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Article Excerpt: Typical clinical presentation of DID

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Article Excerpt: Typical clinical presentation of DID

Postby Nondescript » Thu May 28, 2020 6:58 am

Here's part of the "clinical presentation" section of the academic review article entitled
"Dissociation Debates: everything you know is wrong" by a well-respected DID clinician and researcher:

Symptom patterns of DID patients differ from portrayals in the media and many psychiatric and psychology textbooks. These portrayals are characterized by florid, histrionic behavior, and repeated, dramatic state switching between highly elaborated, distinct self-states, with stable characteristics over time—like “separate people.”2,32 Factor analytic studies have generally found that DID symptoms are subtle and covert.2,32 They are characterized by overlapping and interfering states that typically manifest as inner voices or through symptoms of passive influence, not florid switching behavior—a state of multiple overlapping states.63 Commonly, these states are not elaborated beyond a sense of personal identity, a self-representation, a set of (state-dependent) autobiographical memories, a sense of ownership of personal experience, and a capacity to control behavior, either directly or through influencing other states.2,32 State switching may be relatively uncommon in DID, with states more typically subtly shifting, consistent with better functioning.2,32 Studies repeatedly show that clinicians must make active efforts to diagnose DID in the clinical interview, rather than expect the disorder to dramatically appear.1,2,32,65

Contrary to common belief, the elaboration of the “fascinating” external characteristics of the states, with varying names, wardrobes, hairstyles, accents, etc. is not essential to DID diagnosis or core phenomenology.2,32 Cross-cultural studies suggest that many of these external self-state characteristics represent socio-cultural influences on DID symptoms—actually congruent with aspects of the SCM.2,32 However, the clinical presentation of all psychiatric disorders is shaped by social and cultural factors.1,2,32 These sociocultural factors do not invalidate DID, any more than they invalidate mood disorders or psychotic disorders.4

Paradoxically, psychological assessment data suggest that early life dissociation is also a protective and resilience factor that allows for preservation of capacity for attachment, psychological complexity, intellectual abilities, creativity, sense of humor, and hopefulness.2,66 When not overwhelmed by posttraumatic intrusions, DID patients show good reality testing, diminished cognitive distortions, and a hyperdeveloped capacity to observe their own psychological processes. These predict a positive response to a psychodynamically informed, insight-oriented psychotherapy.2,66 In these studies, DID patients differed significantly from BPD patients, contradicting the IM/SCM/FM.2,65,66 [IM/SCM/FM are theories/movements that claim that DID is not a valid diagnosis or experience.]

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6296396/
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Re: Article Excerpt: Typical clinical presentation of DID

Postby birdsong87 » Thu May 28, 2020 2:56 pm

thanks for sharing
Dx: DID cPTSD
L (host 1); Asti (host 2); Annett (teen protector); Maya (child); Age (observer); Thamara (child); Danielle (aut. teen); Mike (caregiver) and others
Our blog on resources https://www.dis-sos.com
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Re: Article Excerpt: Typical clinical presentation of DID

Postby TheGangsAllHere » Fri May 29, 2020 3:43 am

Thank you so much for that excerpt. It was very validating to read.

Nondescript wrote:DID patients show...a hyperdeveloped capacity to observe their own psychological processes.


I don't think I've seen this pointed out before as a common feature. I could be the poster child for this. :roll: :roll: :roll:
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Re: Article Excerpt: Typical clinical presentation of DID

Postby KitMcDaydream » Fri May 29, 2020 3:13 pm

Interesting, I wonder what it means though if you switch from one type to the other?

Thoughout life I had a 'social front' and a 'secret self' The social front would be who people saw when I attended college,work etc The secret self only ever came out in the bedroom. (walking the family dogs somewhere remote with no-one else about was also so relaxing I felt I could be myself for a while).

in my forties I suddenly became of aware of 'more' and 'others' and felt confused about who 'I' was. Would this signify a breakdown? it was triggered by the death of a companion which triggered severe depression and seems to have resulted in 'the death of an alter' (the one who was the 'social front' for most of the years the companion was with us).

The unstable emotions and hormonal fluctuations then from the menopause kicking in probably didn't help either. When the rage is triggered it feels like there's some psychotic monster inside that is trying to escape and we have to keep it suppressed constantly which is exhausting.

We also now suspect we have a vitamin B12 deficiency from going vegetarian so are working on boosting that to see if the 'rages' decrease after reading a case study where 'uncontrollable rages' were a symptom on B12 deficiency. Psychosis was also listed as a symptom!

Now hoping if B12 can relieve some symptoms and the depression has eased from losing companion which was now over 4yrs ago we can get back to a bit closer to where we used to be.

Though it's a worry anymore future deaths of close loved ones may trigger a relapse right back again.

Edited to Add; I found this online when googling can the menopause trigger psychosis

"Estrogen has been shown to have important neurological and psychological protective activities. A reduction has been shown to potentially trigger or aggravate mental disorders including psychotic ones. This has led researchers to believe there may be a link between estrogen levels and psychosis in women"
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Re: Article Excerpt: Typical clinical presentation of DID

Postby Nondescript » Sat May 30, 2020 4:50 am

KitMcDaydream wrote:Interesting, I wonder what it means though if you switch from one type to the other?

Thanks for posting about your experience. I enjoyed reading what you wrote but am low on brain power to write a full response.

Funny, when I read this excerpt to my partner, he said the same thing: "but you DO have definite switching." I do, but we don't live separate lives. It used to be a little like that during our late teens, and things do get confusing sometimes. Most of my DID experience is in my head and felt sense of reality, though. Passive influence, voices, moods, self-images, our inner worlds.... these are the most of it in our case. My therapist has only talked to other parts of me who declared themselves during one therapy session, long ago, at which point my system decided never to do that again, I guess, because it hasn't been repeated. I'm lucky to have a DID pro as my therapist, and she says that my DID presently very subtly in therapy but that she has no doubt I have DID. My partner says there's nothing subtle about it--alter A is as different from alter B as Ice T is from Weird Al. (Where did that pop music reference come from? I have no idea.)
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Re: Article Excerpt: Typical clinical presentation of DID

Postby KitMcDaydream » Sat May 30, 2020 7:33 am

Nondescript wrote:
KitMcDaydream wrote:Interesting, I wonder what it means though if you switch from one type to the other?

Thanks for posting about your experience. I enjoyed reading what you wrote but am low on brain power to write a full response.

Funny, when I read this excerpt to my partner, he said the same thing: "but you DO have definite switching." I do, but we don't live separate lives. It used to be a little like that during our late teens, and things do get confusing sometimes. Most of my DID experience is in my head and felt sense of reality, though. Passive influence, voices, moods, self-images, our inner worlds.... these are the most of it in our case. My therapist has only talked to other parts of me who declared themselves during one therapy session, long ago, at which point my system decided never to do that again, I guess, because it hasn't been repeated. I'm lucky to have a DID pro as my therapist, and she says that my DID presently very subtly in therapy but that she has no doubt I have DID. My partner says there's nothing subtle about it--alter A is as different from alter B as Ice T is from Weird Al. (Where did that pop music reference come from? I have no idea.)


lol! I remember Ice T but have no idea who Weird Al is! :D

I feel ours is OSDD and they are more like different versions of me they didn't even have their own name until I came on here and was struggling to explain and decided it maybe easier to give each part their own name because everyone else seemed to do this also.

Now after more research I've come to realise its not all the same and some things are different for me
I wonder if some of my more severe dissocation has come from the fact that both vitamin B12 deficiency and going through the menopause can trigger psychosis and its happening in a person who already has a higher chance of dissociation anyway due to being autistic.

An underactive thyroid can also cause psychosis so thats 4 conditions I have or been unknowingly struggling with, that all have the potential to trigger psychosis! :shock:

If I did already have a form of DID due being autistic all my life anyway, could the other conditions adding to that risk on top of the depression and Isolation trigger a worsening?

I found this in relationship to schizophrenia (they didn't specifically mention DID)

"It seems perimenopause may enhance the risk of first onset of schizophrenic psychoses. While schizophrenia typically has its onset in young adulthood, there is a second peak in women around menopause. Researchers have suggested that falling estrogen levels may modulate certain brain neurotransmitters, this may lead to an increase in symptoms of schizophrenia during this hormonal transition"

https://www.sane.org/information-storie ... tal-health


I've talked to several older women with autism (but NOT DID) and they had a worsening of the autistic symptoms through perimenopause (struggling with socialising and communication more, social events taking more out of them and it taking them longer to recover their energy levels)

I just think if its possible in those conditions then surely it's possible it could make something like even a milder case of DID/OSDD worse if a person was hit with one or more conditions known to trigger psychosis?

At the minute all I can do is make sure I remember to take the thyroid meds and try and boost B12 levels via supplements and eating more meat and dairy as I'm still meant to be isolating and our village surgery is shut cos 2GP's and the community nurse have come down with Covid19!!! Local cases are currently higher here than in London and local hospital has said they'll have to shut A&E (ER for US) if they get too many more cases going in. :shock: :shock: ... so not sure why Boris thinks its a good idea to relax lockdown! (just cos London is safe now for him and his rich friends!).

The man stresses me out just thinking about him...so off to cuddle the dog and find something relaxing to do!
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Re: Article Excerpt: Typical clinical presentation of DID

Postby KitMcDaydream » Fri Jun 05, 2020 7:40 am

KitMcDaydream wrote:
If I did already have a form of DID due being autistic all my life anyway, could the other conditions adding to that risk on top of the depression and Isolation trigger a worsening?

I found this in relationship to schizophrenia (they didn't specifically mention DID)

"It seems perimenopause may enhance the risk of first onset of schizophrenic psychoses. While schizophrenia typically has its onset in young adulthood, there is a second peak in women around menopause. Researchers have suggested that falling estrogen levels may modulate certain brain neurotransmitters, this may lead to an increase in symptoms of schizophrenia during this hormonal transition"

https://www.sane.org/information-storie ... tal-health


I've talked to several older women with autism (but NOT DID) and they had a worsening of the autistic symptoms through perimenopause (struggling with socialising and communication more, social events taking more out of them and it taking them longer to recover their energy levels)

I just think if its possible in those conditions then surely it's possible it could make something like even a milder case of DID/OSDD worse if a person was hit with one or more conditions known to trigger psychosis?




Just bumping this thread in the hope someone may read and answer this bit for me?

If falling estrogen levels can effect certain brain transmitters to trigger schizophrenia in women who previously didn't have it, could they also affect them to trigger a worsening of dissociative symptoms in someone already predisposed to them?

Thanks

Kit
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Re: Article Excerpt: Typical clinical presentation of DID

Postby birdsong87 » Fri Jun 05, 2020 9:34 am

I've never come across any data for that for DID.
You might have to ask a doctor about this.
Dx: DID cPTSD
L (host 1); Asti (host 2); Annett (teen protector); Maya (child); Age (observer); Thamara (child); Danielle (aut. teen); Mike (caregiver) and others
Our blog on resources https://www.dis-sos.com
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Re: Article Excerpt: Typical clinical presentation of DID

Postby Sarandipity » Sun Jun 07, 2020 12:44 am

Read some. Is interesting. Will come back to when can.
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No-one and Peter, Beth and Karen, Mandy and Mouse plus a seperate system of fragments including: rabit and others.
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Re: Article Excerpt: Typical clinical presentation of DID

Postby Sarandipity » Mon Jun 08, 2020 7:09 am

I does sound about right. I can reflect and have hopefulness. I can learn and stay with reality when not overwhelmed. Every crisis I have had has involved my mother. Even the most recent one, I don't talk to her told her stay away and I caught her coming to my house when she thought I wasn't there to visit my children. I didn't think about it at the time, brushed it off but I did end up in hospital. My father at least does stay away. I only just realised that preceded the hospital visit two weeks ago. I was OK in lock down but I thought lock down got to me till I just read this and then thought about what usually happens before hospital and what happened this time. Anyway I'll take this to a separate post.

It sounds about right this article. We had different clothes when we weren't aware of DID and until a therapy group we were in 3 times a week commented we didn't notice. Once they pointed it out and we felt exposed we wore two sets of clothes for about three years. The clothes weren't that different and we aren't obviously different usually to people but I think 3 days a week therapy is very intimate and one guy noticed how we are slightly different, told everyone. The therapist moved us tin1-1 but we wasn't ready to talk and she helped how we wanted - to make a life plan, part of which we called "simplifying our wardrobe" but it was really to avoid the whole exposure again. It took years to get over and realise the group was a very different situation. Work there's set clothes, cleaning set clothes but there we turned up without thought I guess. It wasn't just the clothes he noticed, it was a lot of stuff but the clothes are most easy to change. They were normal but sometimes jeans and sometimes flowery dresses and I think it highlighted to that guy the difference in how I spoke and came across at each group. So I agree in principle to that part but there are situations and people who notice. This last ex now friend noticed and no other ex has ever noticed. So generally yes it's very covert disorder but occasionally it is seen. We think sociopaths notice because they tune in so much to people to victimise them but that's just our theory. Sarah.
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No-one and Peter, Beth and Karen, Mandy and Mouse plus a seperate system of fragments including: rabit and others.
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