Time Loss, Full Dissociation and Switching

I am starting to dive into the topic. I begin by re-reading E. Howell's 2011 book on DID. This woman is brilliant and she is my hero!

For those interested in my Time Loss.
I know I have a lot of time loss, but rarely am I so bold as to ask who was out on a certain day and what they did. I did so yesterday however and uncovered a can of worms.
Don't laugh, but this alters name is Sybil. She was one that did not have a name, and perhaps due to the movie, I did suggest it to her quite a while ago and she liked it - at least the name is not Marsha!
http://dx-dissociative-identity-disorde ... o-die.html

Kluft 2009 - "observed that only about 6% of those with DID exhibit obvious switching in an ongoing way."

I am certainly in that 6%.

Dell 2009 - "The phenomenon generally considered most characteristic of DID is switching: Different internal identities can be prone to suddenly taking executive charge, in effect pushing the identity that had previously been in charge, out of charge. This generally results in amnesia on the part of the identity that had been pushed aside for the events that occurred while the other identity was in control. Switching is also known as full dissociation."

E. Howell 2011 - "The current DX in DSM IV places primary emphasis on the phenomenon of switching and provides the following diagnostic criteria for DID."

"The person with DID suffers from amnesia about the very symptoms experienced and often cannot specifically identify the problem. For the person with DID, the sense of self, of continuity of being, of identity, is highly discontinuous. As noted in the DSM IV, "the essential feature of the Dissociative disorders is a disruption in the usually integrated functions of consciousness, memory, identity, or perception."

"...consider the amnesia requirement of Criterion C: "Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness" One might ask, "Which part fails to recall?" "Whose consciousness?" or "Whose thinking has been disrupted" These questions are especially relevant when the host, the part of the self that usually presents to the world, is a collection of several parts who pinch hit for each other or when the host is primarily a shell who faces the world while other parts "fill in" as needed."

Me: These as I see it are the question. Loosing time is not a question. If this is in error, how so?

Partial Dissociation
E. Howell describes partial dissociation which is what DID has in common with DDNOS. Influence from within - taking partial control. The ability to be in 2 minds at once. I think we all know these things well too.

"When we speak of partial dissociation as an important aspect of DID, it is important to note that partial dissociation is not specific to DID or even to dissociative disorders. It also characterized PTSD." Flashbacks are an example of partial dissociation.

There is much more in E. Howell's book which I will share as time allows.

Chapter 8 - Understanding & Treating DID, 2011 by E. Howell

Here are some important points in Howell's book on this topic. pg 148 and 149

"Another contribution to the difficulties of accurate diagnosis has to do with our diagnostic constructs. There are two primary constructs: switching & intrusions /withdrawals of experience. However both the DSM IV and proposed DSM V place emphasis on the switching aspect of DID as well as DDNOS."

She goes on to say that a T does not have to witness switching, (so these people will get the DX of DID as long as they meet the other criteria such as time loss) also that in the DSM V somatic symptoms are important. Also:

"The amnesia requirement (for DID) that is specified in DSM IV continues in DSM V.

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DDNOS - E. Howells 2011 book page 149

"...those severely dissociative patients who do not have amnesia between identity states should be diagnosed, according to the current AND the proposed future criteria, as having DDNOS.

Howell continues... "This is despite the fact that they may have dissociated identity states; that these identity states function as autonomous, personified, separate subselves; and that they benefit from treatment designed for DID.

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Partial Dissociation VS Full Dissociation (time loss)

Dell (2009) distinguished between full dissociation, which is characterized by amnesia, and partial dissociation, which includes such symptoms as flashbacks, hearing voices in the head, passive influence symptoms, and intrusions of dissociated experience. In partial dissociation he noted that there is either subjectively experienced or objectively observable discontinuity in thought, affect, or behavior, without amnesia for behavior or identity.

So - conclusion to have DID you must have time loss. Now the question is what is time loss. For that I turn to research by Dell. Interesting enough the word "current" as in "current time loss is not used." I will have to dive into more books and see where I ever read that term, but I know that I have. (I think)! When it comes to me and memory, I am not really positive about anything.

This is from 2006, so I need to find reference to it in something newer. But according to this study Dell explains what he feels amnesia/time loss is:

DSM-IV provides a vague definition of amnesia. Detection of amnesia would be greatly facilitated if the DSM included well-validated examples of amnesia in DID.

Amnesia is the most frequently reported dissociative symptom of DID
At least 10 different manifestations of amnesia have been reported
in persons who have DID: (1) time (2) fugues (3) being told of disremembered actions (4) temporary loss of well-practiced knowledge or skills (5) finding objects among one’s possessions (6) amnesia for childhood (7) amnesia for personal identity (8) strangers know the person (9) objects are missing and (10) finding evidence of one’s recent actions.

PF Dell - Psychiatric Clinics of North America, 2006 - psycnet.apa.org

Getting into structural dissociation *category trigger

The Haunted Self... Van Der Hart, Nijenhuis, Steele 2006

pg 74
"In DID, there is a requirement for amnesia and for alternation between at least two "identities," but the range and characteristics of dissociative identities are not specified. Furthermore the DSM IV discerns different types of dissociative parts of the personality in terms of being passive, dependent, guilty, depressed, hostile and controlling, but does not describe how dissociative identities of patients WITH DID differ from those of patients WITH DDNOS."

"We propose that secondary and tertiary dissociation differ along several lines.

In secondary dissociation (DDNOS) there are less profound amnesic boundaries among parts of the personality. ANP is by far the most extensive part of the personality, the "major shareholder." EP tends to emerge in daily life less often, and tend not to be mediated by the action s systems of daily life. Thus EP in secondary structural dissociation are more likely to be mediated by defense only, and there is more tendency to have only a single ANP.

"Patients with tertiary dissociation have more than one part of the personality that is active in daily life. They are NOT evoked by traumatic memories, as are EP, but by the specific functions and goals involved in various areas of the patients current life. DID patients may continue in adulthood t develop more ANP to cope with events they cannot integrate.

In tertiary structural dissociation each ANP us restricted to the functions and needs of the particular actions system(s) by which this part is mediated."

pg 118
"DSM IV criteria includes: 2 or more distinct distinct identities or personality states; at least 2 of these identities or personality states recurrently take control of the person behavior; and amnesia."

"These criteria present serious problems in DX. For example, what is the range of what is considered to be a dissociative identity or personality state? How much amnesia must be present? Must a part take complete control, or does passive influence sufficiently meet the criterion of taking control? What about dissociative identities that act in the present, but do not have a particular name or other defining characteristics?

Experts therefore urge clinicians to administer reliable and valid diagnostic instruments such as the SCID-D or the MID."

Thanks for posting this, Tylas. Really interesting.

Thanks! I still have many questions, and will dig into more information.

This is very interesting, thanks for sharing. I'd like to read this book at some stage now that I've read what you've quoted and said here...

Thank you! Like I said - she is my hero. She sums up well a great deal of information that is known to this date on DID.

Wow, really good info Tylas! Thanks! I never even heard of partial diss. and all those examples of manifestations of amnesia. It almost makes me feel...gasp. normal? Or at least, less embarrassed when I don't know who I am, or my basic info., etc.