Dissociative Identity Disorder (DID) Helping Clients with Dissociative Identity Disorder (DID) to...
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Transcript of 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