What's the difference between DID/DDNOS beyond the DSM

I love it here where so many of us have the same questions and interests!

We all want to know more... is our DX right? and why....

Back to reading..

These concepts and the article about structural dissociation are not new to me. I encountered them months before I found this DID forum, back when I thought my problem was late onset PTSD.

Here is a thumbnail sketch of EP and ANP in the context of DID. Our alters who hold rage, anger, lust, fear, traumatic memories, etc., are EPs. Many of our inner persecutors, protectors, firefighters, and exiles are EPs. Most of our abused child alters are EPs. Alters who get on with daily life when life is hard, those usually are ANPs. Our alters who come out to handle threats by fleeing, fighting, negotiating, or managing tend to be ANPs. This includes most of our host and facade alters. Alters who come out to gratify the abuser tend to be EPs.

Someone with DID who has only two alters (host and one other, rare but it happens) has primary structural dissociation. Most of us have secondary structural dissociation: we have more than two alters, hence one or more ANPs and/or EPs. A few of us have tertiary dissociation: our alters have alters.

The really interesting thing is that, contrary to the theory of the first split always occurring between the primary ANP and EP, it seems alters can develop from ANP or EP to a seemingly whole personality who combines both ANP and EP. Robert Oxnam reports in his DID memoir that some of his alters spontaneously integrated with each other. From his descriptions of these alters, integration merged ANPs with EPs, and the resulting personalities were far more complex.

Now why can't they just word that horribly long article like that!

That was great Una!

So what are your thoughts on my first question listed below.


DID has 2 or more Apparently Normal Parts while DDNOS has one

(Save me from all that reading Una!!!)
So... how do we all know if we have only 1 ANP or 2 or more?

We can all give you so many examples and want you to tell us if we do or not, but there must be a way to know.

This is a very interesting discussion- most of it over my head!- but an interesting discussion nonetheless. My T diagnosed me as having DID a couple months ago. I still am skeptical and have fought her on this. If anything, I think it's more DDNOS. She's happy calling it that, and thinks it doesn't really matter so much, as you would treat them the same. What she doesn't understand (and I realize I need to tell her) is that it matters to me. I don't know why but it does. I don't think I've ever lost a considerable chunk of time. Some of my childhood is hazy, but that's completely normal, right? I think my alters were created to hold my painful emotions pertaining to painful situations/events rather that the memories of the situations/events themselves. I could be wrong but nothing has made me think otherwise. Jamie, my 12 year old alter, was out a lot when I was 12 and 13 and helped me get through that very difficult time. But I can remember a lot from that time period, I just feel very disconnected from it.

So I'm curious - you are discussing the primary, secondary and tertiary structures of dissociation. So does it hold true that someone with secondary dissociation has DDNOS and someone with tertiary diss. has DID like tylas said? Or is tertiary diss when alters have alters like una said? Also, what is complex PTSD? My T mentioned that the other day after one of my very traumatized alters came out in therapy. I've always known I have PTSD (or a part of me does) but am not familiar with complex PTSD. Off to google it now!

Dang it! This was suppose to go at the end, but its now at the start too. oops! Dang fuzzy head!

Una sounds like she has done a lot of research into it. All I know is what I got out of the new book I am reading: Book That info from that book is below. I am far from done with that article! However! The author sites Van der hart et all (2006) for this.

Apparently Normal Part - ANP Emotional Part - EP

Inner Antagonism: The Theory of the Structural Dissociation of the Personality

Primary Structural Dissociation (PSD)
PSD - Involves ONE EP and ONE ANP such as found in simple PTSD. The ANP needs to be detached and numb, characterized by partial or complete amnesia of the trauma, whereas the EP is usually limited in scope but is hypermnestic, re-experiencing the trauma.

Secondary Structural Dissociation. (SSD)
SSD - Includes PTSD-Complex and DD-NOS. This is characterized by dividedness of 2 or more defensive subsystems. For example, there may be different EP's who are devoted to flight, fight, freeze, total submission and so on. There is One ANP & MORE than one EP.

Tertiary Structural Dissociation (TSD)
This is DID. There ARE 2 or more ANP's who perform aspects of daily living, such as work in the workplace, child-rearing, and playing as well as 2 or more EP's.

So... bottom line on this is that in DID there is Two or more Apparently Normal Parts.
In DID-NOS there is ONLY ONE Apparently Normal Parts.
Both can have multiple EP's.

I am just...so confused. Every time I think I'm starting to grasp it, I suddenly feel as if I missed the whole point. I tried to post my map, but got too much resistance and deleted it after spending ten minutes typing. Grrr. I sometimes wonder if our Ts or these researchers could even clearly identify for us what each of our alters are. It seems so nebulous.

Make you wonder doesn't it. Look on the chart on that page. It summarizes everything. Not that I have studied it yet.

Post what you have, then go back and edit or repost if you change your mind. Sometimes those immediate thoughts are the best. Just don't ever look and see how many edits I have on my posts.

But MD's are no different.

At least they all have lots of training and experience with others and they get paid to figure stuff out, but most T's have not gone beyond PTSD and the only one within 100 miles that deals with Dissociative Disorders. I know mine had not gone beyond PTSD until me, but she is very interested in learning.

WE just have ourselves and our friends, but on the good side we don't have to figure it out if we don't want to. I just like to, but the problem is when we get older data and new data and an expert vs an expert. Where do we go?

I am going to sleep on it myself. Think I will go and see if my little one is still drowning and what I can do.

yakusoku wrote:I am just...so confused. Every time I think I'm starting to grasp it, I suddenly feel as if I missed the whole point. I tried to post my map, but got too much resistance and deleted it after spending ten minutes typing. Grrr. I sometimes wonder if our Ts or these researchers could even clearly identify for us what each of our alters are. It seems so nebulous.

I feel the same way sometimes. Although what brings me peace is knowing that I don't have to have it all figured out right *now* and that all I can do is the best I can. I know what's true for me, even if that seems to change every five minutes! We can take what we can from "expert sources" but the truth is we are the real experts on our own experience. The hardest thing, for me, is when I begin to question or doubt my own experience. I just need to put aside judgment and trust that I know what I need at any given time.

I started seeing my T for something completely unrelated (he was my husband's T first) and it just so turned out that he has had one DID client before in 25+ years of practice. He thought I might be DID after one month, intuitively, but put it away after I said no to time loss in the way he described it. Then the last few months, it started becoming obvious (first to him, then to me) that it was a possibility. I feel really blessed to somehow have been guided to his care.

Yeah, I am really not allowed to post about them (especially the EPs) in detail. The protective parts went a bit crazy and abusive when I tried, so I "listened" and backed off. I think I have three ANPs (if you include me, the "host"). There are two others who I can't distinguish whether they are EPs or ANPs, because they have external roles (e.g. sex, regulating external attachment relationships), but also hold certain emotions for me. I would guess the rest are EPs, as they seem to contain dissociated emotions about my upbringing or memories of abuse that I still haven't agreed with yet (i.e. there is no context and no proof, so I don't feel like I can trust the snippets I've been shown).

I also wonder if maybe I was more like DDNOS from childhood and then the stuff that happened in my adulthood from my husband's sleep disorder caused further dis-integration or if therapy did, because it was the first attachment relationship I had allowed in over a decade. I don't know if that's even possible. Like I said...confused.

brandic - Yes, the doubting. When I talk to T, it is impossible for me to disbelieve it, because they are so active. Then, slowly, between sessions...I come to think that it must just be some game or lie or delusion or something. My T thinks it is an issues with invalidation that relates to my upbringing. I would be that is a common experience for people with the sort of trauma that creates DID.

Una+ wrote:These concepts and the article about structural dissociation are not new to me. I encountered them months before I found this DID forum, back when I thought my problem was late onset PTSD.

Okay, I will take a stab at trying to see what you wrote, but I am still not done with the article. I have to break everything down, so bear with me. That's how my mind works. You do seem to know this well, but you need to unconfuse us.

Una - Here is a thumbnail sketch of EP and ANP in the context of DID. Our alters who hold rage, anger, lust, fear, traumatic memories, etc., are EPs.

Okay, I agree with this.


Una - Many of our inner persecutors, protectors, firefighters, and exiles are EPs.

Yes, and those terms come from Richard Schwartz's model of the Internal Family System. Okay, I am with you.

Una - Most of our abused child alters are EPs.

Yes, I agree.


Una - Alters who get on with daily life when life is hard, those usually are ANPs. Our alters who come out to handle threats by fleeing, fighting, negotiating, or managing tend to be ANPs. This includes most of our host and facade alters.


Assume you are correct here, but I am still fuzzy on what makes an ANP, but we are all so different, that might stay fuzzy?


Una - Alters who come out to gratify the abuser tend to be EPs.

okay

Una - Someone with DID who has only two alters (host and one other, rare but it happens) has primary structural dissociation.

This is where what you say contradicts or goes beyond the book? Can you give us a quote from the article to support this and help us understand? Perhaps this is where we are all getting confused?


Una - Most of us have secondary structural dissociation: we have more than two alters, hence one or more ANPs and/or EPs.

This books says SSD can only have ONE
SSD - Include PTSD-Complex and DD-NOS. There is ONE ANP, but can be multiple EP's. Again can you give us reference to this?

Una - A few of us have tertiary dissociation: our alters have alters.


TSD - This is DID. There ARE 2 or more ANP's and 2 or more EP's.
I think we agree here, but I would like to know more about the statement - "our alters have alters"
___________________ NEW POST _______________________________

Can't nap until I finish the article. .. So I finally got down to the good stuff....
I want Brownie Points! I read that thing! My thoughts... That paper is the original research paper. The book sums up that work and includes work done afterwards. Therefore I have to say what the book said is correct. I did not find any other answer to my other questions in the text of that paper. But! I bet Una has read more and there is more on the net!

Here is where it starts to get interesting..

Traumatized young children may not have developed a relatively integrated personality prior to the onset of trauma, so in terms of the present theory, the emergent structural dissociation of their personality will basically consist of at least one or more ANPs and one or more EPs. Our clinical observations indeed suggest that even in cases of extreme tertiary structural dissociation of the personality, i.e., DID, the basic division is between parts of the personality that manage daily life and that promote survival of the species (ANPs), and parts that are associated with survival of the individual in the face of (perceived) major threat (EPs). Because some patients with DID display strongly developed -- that is, emancipated -- ANPs and EPs, and because some may have learned to control the switching between these mental systems in the course of treatment, these patients are ideal subjects for studying the psychobiological features of ANP and EP.

Part of the summary following the above paragraph
ANPs would be mediated by action systems dedicated to survival of the species and normal life, and EPs by action systems dedicated to survival of the severe threatened individual. From this theory, a range of hypotheses can be derived, some of which we have begun to study empirically and experimentally.

....... it should be noted that 80% or more of DID-patients have PTSD

.....Conclusion

......
The theory holds that dissociative processes do not split the emotional system that constitutes the premorbid personality in random ways, but rather along metaphoric minute cracks that naturally exist between action systems and subsystems

This is funny Una.. I thought before you meant the idea was cracked.

....we have proposed three levels of structural dissociation that mark a range of trauma-related disorders: simple PTSD; complex PTSD, DES and DDNOS; and DID. According to the theory, these various disorders can be situated on a continuum of complexity of structural dissociation of the personality.

....The theory predicts that overcoming tertiary dissociation in DID is less demanding than overcoming secondary dissociation. It also states that overcoming primary dissociation implies exposure to severe perceived threat, and thus requires the highest level of mental functioning

.........In the first phase, level of functioning of ANPs is raised, by gradually overcoming phobia of mental contents, phobia of ANPs for each other, and phobia of EPs. Also, phobia of attachment is addressed in that at least a working alliance and cooperation between ANPs and EPs among each other, and with the therapist are secured. If, and only if, the integrative level has been sufficiently raised, phobia of traumatic memories can be addressed in the second treatment phase, by stepwise exposure and prevention of re-dissociation. In the third and final phase, integration of the personality, overcoming phobia of intimate attachment, and coping with life in non-dissociative and otherwise non-avoidant ways are the main goals.