Tag Archive: Dissociative Identity Disorder

Do all cases of PTSD have an EP ?

DISCUSSION2014

DO ALL CASES OF PTSD HAVE AN EP ?

And should PTSD be classified as a (Structural) Dissociative Disorder (DD)

This is a very nice question to think over, given by Dr. Colin Ross in his commentary (2014 pg 285) on the Ten reasons for conceiving and classifying post-traumatic stress disorder as a dissociative disorder (E.Nijenhuis 2014)

My personal response to this question:
Let us take a closer look at the Apparently Normal Personality STATE (ANP) – the self and ego states of oneself daily life handling system and a pathologically traumatized Emotional Personality PART (EP) such as given by the theory of a Structural Dissociation of the Personality (Hart, Nijenhuis, Steele 2005, 2006) to account to the basic dissociative elements which lead to the development of a Post-traumatic stress Disorder (PTSD) e.g.: a Primary structural dissociation of the personality (the Haunted Self 2006).

complex trauma discussion

My own Introduction:
Nobody likes to think over a traumatic event or experience. And if thinking about it, or get slightly reminded at a traumatizing experience triggers a pathologically behavior and or emotions (stress) we start automatically avoiding those nasty memories. Such a mental avoidant behavior towards a memory is basic dissociative behavior, and also the first sign to the development of a Post-Traumatic Stress Disorder. We avoid that pathologically (damaged/traumatized) emotional personality part (EP) during our daily life. Our normal functioning starts to develop abnormal behavior towards a memory.

Here the first personality break develops itself to the existence of an ANP and EP:

  1. Our daily life functioning goes on but at the same time starts avoiding a traumatic memory. The Personality no longer functions normal, but apparently normal  (ANP) .
  2. If the memory gets triggered (emotional respond) a pathologically stress reaction caused by an unconscious memory (EP) steps in and influences our normal daily life functioning. We no longer function as normal because we carry an EP around, so the personality – the ANP – gets influenced by an emotional damaged/traumatized personality part.

Such an EP is not in executive control because if such an EP gets triggered the ANP is aware of the nasty emotions and bodily stress. The person is able to point out which object or event in the present time makes him or her restless or stressed. But….. the traumatizing memory can stay full or partial in the dark of the unconscious mind. Thinking over the reason why the object or event triggers emotional stress is partial or fully dissociated and safely stored in the unconscious state of mind by an EP –  mental avoidance – basic dissociation.

If the partial or fully dissociated memory hits the conscious state of mind (remembers – recognition to the past), the Apparently Normal Personality state relives the traumatic event (the past) – a fully, pathologically emotional stress reaction can take over the wellbeing of daily life function – the Personality – the ANP gets overstressed (fear, panic, disturbed behavior,… etc.).

In this context you could conclude that dissociation stands on the basics of every PTSD development, because a traumatizing event or experience which causes pathologically behavior or emotional stress is bound to an Apparently Normal Personality STATE (ANP) and a pathologically (traumatized | damaged) Emotional Personality PART (EP).

The traumatizing memory of an EP can be partial or fully dissociated by the mental state of the ANP (Self and Ego States) until it gets unlocked  (confronting memory, reliving, lifting avoidance). Standard PTSD treatment policy (van Balkom e.a. 2013).

My Conclusion would be:

Dissociation belongs to the basic elements of developing PTSD symptoms.
Because this basic dissociative element leads to basic PTSD symptoms (from mild to severe), so there is no PTSD without Dissociation.
To the theory of a Structural Dissociation of the personality this is called a

Primary Structural Dissociation – PTSD (one ANP – one EP)

 

My restricted answer to a part of the first question page 285 Commentary Colin A. Ross 2014:
Yes, all cases of PTSD have an EP.

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I look forward to the answer e.g. commentary of Ellert Nijenhuis or one of his specialized team member(s) to the full commentary of Colin Ross (2014).

Nique

 

With much respect for all the clinical traumatology researchers
Just simply Nique (December 2014)
Cl.E Top Referent Trauma Center Assen-Drenthe, the Netherlands

Reference:

* Ross CA (2014) 33,3 pg 285 – question 1
* Nijenhuis ERS, TRTC Assen-Drenthe the Netherland (2014) Ten Reasons for conceiving and classifying posttraumatic stress disorder as a dissociative disorder. Psichiatria e Psicoterapia 33, 1, 74-106.
The Haunted Self (Nijenhuis, vd Hart, Steele, 2005, 2006)

* And Nique EU Disja 2014 ANP EP daily life handlingsystem

 

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Dissociative Handling-system of the personality

complex trauma Handling systemsPsychologically-Trauma & Dissociation

The ANP ᶧ ² and EP ³  handling-system

cptsd

Literally Trauma means ‘injury’

  1. An event causes Injury
  2. Injury causes pain
  3. Pain causes physically and psychologically suffering
  4. Psychologically suffering can cause psychologically-injury
  5. Psychologically-injury can cause pathological emotions and pathological somatic responses
  6. a mental illness
  7. A mental health diagnose caused by Trauma

It can happen on every age and has no age boundaries. Someone with a PTSD can suffer a Partial or Full dissociation. Which means he or she can’t recall | remember the traumatic or a part of the traumatic event.

We all own one Personality which is given color by our Self states¹ and Ego states².
To the understanding of, suffering a psychologically-Trauma:
all traumatic events (psychologically and mechanically) can cause Dissociative Behavior | psychologically-Trauma
and all mental disorders caused by psychologically-Trauma hold Dissociative symptoms

Let us take a closer look at our main personality-states which handle every day life,
the self-states and the ego-states;

SD  = Structural Dissociation
ANP =  Apparently Normal Personality Part
EP = Emotional Personality Part (the part that holds a traumatic memory)

  1. The Self-States (SD ANP parts)
    are parts of our personality which function fully autonomic and are daily life task oriented.
    These parts of our personality own their own consciousness and self-awareness.
    Examples of Self-states are:
    You need to clean the house and you instinctively know what to do and how to do it. You know how the vacuum cleaner works or what you have to use to clean the windows etc. To every little task you remember what is needed or what to do at that moment: like cooking, doing your finances, call your friend at his/her birthday, etc.. those are all different self-states (SS’s) which we call smaller Apparently Normal Personality parts of the total personality ANP-EP(’s) handling system.
    Note:
    If a person suffers a PTSD or CPTSD or a Dissociative Disorder like OSDD
    The self-states we call smaller ANP ‘parts’ which belong to the total personality (1 ANP-EP handling system).
    Those Self-state parts¹ (ANP parts) are vulnerable to the influence of Ego-States² and or EP parts³

Beside the Self-States we all also own Ego-states
which influences also our Self-Sates…

  1. Ego States
    are personality states which react emotion oriented. They respond to emotional daily live needs or events and provide us with normal and healthy reactions which color our own personality.
    But… they also can develop a pathologically behavior such as Borderline-, Narcissistic personality disorder, pathological sociopathic- or psychopathic behavior, etc. – and otherwise described dissociative disorders including switching behavior to other personality states (not DID).
    Examples of Ego States are:
    The need for attention, or personal comfort, or the need to be someone (to be recognized), the need to feel proud of what you do or did, the need of being loved or to give love to another person, the need for sex or erotic responses, the need to express your anger or sadness etc. Al those needs are normal human emotions (feelings) which we all carry inside of us. And we also carry all biologically given narcissistic genes or psychopathically genes (we are all able to get triggered to unthinkably or unhealthy behavior). It’s human nature.
    Note:
    Pathologically (damaged, sick, unhealthy, etc.)  Ego-States can cause switching behavior, because they are very vulnerable to the influences of pathologically genes and or biologically given vulnerability. But they also can be controlled or influenced by traumatized EP parts such as most commonly seen within OSDD. Traumatizing experiences and or Childhood neglect can contribute to development of a Borderline Personality Disorder + Dissociative symptomps. Those pathologically Dissociative Ego-States can express itself also by switching behavior to different personality states. That is also the reason why so many people get wrongly diagnosed with a dissociative Identity disorder and the other way around, or misdiagnose with another mental disorder such as Schizophrenia.


PTSD and complex-PTSD (including Dissociative Disorders)

If we get Psychologically-Traumatize we develop pathologically personality parts which hold memories of a traumatic experience. Those parts we call:

raamDissociated Emotional Personality Parts (EP’s)

  1. A traumatized personality part(s) !!
    Like the Self-states those EP’s own their own consciousness and self-awareness
    Within the structural dissociation of the personality we call those parts EP’s which cause dissociative behavior. These psychologically traumatized parts of the personality hold a total memory of a traumatic event or a part of a traumatic event – physical and emotional memories which belong to the past.Those parts can be:
    1. totally dissociated by the personality (full dissociation)
    2. partly dissociated by the personality (partial dissociation)

    Examples of EP’s are:

    Someone who experienced a very severe accident on a particular crossroad, can start to avoid that particular crossroad, or even worse: don’t go nearby a crossroad again. And this (phobic) fear exists without realizing or thinking over the full memory (EP) which caused her/him to develop this pathologically behavior towards crossroads.
    Or someone who experienced severe traumatic events during a war can develop irritated and avoidant behavior towards lots of things in the present time without realizing his behavior is being influenced by the traumatic events he/she experienced during war and which didn’t process in to his own personality sate – the EP’s got stuck in the past. He/she avoids thinking on those traumatic events and develops irritated and or defensive, aggressive behavior under the influence of the EP’s.
    Note:
    If an Self-State or Ego-State gets triggered by ‘recognition’ – by a particular daily life subject or event – the EP that got triggerd by that recognition influences the behavior of the Self-state and Ego-State. On such a moment the ANP-EP system – which we call a handling system – gets in to pathologically behavior (not healthy behavior). The biologically stability of the whole personality will also play a very big role towards ‘how this behavior will express itself’ (including switching behavior to different personality states). But the cause of that particular behavior on such a moment gets triggered and influenced by an EP.

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Personality and Identity:
Above we gave a summary of a normal to a pathologically Personality and the different personality states. Everything above can develop itself without suffering a DID. The expression of the total of our personality-states plus our biologically (determinants) and biographically presentation will give form to our own Identity.

The Dissociative Identity Disorder

All traumatic events can cause Dissociative Behavior e.g. Psychologically-Trauma as we explained already above. So again what is the difference between a primary and secondary Structural dissociation (PTSD CPTSD OSDD) and the Tertiary Structural dissociation (DID)?

Note of importance: One can suffer a Dissociative Identity Disorder (DID)without suffering a Personality Disorder !
Borderline is a symptom diagnose and can develop itself during all ages of childhood, likewise a structural dissociation of the personality OSDD or PTSD.

DID though is another story:
DID Research has shown us that the development of a DID starts during the very early stage of life.

Hypothetically to the explanation of “why could such a very young child develop more than one ‘handling system’”;
We are all born with biological determinants and four autonomic emotional handling/respond systems (the 4 head emotions). Emotional handling systems which immediately after birth are able to react by instinct or reflex. If a baby feels distress caused by hunger it starts to cry. If you have eye contact with a baby which has already its vision and you slap your hands the baby gets scared (you will see the reflex) caused by the loud noise even though its sees you slapping your hands, etc.. The baby is not yet able to mentalize hearing with vision, it’s not yet enough developed to do so (recognition). The emotionally systems pleasure/fun and fear are not yet enough integrated to function as proper team players.
If something disrupted this proses (like repeating Trauma – see part I pnt 1) an infant needs to activate by instinct repeatedly a (survival) reflex which causes that the autonomic functioning emotions can’t synthesize prober with one and other on a natural given way to learn prober functioning as team players. This can lead to the development of a DID cause by Trauma.

A tertiary structural dissociation of the personality
Someone who suffers a Dissociative Identity Disorder developed in a very early stage of life two and sometimes even three of those ANP-EP’s handling systems. Each of those handling systems own their own distinct behavior, knowledge and memories. This causes also a lack of recognition of one’s own autobiographically memories. The switching between those ANP-EP’s systems can occur very subtle but also very recognizable if you know the total personality for a longer time. DID is a poly-symptomatic condition which is characterized by a hidden presentation.

In case of a Dissociative Identity Disorder the ANP’s (self-states) also function task oriented within each main ANP-EP’s handling.
But beside that the main ANP-EP’s handling systems functions also head emotion oriented.
So here we also need to have knowledge about the four head emotion of humanity which within DID form the base to develop a pathologically survival mechanism such as a Dissociative Identity Disorder is.

1 The 4 head emotions
of every human being
Joy, (Pleasure, laughter, sex, etc.)
2 Fear (defense, Freeze, etc.)
3 Anger (defense, physical attack, etc.)
4 Sadness (tears, loneliness, mourning, etc.)

 

** People who suffer a DID have developed two or even (very rare) 3 ANP-EP handling systems which are not only task orientated but also act head emotion orientated. ANP-EP systems behave Apparently Normal – and carry an own distinct, stable over time and growth, identifiable behavior. An identity disorder caused by psychologically-Trauma


Reference doc
:
3-2014 E.R.S..Nijenhuis, Ph.D. – Ten reasons for conceiving and classifying posttraumatic stress disorder as a dissociative disorder
Book advise:
The Haunted Self,- authors Ellert R.S. Nijenhuis Ph.D., Onno.van der.Hart Ph.D. and Kathy Steele

(c) Nique
11 october 2014

 

002-link2

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