Anyone experience with DID AND (true) psychosis ?

My main diagnosis is DID.
In the past weeks/months I experienced yet another psychotic episode. I lost contact with reality, and was on the brink of hospitalization. Also I suffered from depression and hypomania. All this in parallel with the usual symptoms of DID (identity switches, amnesia, derealization, depersonalization).
This was the third episode in 15 months. Now I’m gradually recovering, but becoming “normal” DID will take another couple of weeks .
There is definitely a relation with therapy which is causing overwhelming emotions, but in the past I got these episodes without a clear trigger.
Medication doesn’t work, neither antipsychotics nor antidepressants (in the past I tried almost everything up to very high doses).
My psychotherapist (psychoanalyst, also a psychiatrist, having more than 4 decades experience in psychiatry/psychotherapy) can’t give a diagnosis. He just says “it’s very difficult”, and qualifies it as “not a normal psychosis”. I am BTW OK with that.

Anyone out there experiencing the same?
I’m so fed up being almost permanently very dysfunctional … Just would like to share …

Hm. Psychoanalysis is a rich person's therapy. Which means the client population is almost exclusively the so-called "worried well" and typically a diagnosis is neither needed nor attempted.

Is this experienced psychoanalyst experienced treating DID? If not, it might be a good idea for him to consult a psychoanalyst who does have that experience. Richard Kluft is a psychoanalyst and does a lot of consultations.

Re your psychosis, it might help if you shared with us some details of your symptoms. Do any of our own stories posted here resonate with you?

Without knowing more about your symptoms and situation, about all I could say at this point is that it seems likely your therapy is going too fast and has neglected basic elements of a 3-stage therapy, with stage 1 focusing on stabilization and safety.

I agree with everything Una+ said.

I may have some relevant experience. It will be easier to know how to be helpful if you can describe your experience of psychosis, since this label covers a broad variety of symptoms and situations.

Wishing you well-being and healing. Hang in there.

Thnx, Una+ and Nondescript.

>Psychoanalysis
My therapy is not psychoanalysis, but psychoanalytical psychotherapy. So we sit in a chair, vis-a-vis, contact is weekly. But yes, there are many similarities with the process of psychoanalysis.

>diagnosis is neither needed nor attempted
We (T and I) agree in this. I’m not interested in a formal diagnosis, I’m interested in “the story of my person” and how I can heal.
However, I asked him for a formal DSM diagnosis, because other professionals want to be informed in this way. This was the moment he said “it’s difficult”.

>T experienced treating DID?
Yes, confirmed by himself. In the course of the years I’ve become my own expert in dissociation, and I’m glad to notice that he knows more .

>therapy is going too fast
This is very interesting. A tentative answer might be: perhaps.
I find it remarkable, however, that the images (hallucinations), dreams, distorted thoughts, etc in such an episode also give new valuable insights, contributing to my therapy.

=====

These are the main symptoms (although I do not have all of these symptoms full blown in every episode):
- my thinking becomes (very) incoherent
- racing thoughts
- sounds (and lights, also the feeling of wind) become very intense. It feels like the “filter” in my brain doesn’t work any more. I can’t perceive any more from which direction sounds come.
- I perceive the world in a different way. Sounds, light, darkness, trees, cars, closets, …, anything becomes threatening. People have a predator like appearance (even my SO and therapist). Walls are not vertical any more. Numbers can have a meaning (although I can’t figure it out). Etc.
- I hardly sleep (which doesn’t help of course)
- of course I’m very very anxious
- aggressive and / or suicidal feelings too (from alters? not clear)
- sometimes I feel very agitated; for instance I want to walk in circles, start walking, noticing that things become worse, sit down, want to walk in circles again, etc
- thoughts are implanted / not mine
Note: different from the thoughts of alters; most of the time I can make the difference
- sometimes my speech is incoherent too.
Note: different from the “strange” speech I sometimes have due to very very frequent switches, several times in a sentence. Of course this causes problems becomes an alter has to finish a sentence s/he didn’t start, neither won’t finish.
- I have visual, auditory, tactile and olfactory hallucinations
Note: voices are not those of alters; most of the time I can make the difference. Voices give running commentary of are commanding (most of the time about doing harm to self or others).
*Trigger warning* Hallucinations like: pictures are projected over the reality. For instance when I look in the mirror, I see blood running from my eyes over my cheeks. Or the face of my T changes into a devilish one. Voices “play movies” in my head, about doing harm to self or others. *end TW*

Sometimes I realize that (some of) the hallucinations are not real; sometimes my experience tells me so; sometimes I believe them.

- I do NOT have extensive delusions (paranoid or else)

My hubby says I turn into a mixture of a staring zombie and a very frightened little creature.

Yup, I would say your therapy is going too fast. At times I too have been there, done that. I can relate!

micky_ wrote:I find it remarkable, however, that the images (hallucinations), dreams, distorted thoughts, etc in such an episode also give new valuable insights, contributing to my therapy.

Yes, they are all valuable. But there is very high value, arguably greater value, in maintaining at least somewhat adequate functioning in the rest of your life.

All these symptoms, "psychotic" and otherwise, are common in severe anxiety. Many can occur also in severe depression. Hence the medical concepts of brief reactive psychosis and psychotic depression.

Early in my therapy I experienced severe anxiety including very poor sleep which just compounded the anxiety, and I had many of the same symptoms you describe. For me, slowing things down and working more on self care, safety, and stability really helped. I always need to know all about whatever is bothering me so against my therapist's advice I did read a lot of technical books on DID and related topics. This was both good and bad for me. Some of what I read was very disturbing and tended to heighten my anxiety even more, but over the long run it helped me process and understand all that was happening.

I'll comment on just one of your most concerning symptom now, your command hallucinations. Command hallucinations typically have the quality of seeming to come from "outside". That is, from beyond the "not me" quality of alters speaking. However, authorities on DID generally agree that in most DID patients these command hallucinations are not psychotic. One reason for this view is the observation that generally the commands are quite relevant to the person's life and may even be constructive. They have some basis in reality.

I have experienced command hallucinations, and I have posted about them here in the DID Forum. I also have experienced recurrent compulsions on the same themes, both with the hallucinations and separately. (My therapists say that experiencing a compulsion to obey a command hallucination is a hallmark of a survivor of child abuse.) Command hallucinations are common, and generally not psychotic, not only in DID but also in obsessive compulsive disorder. I have no history of OCD but nonetheless I did a lot of work using techniques for treating OCD, and they proved to be helpful.

Some of your hallucinations sound like you have insiders who are messing with your mind! This is a common experience among multiples although not for me. I am very grateful not to be tormented or persecuted by parts of myself! (Thank you folks!) I do sometimes see and hear things but very clearly these are messages carrying valid information. In every case they have proved to be reality based! Some have been communications from my non-verbal insiders. Some have been messages of a more extra-sensory nature, that can only be labeled clairvoyance. This is all much too "woo woo" for me, but there it is.

I hope this helps.

Thnx Una+, this really helps.
I'm going to re-read your post tomorrow and give a reply. It's evening here. Time to relax so that I can have a nice sleep

And again: my symptoms are qualified as "not a normal psychosis" ...

micky_ wrote:the “strange” speech I sometimes have due to very very frequent switches, several times in a sentence.

Yup, another situation normal. This is the well known word salad that is characteristic of a revolving door crisis. It is very familiar to many of us here on the DID Forum.

DID Forum: Revolving Door

>brief reactive psychosis
Yes, I agree, although technically I do not comply because the episodes typically last a few months.

> My therapists say that experiencing a compulsion to obey a command hallucination is a hallmark of a survivor of child abuse.
> these command hallucinations are not psychotic
This is very helpful. Thnx Una+ ! Do you have a link to literature?

>insiders who are messing with your mind
Yes, this is exactly how I interpret these hallucinations now.
There is also a (psychological) resistance like nature. See below.

And finally
>therapy is going too fast
I discussed this numerous times with my T (of course). I even discussed whether I could stand therapy at all. Every time we agreed that the main ”ingredient” of these episodes is (psychological) resistance (there are other causes too). Becoming psychotic is the ultimate form of shutting down communication. And many T’s will stop, slow down, or change treatment. So it is very effective. My current T isn’t impressed by my symptoms; he just becomes more supportive, and when they fade away (they always do …), we continue as before.
But: I’ll bring this issue up again in my next session, because I found this episode more disturbing than ever.

This thread may be helpful:
DID Forum: questions abt dissociative psychosis

Hi!
I have been wanting to reply in detail but this topic is triggering for me. All the symptoms you report I did experience as a teen, in the absence of thought disorder, and was diagnosed as all kinds of psychotic. ("Pre-schizophrenic, Psychosis NOS, Depression with Psychotic features...") (It led to disastrous consequences for me, which is why it is triggering to discuss.) I also experienced many of these symptoms while a young child.

I would like to give you more eloquent feedback. But I will say that I haven't had symptoms like these in a good 15 years. I hope things get easier for you. Sounds trauma/recovery related to me.