instead of the bed, who vomited from terror in the dark.
These tracks ran side by side. They leaked into each other all the time, but never met.
I felt wrong, dirty, ruined, without knowing why. I didn’t understand what made me different, only that I was. Every cruel twist of social rejection because of this just deepened the barriers.
That’s the paradox of childhood dissociation.
It shields you enough to keep living, but it also leaves you fractured. The unknowing self stumbles through the day, while the knowing self is hidden but still screaming.
The article below is aimed at clinicians to explain how and why to be prepared for a distinction, in-office, between cultural Plurality and dissociative patients.
The online community: DID and plurality
Summary and contextualisation by me :P
Keywords
Cultural competency, Online Support groups, Dissociative identity disorder, Plurality, Plurals, Social media, Differential Diagnosis, Peer support
"In the online community, there appear to be three main groups: people with traumagenic, traditional, clinical DID or partial DID or OSDD; people with false positive, malingering, factitious, or imitating DID, or sociogenic¹ DID; and people who identify as Plural, though they neither suffer from DID nor are distressed by plurality, but who find it helpful to refer to themselves as "Plurals". The bulk of research is for the first group,... only just now being published on the latter two groups. However, all three groups should still receive appropriate clinical treatment according to current research and guidelines specific to their presentation."
On Plural culture:
"These online support groups, discussion threads, resources, and shared experiences have evolved over the years into a more organized state both linguistically and politically, making Plurality its own culture"
"Regardless of years of experience, knowledge of models, and technique, it is difficult for the clinician to ethically treat a patient from a culture of which the clinician is unaware or denies."
The APA's (2017) Clinical Practice Guideline for the Treatment of Posttraumatic Stress Disorder (PTSD) in Adults specifically states that attention to cultural context is a required component of trauma-informed mental health care."
(this refers to how Plurals may enter therapy for related or unrelated issues, so Plural culture must be understood by the clinician.)
"This [Plural] group tends to have a very developed sense of political identity as Plurals and they present very differently in session than those with dissociative disorders."
"Traditional, traumagenic cases of DID have been well-documented and well-researched, with recommendations for treatment that include a phase-based and psychodynamic treatment model according to current guidelines."
On sociogeny:
"Cases of sociogenic plurality* are only just now being discussed in literature. They are distinct from traumagenic cases, and current guidelines do not apply for those reasons."
1: From WikiPedia:
Sociogeny or sociogenesis is the development of a social phenomenon.
*: from the article's 'citation excerpt' where it's stated that, due to data being collected in 2016, this paper doesn't account for the 2020 SysTok boom...
"What Christensen (2022) describes as: the sociogenic phenomenon of online presentations of people self-identifying as having dissociative identity disorder (and/or as plural) whose presentation and history may be inconsistent with a traditional, traumagenic dissociative identity disorder diagnoses."
About clinical perspectives:
"While many patients may have little to no interaction with the online Plural community, an increasing number of them will, due to younger generations' organic fluency in the online world. Lacking awareness of the development of the online community as culture for trauma survivors, and Plurals specifically, at this point could be considered maleficence, while educating oneself on the dynamic of the online community becomes simple beneficence."
"Within this framework, the Plural community called for collaboration with the clinical community to prevent and reduce ruptures in the therapeutic alliance, to co-lead solutions, and to accept lived experience as the best understanding of barriers to treatment. They also formally requested to be included in the revising of treatment guidelines, as well as giving fair compensation and credit for their participation in research."
About DID and ongoing developments in the clinical field:
"...miscommunication when people are using the same words for different things, This is still being reviewed, with Steele (2021) returning to more ego state language, and van der Hart (2021) shifting to degrees of dissociation and reporting that: "dissociative parts of the personality may comprise any number of psychobiological states, which implies that labeling them ego-states or self-states is giving them a too low degree of reality.""
From Google, psychobiology is:
The branch of psychology that interprets psychological phenomena in terms of adaptation to biological, environmental etc. factors
What's fMRI?
"the research confirming DID as a trauma-based disorder is doing just that: confirming traumagenic DID, the disorder, not Plurality, the identity. Reinders (2020) research demonstrating diagnostic capability with fMRI* differentiates already between DID and personality disorders, as well as DID and malingering, as do the common assessments available for dissociative disorders."
Developed: early 1990s
functional magnetic resonance imaging (fMRI) is a type of noninvasive brain imaging technology that takes images of your brain’s activity while it’s performing a particular function.
An fMRI can reveal what part of the brain is active, during tasks like: lifting your arm or even just thinking about something.
An fMRI can “see” thoughts and feelings, essentially creating a functional map on top of the brain images.
Clinicians may be overly concerned about the instances of such cases, with Plurals under-concerned about such cases. The balance is found in considering what a person has endured already, to need to go to such lengths in order to receive the support they need? Even clinically, if support is what a client needs, that is a simple treatment in response.
"There are some Plurals who may be malingering or fictitious and not have DID or a cultural expression of plurality, but only faking DID to receive support.
Other cases may involve a rich inner fantasy life that is not the same as experiencing plurality, but the person may not have other ways to express it or other people who understand that experience, and so resonate with the Plural community."
Some finishing quotes from the article:
"The role of the therapist in this enterprise is to guide the client through the process of thinking something through to a conclusion, while leaving the outcome or actual conclusion in the hands of the client" (Gold, 2009)."
"To accept is not to be passively resigned or hopeless, but to be actively involved in understanding things as they are, rather than as one wishes or demands they should be (Follette et al., 2009, p. 272). Understanding things as they are will be a big part of future research in the field of trauma and dissociation."
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actually reading the haunted self and thinking wow! most of tumblr really doesn't actually know anything about this book, even when they talk about it!
A lot of the time you can't tell what or who you are cuz the parts of 'you' can overlap and change all the time.
Sometimes the inside goes quiet and you wonder if this is the 'real' you.
At times you act in a why that reminds you of someone and you question who 'you' are. What you are. And if you are even valid as a being, with thoughts, feelings, and memories.
When sometimes you know, and other times you don't know. You feel blocked and on the tip of your tongue. If you listen hard enough, the thoughts, you realize are not 'your' own.
You are awake but then you awake again. Your perception changes. Your thoughts shift. You realize that you forgot before and if you were even awake to begin with.
Then you see the task ahead and learn to blend in as you figure out who 'you' are. You learn the thoughts aren't you sometimes. That your items aren't always 'yours'. That the colors seem off and the sky seems impeding. But you know why. You have no words but this innate understanding.
You understand that your number one goal is to continue. Pretend that 'your' thoughts, opinions, logic, morals, loves and hates are constant. In that it makes since when you learn something new to change your mind. And that the memories are based in actuality.
You wake up and understand that you must brush your teeth, wash your face. Use that bag, pack this way, drive to here. But it is a list of instructions instead of 'your' life.
Once you realize this, a word, a diagram, an explanation of this feeling. You now know an answer but it becomes even harder. Now you are aware. Now you analyze. You must hid. For some reason you must hide. You need help, but you need to hide.
The worst part is remembering. Remaining. Awaking to the gray and realizing that this life is yours and not yours at the same time...
