The Trauma-Stressor and Dissociative Disorders Project

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Psychological traumaThe most fundamental effect of trauma is dissociation, so we define trauma as the event(s) that cause dissociation. <ref name=Howell2011/>{{Rp|75}} The original trauma in those with dissociative identity disorder was failure of secure attachment with a primary attachment figure in early childhood. <ref name=Howell2011/>{{Rp|83}} is the key making up what is known as the dissociative disorders and the trauma-stressor disorders in the DSMPublished by the American Psychiatric Association as the standard classification of mental disorders used by US mental health professionals. It consists of diagnostic classification, the diagnostic criteria sets, and descriptive text. The DSM-II listed multiple personality disorder as a symptom of hysterical neurosis, dissociative type. The DSM-III (1980) moved Multiple Personality Disorder from a symptom to its own disorder. The DSM-IV changed the name to dissociative identity disorder (1994) and the DSM-5 (May 2013) updated the listing to current standards. <ref name=DSMIV/> <ref name=DSM5/> <ref name=Dell2009/>{{Rp|384}}-5. Nowhere has information been selected and presented as it is here. The project has pride in offering only the most recent information and facts and theory as presented by the top experts in the field of trauma and dissociationThis explanation refers to pathological dissociation only; which is dissociation which is a symptom of or causes a mental health disorder. For normative dissociation see Dissociation page. Dissociation is a compartmentalization of experience, where elements of a trauma are not integrated into a unified sense of the Self. <ref name=Dell2009/>{{Rp|4-810, 127}}The lay persons idea of [[dissociation]], that which exists in the normal mind, is not what is referred to in this document. True or pathological dissociation requires an experiencing Self. <ref name=Dell2009/>{{Rp|233-234}}. With that in mind, here are our two main categories: dissociative disorders and the trauma and stressor-related disorders.

Dissociative disorders

The Dissociative Disorders (DD), include dissociative identity disorder (DIDDissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}}) which is better known by the highly inadequate and inappropriate name multiple personality disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder in the DSM manual from 1980-1994. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}, as well as dissociative amnesia (DA), depersonalization disorder/derealization (DPD), other specified dissociative disorder (OSDD), (formerly dissociative disorder not otherwise specified DDNOS, and other specified dissociative disorders. [1]:155-159

Trauma and Stressor-related disorders

The Trauma and Stressor-related disordersincluded reactive attachment disorder (RADOriginally the only attachment disorder listed in the [[DSM]]. A stressor-related disorder, disinhibited social engagement disorder was originally a subtype of RAD.), disinhibited social engagement disorder, posttraumatic stress disorder (PTSD), acute stress disorder (ASD), adjustment disorders, other specified trauma and stressor-related disorder and unspecified trauma and stressor-related disorder. [1]:141-153

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DSM-5 Category: Dissociative Disorders

The DSM-5, was released May, 2013 and the DSM-5 committees have settled on the following categories:

  • Dissociative identity disorder (DID)
  • Dissociative amnesia (DA), with or without dissociative fuguepsychogenic fugueA temporary loss of personal identity due to trauma, reclassified as Dissociative Amnesia within the DSM-5. Dissociative amnesia includes dissociative fugue as a subtype, since fugue is a rare disorder that always involves amnesia, but does not always include confused wandering or loss of personality identity. <ref name=DSMIV/> <ref name=DSM5Deskref/> <ref name=Spiegel2013/>Dissociative amnesia (DA) was previously called psychogenic amnesia is a form of temporary amnesia that presents often in traumatic situations; for example in car accidents or victim or witness of a violent crime. Dissociative Amnesia is described in the DSM as a disorder that causes significant distress or impairment in functioning, such as when a person cannot remember significant events that happened to them. <ref name=ISSTD.org/> (DF)
  • Depersonalization/derealization disorder
  • Other specified dissociative disorder (OSDD, formerly dissociative disorder not otherwise specified)
  • Unspecified dissociative disorder (UDD)

DSM-5 Category: Trauma and Stressor-Related Disorders

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The Trauma and Stressor-Related Disorders are:

Note: Complex posttraumatic stress disorder is not named in the DSM-5 but is in the draft version of the ICD-11 manual.

Table of contents

  • Abuse: adult
  • Abuse: child
  • Acute stress disorder
  • Amnesia: memory loss and losing time
  • Adjustment disorder and styles
  • Alternate identity Types of altersAltered states of consciousnessExchangeable terms include parts, dissociative parts, personality states, self-states, states, identities, selves, or ego states. Alters are present only in those with dissociative identity disorder or similar presentations of other specified dissociative disorder, where the parts of the personality are highly dissociated and isolated. No alter, including the host alter, is a complete personality, even though an alter might feel as if they are. <ref name=Howell2011/>{{Rp|55-67}}Alters are psychodynamically interacting parts, each with their own separate centers of subjectivity, identity, autonomy, and sense of personal history. <ref name=Howell2011/>{{Rp|55}}An individual with dissociative identity disorder may have few or many |alters, which include a variety of ages, cross gender, animal or objects, with coconsciousness (see coconsciousness) at varying degrees, and [[communication]] can be limited to one direction. (one way amnesia) <ref name=Dell2009/>{{Rp|301}}
  • Betrayal trauma theory
  • Books: trauma and dissociation
  • Borderline personality disorder
  • Coconsciousness between alters (process of integrationIntegration (state of unification) occurs in the minds of all individuals and is a process rather than an end product. "If integration is impaired, the result is chaos, rigidity, or both. Chaos and rigidity can then be seen as the red flags of blocked integration and impaired development of the mind." <ref name=Siegel2012/>{{Rp|9}} The natural process of the mind is to link differential parts (distinct modes of information processing) into a functional and unified self. No child has unified personality when born, in fact, they need years of sufficient nurturing for the parts of their personality to integrate. (see multiple) <ref name=Siegel2012/>{{Rp|394}} "Integration is more like making a fruit salad than like making a smoothie: It requires that elements retain their individual uniqueness while simultaneously linking to other components of the system. The key is balance of differentiation and linkage." <ref name=Siegel2012/>{{Rp|199}} Integration is the normal process that occurs in early childhood, but if interrupted by trauma and disorganized attachment, the child may not be able to integrate, resulting in a dissociative disorder. <ref name=Howell2011/>{{Rp|143}} As an adult, when therapy is sought out, an individual who has unresolved trauma and lacks integration, can finally get the help needed to process the trauma memories, which needs to be done prior, and to finally [integrate the alters making up the ersonality into one unified self. <ref name=Noricks2011/>{{Rp|141-144}})
  • Comorbiddisorder and dissociative identity disorderPrior to the DSM-IV, <ref name=DSMIV/> <ref name=DSM5Deskref/> dissociative identity disorder was known as multiple personality disorder in the DSM manual from 1980-1994. The International Classification of Diseases,(ICD) still uses this label, <ref name=ICD10/> even though the ICD-11 is expected to change it. The term is misleading and well known that no one can have more than one personality, nor is the disorder a personality disorder. {{See also| Multiple Personality Disorder}}Dissociative identity disorder is a disorder of mental states, where a individual has amnesia due to switching between different personality states (also known as alters). <ref name=Dell2009/>{{Rp|319-321}} {{See also| Dissociative Identity Disorder}}
  • Conversion disorder physical symptoms
  • [[DenialPsychology - Defense mechanism in which the existence of unpleasant realities is disavowed; refers to keeping out of conscious awareness any aspects of external reality that, if acknowledged, would produce anxiety <ref name=Sadock2008/>{{Rp|24}}Crime - "various processes by which individual actors, social groups or states either 'block, shut out, repress or cover up certain forms of disturbing information [about wrong doing] or else evade, avoid or neutralize' its consequences (Cohen, 1995, 19)" Refers to the denial of a perpetrator of a crime, for example denying the crime or the impact of the crime, denying the victim, counter-attacks and appealing to "higher loyalties".<ref name=CrimeDict/>{{Rp|125}}] of mental disorderThe DSM-5 psychiatric manual defines this as "a syndrome characterized by clinically significant disturbance in an individual's cognition, emotion regulation, or behavior that reflects a dysfunction in the psychological, biological, or developmental processes underlying mental functioning. Mental disorders are usually associated with significant distress or disability in social, occupational, or other important activities. An expectable or culturally approved response to a common stressor or loss, such as the death of a loved one, is not a mental disorder. Socially deviant behavior (e.g., political, religious, or sexual) and conflicts that are primarily between the individual and society are not mental disorders unless the deviance or conflict results from a dysfunction in the individual, as described above."<ref name=DSM5Deskref/>{{Rp|20}}
  • Society denial and impact of trauma and child abuse"interactions in which one person behaves in a violent, demeaning or invasive manner towards another person (e.g. child or partner)" <ref name=VandenBos2007/>
  • Diagnosis of mental disorders includes DES, MID, SCID-D
  • Diagnostic and statistical manual of mental disorders DSM-5
  • Disinhibited social engagement disorder
  • Dissociation
  • Somatoform disorders and dissociation
  • Dissociative disorders overview
  • Dissociative symptoms
  • Eating disorders related to the trauma and dissociative disorders
  • Etiology of dissociative identity disorder
  • Eye movement desensitization and processing (EMDRA valid psychotherapeutic approach, especially for treating trauma. <ref name=EMDR.com/> <ref name=ISSTD.org/>)
  • Grounding techniques
  • Category:Healing
  • Historyof dissociative identity disorder
  • Hostwhich is the alter in executive controlThe alter that has control of an individual at that moment has executive control, and the alter most often in executive control is commonly called the host alter. <ref name=Boon2011/>{{Rp|27}} of the self
  • Integration process to unificationAlso known as final fusion. See 'integration'.Integration (state of unification) occurs in the minds of all individuals and is a process rather than an end product. "If integration is impaired, the result is chaos, rigidity, or both. Chaos and rigidity can then be seen as the red flags of blocked integration and impaired development of the mind." <ref name=Siegel2012/>{{Rp|9}} The natural process of the mind is to link differential parts (distinct modes of information processing) into a functional and unified self. No child has unified personality when born, in fact, they need years of sufficient nurturing for the parts of their personality to integrate. (see multiple) <ref name=Siegel2012/>{{Rp|394}} "Integration is more like making a fruit salad than like making a smoothie: It requires that elements retain their individual uniqueness while simultaneously linking to other components of the system. The key is balance of differentiation and linkage." <ref name=Siegel2012/>{{Rp|199}} Integration is the normal process that occurs in early childhood, but if interrupted by trauma and disorganized attachment, the child may not be able to integrate, resulting in a dissociative disorder. <ref name=Howell2011/>{{Rp|143}} As an adult, when therapy is sought out, an individual who has unresolved trauma and lacks integration, can finally get the help needed to process the trauma memories, which needs to be done prior, and to finally [integrate the alters making up the ersonality into one unified self. <ref name=Noricks2011/>{{Rp|141-144}} of the self
  • International classification of diseases (ICD-10)
  • International Society for the Study of Trauma and Dissociation
  • Memory and understanding unprocessed trauma memory"Memory is not a static thing, but an active set of processes." <ref name=Siegel/>{{Rp|51}} "Our earliest experiences shape not only what we remember, but also how we remember and how we shape the narrative of our lives. Memory can be seen as the way the mind encodes elements of experience into various forms of representation. As a child develops, the mind begins to create a sense of continuity across time, linking past experiences with present perceptions and anticipations of the future." <ref name=Siegel/>{{Rp|11}}
  • Related diagnoses: BPD, Bipolar, Schizophrenia
  • Personality
  • Polyfragmented dissociative identity disorder
  • PTSD, complex PTSD and dissociative PTSD
  • Ritual abuse and mind controlMind control programmmng only exists in a minority of people with dissociative identity disorder or other specified dissociative disorder; those who have experienced ritual abuse. Programming is the act of "installing internal, preestablished reactions to external stimuli so that a person will automatically react in a predetermined manner to things like an auditory, visual or tactile signal or perform a specific set of action according to a date and/or time" (Survivor Robin Morgan, in Miller (2012){{Rp|13}}. This is achieved through using extreme, usually life-threatening trauma such as torture to create alter identities during childhood.<ref name=Miller2012/>{{Rp|viii, 19}} These alters are created to be programmed so that the person engage in activities chosen by the abusive group (for example, a cult) without any conscious awareness of it and without a conscious choice on behalf of an alter, for example activities like sex slavery, murder or spying. {{See also| Ritual_abuse}}
  • Schizophrenia
  • Seizure-like movements common in complex dissociative disorders
  • Self harm
  • Structural dissociation of the personalityEvery individual has a personality that is composed of many diverse, fragmentary and generally illusory images of [[Personality|self]]. (see multiples) <ref name=Noricks2011/>The DSM-IV uses the term identity in its definition of dissociation. (see identity) <ref name=Dell2009/>{{Rp|127}}
  • Terminology for trauma and dissociative disorders
  • Therapist
  • Trauma which is psychological
  • Trauma and Stressor-related disorders
  • Unified sense of self also known as being fully integrated, fusion or unification.
  • Videos: trauma and dissociation

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Peer to peer tips for dissociative identity disorder

Child abuse and the Trauma and DissociationThis explanation refers to pathological dissociation only; which is dissociation which is a symptom of or causes a mental health disorder. For normative dissociation see Dissociation page. Dissociation is a compartmentalization of experience, where elements of a trauma are not integrated into a unified sense of the Self. <ref name=Dell2009/>{{Rp|4-810, 127}}The lay persons idea of [[dissociation]], that which exists in the normal mind, is not what is referred to in this document. True or pathological dissociation requires an experiencing Self. <ref name=Dell2009/>{{Rp|233-234}} Project

Infant.jpg

Child abusers, especially pedophiles, and go to great lengths to hide the emotional, physical and sexual abuse they enact upon children, but the fact remains that child abuse is common, and is truly a hideous and hidden epidemic of the human culture. Individuals who are, or were abused, suffer from shame, and often blame themselves for the abuse they suffered at the hands of a caregiver. The abusive parent or abusive caregiver which a child must depend on to live is essential to a child's survival, and cannot be easily discarded. [2]:7-19 The existence of amnesia due to child abuse is both highly desirable and strongly denied by child abusers, who hope their victims will lack the ability to recall their childhood suffering or will not speak about it. The inability to recall aspects of major traumatic events is a diagnostic symptom of posttraumatic stress disorder (PTSD), and traumatic amnesia, particularly for child abuse experiences. Having no conscious memory of child sexual abuse is a common occurrence, particularly among incest survivors. [3]:1173 Traumatic amnesiaMemory loss. {{See also| amnesia}} was first documented in soldiers by Dr Charles Myers, during World War I.

The movies and books about 'SybilSybil is a biography describing the life of a woman with dissociative identity disorder, published as a book in 1973 and released as a TV movie in 1976."It is often the first association that people have when they hear the words MPD or DID. Despite the Hollywood blitz associated with this disorder, however, the diagnosis appears to have begun in the last 1800s with Pierre Janet, a French psychiatrist, and William James, a student of philosophy and psychology." <ref name=Haddock2001/>{{Rp|12-13}} "Sybil" included descriptions of the severe abuse and sexual abuse she suffered during her childhood, and the help she received from her psychiatrist, Dr. Wilbur. <ref name=Schreiber1973/>Nearly 40 years later, after the death of "Sybil", a journalist published the heavily marketed book "Sybil Exposed" claiming Sybil did not have DID, but legal action forced the publishers of Sybil Exposed to remove a false statement on the dust jacket and provided additional evidence of false and fabricated statements in Sybil Exposed.<ref name=Suraci2011/> Coons (2013) later studied the original evidence and stated "the story of Sybil is true, not fraudulent or fiction". <ref name=Coons2013/> {{See also| History of DID}}' did show public that amnesia plays a significant role in those who have dissociative identity disorder (multiple personality disorder), but at the same time spread the misconception that a person can have more than one personality rather than a single, fragmented personality. Jennifer Freyd's "Betrayal Trauma Theory" suggests that dissociative amnesia is an adaptive response to childhood abuse. [2]:225 A child mistreated by their caregiver(s) must find a way to survive, and dissociative amnesia allows this by allowing a child to maintain an attachment with their caretaker/caregiver. [2]:9 Child abuse leads to an insecure attachmentThe communication of emotion between an infant and their primary caregiver(s) is essential to shaping the developing mind. "Emotion serves as a central organizing process within the brain. In this way, an individual's abilities to organize emotions - a product in part, of early attachment relationships directly shapes the ability of the mind to integrate experience and to adapt to future stressors." <ref name=Siegel/>{{Rp|9}} Interruption in the attachment pattern of young children with their caretaker(s) has been shown to be a primary precursor to Dissociative Disorder pathology. (see etiology) <ref name=Medscape/> <ref name=HauntedSelf/>{{Rp|85}} <ref name=Howell2011/>{{Rp|97}} when a child has no one to turn to.

In researching attachment, trauma and dissociation, it was found that any form of early insecure attachment to the primary caregiver, particularly disorganized attachment, increases the likelihood of a child having dissociative reactions to later traumaThe most fundamental effect of trauma is dissociation, so we define trauma as the event(s) that cause dissociation. <ref name=Howell2011/>{{Rp|75}} The original trauma in those with dissociative identity disorder was failure of secure attachment with a primary attachment figure in early childhood. <ref name=Howell2011/>{{Rp|83}}, creating a pathway to trauma-related disorders including dissociative identity disorder. [4]:17 Disorganized attachment is characterized by a child's lack of a coherent organized behavioral strategy for dealing with stressful situations, and occurs most commonly in situations of emotional, physical, or sexual abuse. [2]:66 Severe neglect can also lead to unresolved trauma. [2]:67Pathological dissociation is a complex psychophysiologicalPsychophysiology refers to "the science which studies the physiology of psychic functions through the brain-body-interrelationships of the living organism in conjunction with the environment" <ref name=Mangina1983/>{{Rp|22}} Psychophysiology is concerned with measuring of psychological responses in order to understand behavior, including activities such as reactions to stress, sleep, memory, learning, perception or any activities that psychologists are inclined to study. <ref name=Andreassi2010/>{{Rp|Preface}} This includes measuring heart rate, biofeedback, neuroimaging, such as positron emission tomography (PET) and functional magnetic resonance imaging (fMRI), electroencephalography (EEG) and event-related potential (ERP) approaches to studying the brain and body, including the nervous system, memory, neurotransmitters, motor functions (movement) and brain wave activity for example.<ref name=Andreassi2010/> process that changes the accessibility of memory and knowledge, integration of behavior, and states. Dissociative identity disorder is the ultimate example of how overwhelming life events that occur very early in childhood can affect"a person's present emotional responsiveness, which can be inferred from facial expressions" including both the degree and range of expressive behavior. This can also be shown in tone of voice, hand and body movements. <ref name=Sadock2008/>{{Rp| 6}} the human mind, and how dissociative mechanisms can provide temporary adaptive protection from child abuse. [2]:225 Psychological trauma occurs from a series of severely distressing events such as constant child abuse and/or neglect. [5]

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We encourage those with knowledge of the trauma-stressor and dissociative disorders to join with us in creating an accurate and helpful information based site. Simply make an account and review our editor guidelines. All information is to be referenced to expert information except our section on peer to peer tips. See the bottom of the table of contents at the bottom of this page for the peer section.

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Dissociative Identity Disorder.org is a peer written site, reviewed by health care professionals that presents up to date information on all aspects of dissociative identity disorder. In addition to this branch of the Trauma and Dissociation Project, we strongly encourage all mental health professionals and students to join the International Society for the Study of Trauma and Dissociation (ISST-D) and/or the Society for Traumatic Stress Studies for access to reliable research, education, certification and more. These are also the organizations to contact for people looking for a qualified mental health provider. The ISST-D is responsible for the professional publication titled: Journal of Trauma and Dissociation. The ISTSS equivalent is the Journal of Traumatic Stress, which focuses more on Complex PTSD and PTSD than Dissociative Disorders.

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References

  1. ^ a b Diagnostic and Statistical Manual of Mental Disorders-5.
  2. ^ a b c d e f Chu, James A. (2011). Rebuilding shattered lives treating complex PTSD and dissociative disorders. Hoboken, N.J.:John Wiley & Sons.ISBN 9781118093146.
  3. ^ Williams, LM. Recall of childhood trauma: a prospective study of women's memories of child sexual abuse. Journal of Consulting and Clinical Psychology, volume 62, issue 6, page 1167-1176. (doi:10.1037//0022-006X.63.3.343)
  4. ^ Liotti, Giovanni. Trauma, Dissociation, and Disorganized Attachment: Three Strands of a Single Braid. Psychotherapy: Theory, research, practice, training, volume 41, issue 4, page 472-486. (doi:10.1037/0033-3204.41.4.472)
  5. ^ Siegel, Daniel J. (2012). The developing mind : how relationships and the brain interact to shape who we are. New York:Guilford Press.ISBN 146250390X.