dissociative identity disorder (did) helping clients with dissociative identity disorder (did) to...

Dissociative Identity Disorder

(DID)Helping Clients with Dissociative Identity Disorder (DID) to

Healing

What is Dissociative Identity Disorder?DID is/does not:

1. As portrayed in the movies: “Three Faces of Eve” and “Sybil“

2. Contagious3. Happen suddenly4. Have it’s beginnings in a child older than 8 to 10 years

of age5. Just go away

DID is/does:

1. Treatable2. Respond well to Cognitive and Dialectical Behavior

Therapies3. Involve extreme dissociation4. Require long-term therapy5. Involve programming/conditioning6. An adaptation rather than a disorder

What is Dissociation?A. Falls on a broad continuumB. A survival tool for those who have

experienced severe trauma

Signs of dissociation include:

1. Loss of time2. Gaps in memory3. Staring into space4. Not responding to stimuli5. Changes in mannerisms, facial

expression or voice that are not usual to that person

6. Introducing one’s self as someone unknown

How does Dissociative Identity Disorder happen?

Dissociation begins to happen

Mind becomes fragmented

Can no longer handle the abuse

Physical, EmotionalSexual

Exposed to Repeated abuse

Intelligent, Creative Child

Types of Dissociative Identity Disorder1. Reactive DID

A. No formal programmingB. Random but ongoing abuseC. Good – Bad Parent

1. Ritual Abuse DID

A. No longer called “satanic ritual abuse”B. Predictable, chronic abuseC. Purposeful programmingD. Three Types:

1. Self Styled Ritual Abuse2. Generational Ritual Abuse3. Governmental Ritual Abuse

Diagnostic Tools

Dissociative Experiences Scale – DESa. Easiest to administer

Dissociative Disorder Inventory Scale – DDI

Structural Clinical Interview for Dissociation – SCID-D

a. Gives the most in-depth information

Multidimensional Inventory of Dissociation - MID

Symptoms

1. Appears like Post Traumatic Stress Disorder Symptomology

a. Sleep disturbanceb. Hyper-vigilancec. Intrusive imageryd. Inability to modulate feelingse. Difficulty with focus and decision makingf. Unusual amount of physical symptoms or

Somatizationg. Suicidal or homicidal ideations often occur

Dissociative Symptoms

1. Amnesiaa. Time loss – memory gapsb. Amnesia during the appearance of alternate self statec. Perplexing appearance / Disappearance of possessionsd. Behavior perplexities / Recognition Anomaliese. Temporary loss of knowledge or skills

Dissociative Symptoms Continued

1. Conversion / Somatoform symptoms

2. Hearing voices inside the head3. Depersonalization4. Trance-like behaviors5. Identity – Self alteration6. Flashbacks – Body memories7. Pseudo-Psychotic Symptoms

Working With DID Patients

Bipolar DisorderBorderline Personality Disorder

PsychosisSchizophreni

a

Just want attention

MalingeringManipulative

IrrationalYou’re making all this up

Most DID patients have had many labels put upon them by medical professionals, family, friends, or co-workers

Overly Dramatic

Cry a river, build a bridge, get over it!

In my day we pulled ourselves up by our own

bootstraps!

It’s in the past, why can’t you just move on?

Don’t reveal the family secrets!

Treatment of DIDStages of Recovery

1. Awareness a. Host resistance

2. Acceptance

3. System work a. Memory work b. Barriers

4. System Organization a. Reducing lost time b. Understanding the

“shared body” c. Co-consciousness d. Integration

Emotional Component Goals

Desensitization and tolerance of strong emotiona. Sit with the feeling

Healthy regulation of emotionsa. Awareness of emotional reactionsb. Self talkc. Why am I acting this way?

Appropriate expression of emotions a. Practice healthy emotional reactionsb. Talk out strong emotions in treatment

What!?!

Regulate and control my own emotions!?!

Be responsible for my own feelings!?!

Acting In

Behavior Containment Within Functional

Limits

Containment Behavior Acting Out

Ulcers Numb Who Confusion Breathe Paranoia Nail Biting

IBS Intellectualize

What Avoidance Hydrate Rage Cutting

HTN Dissociation When Isolation Courage Panic Gambling

TMJ Denial Where Caution Clarity Terror Alcohol

Psoriasis

Avoidance How Anger Power Hopeless Drugs

Asthma Humor Rejection Space Anxiety Sex/Porn

Auto Immun

e System

Choice Abandonment

Tools Depression Shopping

Think Sad Time Flashbacks Dissociation

Touch Lonely Safety Body Memories

SI/HI

Sight Happy Soothe Exhaustion Any self -harm

Sound Disconnection

Taste

Smell

Acting In

Behavior Containment Within Functional

Limits

Containment Behavior Acting Out

Ulcers Numb Who-What Confusion Breathe Paranoia Nail Biting

IBS Intellectualize

When-Where Avoidance Hydrate Rage Cutting

HTN Dissociation How Isolation Courage Panic-Terror Gambling

TMJ Denial Humor Caution Clarity Hopeless Alcohol

Psoriasis Avoidance Choice Anger Power Anxiety Drugs

Asthma Think Rejection Space Depression Sex/Porn

Auto Immune System

Touch Abandonment

Tools Flashbacks Shopping

Sight -Sound Sad Time Body Memories

Dissociation

Taste Lonely Safety Exhaustion SI/HI

Smell Happy Soothe Disconnection

Any self -harm

Acting In

Behavior Containment Within Functional

Limits

Containment Behavior Acting Out

Ulcers Numb Who-What Confusion Breathe Paranoia Nail Biting

IBS Intellectualize

When-Where Avoidance Hydrate Rage Cutting

HTN Dissociation How Isolation Courage Panic-Terror Gambling

TMJ Denial Humor Caution Clarity Hopeless Alcohol

Psoriasis Avoidance Choice Anger Power Anxiety Drugs

Asthma Think Rejection Space Depression Sex/Porn

Auto Immune System

Touch Abandonment

Tools Flashbacks Shopping

Sight -Sound Sad Time Body Memories

Dissociation

Taste Lonely Safety Exhaustion SI/HI

Smell Happy Soothe Disconnection

Any self -harm

Acting In

Behavior Containment Within Functional

Limits

Containment Behavior Acting Out

Ulcers Numb Who-What Confusion Breathe Paranoia Nail Biting

IBS Intellectualize

When-Where Avoidance Hydrate Rage Cutting

HTN Dissociation How Isolation Courage Panic-Terror Gambling

TMJ Denial Humor Caution Clarity Hopeless Alcohol

Psoriasis Avoidance Choice Anger Power Anxiety Drugs

Asthma Think Rejection Space Depression Sex/Porn

Auto Immune System

Touch Abandonment

Tools Flashbacks Shopping

Sight -Sound Sad Time Body Memories

Dissociation

Taste Lonely Safety Exhaustion SI/HI

Smell Happy Soothe Disconnection

Any self -harm

Acting In

Behavior Containment Within Functional

Limits

Containment Behavior Acting Out

Ulcers Numb Who-What Confusion Breathe Paranoia Nail Biting

IBS Intellectualize

When-Where Avoidance Hydrate Rage Cutting

HTN Dissociation How Isolation Courage Panic-Terror Gambling

TMJ Denial Humor Caution Clarity Hopeless Alcohol

Psoriasis Avoidance Choice Anger Power Anxiety Drugs

Asthma Think Rejection Space Depression Sex/Porn

Auto Immune System

Touch Abandonment

Tools Flashbacks Shopping

Sight -Sound Sad Time Body Memories

Dissociation

Taste Lonely Safety Exhaustion SI/HI

Smell Happy Soothe Disconnection

Any self -harm

Physical Component Goals

Practicing healthy self-carea. Attention to hygieneb. Right amount of sleepc. Healthy eatingd. Exercise regularly

Coping Skillsa. Making and keeping a

scheduleb. Attending therapy/groupsc. Socializing with othersd. Setting and achieving goals

Psychological Component

Memory work Locus of Control

Cognitive Distortions

Past Versus Present Confusion

Need for Trauma Ed

Memory Work

Purpose

To make sense of life To make life more predictable and safe To understand who one is To relieve emotional pain

Memory Work

Barriers

• Lack of safe and supportive environment• Fear of losing one’s ability to function• Perpetrator loyalty• Fear of perpetrator retaliation• Fear of being overwhelmed• Fear of being evil• Programming - Programmed to self-destruct if remember

Cognitive Distortions

Locus of Control

Internal Locus of Controla. The person attributes the cause or

control of events to something inside of themselves

External Locus of Controla. The person believes that they are not

in control of their environment and the outcomes are instead controlled by luck,

destiny, or powerful others.

Cognitive Distortions

Black and White (All or Nothing) Thinking Irrational beliefs and thought patterns

a. “I have no value.”b. Use of “always” and “never”c. “I deserved it.”d. “It was my fault.”e. “I can’t change my life.”

Irrational fearsa. “They will hurt me again if I tell.”b. “I will fail if I try anything different.”

Past Versus Present Confusion

Continuing to view trauma events with the mind of a child

Not realizing that the trauma is over

Reacting to event happening in the present as you would in the past

Regression to a child-like state

Difficulty staying in the present

ToolsSafe place work Psychodynamic History - System maps Journaling, Letters with promptsProcessing feelings around memoriesTrauma groupsCognitive Behavior TherapyDialectical Behavior TherapyArt TherapyDesensitizationRole play, empty chairAnger management that is a combination

of physical and verbal Daily meetings with “alters” Including supportive family if possible

Need for DID Education

Every DID patient is different Learn to deal with trauma as the patient sees it How to work with “alters” Progress is usually slow Therapy is very intense Must have a “full bag of tricks” Need for provider to practice good boundaries Need for provider to practice good self care

ResourcesMore Than One: An Inside Look at Multiple

Personality Disorder by Terri A. ClarkThe Dissociative Identity Disorder Source Book by

Deborah HaddockGot Parts? An Insiders Guide to Managing Life

Successfully with Dissociative Identity Disorder by A.T.W.

The Haunted Self: Structural Dissociation and the Treatment of Chronic Traumatization by Onno van der Hart

Trauma Model Therapy: A Treatment Approach for Trauma Dissociation and Complex Comorbidity by Colin A. Ross

Waking the Tiger: Healing Trauma by Peter A. LevineInternational Society for the Study of Trauma and

Dissociationhttp://www.isst-d.org/

Links to Presentation Info

www.vickimoodylpc.com