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I sent my posts to my LC and have his answers here. I like to thrash this out with everyone because it really makes it clear in my head - so here goes. My LC was answering at 3am so he might seem a bit sleepy --- but his IQ is at the genius level, so I pay attention when he talks. I hope this helps us all figure things out.
Tylas: You can decide for yourself if you think it is possible to have DID if your abuse began at age 10. Complex PTSD - caused from Childhood abuse is very possible and probable at that age.
LC: Yeah. Personally, if normal personality integration has occurred, I think emergence of DID at age 10 is unlikely. However, OEK (an acronym formed by the first initials of the first names of the authors of The haunted self), while they do not specifically take up the integration of normal personality, relative to other mental developmental milestones (at least if they do I haven't yet found where), they DO, on p. 133 suggest that a variety of scenarios are possible. They do not propose the likely age(s) of children involved.
What they say is simply that integration of traumatic experience depends upon the degree of integration between the individual's actions systems at the time of the trauma experience(s). If the action systems are well enough integrated, in relation to the challenge given by the trauma(s), personality fragmentation will not result. However, if they are NOT integrated (presumably because of the youth of the individual), or if the degree of integration is insufficient, fragmentation will be forced by the challenge the trauma presents. The sheer energy now in the personality system tears it apart, we might say, because the defensive defend/retreat-systems go one way while the normal approach/engage systems needed for daily life go another. At the simplest level, this produces PTSD.
To me, this makes terrific sense, for several reasons.
For one thing, it is a mental analog to what happens with physical disease. Suppose an influenza virus is alive in a local population. Who becomes infected? The vulnerable ones. The ones who cannot respond to the stress the virus, when contacted, presents to the body's self-defense system. Easy to grasp, yes? OEK appear to be proposing exactly the same thing relative to traumatic stress.
In order NOT to acquire permanent dissociation of parts (because different parts are involved with different action systems), the parts must be well enough integrated when the traumatic insult occurs. I say "permanent" because I agree with those who argue that all trauma involves some degree of dissociation. The key question is how long it lasts, and that is determined by how long it takes for the mind to achieve assimilation of the experience of the trauma, if indeed it can at all.
It may help to make all this crystal clear if you draw some diagrams. I'd do it for you but it's 3 AM and I'm desperate to get to bed.
Tylas: Making of DID -A child younger than 5 (but some say it can be as old as 9, but that does not make sense to me as you will see in this writing), is severely abused over and over again by someone they should be able to trust, such as a primary caregiver. If there is more than one caregiver and that adult is not an abuser, the abuse of the children in the family is ignored or unknown by that caregiver, creating confusion. This makes the child feel its not real. During the first couple years of life there is bonding between a child and their caregiver. An infant needs touch, movement, smiles, eye contact and nourishment. A child cries and their caregiver normally takes care of them, giving them love, nutrition. They learn to trust this person and to feel safe. The child cannot do this on their own however, the caregiver also must connect or the infants brain will not develop normally, they will suffer physiologically, cognitively, socially and emotionally.
LC: Going beyond this, someone must respond to the child AS IF they were a single person, so that the child begins to create an internal representation of themselves that is singular. This is, of course, only ever partially true, but it is an artful, useful, and even necessary, illusion.
Tylas: An Infant MUST Feel Safe - The child will be unable to form or maintain a loving and intimate relationship if they do not feel safe. They are unable to trust and are always on guard - forever hypervigilant which prevents them from allowing others to care for them. They are afraid, but do may not appear that way. They usually come to think feel they must control excessively their own environment to survive. It seems irrational to others, but it's very real to us that have gone through this. In addition, if a child is abused we have high levels of stress hormones which again affect how our brain will develop.
"In infancy, behavior is organized as a set of discrete behavioral states, such as states of sleep and waking, eating, elimination, and so on. These behavior states become linked over time and grouped together in sequences. Psychological trauma impedes this linkage: as a result, individuals who have been severely neglected or highly traumatized in childhood have not had the interpersonal attention, support and encouragement necessary to interconnect their self-states and the varying contexts of their lives." E. Howell 2011
Notice: I don't know when the brain actually begins to integrate naturally. It stands to reason in my mind that the problems must occur before this date!
LC: In the simple view, yes. But as I've suggested, drawing upon OEK, if the stress overwhelms the existing integration at any of a wide range of levels, big problems result. One major problem is that since the child develops dramatically up to at least 18 (and more reasonably to about 25), maximal integration is not really possible because all the parts are not there yet. This problem is most severe with younger children, of course.
Tylas: This is a great description of DID Etiology: Merek Manual - "Children are not born with a sense of a unified identity; it develops from many sources and experiences. In overwhelmed children, many parts of what should have blended together remain separate. Chronic and severe abuse (physical, sexual, or emotional) and neglect during childhood are frequently reported by and documented in patients with dissociative identity disorder. Some patients have not been abused but have experienced an important early loss (such as death of a parent), serious medical illness, or other overwhelmingly stressful events.
LC: In contrast to most children who achieve cohesive, complex appreciation of themselves and others, severely mistreated children may go through phases in which different perceptions, memories, and emotions of their life experiences are kept segregated.
OEK give us a model for how this happens: the two great groups of action systems hard wired into the brain are inherently disaggregated. One cannot approach and retreat simultaneously. If one is not to become paralyzed by an overwhelming experience, one must either keep the two actions separate, or coordinate them with a higher level sense of self (which needs to be present already at the time of the trauma).
Such children may over time develop an increasing ability to escape the mistreatment by “going away” or retreating into their own mind. Each developmental phase or traumatic experience may be used to generate a different self-state."
Tylas: Conflicting Behavior - "If a parent provides conflictual behaviors, the infant may use state of mind shifts to adapt to this inconsistent set of behaviors from the same caregiver.
LC: One state of mind may include a sense of security, along with recall of close times and an "internal working model" of security to the accessible parent, and this memory evokes an approach response."
What is not often enough said is that in the child's mind there are TWO integrations that must occur: one is of the parts of self, and the other is of the parts of the caregiver, who also experienced as disaggregated, initially. However, SOME CAREGIVERS ARE SIMPLY NOT EASILY INTEGRATED. Borderline mothers, for example. DID mothers, for another. The child is confronted by their disaggregation and simply cannot solve the problem.
The frightful consequence of that is that at precisely the time the child NEEDS a consistent, reliable, integrated parent, so that they can receive from that parent a consistent sense of THEMSELVES, they do not have such a parent and do NOT get this consistent sense. The effect of this is surely NOT to support the integration of the child. Quite to the contrary. THIS IS VERY IMPORTANT, but usually neglected by professional discussants, except for those, like Daniel Siegel and Alan Schore who specifically talk about the "social creation of self". We need integrated parents to integrate well ourselves. If they are both not well integrated AND abusive, the child is in a truly awful position.
Tylas: Fear of the Parent - "Later, the now abusive parent activates a different state of mind with dominant emotion of fear, a response, pattern of withdrawal, memory recall of previously frightening times, and a model of attachment that may be disorganized. (the attachment figure is a source of terror instead of safety). ...In addition to the actual physical aspects of abuse being traumatizing, the perpetuation of abrupt state transitions may also be developmentally damaging."
LC: Absolutely. "the perpetuation of abrupt state transitions" <- this is the unintegrated parent, as well as the damaged child - whose development is damaged by this perpetuation.
Tylas: Fantasy Develops DID - A young child will fantasize they are not the one being abused and in fact have gone elsewhere during abuse. If this is not sufficient to blunt the physical or mental pain then the child will divide up the pain, making up fantasy personalities to endure the abuse.
LC: Un-integrated action systems will do the job quite nicely.
However, a key point must be made. It takes very little pain to cause brief dissociation. Happens all the time. However, stepping on a thorn is not the same as being physically or sexually assaulted by your caregiver. When great pain occurs, the initial dissociation that occurs is not at all easy to repair. If it is never repaired, you have at least some aspect of PTSD.
This is why understanding the two kinds of dissociation is so critical.
"Peri-traumatic dissociation" (about which Dell writes very well) is the experiential dissociation that occurs in a sensory and cognitive system that is confronted in real time with more than it can make sense of. We all experience this. What happens NEXT is the crucial question. If the peri-traumatic dissociation does not resolve...we have a problem, Houston.
Tylas: Just like you and I, a human can only handle so much before they seek help and serious damage occurs. The more help a overwhelmed a child needs in coping is, the more parts will split and become dissociated self states. If a caring person is available, the child will not have to resort to fantasy means to process the trauma and is therefore unlikely to develop Dissociative Identity Disorder.
LC: Yep!
Tylas: Last Hope of Survival - "As a last alternative for an overwhelmed mind to escape from fear when there is no escape, a person may unconsciously adapt by believing, incorrectly, that they are somebody else...."
LC: Well, I'm not sure that is quite right. We do continually create our sense of self, throughout life. After all, we have to, because the game keeps changing. We are always becoming someone else! But sometimes we do this very abruptly, out of necessity. In Guatemala, years ago, we heard many stories of rural Indians who caught a bus to the big city, and changed out of their colorful Indian clothes in a rest room on the way, becoming non-Indians (at least at a distance) in a matter of hours. They were clearly escaping poverty and lack of opportunity, and making a major grab at a new life. This is not traumatic dissociation, and not even dissociation at all, but it damn sure is active creation of sense of self - and just one of many forms this can take.
Tylas: In rare cases where a child is extremely and constantly abused they can dissociate and form
alternate personalities.
LC: Rare? Who says rare? All the evidence suggest this is NOT rare (of course, we need to define our terms, do we not...)
Tylas: Alternate Parts - Over time these parts take on a "way" of their own and become what is known as an alter.
LC: They develop adaptively, and become more useful to the personality system, over time.
Tylas: Not everyone gets DID - Of course not every abused child will use splitting as a way of survival. This is why most therapists will probably never see a case of this in their life-time.
LC: Well, it's one reason. Here are two others: Most of the distinguishing features of DID, as Dell (2006) has demonstrated, are neither objective nor visible. DID is easy to miss, UNLESS YOU LOOK FOR IT. Second, most therapist are not trained to look for it when they should, nor do they know HOW to look for it accurately. Hell, the DSM hardly gives you a good guide, now does it? That has long been one of the objections very clearly voiced in ISSD meetings by Dell and company, and I agree.
Tylas: Not everyone gets DID, and not every DID gets diagnosed; of those who do, not all get relevant treatment.
LC: Now THAT's a string of understatements!
Tylas: Other alternatives include suicide or violence to oneself or others, antisocial personality disorder, anxiety to list a few alternatives.
LC: I'm not sure antisocial PD belongs in that list. It has long been a problem to make sense of, but there is some good evidence that it is likely due to an organic problem in the brain, such that the brain has real trouble forming useful and accurate representations of human society. It is thus a kind of blindness. The social rules in reality are invisible to APDs, the theory says. They certainly ACT that way. All that aside, angry, pissed off people can certainly act out in antisocial ways, while at the same time NOT having APD.
The social-rule representing part of the brain is the last to mature, coming fully online by about age 25. A Harvard study a few years go, found that by that age, 50% of the antisocials properly diagnosed at age 18 had "matured out of" the disorder. They were just late-bloomers, if you will!
I know, another confusion to ponder. Welcome to the exciting world of psychopathology.
That is all in reply to my first post in the other thread.
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Tylas: I think I get what you are saying and the idea is right, but I think these specifics will help you fine tune your thoughts. That is if I have it all right. I think I do, but I am no expert. Splits can occur but this is not the initial process. First we start out "split" so to say and we need to integrate.
LC: So far, OK.
Tylas: The normal brain will develop ego states. We don't think of that as splitting, but it is still parts of the Self such as an alter is.
LC: Alters, however, have amnesic boundaries and thus cannot access or call into action the resources of other ego states. In a personality system organized with ego states rather than alters, this cross-state access IS normal function, although it certainly does vary in quality.
Tylas: I think, as you stated, that it is easier when young to make various parts of the Self. Those with DID can still develop ANP throughout life, but I doubt they develop EP's after childhood..
LC: Uh, wrong. I recall the case someone wrote about of a DID mother who created an alter to deal with childbirth. Could this alter have been an EP? Sure - if the childbirth had been overly stressful. In that case, a defensive action system would have been activated, and the alter would instantly be an EP. In a reasonably adapted DID.
Tylas: Agreeing to DL - You are correct in that we're all just neuron pathways.
LC: OK, but some of MY neural pathways are wrapped in chocolate, and that makes considerable difference.
Tylas: Let me add this and you can see that indeed parts of the self are functioning as a child. Now weather they are splitting or not I am not sure. If they are - then it still remains that we started out "split" rather than one "integrated self." I am not sure more than that is really known.
LC: Well, we are not either split or integrated. There are degrees of integration, because integration takes a long time, AND is not necessarily equal across the initially split parts. Makes sense, when you think about it.
Tylas: DID can happen because a very young child, who has usually been neglected and abused can dissociate and leave another part of themselves there with the abusers to take the punishment. As a result, the actual abused child, the host, usually has no memory of the abuse.
LC: Amnestic boundary of the EP alter, in action. The emotional parts or child-like alters hold all the trauma memories and those parts of the mind did endure and remember the abuse.
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