My Truth

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I’m very passionate about mental health and abuse awareness, mainly due to my own expieriances. I am very open about my past, which I know is something that many do not like, but I do not see why I should stay silent – afterall that’s what the abusers told me to do and I can’t let them win can I?

I don’t want nor do I expect pity or sympathy. I do not deserve it, and I do not want it, what happened happened and I am only who I am today because of it. I do not want hugs and people saying they are sorry, what I want, what I fight for every day, is for OTHERS to feel safe that they will not be judged. What I want is to make it so that those who currently suffer in silence scared of what may happen if they open up know that they are not alone, and maybe make it so that they no longer have to fear judgement and blame.

I know that my work and my speaking out will not end abuse, discrimination and suffering, but if I can just let people know that they are not alone and do not have to suffer in silence and maybe if I can make a few people stop and think then I am happy with that. I cannot stop abuse, I cannot change the world, but maybe I can help to plant the seeds of change, plant that idea in to the minds of others, and then they can help that idea to grow until one day change can and does occur. Maybe one day the things which I fight will no longer exist, but I doubt that I will see that day. I can do so little, but it’s the best I can do, I just have to hope that human nature is not as bad as I fear and that these seeds if change and the glimmer of hope will take root.

I tell my story, my truth, not for pity, but for the hope that I can help to ignite change in this world. I know most will not believe this, but I know my truth and I hope that a few of you know this truth too. This is why I spend so long creating websites, writting letters, speaking in schools, raising money and trying to spread awareness. It’s an inconvenient truth I know, but it’s a truth that needs to be known, I cannot just sweep it under the carpet when I know that it could help others. So I fight and strive with the hope of helping, of making the suffering of others that little bit better that bit more bearable.  I wish that this truth was not there, that it did not need to be spread, but it is and it does. And for this I am sorry

This is my truth

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Common mis-diagnosis’s and co-mobidies of DID

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On average a multiple will be in the mental health system for 7 years prior to diagnosis and during this time may receive several varying diagnosis’s. They often include:

Temporal lobe epilepsy’

Dissociation is more common in patients with temporal lobe epilepsy than in any other neurologic disorder. The clinician should refer patients with dissociative symptoms for a thorough neurologic workup to rule out the presence of temporal lobe epilepsy or other organic processes. The standard EEG is of little help in distinguishing MPD from temporal lobe epilepsy because a high rate of nonspecific abnormalities has been detected in patients with MPD, most commonly bilateral temporal lobe slowing.

Schizophrenic disorders

The differentiation between dissociation identity disorder and schizophrenia can be made along several lines.

Patients with schizophrenia hear voices emanating from the external world, whereas patients with dissociation identity disorder hear voices originating from within the individual’s own head.

Patients with schizophrenia may experience visual hallucinations, although they are less well formed than those observed with certain other brain disorders. Patients with MPD occasionally experience hypnagogic phenomena.

Poor reality testing is observed with schizophrenia, whereas patients with MPD have essentially intact reality testing.

Tangential or loose associations accompanied by inappropriate affect are commonly observed with schizophrenia. Patients with dissociation identity disorder may have circumstantial association with appropriate affect.

Borderline personality disorder

Borderline personality disorder has been diagnosed in 70% of a sample of 33 patients with dissociative disorder and in 23% of 70 patients with dissociative disorder. Putnam acknowledged that a large number of his cases resembled Briquet syndrome or somatization disorder, but, like other investigators, he proposed that once the diagnostic criteria for MPD are satisfied, MPD should be considered the superordinate diagnosis because working with the alternates can provide a therapeutic device that cannot be used in the unified individual.

Malingering

Malingering is said to be an important differential diagnosis in times when an obvious gain may result from mental health intervention. Malingering is the deliberate and fraudulent production of false and exaggerated symptoms to deceive observers for secondary gain that is recognizable with an understanding of the individual’s circumstances.

Dissociative amnesic disorder

MPD may prove difficult to distinguish from other dissociative amnesic disorders. With other dissociative amnesic disorders, behavior may be complex, but recovery is often complete, recurrences are less common, and the onset of amnesic spells may be intimately related to stressful events or to ingestion or intoxication.

what is DDNOS?

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disorders in which the predominant feature is a dissociative symptom (i.e., a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment) that does not meet the criteria for any specific Dissociative Disorder. Examples include

1. Clinical presentations similar to Dissociative Identity Disorder that fail to meet full criteria for this disorder. Examples include presentations in which a) there are not two or more distinct personality states, or b) amnesia for important personal information does not occur.

2. Derealization unaccompanied by depersonalization in adults.

3. States of dissociation that occur in individuals who have been subjected to periods of prolonged and intense coercive persuasion (e.g., brainwashing, thought reform, or indoctrination while captive).

4. Dissociative trance disorder: single or episodic disturbances in the state of consciousness, identity, or memory that are indigenous to particular locations and cultures. Dissociative trance involves narrowing of awareness of immediate surroundings or stereotyped behaviors or movements that are experienced as being beyond one’s control. Possession trance involves replacement of the customary sense of personal identity by a new identity, attributed to the influence of a spirit, power, deity, or other person, and associated with stereotyped “involuntary” movements or amnesia and is perhaps the most common Dissociative Disorder in Asia. Examples include amok (Indonesia), bebainan (Indonesia), latah (Malaysia), pibloktoq (Arctic), ataque de nervios (Latin America), and possession (India). The dissociative or trance disorder is not a normal part of a broadly accepted collective cultural or religious practice. (See Appendix B in DSM-IV-TR for suggested research criteria.)

5. Loss of consciousness, stupor, or coma not attributable to a general medical condition.

6. Ganser syndrome: the giving of approximate answers to questions(e.g., “2 plus 2 equals 5”) when not associated with Dissociative Amnesia or Dissociative Fugue

From the DSM-IV

Dissociative Disorder Not Otherwise Specified (DDNOS) is an inclusive category for classifying dissociative syndromes that do not meet the full criteria of any of the other dissociative disorders. A person diagnosed with Dissociative Disorder Not Otherwise Specified (DDNOS) typically displays characteristics very similar to some of the other discussed dissociative disorders, but not severe enough to receive their diagnoses. DDNOS includes variants of Dissociative Identity Disorder in which personality “states” may take over consciousness and behavior but are not sufficiently distinct, varients where alters are present but either do not take over consciousness or only ever do so in a co-consiouss mannor with the host, or variants of Dissociative identity disorder in which there is no amnesia for personal information. Other forms of DDNOS include possession and trance states, Ganser’s syndrome, derealization unaccompanied by depersonalization, dissociated states in people who have undergone intense coercive persuasion (e.g., brainwashing, kidnapping), and loss of consciousness not attributed to a medical condition.

DDNOS occurs primarily in men (80%) and is currently regarded as a dissociative means of withdrawal from a traumatic or stressful circumstance. It is characterized by absurd or approximate responses to interview dialogue, a dazed or clouded level of consciousness, somatic conversion symptoms (eg, pseudoparalysis), hallucinations, and, frequently, anterograde amnesia regarding the episode.

What is PTSD ?

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PTSD has a unique position as the only psychiatric diagnosis (along with acute stress disorder ) that depends on a factor outside the individual, namely, a traumatic stressor. A patient cannot be given a diagnosis of PTSD unless he or she has been exposed to an event that is considered traumatic. These events include such obvious traumas as rape, military combat, torture, genocide, natural disasters, and transportation or workplace disasters. In addition, it is now recognized that repeated traumas or such traumas of long duration as child abuse , domestic violence, stalking, cult membership, and hostage situations may also produce the symptoms of PTSD in survivors.

A person suffering from PTSD experiences flashbacks, nightmares, or daydreams in which the traumatic event is experienced again. The person may also experience abnormally intense startle responses (hypervigilance) , insomnia , and may have difficulty concentrating. Trauma survivors with PTSD have been effectively treated with group therapy or individual psychological therapy, and other therapies have helped individuals, as well. Some affected individuals have found support groups or peer counseling groups helpful. Treatment may require several years, and in some cases, PTSD may affect a person for the rest of his or her life.

Causes

When PTSD was first suggested as a diagnostic category for DSM-III in 1980, it was controversial precisely because of the central role of outside stressors as causes of the disorder. Psychiatry has generally emphasised the internal weaknesses or deficiencies of individuals as the source of mental disorders; prior to the 1970s, war veterans, rape victims, and other trauma survivors were often blamed for their symptoms and regarded as cowards, moral weaklings, or masochists. The high rate of psychiatric casualties among Vietnam veterans, however, led to studies conducted by the Veterans Administration. These studies helped to establish PTSD as a legitimate diagnostic entity with a complex set of causes.

BIOCHEMICAL/PHYSIOLOGICAL CAUSES. Present neurobiological research indicates that traumatic events cause lasting changes in the human nervous system, including abnormal secretions of stress hormones. In addition, in PTSD patients, researchers have found changes in the amygdala and the hippocampus—the parts of the brain that form links between fear and memory. Experiments with ketamine, a drug that inactivates one of the neurotransmitter chemicals in the central nervous system, suggest that trauma works in a similar way to damage associative pathways in the brain. Positron emission tomography (PET) scans of PTSD patients suggest that trauma affects the parts of the brain that govern speech and language.

SOCIOCULTURAL CAUSES. Studies of specific populations of PTSD patients (combat veterans, survivors of rape or genocide, former political hostages or prisoners, etc.) have shed light on the social and cultural causes of PTSD. In general, societies that are highly authoritarian, glorify violence, or sexualize violence have high rates of PTSD even among civilians.

OCCUPATIONAL FACTORS. Persons whose work exposes them to traumatic events or who treat trauma survivors may develop secondary PTSD (also known as compassion fatigue or burnout). These occupations include specialists in emergency medicine, police officers, firefighters, search-and-rescue personnel, psychotherapists, disaster investigators, etc. The degree of risk for PTSD is related to three factors: the amount and intensity of exposure to the suffering of trauma victims; the worker’s degree of empathy and sensitivity; and unresolved issues from the worker’s personal history.

PERSONAL VARIABLES. Although the most important causal factor in PTSD is the traumatic event itself, individuals differ in the intensity of their cognitive and emotional responses to trauma; some persons appear to be more vulnerable than others. In some cases, this greater vulnerability is related to temperament or natural disposition, with shy or introverted people being at greater risk. In other cases, the person’s vulnerability results from chronic illness, a physical disability, or previous traumatization—particularly abuse in childhood. As of 2001, researchers have not found any correlation between race and biological vulnerability to PTSD.

Symptoms

  • Traumatic stressor: The patient has been exposed to a catastrophic event involving actual or threatened death or injury, or a threat to the physical integrity of the self or others. During exposure to the trauma, the person’s emotional response was marked by intense fear, feelings of helplessness, or horror. In general, stressors caused intentionally by human beings (genocide, rape, torture, abuse, etc.) are experienced as more traumatic than accidents, natural disasters, or “acts of God.”
  • Intrusive symptoms: The patient experiences flashbacks, traumatic daydreams, or nightmares, in which he or she relives the trauma as if it were recurring in the present. Intrusive symptoms result from an abnormal process of memory formation. Traumatic memories have two distinctive characteristics: 1) they can be triggered by stimuli that remind the patient of the traumatic event; 2) they have a “frozen” or wordless quality, consisting of images and sensations rather than verbal descriptions.
  • Avoidant symptoms: The patient attempts to reduce the possibility of exposure to anything that might trigger memories of the trauma, and to minimize his or her reactions to such memories. This cluster of symptoms includes feeling disconnected from other people, psychic numbing, and avoidance of places, persons, or things associated with the trauma. Patients with PTSD are at increased risk of substance abuse as a form of self-medication to numb painful memories.
  • Hyperarousal: Hyperarousal is a condition in which the patient’s nervous system is always on “red alert” for the return of danger. This symptom cluster includes hypervigilance, insomnia, difficulty concentrating, general irritability, and an extreme startle response. Some clinicians think that this abnormally intense startle response may be the most characteristic symptom of PTSD.
  • Duration of symptoms: The symptoms must persist for at least one month.
  • Significance: The patient suffers from significant social, interpersonal, or work-related problems as a result of the PTSD symptoms. A common social symptom of PTSD is a feeling of disconnection from other people (including loved ones), from the larger society, and from spiritual or other significant sources of meaning.

What is depersonalizaton?

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Depersonalization is a mental state in which a person feels detached or disconnected from his or her personal identity or self. This may include the sense that one is “outside” oneself, or is observing one’s own actions, thoughts or body.

A person experiencing depersonalization may feel so detached that he/she feels more like a robot than a human being. However, the person always is aware that this is just a feeling; there is no delusion that one is a lifeless robot or that one has no personal identity. The sense of detachment that characterises the state may result in mood shifts, difficulty thinking, and loss of some sensations – a state that can be described as numbness or sensory anesthesia. Twice as many women as men are treated for depersonalization, which can last from a few seconds to years. Episodes may increase after traumatic events such as exposure to combat, accidents or other forms of violence or stress . Treatment is difficult and the state is often chronic, although it may occur during discrete periods or increase and decrease in intensity over time. Individuals with depersonalization often feel that events and the environment are unreal or strange, a state called derealization

Findings in 2002 indicate that emotional abuse in particular is a strong predictor of depersonalization disorder in adult life, as well as of depersonalization as a symptom in other mental disorders. Analysis of one study of 49 patients diagnosed with depersonalization disorder indicated much higher scores than the control subjects for the total amount of emotional abuse endured and for the maximum severity of this type of abuse. The researchers concluded that emotional abuse has been relatively neglected by psychiatrists compared to other forms of childhood trauma.

It is thought that abuse in childhood or trauma in adult life may account for the distinctive cognitive (knowledge-related) profile of patients with depersonalization disorder. These patients have significant difficulties focusing their attention, with spatial reasoning, and with short-term visual and verbal memory. However, they have intact reality testing. (Reality testing refers to a person’s ability to distinguish between their internal experiences and the objective reality of persons and objects in the outside world.) Otherwise stated, a patient with depersonalization disorder may experience his/her body as unreal, but knows that “feelings aren’t facts”. The DSM-IV-TR specifies intact reality testing as a diagnostic criterion for depersonalization disorder.

What is dissociative amnesia?

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Dissociative amnesia is classified by the Diagnostic and Statistical Manual of Mental Disorders , 4th Edition, Text Revision, also known as the DSM-IV-TR as one of the dissociative disorders, which are mental disorders in which the normally well-integrated functions of memory, identity, perception, or consciousness are separated (dissociated). The dissociative disorders are usually associated with trauma in the recent or distant past, or with an intense internal conflict that forces the mind to separate incompatible or unacceptable knowledge, information, or feelings. In dissociative amnesia, the continuity of the patient’s memory is disrupted. Patients with dissociative amnesia have recurrent episodes in which they forget important personal information or events, usually connected with trauma or severe stress. The information that is lost to the patient’s memory is usually too extensive to be attributed to ordinary absentmindedness or forgetfulness related to aging. Dissociative amnesia was formerly called “psychogenic amnesia”.

Amnesia is a symptom of other medical and mental disorders; however, the patterns of amnesia are different, depending on the cause of the disorder. Amnesia associated with head trauma is typically both retrograde (the patient has no memory of events shortly before the head injury) and anterograde (the patient has no memory of events after the injury). The amnesia that is associated with seizure disorders is sudden onset. Amnesia in patients suffering from delirium or dementia occurs in the context of extensive disturbances of the patient’s cognition (knowing), speech, perceptions, emotions, and behaviors. Amnesia associated with substance abuse, which is sometimes called “blackouts” typically affects only short-term memory and is irreversible. In dissociative amnesia, in contrast to these other conditions, the patient’s memory loss is almost always anterograde, which means that it is limited to the period following the traumatic event(s). In addition, patients with dissociative amnesia do not have problems learning new information.

Dissociative amnesia as a symptom occurs in patients diagnosed with dissociative fugue and dissociative identity disorder . If the patient’s episodes of dissociative amnesia occur only in the context of these disorders, a separate diagnosis of dissociative amnesia is not made.

atients with dissociative amnesia usually report a gap or series of gaps in their recollection of their life history. The gaps are usually related to episodes or abuse or equally severe trauma, although some persons with dissociative amnesia also lose recall of their own suicide attempts, episodes of self-mutilation, or violent behavior.

Five different patterns of memory loss have been reported in patients with dissociative amnesia:

  • Localised. The patient cannot recall events that took place within a limited period of time (usually several hours or 1–2 days) following a traumatic event. For example, some survivors of the World Trade Center attacks do not remember how they got out of the damaged buildings or what streets they took to get away from the area.
  • Selective. The patient can remember some, but not all of the events that took place during a limited period of time. For example, a veteran of D-Day (June 6, 1944) may recall some details, such as eating a meal on the run or taking prisoners, but not others (seeing a close friend hit or losing a commanding officer).
  • Generalised. The person cannot recall anything in his/her entire life. Persons with generalized amnesia are usually found by the police or taken by others to a hospital emergency room.
  • Continuous. The amnesia covers the entire period without interruption from a traumatic event in the past to the present.
  • Systematised. The amnesia covers only certain categories of information, such as all memories related to a certain location or to a particular person.

Most patients diagnosed with dissociative amnesia have either localised or selective amnesia. Generalized amnesia is extremely rare. Patients with generalized, continuous, or systematized amnesia are usually eventually diagnosed as having a more complex dissociative disorder, such as dissociative identity disorder (DID).

What is dissociative fugue?

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The key feature of dissociative fugue is “sudden, unexpected travel away from home or one’s customary place of daily activities, with inability to recall some or all of one’s past,”. The travels associated with the condition can last for a few hours or as long as several months. Some individuals have traveled thousands of miles from home while in a state of dissociative fugue. (The word fugue stems from the Latin word for flight— fugere). At first, a person experiencing the condition may appear completely normal. With time, however, confusion appears. This confusion may result from the realisation that the person can not remember the past. Victims may suddenly realise that they do not belong where they find themselves.

During an episode of dissociative fugue, a person may take on a new identity, complete with a new name and even establish a new home and ties to their his/her community. More often, however, the victim realises something is wrong not long after fleeing – in a matter of hours or days. In such cases, the victim may phone home for help, or come to the attention of police after becoming distressed at finding himself/herself unexplainably in unfamiliar surroundings.

Dissociative fugue is distinct from Dissociative Identity disorder (DID). In cases of DID, which previously was called Multiple Personality Disorder (MPD), a person loses memory of events that take place when one of several distinct identities takes control of the person. If a person with dissociative fugue assumes a new identity, it does not co-exist with other identities, as is typical of DID. Repeated instances of apparent dissociative fugue are more likely a symptom of DID, not true dissociative fugue.

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