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