Dissociative Identity Disorder From Wikipedia

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Multiple personality disorderClassifications and external resources
ICD-10 F44.81
ICD-9 300.14

Dissociative identity disorder (DID) is a diagnosis described in the Diagnostic and Statistical Manual of Mental Disorders, 4th Edition, Revised, as the existence in an individual of two or more distinct identities or personalities, each with its own pattern of perceiving and interacting with the environment. At least two of these personalities are considered to routinely take control of the individual's behavior, and there is also some associated memory loss, which is beyond normal forgetfulness. This memory loss is often referred to as "losing time". These symptoms must occur independently of substance abuse, or a general medical condition.

Dissociative identity disorder was initially named multiple personality disorder (MPD), and, as referenced above, that name remains in the International Statistical Classification of Diseases and Related Health Problems. Regardless of whether the disorder is termed dissociative identity disorder or multiple personality disorder, it is in no way related to schizophrenia. Although schizophrenia and dissociative identity disorder are commonly linked in the minds of lay people, it is a misconception.

While dissociation is a demonstrable psychiatric condition that is tied to several different disorders, specifically those involving early childhood trauma and anxiety, multiple personality remains controversial. Despite the controversy, many mental health institutes[citation needed], such as McLean Hospital[1], have wards specifically designated for dissociative identity disorder.

Contents
1 DSM-IV-TR diagnostic criteria
2 A definition of dissociation
3 Defining the controversy
3.1 The DSM re-dress
3.2 Other positions
4 Potential causes of dissociative identity disorder
5 Symptoms
6 Diagnosis and treatment
6.1 Diagnosis
6.2 Prognosis
6.3 Treatment
7 See also
8 References
9 External links

DSM-IV-TR diagnostic criteria

Due to copyright infringement issues and editorial concerns, the American Psychiatric ssociation has requested that specific reference to the DSM-IV-TR by Wikipedia be outlinked. The current diagnostic criteria for Dissociative identity disorder published in the Diagnostic and Statistical Manual of Mental Disorders may be found here:

DSM-IV-TR Diagnostic Criteria: Dissociative identity disorder (DID)

A definition of dissociation
Dissociation is a complex mental process that provides a coping mechanism for individuals confronting painful and/or traumatic situations. It is characterized by a dis-integration of the ego. Ego integration, or more properly ego integrity, can be defined as a person's ability to successfully incorporate external events or social experiences into their perception, and to then present themselves consistently across those events or social situations. A person unable to do this successfully can experience emotional dysregulation, as well as a potential collapse of ego integrity. In other words, this state of emotional dysregulation is, in some cases, so intense that
it can precipitate ego dis-integration, or what, in extreme cases, has come to be referred to diagnostically as dissociation.

Dissociation describes a collapse in ego integrity so profound that the personality is considered to literally break apart. For this reason, dissocation is often referred to as "splitting" or altering". Less profound presentations of this condition are often referred to clinically as disorganization or decompensation. The difference between a psychotic break and a dissociation, or dissociative break, is that, while someone who is experiencing a dissociation is technically pulling away from a situation that s/he cannot manage, some part of the person remains connected to reality. While the psychotic "breaks" from reality, the dissociative disconnects, but not all the
way.

Because the person suffering a dissociation does not completely disengage from his/her reality, s/he may appear to have multiple "personalities". In other words, different people" (read: personalities) to deal with different situations, but generally speaking, no one person (read: personality) who will retreat altogether.

Defining the controversy
Main article: Multiple personality controversy

One of the primary reasons for the on-going re-categorization of this condition is that there ere so few documented cases (research in 1944 showed only 76[2]) of what was then referred to as multiple personality. Conversely, dissociation is now recognized as a symptomatic presentation in response to trauma, extreme emotional stress, and, as noted, in association with emotional
dysregulation and borderline personality disorder[3]. Often regarded as a dynamic sub-symptomology, it has become more frequent as an ancillary diagnosis, rather than a primary diagnosis. [citation needed] A full blown DID diagnosis, that intends an individual is evidencing
quantifiable multiple personalities and presents itself independently of a primary personality disorder, remains rare. [citation needed]

The DSM re-dress
There is considerable controversy over the validity of the Multiplepersonality profile as a diagnosis. Unlike the more empirically verifiable mood and personality disorders, dissociation is primarily subjective for both the patient, and the treatment provider. The relationship between dissociation and multiple personality creates conflict regarding the MPD diagnosis. While other disorders do, indeed, require a certain amount of subjective interpretation, those disorders more readily present with generally accepted, objective symptomology. The controversial nature of the dissociation hypothesis evidences itself quite clearly by the manner in which the American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders has addressed, and re-dressed, the categorization over the years.

The second edition of the Diagnostic and Statistical Manual of Mental Disorders, referred to this diagnostic profile as Multiple Personality Disorder. The 3rd Edition of the DSM Manual grouped Multiple Personality Disorder in with the other 4 major dissociative disorders. The current edition, the DSM-IV-TR, categorizes the disorder as Dissociative Identity Disorder. The ICD-10 (International Statistical Classification of Diseases and Related Health Problems) continues to list the condition as multiple personality disorder.

Other positions
The debate over the validity of this condition, whether as a clinical diagnosis, a symptomatic presentation, a subjective misrepresentation on the part of the patient, or a case of unconscious collusion on the part of the patient and the professional is considerable (see Multiple
personality controversy). Unlike other diagnostic categorizations, there is very little in the way of objective, quantifiable evidence for describing the disorder. This makes the disorder itself subjective, as well as its diagnosis.

The main points of disagreement are:

1. Whether MPD/DID is a real disorder or just a fad.
2. If it is real, is the appearance of multiple personalities real or delusional.
3. If it is real, should it be defined in psychoanalytic terms.
4. Whether it can, or should, be cured.
5. Who should primarily define the experience -- therapists, or those who believe that they have multiple personalities.

Skeptics claim that people who present with the appearance of alleged multiple personality may have learned to exhibit the symptoms in return for social reinforcement. One case cited as an example for this viewpoint is the "Sybil" case , popularized by the news media. Psychiatrist Herbert Spiegel [citation needed] stated that "Sybil" had been provided with the idea of multiple personalities by her treating psychiatrist, Cornelia Wilbur, to describe states of feeling with which she was unfamiliar.

Potential causes of dissociative identity disorder
Dissociative identity disorder is attributed to the interaction of several factors: overwhelming
stress, dissociative capacity (including the ability to uncouple one's memories, perceptions, or identity from conscious awareness), the enlistment of steps in normal developmental processes as defenses, and, during childhood, the lack of sufficient nurturing and compassion in response to hurtful experiences or lack of protection against further overwhelming experiences. Children are not born with a sense of a unified identity — it develops from many sources and experiences. In overwhelmed children, its development is obstructed, and many parts of what should have blended into a relatively unified identity remain separate. North American studies show that 97 to 98% of adults with dissociative identity disorder report abuse during childhood and that abuse can be documented for 85% of adults and for 95% of children and adolescents with dissociative identity disorder and other closely related forms of dissociative disorder. Although these data establish childhood abuse as a major cause among North American patients (in some cultures, the consequences of war and disaster play a larger role), they do not mean that all such patients were abused or that all the abuses reported by patients with dissociative identity disorder really happened. Some aspects of some reported abuse experiences may prove to be
inaccurate. Also, some patients have not been abused but have experienced an important early loss (such as death of a parent), serious medical illness, or other very stressful events. For example, a patient who required many hospitalizations and operations during childhood may have been severely overwhelmed but not abused.[4]

Human development requires that children be able to integrate complicated and different types of information and experiences successfully. As children achieve cohesive, complex appreciations of themselves and others, they go through phases in which different perceptions and emotions are kept segregated. Each developmental phase may be used to generate different selves. Not every child who experiences abuse or major loss or trauma has the capacity to develop multiple personalities. Patients with dissociative identity disorder can be easily hypnotized. This capacity, closely related to the capacity to dissociate, is thought to be a factor in the development of the disorder. However, most children who have these capacities also have normal adaptive mechanisms, and most are sufficiently protected and soothed by adults to prevent development of dissociative identity disorder.[4]

Symptoms
Patients often have a remarkable array of symptoms that can resemble other neurologic and psychiatric disorders, such as anxiety disorders, personality disorders, schizophrenic and mood psychoses, and seizure disorders. Symptoms of this particular disorder can include:

• depression
• anxiety
• (sweating, rapid pulse, palpitations)
• phobias
• panic attacks
• physical
• symptoms (severe headaches or other bodily pain)
• fluctuating levels of function, from highly effective to disabled
• time distortions, time lapse, and amnesia
• sexual dysfunction
• eating disorders
• post traumatic stress
• suicidal preoccupations and attempts
• episodes of self-mutilation
• psychoactive substance abuse[4]

Other symptoms include: Depersonalization, which refers to feeling unreal, removed from one's self, and detached from one's physical and mental processes. The patient feels like an observer of his life and may actually see himself as if he were watching a movie. Derealization refers to experiencing familiar persons and surroundings as if they were unfamiliar and strange or unreal.

Again, doctors must be careful not to assume that a client has MPD or DID simply because they present with some or all of these symptoms. Another factor in the diagnosis is the all squares are rectangles but not all rectangles are squares idea, which is to say that although many of these symptoms may be present in an individual, he or she may not necessarily have DID. For example, someone may have severe PTSD (one symptom) and self mutilate with suicidal
ideas, which is 3 of the above symptoms, but will not have DID. In order for DID to be diagnosed, there must be two or more distinctly present personalities.

Persons with dissociative identity disorder are often told of things they have done but do not remember and of notable changes in their behavior. They may discover objects, productions, or handwriting that they cannot account for or recognize; they may refer to themselves in the first person plural (we) or in the third person (he, she, they); and they may have amnesia for events that occurred between their mid-childhood and early adolescence. Amnesia for earlier events is normal and widespread.

Diagnosis and treatment

Diagnosis
If symptoms seem to be present, the patient should first be evaluated by performing a complete medical history and physical examination. The various diagnostic tests, such as X-rays and blood tests are used to rule out physical illness or medication side effects as the cause of the symptoms. Certain conditions, including brain diseases, head injuries, drug and alcohol
intoxication, and sleep deprivation, can lead to symptoms similar to those of dissociative disorders, including amnesia. If no physical illness is found, the patient might be referred to a psychiatrist or psychologist. Psychiatrists and psychologists use specially designed interview and personality assessment tools to evaluate a person for a dissociative disorder.[5]

Prognosis
Patients can be divided into three groups with regard to prognosis. Those in one group have mainly dissociative symptoms and post traumatic features, generally function well, and generally recover completely with specific treatment. Those in another group have symptoms of other serious psychiatric disorders, such as personality disorders, mood disorders, eating
disorders, and substance abuse disorders. They improve more slowly, and treatment may be either less successful or longer and more crisis-ridden. Patients in the third group not only have severe coexisting psychopathology but may also remain enmeshed with their alleged abusers. Treatment is often long and chaotic and aims to help reduce and relieve symptoms more than to achieve integration. Sometimes therapy helps a patient with a poorer prognosis make
rapid strides toward recovery.[4]

Treatment
Perhaps the most common approach to treatment aims to relieve symptoms, to ensure the safety of the individual, and to reconnect the different identities into one well-functioning identity. There are, however, other equally respected treatment modalities that do not depend upon integrating the separate identities. Treatment also aims to help the person safely express and process painful memories, develop new coping and life skills, restore functioning, and
improve relationships. The best treatment approach depends on the individual and the severity of his or her symptoms. Treatment is likely to include some combination of the following methods:

See also

• Multiple personality controversy
• DID/MPD in fiction
• Healthy multiplicity
• Repressed memory
• Recovered memory therapy
• Shirley Ardell Mason, also known as "Sybil"
• Chris Costner-Sizemore also known as "Eve"
• Truddi Chase

References

1. ^ Dissociative Disorders and Trauma Program
2. ^ Creating Hysteria by Joan Acocella, 1999.
3. ^ Rethinking the comparison of borderline personality disorder and multiple personality disorder., Marmer SS, Fink D. 1994
4. ^ a b c d Merck.com The Merck Manual.
5. ^ a b Webmd.com
   

External links

• Piper A, Merskey H. The persistence of folly: A critical examination of dissociative identity disorder. Part I. The excesses of an improbable concept. Can J Psychiatry 2004;49:592–600
• Piper A, Merskey H. The persistence of folly: A critical examination of dissociative identity disorder. Part II. The defence and decline of multiple personality or dissociative identity disorder. Can J Psychiatry 2004;49:678–83.
• Multiple Personality Disorder: Fact or Fiction? Alexandria K. Cherry Rochester Institute of Technology
• Guidelines for Treating Dissociative Identity Disorder in Adults (2005) James A. Chu, MD
• Dissociative Identity Disorder(formerly Multiple Personality Disorder) Nami.org
• Essay from the Skeptic's Dictionary
• International Society for the Study of Dissociation
• Mental Health Matters: Dissociative Identity Disorder

Retrieved from "http://en.wikipedia.org/wiki/Dissociative_identity_disorder"
Categories: Articles with unsourced statements Dissociative disorders

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What is Post Traumatic Stress Disorder

What is Posttraumatic Stress Disorder?

A National Center for PTSD Fact Sheet

Posttraumatic Stress Disorder, or PTSD, is a psychiatric disorder that can occur following the experience or witnessing of life-threatening events such as military combat, natural disasters, terrorist incidents, serious accidents, or violent personal assaults like rape. Most survivors of trauma return to normal given a little time. However, some people will have stress reactions that do not go away on their own, or may even get worse over time. These individuals may develope PTSD. People who suffer from PTSD often relive the experience through nightmares and flashbacks, have difficulty sleeping, and feel detached or estranged, and these symptoms can be severe enough and last long enough to significantly impair the person's daily life.

PTSD is marked by clear biological changes as well as psychological symptoms. PTSD is complicated by the fact that it frequently occurs in conjunction with related disorders such as depression, substance abuse, problems of memory and cognition, and other problems of physical and mental health. The disorder is also associated with impairment of the person's ability to function in social or family life, including occupational instability, marital problems and divorces, family discord, and difficulties in parenting.

Understanding PTSD

PTSD is not a new disorder. There are written accounts of similar symptoms that go back to ancient times, and there is clear documentation in the historical medical literature starting with the Civil War, when a PTSD-like disorder was known as "Da Costa's Syndrome." There are particularly good descriptions of posttraumatic stress symptoms in the medical literature on combat veterans of World War II and on Holocaust survivors.

Careful research and documentation of PTSD began in earnest after the Vietnam War. The National Vietnam Veterans Readjustment Study estimated in 1988 that the prevalence of PTSD in that group was 15.2% at that time and that 30% had experienced the disorder at some point since returning from Vietnam.

PTSD has subsequently been observed in all veteran populations that have been studied, including World War II, Korean conflict, and Persian Gulf populations, and in United Nations peacekeeping forces deployed to other war zones around the world. There are remarkably similar findings of PTSD in military veterans in other countries. For example, Australian Vietnam veterans experience many of the same symptoms that American Vietnam veterans experience.

PTSD is not only a problem for veterans, however. Although there are unique cultural- and gender-based aspects of the disorder, it occurs in men and women, adults and children, Western and non-Western cultural groups, and all socioeconomic strata. A national study of American civilians conducted in 1995 estimated that the lifetime prevalence of PTSD was 5% in men and 10% in women. A revision of this study done in 2005, reports that PTSD occurs in about 8% of all Americans.

How does PTSD develop?

Most people who are exposed to a traumatic, stressful event experience some of the symptoms of PTSD in the days and weeks following exposure. Available data suggest that about 8% of men and 20% of women go on to develop PTSD, and roughly 30% of these individuals develop a chronic form that persists throughout their lifetimes.

The course of chronic PTSD usually involves periods of symptom increase followed by remission or decrease, although some individuals may experience symptoms that are unremitting and severe. Some older veterans, who report a lifetime of only mild symptoms, experience significant increases in symptoms following retirement, severe medical illness in themselves or their spouses, or reminders of their military service (such as reunions or media broadcasts of the anniversaries of war events).

How is PTSD assessed?

In recent years, a great deal of research has been aimed at developing and testing reliable assessment tools. It is generally thought that the best way to diagnose PTSD-or any psychiatric disorder, for that matter-is to combine findings from structured interviews and questionnaires with physiological assessments. A multi-method approach especially helps address concerns that some patients might be either denying or exaggerating their symptoms.

How common is PTSD?

An estimated 7.8 percent of Americans will experience PTSD at some point in their lives, with women (10.4%) twice as likely as men (5%) to develop PTSD. About 3.6 percent of U.S. adults aged 18 to 54 (5.2 million people) have PTSD during the course of a given year. This represents a small portion of those who have experienced at least one traumatic event; 60.7% of men and 51.2% of women reported at least one traumatic event. The traumatic events most often associated with PTSD for men are rape, combat exposure, childhood neglect, and childhood physical abuse. The most traumatic events for women are rape, sexual molestation, physical attack, being threatened with a weapon, and childhood physical abuse.

About 30 percent of the men and women who have spent time in war zones experience PTSD. An additional 20 to 25 percent have had partial PTSD at some point in their lives. More than half of all male Vietnam veterans and almost half of all female Vietnam veterans have experienced "clinically serious stress reaction symptoms." PTSD has also been detected among veterans of the Gulf War, with some estimates running as high as 8 percent.

Who is most likely to develop PTSD?

1. Those who experience greater stressor magnitude and intensity,
unpredictability, uncontrollability, sexual (as opposed to nonsexual)
victimization, real or perceived responsibility, and betrayal
2. Those with prior vulnerability factors such as genetics, early age of onset and
longer-lasting childhood trauma, lack of functional social support, and
concurrent stressful life events
3. Those who report greater perceived threat or danger, suffering, upset, terror, and horror or fear
4. Those with a social environment that produces shame, guilt, stigmatization, or self-hatred

What are the consequences associated with PTSD?

PTSD is associated with a number of distinctive neurobiological and physiological changes. PTSD may be associated with stable neurobiological alterations in both the central and autonomic nervous systems, such as altered brainwave activity, decreased volume of the hippocampus, and abnormal activation of the amygdala. Both the hippocampus and the amygdala are involved in the processing and integration of memory. The amygdala has also been found to be involved in coordinating the body's fear response.

Psychophysiological alterations associated with PTSD include hyper-arousal of the sympathetic nervous system, increased sensitivity of the startle reflex, and sleep abnormalities.
People with PTSD tend to have abnormal levels of key hormones involved in the body's response to stress. Thyroid function also seems to be enhanced in people with PTSD. Some studies have shown that cortisol levels in those with PTSD are lower than normal and epinephrine and norepinephrine levels are higher than normal. People with PTSD also continue to produce higher than normal levels of natural opiates after the trauma has passed. An important finding is that the neurohormonal changes seen in PTSD are distinct from, and actually opposite to, those seen in major depression. The distinctive profile associated with

PTSD is also seen in individuals who have both PTSD and depression.

PTSD is associated with the increased likelihood of co-occurring psychiatric disorders. In a large-scale study, 88 percent of men and 79 percent of women with PTSD met criteria for another psychiatric disorder. The co-occurring disorders most prevalent for men with PTSD were alcohol abuse or dependence (51.9 percent), major depressive episodes (47.9 percent), conduct disorders (43.3 percent), and drug abuse and dependence (34.5 percent). The disorders most frequently comorbid with PTSD among women were major depressive disorders (48.5 percent), simple phobias (29 percent), social phobias (28.4 percent), and alcohol abuse/dependence (27.9 percent).

PTSD also significantly impacts psychosocial functioning, independent of comorbid conditions. For instance, Vietnam veterans with PTSD were found to have profound and pervasive problems in their daily lives. These included problems in family and other interpersonal relationships, problems with employment, and involvement with the criminal justice system.
Headaches, gastrointestinal complaints, immune system problems, dizziness, chest pain, and discomfort in other parts of the body are common in people with PTSD. Often, medical doctors treat the symptoms without being aware that they stem from PTSD.

How is PTSD treated?
PTSD is treated by a variety of forms of psychotherapy (talk therapy) and drug therapy. There is no definitive treatment, but some treatments appear to be quite promising, especially cognitive-behavioral therapy, group therapy, and exposure therapy. Exposure therapy involves having the patient repeatedly relive the frightening experience under controlled conditions to help him or her work through the trauma. Studies have also shown that medications help ease associated symptoms of depression and anxiety and help with sleep. The most widely used drug treatments for PTSD are the selective serotonin reuptake inhibitors, such as Prozac and Zoloft.

At present, cognitive-behavioral therapy appears to be somewhat more effective than drug therapy. However, it would be premature to conclude that drug therapy is less effective overall since drug trials for PTSD are at a very early stage. Drug therapy appears to be highly effective for some individuals and is helpful for many more. In addition, the recent findings on the biological changes associated with PTSD have spurred new research into drugs that target these biological changes, which may lead to much increased efficacy.

DID/MPD Explained

Dissociative Identity Disorder(Multiple Personality Disorder)
A disorder characterized by two or more identities or personalities that alternatively take over the person's behavior.

Amnesia involving an inability to recall important personal information relating to some of the identities is present. Amnesia is not uniform in all personalities; what is not known by one personality may be known by another. Some personalities may appear to know and interact with other personalities in an elaborate inner world. For example, some personalities of which personality A is unaware may be aware of personality A and know what it does, as if observing its behavior. Others may be unaware of personality A or may be aware of personality A but lack co-consciousness (the simultaneous awareness of events by more than one personality) with personality A.

Dissociative identity disorder is serious and chronic and may lead to disability and incapacity. It is associated with a high incidence of suicide attempts and is believed to be more likely to end in suicide than any other mental disorder.

Several studies show that previously undiagnosed dissociative identity disorder is present in 3 to 4% of acute psychiatric inpatients and in a sizable minority of patients in psychoactive substance abuse treatment settings. It appears to be rather common, being diagnosed more frequently in recent years because of enhanced awareness of it, improved diagnostic methods, and increased awareness of childhood mistreatment and its consequences. Although some experts believe that increased reports of this disorder reflect the influence of physicians on suggestible patients, no firm evidence substantiates this view.

Etiology

Dissociative identity disorder is attributed to the interaction of several factors: overwhelming stress, dissociative capacity (including the ability to uncouple one's memories, perceptions, or identity from conscious awareness), the enlistment of steps in normal developmental processes as defenses, and, during childhood, the lack of sufficient nurturing and compassion in response to hurtful experiences or lack of protection against further overwhelming experiences. Children are not born with a sense of a unified identity--it develops from many sources and experiences. In overwhelmed children, its development is obstructed, and many parts of what should have blended into a relatively unified identity remain separate. North American studies show that 97 to 98% of adults with dissociative identity disorder report abuse during childhood and that abuse can be documented for 85% of adults and for 95% of children and adolescents with dissociative identity disorder and other closely related forms of dissociative disorder. Although these data establish childhood abuse as a major cause among North American patients (in some cultures, the consequences of war and disaster play a larger role), they do not mean that all such patients were abused or that all the abuses reported by patients with dissociative identity disorder really happened. Some aspects of some reported abuse experiences may prove to be inaccurate. Also, some patients have not been abused but have experienced an important early loss (such as death of a parent), serious medical illness, or other very stressful events. For example, a patient who required many hospitalizations and operations during childhood may have been severely overwhelmed but not abused.

Human development requires that children be able to integrate complicated and different types of information and experiences successfully. As children achieve cohesive, complex appreciations of themselves and others, they go through phases in which different perceptions and emotions are kept segregated. Each developmental phase may be used to generate different selves. Not every child who experiences abuse or major loss or trauma has the capacity to develop multiple personalities. Patients with dissociative identity disorder can be easily hypnotized. This capacity, closely related to the capacity to dissociate, is thought to be a factor in the development of the disorder. However, most children who have these capacities also have normal adaptive mechanisms, and most are sufficiently protected and soothed by adults to prevent development of dissociative identity disorder.

Symptoms and Signs

Patients often have a remarkable array of symptoms that can resemble other neurologic and psychiatric disorders, such as anxiety disorders, personality disorders, schizophrenic and mood psychoses, and seizure disorders. Most have symptoms of depression, manifestations of anxiety (sweating, rapid pulse, palpitations), phobias, panic attacks, physical symptoms, sexual dysfunction, eating disorders, and posttraumatic stress. Suicidal preoccupations and attempts are common, as are episodes of self-mutilation. Many have abused psychoactive substances at some time.

The switching of personalities and the amnesic barriers between them frequently result in chaotic lives. Because the personalities often interact with each other, patients with dissociative identity disorder often report hearing inner conversations and the voices of other personalities, which often comment on or address the patient. The voices are experienced as hallucinations.
Several symptoms are characteristic of dissociative identity disorder: fluctuating symptom pictures; fluctuating levels of function, from highly effective to disabled; severe headaches or other bodily pain; time distortions, time lapse, and amnesia; and depersonalization and derealization. Depersonalization refers to feeling unreal, removed from one's self, and detached from one's physical and mental processes. The patient feels like an observer of his life and may actually see himself as if he were watching a movie. Derealization refers to experiencing familiar persons and surroundings as if they were unfamiliar and strange or unreal.

Persons with dissociative identity disorder are often told of things they have done but do not remember and of notable changes in their behavior. They may discover objects, productions, or handwriting that they cannot account for or recognize; they may refer to themselves in the first person plural (we) or in the third person (he, she, they); and they may have amnesia for events that occurred between ages 6 and 11. Amnesia for earlier events is normal and widespread.
Because dissociative identity disorder tends to resemble other psychiatric disorders, patients typically give histories of having had three or more different psychiatric diagnoses and of prior treatment failure. As a group, they are very concerned with issues of control, both self-control and control of others.

Diagnosis

The diagnosis requires medical and psychiatric evaluation, including specific questions about dissociative phenomena. Under some circumstances, the psychiatrist may use prolonged interviews, hypnosis, or drug-facilitated interviews and may ask the patient to keep a journal between visits. All of these measures encourage a shift of personality states during the evaluation. Specially designed questionnaires can help identify patients with dissociative identity disorder.

The psychiatrist may attempt to contact and elicit other personalities by asking to speak to the part of the mind involved in behaviors for which the patient had amnesia or that were experienced in a depersonalized or derealized fashion.

Prognosis

Patients can be divided into three groups with regard to prognosis. Those in one group have mainly dissociative symptoms and posttraumatic features, generally function well, and generally recover completely with specific treatment. Those in another group have symptoms of other serious psychiatric disorders, such as personality disorders, mood disorders, eating disorders, and substance abuse disorders. They improve more slowly, and treatment may be either less successful or longer and more crisis-ridden. Patients in the third group not only have severe coexisting psychopathology but may also remain enmeshed with their alleged abusers. Treatment is often long and chaotic and aims to help reduce and relieve symptoms more than to achieve integration. Sometimes therapy helps a patient with a poorer prognosis make rapid strides toward recovery.

Treatment

Symptoms wax and wane spontaneously, but dissociative identity disorder does not resolve spontaneously. Drugs help manage specific symptoms but do not affect the disorder itself. All successful treatments that aim to achieve integration involve psychotherapy that specifically addresses the dissociative identity disorder. Some patients are unable or unwilling to pursue integration. For them, treatment aims to facilitate cooperation and collaboration among the personalities and to reduce symptoms. This treatment is often arduous and painful, and many crises tend to arise as a result of the personalities' actions and the patient's despair when dealing with traumatic memories. One or more periods of psychiatric hospitalization may be necessary to help some patients through difficult times and during the processing of particularly painful memories. Hypnosis is often used to help access the personalities, facilitate communication between them, and stabilize and interpret them. Hypnosis is also used to discuss traumatic memories and diffuse their impact. Eye movement desensitization and reprocessing (EMDR), applied cautiously, is a useful adjunct. EMDR tries to process traumatic memories and to replace negative thoughts about self that are associated with these memories with positive ones.

Generally, two or more psychotherapy sessions per week for 3 to >= 6 years are necessary to integrate the personalities or to achieve harmonious interaction among them that allows normal functioning without symptoms. Integration of the personalities is the most desirable outcome.

Psychotherapy has three main phases. In the first phase, the priority is safety, stabilization, and strengthening of the patient in anticipation of the difficult work of processing traumatic material and dealing with problematic personalities. The personality system is explored and mapped to plan the remainder of the treatment. In the second phase, the patient is helped to process the painful episodes of his past and to mourn the losses and other negative consequences of the trauma. As the reasons for the patient's remaining dissociations are addressed, therapy can move to the final phase, in which the patient's selves and relationships and social functioning can be reconnected, integrated, and rehabilitated. Some integration occurs spontaneously, but much must be encouraged by conversing with and arranging the unification of the personalities or must be facilitated with imagery and hypnotic suggestion. After integration, patients continue treatment to deal with some issues that have not been resolved. After postintegration treatment appears complete, visits to the therapist are tapered but are rarely completely terminated. Patients come to think of the psychiatrist as someone who can help them deal with psychologic issues, just as they periodically need assistance from a primary care physician.

Catching Up

9 September 2005

It’s been a while since I’ve posted anything in here, and I apologize to any reader who looks for information here.

It’s rough, dealing with depression, acute chronic pain, multiple personalities, and abuse issues that still are active in my life.

You see, I’m not doing well. Many of my “family members” or some would call them personalities, personas, or manifestations, are in a dangerous downward slide. I have 2 or 3 family members who are self destructive, and or suicidal.

It does not help that one of the main abusers in my life… is still in my life, and trying her damnedest to ruin me. Not a meeting goes by where she does not put me down for one reason or another. “Can’t you clean up this mess?” “Why do you dress that way?” (I’m in my pajamas when she says this) It doesn’t matter what I do, I cannot please the thing called mother.

Meanwhile, Father-dearest stands by and does nothing. He says nothing, he doesn’t intervene. He thinks they have a right to talk to me in this manner.

I am disabled. It is part psyche, part physical. I broke my back twice. I cannot bend well, lift anything, twist my torso from left to right nor right to left. I needed spinal injections just last month. I have to rely on the parental things when I cannot drive or do anything, because they stuck me out in the middle of no-where so that if my car breaks down, I have absolutely no alternative transportation.

When I got the injections, I was not able to drive afterwards. This meant my father (or mother-dearest) had to come pick me up (an hour drive away), drive me to my appointment (back towards where they live – an hour away) wait for me to get the injections and then drive me back..

My fat headed father was pissed off at me – the second set of shots because my most wonderful  (in their eyes) Brother had to be at the airport to go to Ireland. So.. I got a hard time from my father about the appointment, and how he was not sure he’d be able to take me.. come to find out, my brother was not leaving the area until 7pm at night, and my appointment was for 10am.  HOW on earth did my appointment mess up HIS most glorious schedule???

My brothers can do no wrong, yet I am not able to do anything right. I am pissed at this. They drag me back to NY so I can be closer to “Family.” Well.. I have no ties to my “Family” here.  No-one cares that I am alive and breathing.. unless they have something to scream at me about.

There are things that need fixing around my house. I’ve tried time and again to get help doing them. They are supposed to be my landlords. I am supposed to be a tenant. Yet it goes 2 months before my lawn is mowed, I’ve asked 15 times to get stone put down between the end of my deck step and the gate leading out to the driveway (a total of 3-1/2 to 4 feet), and yet.. I still keep asking. However, if Mr.Wonderful brother asks for ANYTHING.. it’s there in a heartbeat.

Do I sound jealous? I’m not. I don’t want anything from my parents other than for them to get off my back. I’m done with them. I can’t afford to be here. I’m sick over what the new heating costs are going to be this winter, and I KNOW I’m going to hear about that. I might as well turn my bills over to them, and my paycheck.. and say “HERE You do the math!”

My younger brother is a loser. He works full time as a respiratory therapist. He owns several houses that he rents out apartments in. Yet he still lives with mommy and daddy. He’s 41 years old, and has not lived on his own for more than a few months at a time before he comes crawling back home.

He’s getting married to a woman he met through our sister-in-law. They’ve only talked on the computer and on the phone until just recently when my brother worked up the courage to go to Ireland to meet her. Now he plays the lovesick teenager, all drool and sap. It’s sickening to watch, because it is fake. He is too tightly wrapped in the umbilical cord that has never been severed to ever leave mommy. Oh, he’ll get married alright.. but the marriage won’t last. She will never measure up or replace his mommy.

I have two older brothers as well. One has fallen out of the graces of the mother’s eyes. He told her off, she told him off, he’s living with a woman my mother can’t stand (nor can I), he is an abuser, so I do not miss him. I wonder how many broken ribs his new woman will end up with. I know his ex- was not treated well. He threw her around as well as their son. I do not miss him, nor consider having lost him. Good Riddance.

My Oldest brother is only five miles from me. I hear nothing from him, nor his wife. I never know when they are home. I hear things second hand from my parental things.. like a couple weeks ago my sister-in-law wrapped her car around a telephone pole. Why didn’t THEY inform me, instead of my parents?
It’s simple, I’m second class in this family. I’m a burden, and not something they want around.

It’s no wonder that I have “Family” who are self destructive and suicidal. With all that “well deserved” treatment I get from my parental beings, and lack of support I get from the rest of the family… why would someone care to continue on in this existence?

Child Abuse Can Cause Permanent Damage to the Brain, Body, and Emotional Well-Being

In the first years of life, a child is especially vulnerable to abuse, not only because of their physical fragility, but also because the early years can be an especially challenging time for even the most well-meaning parents.

Many cases of child abuse aren’t intentional acts of violence committed by violent, uncaring parents--rather, child abuse often occurs in an instant of unthinking frustration and anger. An instant of uncontrolled anger is all it takes to shake a baby and inflict permanent brain damage, to yank a small arm out of its socket, or to inflict alarming physical pain and longlasting emotional injury.

Abuse During Childhood Can Permanently Rewire and Restructure the Brain

Researchers at McLean Hospital, the largest psychiatric affiliate of Harvard Medical School, have found that child abuse and neglect can "rewire" the developing brain. When brain circuitry is altered during the formative years it may eventually cause such disorders as anxiety and depression to more readily surface in adulthood.

According to Martin Teicher, MD, PhD, director of the Developmental Biopsychiatry Research Program, "science shows that childhood maltreatment may produce changes in both brain function and structure. These changes are permanent. This is not something people can just get over and get on with their lives."

During the course of their studies, the researchers found that four abnormalities are more likely to be present in victims of child abuse and neglect:

Changes to the Limbic System, the area of the brain that, together with the hypothalamus, controls hunger, thirst, emotional reactions and biological rhythms. In addition, it coordinates complex activities requiring a sequence of performance steps. Changes to the limbic system can result in epileptic seizures and abnormal electroencephalograms (EEG), usually affecting the left hemisphere of the brain, which is associated with more self-destructive behavior and more aggression.

Deficient Development of the Left Side of the Brain, which can contribute to depression and impaired memory.

Impaired Corpus Callosum, the pathway integrating the two hemispheres of the brain, which can result in dramatic shifts in mood and personality.

Increased Blood Flow in the Cerebellar Vermis, the part of the brain involved in emotion, attention, and regulation of the limbic system, which can disrupt emotional balance.

Animal studies have shown that neglect and emotional trauma triggers changes in hormones and neurotransmitters within parts of the brain that are responsible for regulating fear and anxiety. The researchers suggest that this may also occur in children. As Teicher emphasizes, "We know that an animal exposed to stress and neglect early in life develops a brain that is wired to experience fear, anxiety and stress. We think the same is true of people."

In July 2000, the Journal of the American Academy of Child and Adolescent Psychiatry reported that early emotional abuse can distort the processes of attachment and affective development. Child abuse and neglect could also impair the individual’s capacity to develop appropriate emotional responses, leading to lifelong emotional and social difficulties.

From: http://www.mental-health-matters.com/abuse/index.php

Children and Trauma

What are traumatic life experiences?
Traumatic life experiences challenge a person's normal coping efforts. For children and adolescents, traumatic experiences include such things as sexual and other physical abuse and neglect, peer or family suicide, dog bites, severe burns, natural disasters (e.g. floods, tornadoes, hurricanes, etc.), fires, and medical procedures.

It can be traumatic for children to witness or experience violent crimes (e.g., kidnapping, sniper fire, and school shootings) or vehicle accidents such as automobile and plane crashes. Witnessing assault, rape, or murder of a parent can also be traumatic for children. Traumatic life events are fairly common in childhood. Research suggests that 14 to 43% of children have experienced at least one traumatic event in their lifetime.

What is the range of responses?
There is a wide range of responses to catastrophic events. Some children and teenagers experience temporary worries and fears that get better quickly.

Others experience long-term problems such as fear, depression, withdrawal, anger, haunting memories, avoiding reminders of the event, regressive behavior (acting younger than their actual age), worrying about themselves and others dying or being hurt, and irritability.

Reactions can occur immediately after the event or weeks later.

Children who have had traumatic experiences may have difficulty sleeping or have nightmares. They may avoid activities, situations, thoughts, or conversations that may be related to the traumatic events, even if other people don't perceive them as related (e.g., a child who was eating corn flakes on the morning of a terrible event may not want to eat corn flakes).

They may play in ways that repeat something from their traumatic experiences (e.g., twirling or hiding under things after exposure to a tornado). They may recreate aspects of the traumatic experience in their behavior (e.g., a child who was exposed to a fire may set fires).

They may not want to be with people as much as before. They may avoid school, have trouble with schoolwork, or feel unable to pay attention. They may not want to play as much, avoid certain kinds of play, or lose interest in things they once enjoyed.

They may be sad or seem to have less emotion or feel guilty about things they did or did not do related to the traumatic experience.

Young children (age 5 and younger) may experience new fears such as separation anxiety or fear of strangers or animals. They may act younger or lose a skill they have already mastered (such as toilet training).

Elementary school-aged children (6 to 11) may get parts of the traumatic experience confused or out of order when recalling the memory. They may complain of body symptoms that have no medical cause (e.g., stomach aches). They may stare into space or seem "spacey," or startle easily.

Adolescents (12 to 18) may experience visual, auditory, or bodily flashbacks of the events, have unwanted distressing thoughts or images of the events, demonstrate impulsive and aggressive behaviors, or use alcohol or drugs to try to feel better. They may feel depressed or have suicidal thoughts.

What are the risk factors for long-term problems?
Children are at greater risk for developing problems if the traumatic event was very severe (death, injury, bloody scenes), if the child's parents are extremely distressed in the aftermath of the traumatic event, or if the child was directly exposed to the event (versus hearing about it later).

In addition, risk increases if the event is an interpersonal trauma (caused by another person) such as rape and assault or if the child or adolescent has been exposed to numerous stressful life events previously or has a pre-existing mental health problem.

None of these risk factors means that the child will definitely have problems, but the risk factors increase the probability a child or teenager might develop problems after an extremely stressful event.

What can adults do to help?

• Let the child know it's normal to feel upset when something bad or scary happens
• Encourage the child to express feelings and thoughts, without making judgments
• Protect the child or adolescent from further exposure to traumatic events, as much as possible
• Return to normal routines as much as possible
• School can be a major healing environment as the child's most important routine.
• Educate school personnel about the child's needs. Reassure the child that it was not his or her fault, that adults will try to take care of him or her, etc.
• Allow the child to feel sad or cry
• Give the child a sense of control and choice by offering reasonable options about daily activities (choosing meals, clothes, etc.)
• If the child regresses (or starts to do things he or she did when younger), adults can help by being supportive, remembering that it is a common response to trauma, and not criticizing the behavior

Adults can be most helpful if they take care of themselves and get help for their own distress, since children and adolescents may respond to adults' feelings and reactions.

Most children and adolescents will recover within a few weeks with such support. However some children may require more help.

Responsible adults who are concerned about their child's reaction to a very stressful event may want to consider seeking the help of a mental health professional who is trained in helping children with traumatic responses or post-traumatic stress disorder.

Therapies can be individual, group or family sessions that include talking, drawing and writing about the event. In some cases medication can be helpful.

A family doctor, clergy person, local mental health association, state psychiatric, psychological, or social work association, or health insurer may be helpful in providing a referral to a counselor or therapist with experience in treating children affected by traumatic stress.

For more information about traumatic stress or the International Society of Traumatic Stress Studies, call 847-480-9028.

© 2005 International Society For Traumatic Stress Studies. All rights reserved.

Self Injury Fact Sheet

source: Deb Martinson

Self-injury basics:

• Most researchers agree that self injury (SI) is self-inflicted physical harm severe enough to cause tissue damage or marks that last for several hours, done without suicidal intent or intent to attain sexual pleasure. Body markings (piercing, tattooing, etc) that are done as part of a spiritual ritual or for ornamentation purposes generally aren't considered SI.
  SI generally is done as a way of coping with overwhelming psychophysiological arousal. This can be to express emotion, to deal with feelings of unreality or numbness, to make flashbacks stop, to punish the self and stop self-hating thoughts, or to deal with a feeling of impending explosion. SI is more about relieving tension or distress than is it about anything else.


• Although cutting is the most common form of SI, burning and head-banging are also very common. Other forms include biting, skin-picking, hair-pulling, hitting the body with objects or hitting objects with the body, etc.


• SI is a crude, ultimately destructive coping mechanism, but it works. That's why it sometimes seems to have addictive qualities. To help a client, you must offer more effective coping strategies as replacement. Learning these ways can take time; punishing a client or patient for coping in the only way s/he knows how can make therapy unworkable.


• Most people who self-injure hate the term "self-mutilation." That phrase speaks to intent and maiming the body is usually not the intent of SI anyway. Better phrases are self-inflicted violence, self-harm, and self-injury.

Who is likely to self-injure:

• Self-injurers come from all walks of life and all economic brackets. People who harm themselves can be male or female; gay, straight, or bi; Ph.D.s or high-school dropouts; rich or poor; from any country in the world. Some people who SI manage to function effectively in demanding jobs; they are teachers, therapists, medical professionals, lawyers, professors, engineers. Some are on disability. Some are highly-achieving high-school students.


• Their ages range from early teens to early 60s, maybe older and younger. In fact, the incidence of self-injury is about the same as that of eating disorders, but because it's so highly stigmatized, most people hide their scars, burns, and bruises carefully. They also have excuses to pull out when someone asks about the scars (there are a lot of really vicious cats around).


• People who deliberately harm themselves are no more psychotic than people who drown their sorrows in a bottle of vodka are. It's a coping mechanism, just not one that's as understandable to most people and as accepted by society as alcoholism, drug abuse, overeating, anorexia, bulimia, workaholism, smoking cigarettes, and other forms of problem avoidance are.


• Self-injury is VERY RARELY a failed suicide attempt. People who inflict physical harm on themselves are often doing it in an attempt to maintain psychological integrity -- it's a way to keep from killing themselves. They release unbearable feelings and pressures through self-harm, and that eases their urge toward suicide. Some people who self-injure do later attempt suicide, but they almost always use a method different from their preferred method of self-harm. Self-injury is a maladaptive coping mechanism, a way to stay alive. Unfortunately, some people don't understand this and think that involuntary commitment is the only way to deal with a person who self-harms. Hospitalization, especially forced, can do more harm than good.

What helps people who self-injure:

Medications (mood stabilizers, anxiolytics, antidepressants, and some of the newer neuroleptics) have been tried with some success. There is no magic pill for stopping self-harm (naltrexone, though effective in people with developmental disabilities, doesn't seem to work nearly as well in other patients). Many therapeutic approaches have been and are being developed to help self-harmers learn new coping mechanisms and teach them how to start using those techniques instead of self-injury. They reflect a growing belief among mental-health workers that once a client's patterns of self-inflicted violence stabilize, real work can be done on the problems and issues underlying the self-injury.

This does not mean that patients should be coerced into stopping self-injury. Any attempts to reduce or control the amount of self-harm a person does should be based in the client's willingness to undertake the difficult work of controlling and/or stopping self-injury. Treatment should not be based on a practitioner's personal feelings about the practice of self-harm.

Self-injury brings out many uncomfortable feelings in people: revulsion, anger, fear, and distaste, to name a few. If a medical professional is unable to cope with her own feelings about self-harm, then she has an obligation to herself and to her client to find a practitioner willing to do this work. In addition, she has the responsibility to be certain the client understands that the referral is due to her own inability to deal with self-injury and not to any inadequacies in the client.

People who self-injure do generally do so because of an internal dynamic, and not in order to annoy, anger or irritate others. Their self-injury is a behavioral response to an emotional state, and is usually not done in order to frustrate caretakers. In emergency rooms, people with self-inflicted wounds are often told directly and indirectly that they are not as deserving of care as someone who has an accidental injury. They are treated badly by the same doctors who would not hesitate to do everything possible to preserve the life of an overweight, sedentary heart-attack patient.

Doctors in emergency rooms and urgent-care clinics should be sensitive to the needs of patients who come in to have self-inflicted wounds treated. If the patient is calm, denies suicidal intent, and has a history of SI, the doctor should treat the wounds as they would treat accidental injuries. Refusing anesthesia for stitches, making disparaging remarks, and treating the patient as an inconvenient nuisance simply further the feelings of invalidation and unworthiness the self-injurer has. It is useful to offer mental-health follow-up services; however, psychological evaluations with an eye toward hospitalization should be avoided in the ER unless the person is clearly a danger to him/herself or to others. In places where people know that seeking treatment for self-inflicted injuries are liable to lead to mistreatment and lengthy psychological evaluations, they are much less likely to seek medical attention for their wounds and thus are at a higher risk for wound infections and other complications.

©1999 by Deb Martinson. Reproduction and distribution of this material is enthusiastically encouraged, especially distribution to medical personnel.

References:

Alderman, T. (1997). The Scarred Soul: Understanding and Ending Self-Inflicted Violence. Oakland: New Harbinger.

Coccaro, E. F., Kavoussi, R. J. , Sheline, Y. I., Berman, M. E., & Csernansky, J. G. (1997). Impulsive aggression in personality disorder correlates with platelet 5-HT2A receptor binding. Neuropsychopharmacology, 16(3), 211-216.

Crawford, M. J., Turnbull, G., & Wessely, S. (1998). Deliberate self-harm assessment by accident and emergency staff -- an intervention study. Journal of Accident and Emergency Medicine, 15(1), 18-22.

Favazza, A. R. (1998). The coming of age of self-mutilation. Journal of Nervous and Mental Disease, 186(5), 259-68.

Favazza, A. R. (1996). Bodies Under Siege: Self-Mutilation and Body Modification in Culture and Psychiatry, 2nd ed. Baltimore: The Johns Hopkins University Press.

Haines, J., Williams, C. L., Brain, K. L., Wilson, G. V. (1995). The psychophysiology of self-mutilation. Journal of Abnormal Psychology, 104(3), 471-489.

Hawton, K., Arensman, E., Townsend, E., et al. (1998). Deliberate self harm: systematic review of efficacy of psychosocial and pharmacological treatments in preventing repetition. BMJ, 317(7156), 441-7.

Herpertz, S., Sass, H., & Favazza, A. R. (1997). Impulsivity in self-mutilative behavior: psychometric and biological findings. Journal ofPsychiatric Research, 31(4), 451-465.

Herpertz, S., Steinmeyer, S. M., Marx, D., et al. (1995). The significance of aggression and impulsivity for self-mutilative behavior. Pharmacopsychiatry, 28(Suppl 2), 64-72

Hogg, C. & Burke, M. (1998). Many people think self-injury is just a form of attention seeking. Nursing Times, 94(5), 53.

Linehan, M. M. (1993). Cognitive-Behavioral Treatment of Borderline Personality Disorder and Skills Training Manual for Treating Borderline Personality Disorder. New York: The Guilford Press.

Miller, D. (1994). Women Who Hurt Themselves: A Book of Hope and Understanding. New York: BasicBooks.

New, A. S., Trestman, R. L., Mitropoulou, V., et al. (1997). Serotonergic function and self-injurious behavior in personality disorder patients. Psychiatry Research, 69(1), 17-26.

Simpson, E. B., Pistorello, J., Begin, A., et al. (1998). Use of dialectical behavior therapy in a partial hospital program for women with borderline personality disorder. Psychiatric Services, 49(5). 669-73.

Solomon, Y. & Farrand, J. (1996). "Why don't you do it properly?" Young women who self-injure. Journal of Adolescence, 19(2), 111-119.

Stein, D. J., Trestman, R. L., Mitropoulou, V., et al. (1996). Impulsivity and serotonergic function in compulsive personality disorder. Journal of Neuropsychiatry and Clinical Neurosciences, 8(4), 393-398.

Strong, Marilee. (1998). A Bright Red Scream. New York: Viking.

MPD/DID Key Findings Quick Facts

From the National Foundation for the Prevention and Treatment of Multiple Personality

• Victims of multiple personality disorder (MPD) are persons who perceive themselves, or who are perceived by others, as having two or more distinct and complex personalities. The person's behavior is determined by the personality that is dominant at a given time.

• Multiple personality disorder is not always incapacitating. Some MPD victims maintain responsible positions, complete graduate degrees, and are successful spouses and parents prior to diagnosis and while in treatment.

• A MPD victim (a multiple) suffers from "lost time," amnesia or "black-out spells," which lead the victim to deny his/her behavior and to "forget" events and experiences. This may result in accusations of lying and manipulation and may cause severe confusion for the undiagnosed multiple.

• More than 75% of MPD victims report having personalities in their system who are under 12 years of age. Personalities of the opposite sex or with differing styles are also common. Personalities within a multiple system often hold conflicting values and behave in ways that are incompatible with one another.

• 97% of MPD victims report a history of childhood trauma, most commonly a combination of emotional, physical and sexual abuse.

• Multiple personality disorder can be reduced or prevented by early diagnosis and treatment of traumatized children and by working to eliminate abusive environments.

• While usually not diagnosed until adulthood, 89% of MPD victims have been mis-diagnosed include: depression, borderline and sociopathic personality disorder, schizophrenia, epilepsy and manic depressive illness.

• When they first enter treatment, most MPD victims are not aware of the existence of other personalities.

• MPD victims require treatment techniques which specifically address the unique aspects of the disorder. Standard psychiatric interventions used in the treatment of schizophrenia, depression and other disorders are ineffectual or harmful in the treatment of MPD.

• Appropriate treatment results in a significant improvement in the quality of life for the MPD victim. Improvements commonly include reduction or elimination of: confusion, feelings of fear and panic, self- destructive thoughts and behavior, internal conflicts and stressful periods of indecision.

• Multiple personality disorder has been recognized by physicians since the 17th century. While often confused with the relatively new diagnosis of schizophrenia throughout most of the 20th century, MPD is again being understood as a legitimate and discrete disorder.
  

Multiple personality disorder IS treatable!

Mother-Daughter Sexual Abuse

source: Kali Munro, M.Ed., Psychotherapist

Sexual abuse perpetrated by mothers on their daughters is an uncomfortable subject for many people. It defies everything we believe, or want to believe, about women and mothers. Most people don't want to believe that female perpetrators of sexual abuse exist, and certainly don't want to believe that a mother could sexually abuse her own children.

Sexist Views About Women and Mothers

Most of us are raised to view women as being very different than men - to view them almost as opposites. Some people can't even imagine women doing the same things that men do, or being anything like men. Even when cultures view women to be strong, capable, and competent most continue to view women as inherently different than men because of their child-bearing abilities. Many character traits are presumed to be true about women because of their ability to bear children - women are believed to be more caring, sensitive, nurturing, and maternal than men. The reality that there are female perpetrators of sexual abuse, particularly mothers, is a fact that many people are not willing to believe.

Heterosexist Views Of Women and Mothers

This view of mothers, and even of all women, runs very deep in most cultures, and is linked with another assumption - that all women (and particularly mothers) are heterosexual.

Heterosexism and Homophobia

Sexual abuse has nothing to do with the perpetrator's sexuality or sexual identity; most abusers identify as heterosexual. Sexual abuse is not sex. Yet because of homophobia, same-sex sexual abuse is linked in most people's minds with lesbian or gay sex. How often do we see in the newspapers exclaiming "lesbian sex abuser" but not "heterosexual sex abuser?" It is an ingrained presumption.

This presumption is important to examine for many reasons. That the perpetrator is perceived to be lesbian fuels many people's denial. Mothers can't be lesbian, the thinking goes, therefore the abuse couldn't have happened. On the other hand, some people may be more likely to believe that the abuse happened, precisely because they perceive the perpetrator to be lesbian. It confirms their belief that lesbians are child molesters. When this occurs people are far more outraged than they are with father-daughter sexual abuse because a female perpetrator of incest is seen to have violated not only the heavy social expectations of the way mothers should act and be, but also of women.

How People View Mother-Daughter Sexual Abuse

People tend to feel far more conflicted and confused about mother-daughter sexual abuse - or female perpetrators generally - than they are about father-daughter sexual abuse (or male perpetrators). People respond with outright denial: "A mother wouldn't do that sort of thing." Others minimize the abuse: "How bad could it be? The abuser was a woman; she was probably gentle." And still others vilify female perpetrators, viewing them as worse than male perpetrators because they are women or mothers.

Some people try to explain away the behavior of female perpetrators by pointing to the history of sexual abuse that they have undergone. Having been sexual abused is one factor that can contribute to a mother abusing her own daughter (although there are plenty of survivors who do not sexually abuse children) - and it is possibly one of the more important factors that might lead female perpetrators to sexually abuse their children because they, unlike men, aren't socially conditioned to be sexually aggressive, or to sexualize children. However, this argument should not be used to minimize the responsibility of female perpetrators nor the devastating effects of this form of abuse.

It is not uncommon when female perpetrators are discussed, the tone is often distinctly softer and more sympathetic than when male perpetrators are discussed. This misplaced sexist sympathy for female perpetrators minimizes the effects of the abuse that a survivor went through and denies a survivor's reality of the trauma. In addition, when survivors are aware of this attitude, and many are, it can make it even harder for them to take their own abuse, and the effects of that abuse seriously.

Survivors of Mother-Daughter Sexual Abuse

Imagine how a survivor of mother-daughter sexual abuse feels, when the general population who has not undergone this trauma feels this confused and conflicted about it. Survivors tend to be very confused and conflicted about the abuse and their mothers, especially when, as usually is the case, their mothers were their primary care givers. They may have a lot invested in not acknowledging that the abuse happened - both because of their own beliefs about mothers (nevermind the emotional trauma of acknowledging the abuse), and because of the often rigid assumptions made by others about mothers.

When survivors of mother-daughter incest are able to acknowledge the abuse they experienced, they often believe that there must be something terribly wrong or bad about them. "How could my own mother sexually abuse me?" This belief that they are bad comes from the myth that mothers are intrinsically caring and loving. If all mothers are loving to their children, the thinking goes, then there must be something really bad about the child whose mother abused them. It makes sense that a child would think this way, especially in a context loaded with societal myths about mothers. It's easier for a child to believe that the abuse is her fault than to admit that the person who was supposed to love and protect her actually harmed her. Sadly, this way of thinking is carried into adulthood by many survivors, and it hurts them a great deal.

That Which Has No Name

It is very difficult for even survivors themselves to acknowledge that they were abused by their mothers because of the sexist beliefs many of us hold about women, and particularly mothers. It can be a great struggle to label their experience as abuse. Survivors may not have words to describe what happened; they may not know what to call it. They may fear that the incest was lesbian sex; something "dirty" - not to be talked about or admitted. They may be afraid of being perceived as lesbian, or afraid that the abuse makes them lesbian. Survivors who are lesbian may fear that their sexuality was caused by the abuse.

It is also difficult for survivors to acknowledge their abuse because there are very few places that survivors can hear or read about mother-daughter incest, or even about female perpetrators. Sexual abuse and incest have become almost synonymous with male sexual abuse of females and father-daughter incest. It is within this vacuum that survivors of mother-daughter incest struggle to make sense of and understand their experience.

Homophobic Beliefs - One Effect of The Abuse

Many people confuse same-sex sexual abuse with lesbian sex, thinking that the perpetrator and even the victim is lesbian, or was made lesbian by the abuse. None of this is true. Yet these myths continue to exist, and they confuse and haunt many survivors who live in fear and shame that they really are lesbian when they aren't, or that their lesbian sexuality was caused by the abuse.

Being abused by her mother does not make a survivor a lesbian. Even if the survivor's body physiologically responded to the sexual stimulation, this has nothing to do with sexuality. It is the body's natural physiological response to stimulation, and has nothing to do with the survivor's own sexual desires, or even consent. Sexual abuse effects a survivor's comfort level with and responses to being a sexual person, but it does not cause her sexuality.

Identifying With Mother Perpetrators

Even when survivors acknowledge that they were sexually abused by their mothers, they often strongly identify with their mothers. Just both of them being female in a sexist society can lead to identification with the mother. This identification with the perpetrator can make it more difficult for survivors to separate themselves, emotionally and otherwise, from their abuser.

Many daughters look to their mothers as a mirror for their future lives. Survivors of mother-daughter sexual abuse often see their future as a woman and mother as dismal. Many adult survivors painfully worry that they will sexually abuse children, that they are unsafe around children, or that they are potential perpetrators - just like their mothers. This may lead survivors to feel that they are untrustworthy, thus many survivors are reluctant to have children of their own (although the choice to not have children can be a perfectly healthy choice on its own.)

Are They Victims Or Are They Abusers?

Daughters, and thus many survivors, often look to their mother's experiences (in the home and with their fathers) as their future, and identify with their mother's situation. If their mother is in an upsetting situation, survivors will often feel empathy for their mothers, and want to help them. This is heightened for survivors whose mothers turn to them for support.

If the perpetrator views herself as a victim of circumstances, or is a victim of her husband, the survivor often feels sorry for her and fears losing her. This dynamic makes it very hard for the daughter to see her mother as an abuser. Many of us tend to see people in extreme categories - either victim or abuser. For children, this either-or-thinking is the norm, but for survivors it often remains with them and becomes entrenched. The truth is that people can be both - victims in one context, and abusers in another.

"I Feel Like I Am My Mother"

The more a survivor identifies with her mother, the harder it is to separate her identity from her abuser - a crucial step in healing. Many survivors of mother-daughter incest report looking in the mirror and seeing their mothers, and hating themselves for it. When they see their own body naked (which they may avoid doing), many survivors see their mother's body, and as a result feel deeply ashamed of and angry at their bodies. Some survivors respond to these feelings by not wanting to be women, or lesbian (as they may perceive their mother to be), or anything associated with women or lesbians.

The feelings of shame and self-hatred that survivors can have may lead to their feeling uncomfortable with and/or hatred toward women and lesbians; inadequate and bad about themselves; confused and ashamed about being women; uncomfortable with their sexuality; engaging in self-injurious behavior (particularly in the genital and breast area); developing an eating disorder; experiencing body shame; and having difficulties in relationships, particularly with other women.

It is crucial for survivors of mother-daughter sexual abuse to create boundaries with their mothers (physical, emotional, intellectual, and spiritual); to re-claim their bodies as their own, and to truly know the differences between themselves and their mothers.

Longing for a Mother's Love

Mother-daughter sexual abuse wounds survivors' hearts and souls. Their mothers were often their only care-givers and the only source of much-needed care. When this care is mixed with sexual abuse, the effects are devastating. This mixture of nurturance (if there was any) and sexual abuse may have been all the parenting a survivor received. Often the father was absent or simply did not take an active role in parenting. This mixture of caring and sexual abuse leaves survivors with an unpleasant, and often sickening or repulsive feeling. On the one hand, the survivor desperately needed to be loved, held, kissed, and nurtured, but when that nurturance comes with such a high price, it is devastating to the child's psyche. Even nurturance that is offered separate from the sexual abuse becomes hard to trust or to take in freely and openly. This leaves many survivors feeling a desperate need for love, and at the same time, highly conflicted about that need, and wary of those, particularly women who offer support. The grief connected to not receiving safe love from a mother or primary caregiver is profound.

Summing Up the Effects of Mother-Daughter Sexual Abuse

While survivors of mother-daughter sexual abuse experience many of the same effects as other incest and sexual abuse survivors, they tend to have heightened difficulties with:

• Naming their experience as abuse. This is particularly true in light of the myth
  that women do not sexually abuse children
• Identity. Many survivors have difficulty knowing that they are separate from and different than their perpetrators.
• Boundaries. Many survivors have difficulty maintaining their boundaries, specially with other women. They may be overly flexible or overly rigid.
• Self-blame. This is particularly true in light of the fact that they were abused by their mothers who are mythologized as all loving and caring.
• Gender identity. Many survivors do not want to be a woman, have trouble identifying as women, or do not like what they perceive women to be, because the abuser was a woman.
• Gender shame. Many survivors feel great shame about being a woman because of their identification with the perpetrator.
• Body shame. Survivors often feel great shame about their bodies, particularly their bodies' womanliness, because the perpetrator had a woman's body.
• Homophobic fears about one's actual or perceived sexuality. Survivors are often very confused about the differences between sexual abuse and lesbian sexuality, and may believe the myth that abuse causes a survivor's sexuality.
• Longing to be loved. Survivors frequently have a profound need to be loved in the way that they were not as a child, and they may fear or be unable to accept it, particularly from other women.

Final Thoughts

Abuse is never pleasant. However, mother-daughter sexual abuse seems to provoke particularly strong reactions in people, even those working in the area of trauma. Sometimes, when mother-daughter sexual abuse is acknowledged, people feel the need to say that it doesn't happen as frequently as father-daughter sexual abuse, or that women aren't as violent as men. Even if those things are true, it is not helpful information when listening to and understanding women who have been sexually abused by their mothers (or other women). If we want to create a safe environment for women to speak about their experiences, we need to talk and write about the fact that women and mothers do sexually abuse children. Only in that environment will survivors be truly free to tell their stories and heal themselves.

© Kali Munro, 2001 (reprinted with permission)

Kali Munro, M.Ed., Psychotherapist (416) 929-4612

mail@KaliMunro.com
www.KaliMunro.com

A Lot Has Happened since I last visited...

Hospitalization SUCKS If you have to go .. go.. but don't let them stop your meds! My doctor saw fit to stop everything but the damn glucophage and Glucotrol.. cuz I'm a diabetic.. maybe i shoulda left that off the chart. They feed ya like shit, and keep pokin' you with needles... and give ME fake sugar.. which they refuse to remember that I'm ALLERGIC TO!!! ALSO: I take a very potent nerve pain medication. They quit giving that to me right away..as per normal hospital bureaucracy. NEVER Stop taking nerve pain medication abruptly... EVER... unless you want to suffer. I take it for severe lower back pain.. guess what... I suffered.. on top of that.. they give me this foam mattress on wood bed.. like in a prison, and this is supposed to be one of our Capitol's finest Hospitals??? Oh what a wonderful experience.

3 Nights on that bed and this crap before they could transfer me off the "NUTHATCH WARD" and onto the "NOT SO NUTTY" ward, where I actually had a regular Hospital Bed.. that I could adjust. Showers.. however.. centrally located in front of the nurses' station... where EVERYBODY hangs out.. NOT my cuppa tea.. I waited til I got home thank you very much! I just washed up in my bathroom as best I could.

What got me to go in the first place?

Suicide.. is painless.. it brings on many changes.. rings in my ears for weeks on end. I know the words to this song .. mostly by heart. ALL of the stanzas.. not just the chorus. I try, desperately to bury my head in the sand.. to keep from hearing Janet singing this.. because she sings it so loud.. that even I .. who am not co-conscious can hear her voice almost clearly.

Desperate e-mails and phone calls to my wonderful therapist, and burying myself into a video game that I deem as harmless keep me occupied... but is the Video Game harmless? I'm told it may not be.

It's called America's Army.. and my 'nickname' on there is Cutemdown.. pronounced Cut 'Em Down ... hmm very very close to one of my 'family member's' name.. "Cutter".. who does what his name implies. Who... although he has not acted out yet.. he's been felt nearby. Whenever Janet is active.. so is Cutter. Janet.. is the suicidal one, Cutter, the pain releaser. I think there are others inside who are also very very sad... but I do not know of them.. These two.. I know about from past experiences that I've managed to survive... barely.

America's Army is as the name implies.. An Army shoot-em-up game... what makes this game different.. is it is a MMPRG.. Massively Multiple Player Game, run by the US Army. (And others). when you play, your 'character' "=WFC=(clan tag)1Lt.(my rank)Cutemdown moves around.. all you see of yourself.. is the gun, or hands in front of you, and the terrain of the map you are playing, your teammates, and if you're "Lucky" or "Unlucky" .. the Enemy - or as they call them "OpFor" (Opposing Forces).

OpFor .. are not computer generated graphics.. they are actual graphics motorized by other players. Thus - MMPRG. It makes the game intense, hard to play, FUN, and.... possibly a release, or ... a draw for someone deep inside. I personally am not violent, I am not a foul mouthed person, yet the Clan (group of people I joined to play with) ... "Cutemdown" swears up a storm sometimes... and at others... commits suicide runs.. and so-on...

Now.. I play this game.. and I yell at people who swear up a storm. I'm sure I confuse the "Boys" as I call them to pieces.. as I'm sure they've heard me swearing one minute, and yelling at them for swearing the next. I call them "The Boys" because I'm one of two females in the AA division of WFC.. I recruited the other woman, my friend Beth... we're both the 'oldest'. The oldest of the "Boys" is 34..close.. but many 16 yr olds, and 18 yr olds, and younger.

Anyhow.. don't know if this is a good game for me or not. I love the game. I love playing with the boys. I'm hanging out in the chat server as I type this up. I played for 5 hrs straight last night .. with the guys.. I don't remember 5 hours going by.. but I know my butt was sore from sitting for so long, and I was having a ball getting back with the "Boys" after being in the Hospital for a week. The actually more than 5 hours of game play ( the 5 hrs was just one map ) .. was more a social thing for me than actually playing the game. I was having a ball getting back in touch with my friends. This is nothing different than I've ever done before in other chat servers, on other places.. there just wasn't a video game attached at the time.

I've played video games all my life. Cut'em up shoot'em down, fight, magic them, blow them to bits, create worlds only to blow them to bits.. Star Wars Jedi - where you fight as a Jedi Knight against computer generated graphics. I grew up on computers. Games were a big part of them. WAR was the first game I ever "Cracked" .. I got it on a floppy disk.. with no instructions.. just the game. Had no idea how to play it.. and it was choose your Battle Lord, and the computer chose it's Battle Lord, then choose the map you fought over. Then the game began.. WAR you against the other Battle Lord. (I'm not putting this in the right terms.. like i said, I didn't have the instructions).

I taught myself Windows. I taught myself DOS. I taught myself how to manipulate a modem to connect to BBS's when I was 10 yrs old. I wrote on a Poetry BBS.. I barely remember that. I had an ATARI. I was a loner in highschool. I had a few friends, I never went to the mall with friends, I went to work there. So, before work, I'd spend my quarters in a video arcade... playing... computer games. This is nothing new to me.. other than it's "Live Fire". To me.. this game is great.. because - after 3 times dying.. the game isn't "OVER".

I don't know. I'm thinking maybe I'm over analyzing this.

Til we meet again.