Mind Mapping - the NEWS (slowly - work in process)

Friday, August 31, 2012

http://www.dissociative-identity-disorder.org/


  • Case studies report that most cases of DID resolve with proper therapy. Untreated, DID is chronic and recurrent with symptoms varying over time.
  • Psychotherapy for adults usually takes years depending on the patients goal.
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  • "This review examines empirical reports of treatment for Dissociative Disorders (DD), including 16 DD treatment outcome studies and 4 case studies that used standardized measures. Collectively, these reports suggest that treatment for DD is associated with decreased symptoms of dissociation, depression, posttraumatic stress disorder, distress, and suicidality." [42]

  • The newest diagnostic criteria are those for the proposed DSM-5 include the following plus there will be specifiers for "prominent non-epileptic seizures  (pseudoseizures) and/or other sensory-motor (functional neurologic) symptoms. "prominent non-epileptic seizures (PINES or pseudoseizures) and/or other sensory-motor (functional neurologic) symptoms. psychogenic non epileptic seizures (PNES). "DEFINITION AND EPIDEMIOLOGY: PNES are, as altered movement, sensation or experience, similar to epilepsy, but caused by a psychological process." [20]

  • "...alternate identities result from the inability of many traumatized children to develop a unified sense of self that is maintained across various behavioral states, particularly if the traumatic exposure first occurs before the age of 5. These difficulties often occur in the context of relational or attachment disruption that may precede and set the stage for abuse and the development of dissociative coping."
  • "Severe and prolonged traumatic experiences can lead to the development of discrete, personified behavioral states (i.e., rudimentary alternate identities) in the child, which has the effect of encapsulating intolerable traumatic memories, affects, sensations, beliefs, or behaviors and mitigating their effects on the child’s overall development.
  • ...posits that the development of DID requires the presence of four factors: (a) the capacity for dissociation; (b) experiences that overwhelm the child’s nondissociative coping capacity; (c)secondary structuring of DID alternate identities with individualized characteristics such as names, ages, genders; and (d) a lack of soothing and restorative experiences, which renders the child isolated or abandoned and needing to find his or her own ways of moderating distress.
  • The secondary structuring of the alternate identities may differ widely from patient to patient. Factors that may foster the development of highly elaborate systems of identities are multiple traumas, multiple perpetrators, significant narcissistic investment in the nature and attributes of the alternate identities, high levels of creativity and intelligence, and extreme withdrawal into fantasy, among others." [55]
  • "In short, these developmental models posit that DID does not arise from a previously mature, unified mind or “core personality” that becomes shattered or fractured. Rather, DID results from a failure of normal developmental integration caused by overwhelming experiences and disturbed caregiver–child interactions (including neglect and the failure to respond) during critical early developmental periods. This, in turn, leads some traumatized children to develop relatively discrete, personified behavioral states that ultimately evolve into the DID alternate identities. [55]

  • For this linking to occur, someone, usually a caregiver, must respond to the child in such a way that the child begins to create an internal singular representation of themselves and an adult provides a secure base for that child to live and explore, where if distressed they can return to the safe haven provided by their trusted caregiver. Severe and ongoing trauma and neglect by caregivers, starting early in childhood and consistently repeated throughout other important developmental periods of early life inhibit achievement of normal integration. [4]

  • The various dissociated parts of a system, other than the host will usually have their own history, self image and usually have their own name. In addition these alters usually have amnesia between them. During therapy dissociative boundaries (amnesic boundaries) are broken down and sharing and awareness takes place between the alters - including co-consciousness, a feeling of being in 2 minds at once.
  • The identity of each part created in childhood was influenced by their relationship with the original abuser(s). Twin parts might be seen as good and evil. Deformities and handicaps can be perceived such as a mute alter might represent how telling of the childhood abuse is forbidden. [4] (p.61)
  • There can be more than one ISH, but this is mostly found in larger systems. ISH's will often describe themselves as not having a body, unlike all the other alters. They might appear savant like, but they can only answer the best they can, just like every other personality state.

  • The most common alters in Dissociative Identity Disorder personality systems include: hosts, children, abusers, protectors, differently gendered, animals, managers, inner-self helpers, parts that wish for or inflict self harm including suicide, and alters that are thought to be dead. "Dead alters" are interesting since alters cannot be killed. These personality states are instead strongly dissociated from consciousness, so that their abuser(s) cannot find them. Any of these alter types, including the "host alters," will experience major deficits in self-awareness and functioning. The function of any alter is to attempt to address a system need; they do not choose their function. [53]
  • Two personality states, dissociated or not, cannot actually be present at the same time, but they can and do rapidly switch, appearing and feeling as if two or more are "out" at the same time. The event is called co-consciousness, co-awareness, co-hosting or co-presence depending on what exactly is going on. Those with DID tend to switch when there is a "perceived psychosocial threat. This switching allows a distressed alter to retreat while an alter who is more competent to handle the situation emerges". [58]

  • "During infancy, behavior is organized as a set of discrete behavioral states, such as states of sleep and waking, eating, elimination, and so on. If an infant/toddler is appropriately cared for, then these "behavioral states become linked over time and grouped together in sequences," [4] until a unitary personality sense emerges that can switch from one task-focused mental state to another, dependent upon need. As a child's brain develops, various personality states come to share a sense of having a common identity, while retaining the ability to switch from one personality state to another. [4] In a landmark study, C. Ross and L. Ness "conclude that symptom patterns in Dissociative Identity Disorder are typical of the normal human response to severe, chronic childhood trauma and have ecological validity for the human race in general." [62]
  • Common types of alters include: hosts, child parts, inner-self helpers, introjects, protectors, managers, suicidal states, twins, otherkin, dead alters, persecutors, gatekeepers and care-takers.  Each part in the system has a job that they perform - a needed job rather than a preferred job.
  • The proposed edition of the DSM-5 will emphasize fragmentation of identity, memory, and consciousness and at the same time add the "disruptive effect of symptoms on consciousness and a broader definition of symptoms." [19]
    • Disruption of identity characterized by two or more distinct personality states (one of course can be the host, since this is also a dissociated state) or an experience of possession, as evidenced by discontinuities in sense of self, cognition, behavior, affect, perceptions, and/or memories. This disruption may be observed by others, or reported by the patient.
    • Inability to recall important personal information, for everyday events or traumatic events, that is inconsistent with ordinary forgetfulness.
    • Causes clinically significant distress and impairment in social, occupational, or other important areas of functioning.
    • The disturbance is not a normal part of a broadly accepted cultural, religious practice, or part of the normal fantasy play of children.
    • The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (e.g., complex partial seizures). [54]
  • The study reports that the description in the DSM is "deficient because it omits most of the dissociative phenomena of Dissociative Identity Disorder and focuses solely on alter personalities."
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