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Trauma disorders, Borderline- and Dissociative Disorders

(c) Nique(c) Nique TRTCenter NLI did receive the question:

Could you try to explain in your own words and average understandable language; the different types of Trauma disorders (diagnoses), versus a Borderline Personality Disorder and the relation of both with Dissociative Disorders – without the interference of the understanding of a Structural dissociation of the personality.

And my answer to it is: Yes I feel very honored to give it a try in my own words.

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I. TRAUMA and Posttraumatic Stress Disorders – PTSD & CPTSD

Very simplified we know 3 main groups of diagnoses to a mental disturbance caused by Trauma:childabuse

1 an acute short term mentally disturbance (ASD)
2 a middle long term mentally disturbance (PTSD)
3 a long term e.g. chronically disturbance (CPTSD)

a bit more defined:

  1. Acute Stress Disorder
    an acute short term mentally disturbance / reaction to a one time experienced Traumatic event
    for example: witnessing a very heavy train accident
  2. PTSD
    Post-Traumatic Stress disorder – middle long term mentally disturbance caused by experiencing a dead scary Traumatic event
    for example: a kidnapping or a onetime rape experience, or other dead scary experiences
  3. C-PTSD
    Complex Post-Traumatic Stress disorder – a long term e.g. chronically mentally disturbance caused by experiencing more than one Traumatic event
    a. Childhood trauma like sexually and or physically abuse
    for example: incest or other repeated child molestation e.g. child abuse
    b. War experiences (veteran care), etc.

To simplify: above we have mentioned the different types of Trauma disorders (diagnoses).

And keep in mind that those diagnoses can be given to everyone who experienced a Traumatic event. So also to people with Borderline, with Autism, with no mental disorder, etc.. From the policeman to the house wife – they can all experience a dead scary traumatic event which can lead to a post traumatic stress disorder.

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II. DISSOCIATIVE DISORDERS – DD

The Second mental disorders I want you all to get acquainted with is the category
Dissociative Disorder – abbreviation = DD (watch out, it’s no DID)

  1. Dissociative identity disorder – DID a trauma related polysymptomatic condition which is characterized by a hidden presentation
  2. Other Specified Dissociative Disorder – OSDD
  3. Dissociative Amnesia
  4. Depersonalization/Derealization Disorder
    sub group:
  5. Unspecified Dissociative Disorder (DDnos)

Are dissociative disorders with switching behavior to different personality states always related to a Dissociative Identity Disorder (DID)………   :  NO

Switching between personality parts is not a phenomenon that only belongs to a Dissociative Identity Disorder (trauma related).There are other disorders that have symptoms of identity problems and switching behavior between personality states such as a theatrical personality disorder, a Borderline Personality disorder, a bipolar disorder or schizophrenia.
A Dissociative Disorder (DD) has a wider range of being a co-morbidity disorder.

PTSD and it’s relation to Dissociative Disorders (OSDD and DID):
Within the category Dissociative Disorders, we know two types of diagnoses which are related to Psychologically-Trauma:

1. Otherwise Subscribed Dissociative Disorders (OSDD) and
2. the Dissociative identity Disorder (DID) – caused by Psycholotically-Trauma

Those two Dissociative disorders are both categorized by Trauma specialists as Complex Psychologically-Trauma disorders.
Sometimes also knows as a Trauma type – II and type – III

And both disorders are known with a wide range of dissociative problems. From Amnesia, Depersonalization to Derealization to somatic dissociation, etc.. The difference between a trauma related OSDD and DID is the comorbidity of disorders and the presentation of the Switching behavior. Both disorders are likewise severe and don’t tell a thing about more or more severe Trauma experiences – because both disorders are categorized as likewise very severe disorders ! they cause severe clinically distress and agony in life.

A Trauma related diagnose tells you only something about the complexity of the disorder(s).

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III. BORDERLINE PERSONALITY DISORDER – BPD

not C-PTSD related – Abbreviation BPD

A Borderline personality disorder is a personality disorder which causes severe agony to life. It’s also a disorder which very often is misunderstood and stigmatized. People with a BPD suffer a lot, so please don’t judge them by the disorder but try to understand them.

BPD is a diagnose of a mental disorder which points out a list of ongoing disturbed, unstable and or harmful symptomatically behavior caused by a broad range of influences during childhood and a biologically given mental weakness. Examples of causes:

  • too less love and attention (negative child neglect)
  • too much negative love and attention (positive child neglect)
  • broth up by parents with harmful addictions
  • broth up by parents with social problems
  • broth up in a harmful e.g. stressful living environment
  • etc.
  • and the most upper handed cause to develop BPD:
    is most likely a mental weakness given by biologically genes (Borderline structure).
    A by nature given, not being able to handle or coupe well with stressful situations. A biological basis to develop a BPD.
    Note: Not everyone born with the biologically genes will develop a Borderline Personality Disorder during life –  A Borderline structure (is not a BPD) only tells something about the mental straight to coupe or handle with stressful situations.

Some psychologist e.g. mental clinicians like to call the causes to the development of a BPD – ‘childhood trauma’. But if you understand the clinical definition of Trauma you can’t place those causes in a direct line of Traumatic experiences. So I fully disagree with people who think and or declare that a Borderline Personality disorder is per definition caused by Trauma, and or is always trauma related, because it isn’t.

A Borderline Structure or a Borderline Personality Disorder by itself isn’t caused by Trauma !

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And now we end up to the most spoken CLINICAL DISPUTE * * *

BPD and It’s relation with Dissociative Disorders  (OSDD and or DDnos):

attentionOf course it all needs research and a global acceptance to define the difference and or relation of causes and the influences of different comorbidity disorders, but I will give you a bit of an explanation in the line of both clinical streams which are still arguing about the cause and understanding of a BPD in combination with Dissociative Disorders and or dissociation caused by Trauma:

A bit Freudiaans and a bit Janetiaans – I think; both theoretically streams do have a point

                      1. BPD + DDnos not Trauma related
                        BPD + Dissociative symptoms and switching behavior to different emotional personality states NOT Trauma related
                        (BPD + comorbidity DDnos)

People who suffer a Borderline Personality Disorder very often can’t coupe (independently) with stressful situation. They clamp on to addictive behavior to escape the inner stress and daily life stress, and or they clamp on to other people which can guide them through a stressful situation of life. If stress comes in to (such) a relation someone who suffers a BPD wants also to escape this relation (again) by clamping on to another person. They don’t attach on a healthy way and it’s not uncommon that someone with a BPD has a storrmy history of different relationships or switches back and forward towards and between more than one relationship. They easily panic if they are left alone. And they show very often impulsive and or addictive behavior.  It’s also not uncommon that someone who suffers a BPD seeks attention, I prefer to call it   they seek HELP because they are scared – they do this to escape the inner stress and the fear of being left alone. Life itself is sometimes even too much to handle and the fear of loneliness then also gets enormous, almost unbearable.
Graphed by this fear they sometimes develop different somatic problems with no physical cause, or they even start to develop their own internal family and play mates to escape the fear of being left alone. They start to Dissociate by the development of emotional personality parts.

                      1. BPD + (CPTSD) OSDD Trauma related
                        BPD + Dissociative symptoms and switching behavior under the influence of emotional personality parts:Trauma Related
                        (BPD + CPTSD + OSDD)

Like every human being also someone who suffers a BPD can experience a dead scary traumatic events or have suffered also Childhood sexual and or physical abuse which leads to the symptoms of a PTSD or a CPTSD with dissociative symptoms.
It’s also not oncoming that you see also severe Dissociative symptoms and dissociative Switching behavior in this category of a double mental disturbance and category of diagnosis.

But it’s also very difficult for diagnosticians to diagnose BPD + Dissociative Symptoms and the Switching behavior to other personality states of this category, because they need to determine if the Dissociative symptoms are caused by the BPD or by trauma related Dissociation (OSDD). And that is not an easy thing to do.

 

Fact or Factious:
ptsd vrijSomeone who suffers a BPD + Dissociative symptoms (DDnos and or OSDD) suffers severe agony in life. We know that this group is also the most difficult group to treat because of the underlying BPD and wide range of dissociative symptoms. Prognosis of treatment aren’t much positive because of the severity of the combinations of disorders. And although researches are doing their best to develop better diagnostically instruments (differential instruments) and treatment possibility’s, it’s still a group which gets to less global attention and understanding.

For the difference between a OSDD and DID dissociative disorder
I refer to the following link: The difference between OSDD and DID

(c) Nique

Complex Trauma PTSD

Safety and Internet

develop your own safetySAFETY AND THE USE OF INTERNET

Complex-Trauma & Structural Dissociation
© Nique, 31 august 2014
What do you need to know about
Support, Advocacy, Help or even Professional help – versus the use of the internet

Because lots of fellow sufferers question safety and trust as they join a (support) group or community, I want to write the following lines to give you all something to think over.

I think those lines are important, so don’t ignore them – give them a change by reading them.

 

What do we need to know about the mental healthcare workers e.g. fields

Know the basic differences in degrees of psychological working fields and their abbreviations. Lots of people use abbreviations on the internet to impress. Don’t be impressed by an abbreviation without a public mentioned licensee number and working field and working address.

(c) Nique DIDWhat is the Difference Between Psychologists,
Psychiatrists, and Social Workers?

 

internetsafety-wordleSupport groups are nice places to talk with your fellow sufferers, but they also can be very hurtfully. So keep your emotions and yourself safe at all times, because a community holder e.g. owner can’t guaranty you any safety. So please don’t believe otherwise and know that it it’s you and only you who can keep you safe on the internet.

Don’t follow medical advises from people who carry only an online profile with an alias name.

Many people use fake accounts, nothing wrong with that, its even smart in order to communicate safe through the internet. But it’s very badly wrong if they start to advise you, educate you or even analyse or treat you on a medical or therapeutically way with a fake account.

If you accept help from someone by the use of the internet, then know who you’re talking to before you share private information with such a person, and take notice of the following handles.

Safety_MattersYour contacts with a medical background
e.g. Professionals

Ask always for a copy of license if someone advises you under the title of Ph.D., clinical- or average Psychologist, SW, LCSW or other likewise practicing working fields. Even students have a scholarship number.

Never accept online counseling or psychological treatment if you don’t know who you are dealing with.
And above all keep in mind: Professionals will keep a professional distance too their clients because they know their ethics. This means also that they don’t join their clients in an online community advocacy or support group.

Follow never education, medical advises or knowledge from people which refuses to identify themselves with their real name and living or working address. Professionals will carry a profile picture to be cognizable, because they don’t want to hide and they do want to be trustworthy.

Professionals will always identify themselves and they have also no problems with being recognizable.

support-groupsSupport and Advocacy Groups

Support Group:
What does it mean? Members provide each other with various types of help, nonprofessional and nonmaterial, for a particular shared, usually burdensome, characteristic. Members with the same issues can come together for sharing coping strategies, to feel more empowered and for a sense of community. The help may take the form of providing and evaluating relevant information, relating personal experiences, listening to and accepting others experiences, providing sympathetic understanding and establishing social.

Advocacy:
What does it mean: It’s a commonly used English term (the emphasis is on the first syllable) that indicated the work of organizations that are committed to the rights of certain groups, e.g. women, minorities or children.
The term literally means ‘ voice ‘ or ‘ defense ‘

How to join safely a Support or Advocacy Group or community

After all those warnings you could get scared to join an online support or advocacy group e.g. community, don’t because that isn’t necessary if you keep on guard with your own safety!
So I will give you also some handles to Join safely a support or advocacy group on the internet.

Make sure you don’t use your real or full name – and please don’t use double accounts because it’s very important to be recognizable for other community users and members. Make as less as possible changes in you profile.
Don’t share your real personal name and living details, it adds no value to a membership of an online support or advocacy community or group because the moderators and owners can’t protect your personal details and they also don’t need them. Even professionals keep their personal home address privately.
Don’t take this lithely and help new members to start safely by sharing and advising those handles.

Do not to another person what you don’t like done to you, treat them as how you would like to be treated !!

TeamHow can I share my personal story, emotions and or feelings

You can easily share your personal story if you don’t share your photo, real name and address. So it is not harmful to tell someone what your experiences were and what harmed you so much. What your emotions are and why you join this group, etc..

But keep in mind to do it on a way that they can’t trace your story back to your personal address and name.  With an alias you are pretty safe in a Google+ community and within G+ you stay the boss over your own messages. This in contrast with the use of a forum such as a php forum or likewise where the administrators and management can censure or edit your personal messages.

Don’t share personal pictures or likewise – family pictures if you don’t want to be recognizable all over the place. Pictures will be very easily found by search engines like a google picture robot and likewise search engines.

i_love_internet_safetySupport Groups with a mental healthcare issue as there topic title

Joining a group with a mental health issue, for example:
Support groups Complex-Trauma, or a DID group or a BPD group or a Trauma and dissociation group, etc..

Know this, knot it even in your ears:

In such a group you will meet other people with also a mental health issues. They can be very friendly, they are most likely fellow sufferers and it can very easily feel very trust worthy. But also there you need to keep something very important in your mind!
The behavior of someone with a mental health issue can change in an instant and under the influence of their mental health issue. It is also not uncommon that this activates a disturbed chain reaction in such a group. On such a moment take a step back, take a brake (a day or even two days or as long is needed) until the group has calmed down. Don’t let yourself talking in to something if you had nothing to do with a or the conflict yourself. In other words ‘mind you own business’.

This sounds hard but it isn’t.
Very often a conflict accelerates by the interference of others.

Support means also: help conflicting members to talk with each other – don’t talk for them, don’t talk about them and also don’t interfere with the conflict: Help them to talk with each other and stay neutral

Always keep in mind – everything you say can be used against you because you can’t predict the behavior of an individual with a mental illness as you also can’t predict the behavior of a healthy person. So avoid private conversations as much as possible in a mental health issue group or community. The more open you communicate, the more safe a community and you are. It’s very honorable if we can help each other and it will always be our intention, but do it in the open of the group and back off during a conflict.

Then you guarantee your own safety at the best.

And at the end I want to write:
Keep always your own mental health and well being on the top level of your social
PRIORITIES AND ACTIVITIES.

Internet is as safe as you make it safe – for and by – yourself !
Create or keep a natural and healthy distrust towards the use of social activities on the net

Make the Net useful for You

Friendly regards,
Nique
CE at the Dutch Top Referent Trauma Center, Assen-Drenthe – The Netherlands

 

Complex Trauma PTSD

The difference between OSDD+ and DID

(c) Nique TRTCenter NLThe difference between a secondary and tertiary SD 

a secondary (OSDD+) and a tertiary (DID) structural dissociation of the personality
Other Specified Dissociative Disorder (300.15) and the Dissociative Identity Disorder (300.14)

As we explained and know already…

DID is a Dissociative Disorder (DD)

A Dissociative Disorder (DD) leads very rarely to a diagnose of a dissociative Identity disorder (DID), more common is a secondary SD. Read also my previous post and the notification I shared of Prof.Ph.D. Onno van der Hart and Ph.D. Ellert Nijenhuis.

OSDD criterea

And although a trauma related secondary Structural Dissociation, diagnoses OSDD+ in combination with another (personality) disorder such as BPD, far more often occurs than a DID, you will find hardly websites that inform you about a OSDD+. It is also a very severe Trauma related disorder which presents itself with a wide range of dissociative symptoms and switching behavior under the influence of EP’s (more than one). But its also very often mistaken with DID and diagnosed as a DID – but it isn’t a DID.

That alone should ring a bell to the leg of understanding a Trauma related SD !!

Why are there so much websites and blogs about DID and nearly none about OSDD+ (DSM-5  code 300.15  – ICD F44.89 – ) And why are most of the DID related websites focused on, and explaining ANP-EP switching behavior and not ANP-ANP switching behavior which is more common to a DID?
I leave that answer to my readers who are willing to understand the theory of a trauma related structural dissociation of the personality (SD), but I will give you all some theoretically and educational stuff to think over in order to understand even better the difference between a OSDD+ and DID, e.g.  the difference between a secondary and a tertiary structural dissociation of the personality.

DID critereaDID versus OSDD+ and again I start with writing . . .

Switching behavior caused and under the influence of Emotional personality parts ANP-EP’s switching is not a phenomenon that occurs most commonly as a symptom of a dissociative identity disorder (DID) – a Tertiary Structural Dissociation of the Personality. Indeed it is more common to a Secondary Structural Dissociation of the personality OSDD + very often in combination with a Borderline Personality disorder.

So there are also other disorders that have symptoms of identity problems, or which causes switching behavior, such as a theatrical personality disorder, a Borderline personality disorder (BPD), a Bipolar disorder, Schizophrenia etc.. A Dissociative Disorder (DD) has a wider range of being a co-morbidity disorder.

 

Take notice:
a tertiary Structural Dissociation – a trauma related Dissociative Identity disorder (DID) – is a poly-symptomatic condition which is characterized by a hidden presentation (Boon/Daijer). Diagnoses of a ‘trauma related’ structural dissociation of the personality can only be done by an experienced clinical trauma psychologist/psychotherapist which is specially taint to do so.

By KamarzaIt’s hard to accept a diagnose of a mental disorder

I know that most of us who suffer mentally problems don’t like to be lined out with a Personality disorder or an other mentally disorder diagnose which we don’t like to accept or were we don’t want to hear about. I’m no different to that. I also walked the way rejection. I also rejected every mental disorder diagnose for years – I wanted to be accepted as ‘Neuro typical without any mental problems’. I didn’t want to hear or know about it, I didn’t suffer a mental disorder, I also didn’t want to hear about my history or about the past. I was strong, nothing was wrong with me because I could survive everything, it had to be a physical problem – but it was a big lie, told by my own misleading mind. I hated to be diagnosed or to accept ‘I have problems and I need help’. So I know how hard it is to accept a diagnose of a mental disorder .

Especially a diagnose which is so painful and hard to understand, and which carries a  very stigmatizing character. But I did accept eventually and I also will beat the monster inside of me.

So a diagnose will never be something to please or pleasure, and in a way it will always hurt until you learn to accept who you are and which problems you need to face and fight. So I don’t write to please, pleasure or hurt someone. I write to explain something. Because the diagnose of a tertiary and also secondairy “structural dissociation” – is still very misplaced, misunderstood, unknown and very often wrongly explained.

And likewise,there are DID sufferers misdiagnosed with a personality or other mentally disorder,
there are also OSDD+ sufferers misdiagnosed with a the diagnose MPD or DID

Suffering a DID 

In my previous column the diagnostically reality of a SD-DID sufferer I wrote:

Are all DID diagnoses a tertiary structural dissociation?
And I answered to it:
Technically and to the theory of a Structural Dissociation: YES
Realistic and to the present time of a global diagnostically acceptance and understanding of a Structural Dissociation: NO

Until this moment a level 2 and 3 of the structural dissociation of the personality are a diagnostically mess and you also get easily misinformed about a level 3 SD-DID. Because there is still no suitable diagnostically DSM category to define a Complex Trauma (CPTSD) with severe dissociative symptoms. And there is also still a big leg of understanding to the SD theory and diagnosticians who can proper diagnose a trauma related structural dissociation of the personality. 

Result: Level 2 and 3 of a Structural Dissociation are totally mixed up as a Dissociative Identity Disorder. And DID sufferers still get stigmatized by a global a populistic presentation of unrealistic switching behavior which isn’t a realistic match to someone who suffers a Tertiary Structural dissociation of the personality. 

In reaction someone commented to it:

The diagnosis of MPD (multiple personality disorder) was renamed as DID
but the DSM criteria barely changed, so that part I don’t follow

The DSM – DID criteria A holds:

  • Disruption of identity characterized by two or more distinct personality states. ANP states !

Here the biggest misunderstanding starts already.
Lots of people mess up the explanation and understanding of the EP and ANP (alters, hosts, personality parts or personality state, etc.):

An Emotional personality Part (EP)
An Apparently Normal Personality state (ANP)

  1. Emotional Personality part (EP)
    Every human being is gifted with emotions and a personality.
    So everyone can also develop EP’s during live (no age boundaries) – Emotional parts of the personality. But an EP is NO autonomic functioning personality state that takes care of daily life events (its not task oriented). Also EP’s aren’t a realistic match to the present time and they don’t take care of everyday life (the present time). EP’s are emotional personality Parts which are stocked in a traumatizing experience, a memory in the past. And EP’s react to everything that (could) trigger a traumatizing memory or a part of that nasty memory – they go in contact with that memory.
  1. Apparently Normal Personality state (ANP)
    ANP’s are very ingenious Personality states. Survival oriented personality states. They function fully autonomic and they stay fully in contact with the present time. Their main function is ‘not remembering traumatizing experiences at all’. They act Apparently Normal. They take care of everyday life emotions and tasks. And they don’t leave a lot of room to EP’s to take over or to react on situations which could trigger EP’s (remembering the past or a part of the personality that goes in contact with that experience in of the past). If you don’t know the person who suffers a DID very well, you probably wouldn’t notice their switching behavior. This also causes difficulties to diagnose a DID because very often it’s the same ANP which will present itself to a diagnostician. DID is poly-symptomatic condition which is characterized by a hidden presentation. Someone who suffers a DID very often also suffers a very superficial emotional life. Their life is very often tasks oriented and not emotional oriented. A very common pronunciation of someone who suffers a DID is: I wear the feeling as if I’m only able to function like a robot.

Thinking this over, you could ask yourself at the same time:

  • Is someone who suffers acting-out behavior, impulsive behavior, etc. able to live a life of a DID sufferer? A very stable, emotional superficial, task oriented life?
  • The second question you could ask yourself is;
    Would someone who suffers a DID present oneself on a vulnerable way – by the presentation of an emotional personality part? Or is the life of someone who suffers a DID more task oriented with a constantly avoiding of being vulnerable on any way (a hidden presentation)?
  • The third question you could ask yourself is;
    Does someone who suffers DID shows unstable behavior that is strongly influenced and inflicted by emotional personality parts? Does someone who suffers DID know how to live an emotionally life? Or are they only acquainted with a superficial emotional and Surviving task oriented life style?
  • The fourth question you could ask yourself is;
    Would you be able to diagnose someone with DID who you know barely and who you didn’t observe over a reasonable time expand, and where you have no knowledge of development and behavior history, and were you have no excess to an extensive hetero case history etc.. Could you diagnose someone with DID just within a couple of clinical diagnostically meetings / appointments with filling out some questionnaire lists?

To all the professionals out there I would like to say, please…..
Don’t take it lightly if you are up to diagnose someone who suffers Switching behavior. Switching behavior is not a phenomenon that only occurs as a symptom of a dissociative identity disorder (DID), likewise hearing voices or having interrupting thoughts, or suffering amnesia to a Traumatic Experience (a partial or full dissociation – ANP to EP) and or a general micro amnesia.
Please inform yourself very extensively about a Trauma related Structural Dissociation of the personality before you diagnose someone with it.

 

DSM-5General diagnostically information:

DSM-5 300.14 –  ICD F44.81 diagnostically criteria A, B, C, D and E;

A)
Disruption of identity characterized by two or more distinct personality states. The disruption in identity involves marked discontinuity in sense of self and sense of agency accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning. These signs and symptoms may be observed by others or reported by the individual.

Here we are talking about ANP’s (and not about EP’s). The Apparently Normal Personality state. Living the present time, taking care of daily tasks, having their own distinct behavior, thinking and feelings about their environment and oneself. Daily life emotion and task oriented personality parts – the ANP’s.

for example:

ANP 1 would also wear a skirt
ANP 2 would never wear a skirt

ANP 1 has a soft and warm voice
ANP 2 has a clear but cold voice

ANP 1 can’t read without reading glasses
ANP 2 read without them and doesn’t need reading glasses

ANP 1 drinks coffee with sugar and milk
ANP 2 drinks only black coffee

ANP 1 loves to cook
ANP 2 doesn’t know how to cook and also doesn’t like to cook

ANP 1 has parents or a parent
ANP 2 has no parents, was adopted and doesn’t know her own parents

etc.

B)
Recurrent gaps in the recall of every day events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting.

For example:

If ANP 1 is out, ANP 2 doesn’t take in the memory of that daily life tasks. The task which where done by ANP 1. Likewise the other way around. Sometimes an ANP has some recognition (can recall memories) about doing tasks done by another ANP but then it still doesn’t recognize it as something done by the own self (someone else did it, not me). Both (and very rarely even three) ANP’s have different memories of doing tasks in the present time and they have also a different recognition/memories of a past. The ANP’s don’t have a autobiographically memory that fits the reality of the own past (a autobiographically memory that fits one main healthy personality).

C)
The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

The amnesia, the different life styles and also living a very superficial emotional life which is task and survival oriented causes severe insecurity, loneliness and suppressed emotional chaos. Someone who suffers a DID is without self-knowing, constantly living a high alert state. They get easily confused and exhausted because they are ongoing on a wake to avoid being vulnerable to the outside and also inside world.  It’s also not uncommon that someone who suffers a DID slips in to an isolated life style (a very pour social life) because they can’t keep up the different preferences of each ANP. The pour emotional life causes very often a severe inner loneliness. Emotions are likely experienced as a fragile state and the ANP’s don’t like a fragile state so they avoid those feelings by an automatically switching back and forward between the different ANP states. This causes memory gaps during daily life (broken time and chaotic memory fragments) which mess up daily life. The presence of more than one ANP also causes ongoing conflicting thoughts: did I do this already, no I didn’t do this, yes you did, no I didn’t etc. And also new experiences, new life events or new daily life tasks causes conflicting situations and chaotic thoughts as; do I like or need to do this, no I don’t, yes I do, no I don’t and I won’t do this, yes I would like or need to do this (etc.). Also trusting someone is very chaotic and causes severe inner conflicts; can I trust this therapist, no you can’t, yes you can, you need help, no I don’t need help, etc..

I by myself always say:
someone who suffers DID, suffers the loneliness of surviving the own inner self (oneself) and no longer a traumatic event or the past. There was a time our instinct created this survival mode because it was needed, but it also caused that we didn’t learn how to feel and live life – we only learnt how to survive and that’s not living, it’s surviving! Our inner self which is constantly on the run, trying to escape from the own autobiographical memory.

D)
The disturbance is not a normal part of a broadly accepted cultural or religious practice. Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play.

E)
The symptoms are not attributable to the physiological effects of a substance (e.g. blackouts or chaotic behavior during alcohol intoxication) or another medical condition (e.g., complex partial seizures).

 

ptsd vrijI want to close this column with a very personal note:

I don’t switch at all to personality states which loose contact with the reality of daily life. The ANP’s which are a part of my whole personality, are very stable daily life task oriented.  Lots of people don’t understand at all if we talk about our switching behavior. And very often there goes a big misunderstanding to the difference between ANP to ANP switching behavior, and ANP under the influence of EP switching behavior.

I suffer, I suffer a lot by the switching behavior back and forward between more than one ANP state. A specific symptom that comes with a Tertiary Structural dissociation of the personality and which is common to the Dissociative Identity Disorder – a A typical diagnostically criteria. A very typical symptom to the third level of a SD.
Within a therapeutically frame and only within a therapeutically frame, and with the help of an experienced clinical psychologist and (hypno)therapist we bring the phobic ANP’s step by step in contact with each other and each experiences (the ANP’s and EP’s) in order to learn recognizing, working together (the ANP’s) and handling our own autobiographically being (one personality state). So we hopefully can learn to feel and functioning as one personality. And although I’m very aware of the even more severe agony someone suffers diagnosed with OSDD+ and the switching behavior that comes with it, I want to write: you will not find us switching to a vulnerable ANP sate that goes under the influence of an EP part. We will avoid that on all times, which is also very common to DID sufferers.

And please keep in mind that I’m not writing this to hurt someone, but to explain the difference between a Trauma related secondary and tertiary structural dissociation, because a SD level 2 and 3 doesn’t express itself on the same way. I hope there will be a sufferer of a OSDD+  a secondary structural disoociation of the personality that has the gusts to also tell and write about it. Because it’s known that a level 2 of a structural dissociation of the personality even comes with more dissociative symptoms and agony in life.

Understanding and even healing doesn’t come with rejecting or denial. It only comes with the acceptance of our own being and recognizing what causes our own behavior and suffering that comes with it. A secondary structural dissociation of the personality is also a very severe ‘Trauma related’ disorder witch causes even more and very severe agony in life. The co-morbidity of this disorder is far too much under exposed, accepted and recognized. It should even get more attention and research than DID.

 

Complex Trauma PTSD