how did your therapist diagnose you?

The T I went to before my current T apparently suspected from the get-go that I could have DID, but she didn't have the knowledge or experience to do much about it. She recommended my current T when I moved and the T flat out asked me if I had DID to which I responded that I didn't know. Then she did the SCID-D and several other interviews and determined that I either had schizophrenia, DID, schizotypal personality disorder, or really vivid imaginary friends. Several months later when I was having an existential crisis she told me she had diagnosed me with DID because she'd seen me switch several times in addition to the evidence from the SCID-D and other things she had asked me.

As for alters as hallucinations, in my hospital stay, despite the fact that I was staying in a trauma ward that had large amounts of DID and dissociative patients going in and out, the nursing staff STILL insisted that's what they were. If you mentioned your alters when they quizzed you about your day then they would mark down that you were actively hallucinating. I did mention this to the doctors, and they said that was ultimately an unfortunate form of ignorance.

LittleRedDogToo wrote:As for alters as hallucinations, in my hospital stay, despite the fact that I was staying in a trauma ward that had large amounts of DID and dissociative patients going in and out, the nursing staff STILL insisted that's what they were. If you mentioned your alters when they quizzed you about your day then they would mark down that you were actively hallucinating. I did mention this to the doctors, and they said that was ultimately an unfortunate form of ignorance.

i know how upset you are if you are told that you are hallucinating due to mentioning your alters. Many clinical workers DON'T know that people with Dissocaitive Disorders or PTSD would probably see, hear or feel something which seems to be unreal... it is disappointing.

But, in an academic way, i wonder, is the hallucination from people with Dissocaitive Disorders or PTSD also called "hallucination"? Or, is there any other term? Thank you!

woodreus18 wrote:Then, how about the hallucinations of patients with PTSD? When they face flashback, they also "see", "hear" or "feel" something "unreal"--maybe replaying the traumatic experiences. Would it also be considered as psychosis? Or, what are the differences?

Again, psychosis is the loss of contact with reality. A PTSD flashback becomes a psychotic episode if and only if the person loses awareness of the here and now.

Initially I had a PTSD diagnosis because I was having flashbacks. However I did not lose contact with reality. I knew I was in the here and now and yet at the same time I was re-experiencing a past event. It was very confusing.

As for your other questions, that's why the clinical mental health folks spend years in training and get paid. They are trained (we hope) to be able to recognize and tell apart superficially similar symptoms. Diagnosis is very important. I will not work with a health care provider who is causal about diagnosis; that is a big red flag for incompetence. A common cold and a strep throat may appear similar, but differential diagnosis is very important because one is a relatively benign virus and the other is a bacterial infection that can kill you.

-- Tue Feb 26, 2013 3:37 pm --

woodreus18 wrote:is the hallucination from people with Dissocaitive Disorders or PTSD also called "hallucination"? Or, is there any other term?

Vocabulary varies within the various professional specialties. In the context of PTSD, re-experienced sounds, sights, scents, flavors, and sensations from the past are often called flashbacks. They are distinct from ordinary hallucinations. In the context of DID, seeing or hearing or feeling the presence of an alter is called having internal communication.

It was difficult in my case because I did lose touch with reality for a while and I had some rather strange beliefs. Plus Darren was always trying to get me to hurt people. My first psychologist ignored me when I told her these things and just focused on my depression so at first I was just clinically depressed. Then one day I went a little crazy and started telling her I had all these powers and I would use them to control the world and also that Darren was telling me if I kill myself everything would be better. I think she finally realized I was perhaps more than just depressed so that's when I got referred to a team that deal with psychosis- of which I am still currently with.

However after this episode or breakdown I started to think more rationally. I'll admit such thoughts come back from time to time but I just keep my mind open. I don't believe nor disbelieve them. I just try and carry on with life. The docs had trouble fitting me with a label. They looked at things like schizophrenia, bipolar disorder, schizoaffective and so on but I seemed to have traits of everything and because I was starting to behave more "normal" but still had voices in my head all the time they were never sure what to do with me. The thing is I very rarely switch. Sometimes the voices/alters are co-conscious with me or influence my behaviour but very rarely is one ever fully out so I don't think they thought of DID. My doc thought about a dissociative disorder based off the diary entries I let him read and once we looked deeper into the nature of the voices and my thoughts, feelings and behaviour did we decide that DID was a better fit than anything else I had been given.

I'd also like to add that I still refer to my alters as hallucinations at times. I think thats simply because that's what I referred to them as for so long that I'm okay with that. Plus a lot of the time they sound like they are outside of my head and I sometimes see them. Would seeing them be considered a hallucination in the case of DID?

Woodreus18,

Hi! I looked back through your posts on the DID Forum and I notice you mentioned being a native speaker of Cantonese. There is one therapist in the ISSTD member directory, a woman in Taiwan, who gives Chinese as a first language. Perhaps she could help you locate a translator or other professional who could assist you in getting a diagnosis. She may even be trained to administer the SCID-D and perhaps could do it over the internet by Skype or other form of video teleconference. I will send you her current directory info via PM.

Also, there is a 2006 journal article about a study using the DES in China. That means there exists a Chinese version of the DES. Here is the publication record:

J Trauma Dissociation. 2006;7(3):23-38.
Dissociative experiences in China.
Xiao Z, Yan H, Wang Z, Zhou Z, Xu Y, Cheng J, Zhang H, Ross CA, Keyes BB.
Shanghai Mental Health Center.

If you can manage the English version of the DES, it is online and we have a "check in" thread for it here: DID Forum: Dissociative Experiences Scale

Frank_Darko wrote:Plus a lot of the time they sound like they are outside of my head and I sometimes see them. Would seeing them be considered a hallucination in the case of DID?

I think you mean you see them outside your head. That is not typical but it is well within normal limits for DID.

Some professionals would use the term hallucination; others would not. It is very much a matter of how the professional was trained. Training background influences not only their choice of word but also the meaning they give to the word.

A patient with "frank psychosis" who is also "high functioning" would be a mind-bending awakening experience for providers who specialize in treating psychosis but have never seen DID before. Good for you in sticking with them!

There are four very high quality, well validated tools for assessing dissociative disorders.

The Dissociative Experiences Scale (DES) can be self-administered and does not require any special training to interpret. It is only a screening tool, however.

The The Multidimensional Inventory of Dissociation (MID) can be self-administered but scoring it requires some training and experience, and access to a complicated and non-public software.

The Dissociative Disorders Interview Schedule (DDIS) I am not sure about, not having seen all of it myself, but it is an interview instrument so probably does require training and experience to administer.

The Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D) I have seen and it absolutely does require training to administer properly.

Wikipedia: Screening (medicine)

My T suspected as early as the beginning of our third session that I might have DID. At first it was just an intuition based on a past DID client he had treated. He didn't share his opinion with me, but did ask a few questions I later learned had to do with DID. When he initially asked, he only thought to ask about major time loss, which I didn't even listen much to his question about and blurted out, "No! Well, unless you count manipulative people!!!"

My problem was that, going only based on timeloss: 1) My system had been mostly sleeping for nearly a decade; 2) I had amnesia for almost all of my time loss (some of which close friends later told me about once finding out my diagnosis); 3) the time loss I did have evidence of, I denied or wrote off as normal (like it's normal to write slightly offensive things in your study guide during a college course and have your teacher point it out to you and not know how it got there); 4) most of my time loss outside of letting parts speak in therapy is brief and difficult to notice unless we get extremely triggered (e.g. a couple of car accidents, unfortunately, before we figured out what was going on with me).

Because I responded negatively to his questions, he set the diagnosis aside and continued to work with me for another nine months. He did note to me times when my responses to him seemed dissociated (especially when describing my past) or episodes of disorientation. He didn't give me a label though, even with a young part started communicating (at first through me) with him. I then had some shocking experiences with a protector/persecutor literally deleting stuff I planned on sending him and I didn't know how it happened, started freaking out, and was getting pretty desperate to figure out what was going on. I had read a bit about DID at this point, but I wasn't sure it fit, because even if this was evidence of time loss, it was really brief.

After nine months (since those initial sessions when he suspected DID), T decided on a working diagnosis of DID. Within a few months, as parts started to come out and talk to him (some of which I remembered clearly, some very fuzzy (barely at all) and on occasion, not at all), he started to view the working diagnosis as confirmed. I didn't ask him about it until months later, but he has said at this point he is absolutely sure, without a doubt, that I have DID, despite my constant need to interrogate whether it is true, whether I might some how be faking it or making it up (and in a way, DID is something my own mind has done to itself, but it's not faked, which is different).

I haven't had any professionally-administered tests, but I have done a few outside of therapy, and all of them have seemed to confirm the diagnosis. I find myself much less in denial about it now. It's more and more just my reality. Now, most of the denial and invalidation is focused on the memories themselves.

I'm lucky to be working with my T. He's not perfect (softer boundaries than expected, a little more disclosure than average, but it makes him very real and easy to trust), and we've had our disruptions and ruptures like any relationship, but he's very intuitive and the safest person I've ever known. He "sees" me better than any person ever has, which is unnerving, distressing, and comforting all at the same time. I am not a person who most people would probably think of "obviously" DID. And T had only treated a couple of other DID or DID-relative patients. He does have about 30 years of experience, but I still don't understand how he knew.

It scares me sometimes. Is it that obvious or or was it just some sort of fated coincidence that I happened to go to a T (my H's at the time and still) who had met someone so similar to me before that his instincts took him there? To be fair, I didn't believe him at first. He called "dissociation" on H too, and turns out H is pretty dissociative. We got together basically from having similar reactions to very chaotic, disrupted childhoods, so it's not a huge surprise. But, when T first said my responses were dissociative, I thought, "Well, yeah, but you just say that to everybody," because he did with H too. When I got the guts to ask him about it later, turns out he does not say that to everybody, and it just happened to be something he noticed about both H and myself off the bat. I wonder how that is. Like I said, kind of spooky.

My T's intuition on this stuff (though he has had his fair share of "not getting it") is, as I said, alarming (we feel too exposed) and comforting (he understands, usually) at the same time.

Hi Yakusoku. I am pleased to see you posting more, and that you've been making great progress!

yakusoku wrote:But, when T first said my responses were dissociative, I thought, "Well, yeah, but you just say that to everybody," because he did with H too. When I got the guts to ask him about it later, turns out he does not say that to everybody, and it just happened to be something he noticed about both H and myself off the bat. I wonder how that is. Like I said, kind of spooky.

It sure is scary to be seen. My insiders still aren't used to it, not in the least. On the other hand, now when they come right out front and interact with someone who knows I have DID and knows all about them, and the other person still does not see them, that is invalidating and infuriating and perplexing. And yet I think I am causing the other person not to see. I think I am doing that projective identification thing! I think I project such a strong vibe of "you can't see me" that I can make a therapist who is very experienced with DID nonetheless not see what is right in front of them.

Like you I am not florid, yet I have now met several therapists who did notice in initial interviews certain of my behavioral and cognitive signs. And the same signs are easy for me to see in other people. Moreover, when I am dealing with another DID system I feel something inside. It is as if my system warms up and gets ready to activate whichever alter best matches whichever alter comes forward in the other system.

My T hasn't used any (screening) test or interview. I've got the DDNOS diagnosis ("because that's pretty clear") but he mostly just seemed to ignore any dissociation (when I sent him a list of alter names, he once said something like that they might be alters and never came back on them. Really invalidating. Also because it required quite a bit of convincing myself it was a good idea.)
We never discuss any diagnosis, nor does he tests for dissociation (he used a few tests clearly for depression and the like, but nothing alarming came out of it. Not surprising, though.) The reason I know about the DDNOS is because he needed to put that on some semi-official form.

I'm now starting to doubt whether it is a good idea to continue with him.