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

[tweetmeme source=”Life_With_DID”]

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.

Advertisements

The worst thing about DID

[tweetmeme source=”life_with_DID”]

the worst thing is not the loss of time, not the headaches, nor the feeling of being unreal. The worst thing is not the finding yourself in random places, or covered in random injuries. It’s not the constant chatter in your head, nor the inability to plan ahead as you have no idea if you will even be pressent or not at any given time. It’s not even the flashbacks, the lack of a memory or the way it messes up the way you think and learn making you feel asif you’ve basically become stupid…

nope… the worst thing is that in any given conversation where it is brought up there is about a 60% chance that someone there will claim that it’s not a real disorder, that alters are not real, that essentially you are faking.

If I wanted to fake a disorder (and god only knows why anyone would) then surely I would have picked an easier one to do so than DID???

Ritual abuse. What is it? (potentially triggering)

[tweetmeme source=”life_with_DID”]

Many people with DID suffered some form of ritual abuse either in a cult or in some other organisation during childhood. As such I thought it might be a topic I should touch upon in this blog…

A cult is a group of people who share an obsessive devotion to a person or idea. Some cults use violent tactics to recruit, indoctrinate, and keep members. Ritual abuse is defined as the emotionally, physically, and sexually abusive acts preformed by violent cults, many of these cults do not openly express their beliefs and practices, often living separately from the general public, isolating and alienating their members from outside influences.
Some victims of ritual abuse are children abused outside of the home by non-family members, often in public settings such as day care centres and Sunday schools. Other victims are children and teenagers who are forced by their parents, or other family members, to witness and participate in violent rituals. Adult ritual abuse victims often include these grown children who were forced from childhood to be members of the group. Other adult and teenage victims are people who unwittingly joined and organisation or social group that slowly manipulated and blackmailed them into becoming permanent members of the group. All cases of ritual abuse, no matter what age of the victim, involve intense physical and emotional trauma.
Violent cults may sacrifice humans and animals as part of religious rituals. They use torture to silence victims and other unwilling participants. Ritual abuse victims say that they are degraded and humiliated and are often forced to torture, kill, and sexually violate animals or other helpless victims. The purpose of the ritual abuse is usually indoctrination. The cults intend to destroy these victims free will by understanding their sense of safety in the world and by forcing them to hurt others.
In recent years a number of people have been convicted on sexual abuse charges in cases where the victims had reported elements of ritual abuse. These survivors (mainly children) described being raped by groups of adults who were wearing costumes or masks and said that they were forced to witness religious-type rituals in which animals and humans were tortured or killed. In one case, in 1989, the defence introduced in court photographs of the children being abused by the defendants. In another case, the police found tunnels etched with crosses and pentagrams along with stone alters and candles in a cemetery where abuse had been reported. The defendants in this case pleaded guilty to charges of incest, child cruelty, and indecent assault.
There are many myths concerning the parents and children who report ritual abuse. Some people suggest that the whole idea of ritual abuse is nothing more than “mass hysteria”. They say that the parents of these children who report ritual abuse are often just on a “witch hunt”. These sceptics claim that the parents fear Satanists and used their knowledge of the Black Mass (a historically well-known sexualised ritual in which animals and humans are sacrificed) to brainwash their children into saying that they have been ritually abused by Satanists.

The practice of ritual abuse is a difficult topic for many to confront or even comprehend. The children are tortured and brainwashed in order to assure compliance and loyalty to the group. The memories of ritual abuse survivors are often so graphic and perverse that some people question whether any of the stories could be true. Yet ritual abuse survivors experience overwhelming pain and trauma related symptoms as they remember the abuse: flashbacks; body memories; dissociation; anxiety; fear; etc. all of which are also seen in torture victims from wartime incidents, prisoners of war and war crimes.

Ritual abuse is a real, systematic and brutal practice happening today

self injury, dissociation and amnesia

[tweetmeme source=”life_with_DID”]

Self-injury in all its forms, including accident-proneness or a tendency to be victimised again in abusive relationships, may actually constitute screen memories of abuse or symbolic memories that a person is using to keep explicit abuse memories out of consciousness. Repeatedly hurting oneself is a way of not having to remember the original hurt. Self-wounding may also be an unconscious repetition of past abuse in an attempt to make sense of a dim but haunting memory. The person is trying to knit the implicit remnant of the trauma memory into fabric of a continuous mental narrative.

The amnesia that many self-injurers have for their destructive behaviour may be related to the return of memories from which they have disconnected. Since the emotional pain of returning memories is overwhelming, the person enters a trancelike state in an effort to keep them blocked. Self-injurers with dissociative disorders often say that they “find themselves” with injuries on their bodies in the same way that they in strange places without knowing how they got there. Self-injuring can be a form of reality testing for abuse that the person, on some level, knows happened but has split off from consciousness. Injuring oneself can bring “forgotten” memories of abuse into the awareness in several ways. The wounds themselves can reinforce the reality of past abuse, long disavowed by dissociation and the persistent denials of family members who maintain that the abuse never happened or was an expression of love. The pain of self-injury can test reality by restoring the feeling of being alive. Self-injury can also re-enact past abusive events symbolically, recalling them behaviourally, and reinforce the persons conviction that he/she was abused as a child. The fear of remembering what one was forbidden to remember may make amnesia a survival tactic once again.

How trauma effects memory

[tweetmeme source=”life_with_DID”]

Traumatic memories are more likely to be “forgotten” than non-traumatic memories due to faulty encoding or retrieving. A major mental process contributing to amnesia in dissociative disorders is known as state-dependant learning. According to this theory, information encoded in one mental state is most easily retrieved at a later time when in that same state. If a person experiencing trauma dissociates into separate state of mind, different memories will become available to that person at different times. Data encoded in one state will not be available to a person who is in a different psychological state; it will only be available when the person returns to the same state he/she was in at the time when it was encoded. For example: Harris, a thirty-seven-year-old pharmacist who was sexually abused repeatedly throughout his childhood by an older cousin, developed a six-year-old alternative personality named Barney. Harris could not remember the abuse until an assault by an armed robber at the drugstore where he worked triggered Barneys return.

State-dependent learning theory explains the severe amnesia that occurs in DID. Experiences encoded in a psychological state of abuse can chain together into a complex and consistent personality if the abuse is sufficiently traumatic and persistent. These particular alert personalities of overwhelming pain and fear are outside the persons conscious cognitive awareness, they live on in an alter personality and are still psychologically active and influential.

The “lost time” or “memory gaps” of someone with DID have preserved their sanity but have also swallowed up vast chunks of their past and identity. The future of a person with amnesia can be compromised too. The inability to integrate traumatic memories caused the person to fixate art the time of the trauma and impairs the integration of new experiences. When Barney resurfaces Harris was unable to concentrate on his job as a pharmacist and fill prescriptions that were beyond the comprehension of a six-year-old child. For many people, traces of the painful memory tend to linger and intrude as flashbacks, obsessions, or re-enactments of the trauma in self-mutilation or other self-destructive behaviours.

What is dissociative amnesia?

[tweetmeme source=”life_with_DID”]

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).

%d bloggers like this: