Traumatic Stress Disorder O Dissociative Symptom example essay topic

Dissociative Identity Disorder: A Preliminary Examination& Dealing with the Disorder as an Adult Dissociative Identity Disorder Dissociative Identity Disorder, or DID, is defined as: "The result of a marvelously creative defense mechanism that a young child uses to cope with extremely overwhelming trauma" (Hawkins, 2003, p. 3). Ross describes DID in this way: "In its childhood onset forms, the disorder is an effective strategy for coping with a traumatic environment: It becomes dysfunctional because environmental circumstances have changed by adulthood" (1997, p, 62). What types of traumatic environments are we talking about here? Often children who form DID are involved in some sort of abuse.

These types of abuses can be physical, sexual and even ritual. Such abuses are not meant for children to have to endure, however, the mind is able to deal in effective ways to allow the child to bear such intolerable environments. As one examines this subject, one finds that there are varied opinions on DID, however, it is important to understand the nature of DID, types of DID as well as DID symptoms and healing in adults. DID, formerly known as Multiple Personality Disorder, often seems to come with a stigma of someone who is mentally ill or psychotic. As we look into society at popular media sources and examine the characters who display the symptoms in movies, we can see that characters with DID are often portrayed as murderers or psychotic people. In 2003 Columbia Pictures Industries, inc. released a movie called Identity.

The basis of the film is that all the murders and evil happenings were happening in one man's mind. The man, who was on death row for murdering young women in real life, was in the midst of treatment to overcome DID, however, he remains a real life murderer even until the end. In one of the most popular movies of this generation, and a trilogy of great fantasy literature, involves a character named Golem who himself has multiple personalities. His character is troubled, cunning and evil, and has murderous intent. However, in real life DID is not like this. DID is a coping strategy for children who are involved in great trauma.

Hawkins puts it this way: "God built marvelous ingenuity into the human mind in order to allow the most vulnerable part of His creation - the little children - to survive the worst kinds of evil that Satan would perpetrate through fallen man" (2003, p. 3). Ross goes into further detail: What is DID? DID is a little girl imagining that the abuse is happening to someone else. This is the core of the disorder, to which all other features are secondary. The imagining is so intense, subjectively compelling, and adaptive, that the abused child experiences dissociated aspects of herself as other people. (Ross, 1997, p 59) However, DID is not as simple as it seems.

There are some who believe that it is created by therapists. Paul R. McHugh writes: MPD like -epilepsy, is created by therapists. This formerly rare and disputed diagnosis became popular after the appearance of several best-selling books and movies. It is often based on the crudest form of suggestion. (web) In fact there are many more certified psychiatrists in America who are in agreement with McHugh.

In a survey of 300 psychiatrists in 1999, 2/3 believed that DID should not be included in the DSM-IV (web 2. htm). This is a staggering number, for a truly remarkable psychological condition. In spite of these statistics these same people believed DID should be a proposed diagnosis, because of skepticism. In true cases of DID new identities are formed to enable the child to be sheltered from the reality of abuse.

This diagnosis of DID is considered to be the most severe type of DID by Ross. He views DID as a multifaceted psychological condition. Consider the following chart, found on page 98 of his book, Dissociative Identity Disorder. S CI OM MP PL Normal Dissociative Dissociative Partial DID DID LE Dissociation Amnesia Fugue DIDNOS E X (1997) This chart shows the 5 areas of DID progressing from the more normal (left), to the more extreme (right). On the far end of the spectrum there is what people experience with regularity. Normal Dissociation is most easily explained by thinking of examples, such as day-dreaming or having imaginary friends.

However in more extreme cases individuals will need treatment to receive healing. The most extreme case is that of DID. This will often develop during the perils of child abuse. It is also the most commonly treated version of DID.

DID is created during severe chronic childhood trauma. The most common of the abuses is that of sexual and / or physical abuse. This is usually perpetrated by the father, or a male figure in the life of a child, who is often a female. During these chronic abuse periods the child will often imagine that she (for the sake of simplicity the feminine personal pronoun will be used to indicate the individual developing DID, as most recorded instances of abuse are against female children) is distancing herself away from the action.

This may occur by floating to the ceiling and watching the abuse in a detached fashion (Ross, 1997, p. 64). By doing this the mind is creating a strategy in which she is able to absorb these intolerable moments into manageable bits of knowledge (Ross, 1997, p. 64). During these chronic periods of trauma the mind creates dissociative pathways which divide her mind into separate selves to absorb the trauma. As she experiences more abuse these segments of the mind, or "segments of consciousness" (Hawkins, 2003, p. 8), are separate into viable identities which are "able to operate independently within the person as divided portions of the soul" (Hawkins, 2003, p. 8).

In order to accommodate the divided personalities, the mind creates amnesiac barriers to protect her from the trauma experienced. At a very basic level of humanity, the reason why a child in this situation needs to undergo this process of dissociation is to protect her. During the process of abuse the child senses the need to "shut down her attachment systems, but her genes override this environmental imperative" (Ross, 1997, p. 65). To detach from the caregiver would be certain death, so the child will endure this type of abuse to attach to the parent. This idea of attachment is one that is ingrained within our genes. It cannot be overridden, so the mind needs to somehow overcome this need, it does so by dissociating from the abuse, separating the abuse in the mind so that the child can function well under normal circumstances.

This adaptation is quite unique and is incredibly important in the growth and development of the child. However, the problem arises once the child has passed the point of abuse. The adaptation of the mind has protected her from danger, however, when the danger has ceased, a new danger begins. The dissociation remains, in spite of the lack of trauma, and if the trauma continues new dissociation's may be created. Thus, DID becomes dysfunctional in adulthood.

A second form of DID is called DIDNOS [Dissociative Identity Disorder not Otherwise Specified] (Ross, 1997, p. 67). DIDNOS arises from the Childhood Neglect Pathway (Ross, 1997, p. 66). In less traumatic abuse the child may experience a parent who is unable to provide the attachment needed. Thus Ross describes this as: Childhood neglect pathway patients describe mothers who were depressed, schizophrenic, alcoholic, or themselves had DID, and who were physically absent and emotionally unavailable. The neglect may have involved being locked in closets and basements or left in a crib for prolonged periods.

The pervasive trauma was the absence of a secure attachment figure. These neglected and emotionally deprived children retreat into an internal imaginary world to fill up the emptiness and form internal attachments. They created an elaborate internal landscape populated by characters with histories and complex interactions. (Ross, 1997, pp. 66-67) This trauma though severe, is not severe enough to create true DID.

Often due to misdiagnosis DID treatment is ensued. This type of DID is considered to be created by the therapist, though there is partial DID present. It is not a full version of the psychological condition, and does not require as extensive treatment because the true DID pathways in the mind have not been developed fully (Ross, 1997, p. 67). Two lesser forms of DID are the Factitious Pathway and the Iatrogenic Pathway. The Factitious Pathway is created by the patient. Often these individuals have a medical-history of abuse of the medical system, and fake diseases repeatedly.

Ross considers these people to be "con-artists and are consciously running a scam on the health care system" (Ross, 1997, p. 68). These people will show the symptoms, but will often live out the symptoms in a very exaggerated way. The Iatrogenic Pathway, on the other hand is similar to that of the Childhood neglect pathway, in as much as the patient undergoes misdiagnosis by the therapist. The patient thus takes on the symptoms of the disease. However, these individuals who experience this are not as "trance prone" (Ross, 1997, p. 69) as true DID patients. As the child matures into adulthood with DID several things will surface.

Though the splitting of the mind usually happens at an early age, it does not simply heal itself. Often the Alters (Alternative personalities) are broken down logically. There are some basic alters that need to be mentioned at this point. The common identities in someone with DID are: Core; Host; Primary identities; Presenters; Function alters; Victims; Protectors; Controllers; Persecutors; Reporter; Inner Self Helper and Caretaker (Hawkins, 2003, pp. 9-11) (for more information see Appendix A). Some individuals display some or all of these alternative personalities. In adults these personalities show themselves in a variety of ways.

A simple way to find out if someone needs to seek professional help is to fill out a survey, such as the one found in Appendix B. This survey covers everything quite simply, though it is not final in diagnosis, it may shed light for individuals with traumatic memories. Some common symptoms of DID are: o Post-traumatic stress disorder o Complex post-traumatic stress disorder o Dissociative symptom so Affective symptom so Somatic symptom so Behaviour Symptoms Mental Symptoms (Hawkins, 2003, pp. 36-41) The DSM-IV has a much simpler way of looking at the symptoms, though it is perhaps so simple it may lead to more false diagnosis (Ross, 1997, p. 100) A. The presence of two or more distinct identities or personality states (each with is own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self). B. At least two of these identities or personality states recurrently to take control of the person's behavior. Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness. D. The disturbance is not due to the direct physiological effects of a substance (e. g., blackouts or chaotic behavior during Alcohol Intoxication) or general medical condition (e. g., complex partial seizures. Note: In Children, the symptoms are not attributable to imaginary playmates or other fantasy play. (Ross, 1997, p. 100) When dealing with an adult who has these symptoms treatment must be undertaken to make the soul whole again. Krakauer sees three primary stages for therapy, which are found in Chapter 3 of her book Treating Dissociative Identity Disorder.

In Stage One the hope is to increase safety and stability of the person, and establishing a therapeutic alliance between therapist and client (Krakauer, 2001, p. 47). The patient has to accept the diagnosis in order to allow for increased internal communication, as well the she needs to learn to take better care of herself by reducing self-injury and improving relational skills with other (Krakauer, 2001, p. 58). Through these things she will increase her initiative, confidence and self-esteem, ultimately creating hope (Krakauer, 2001, p. 58). Once Stage One has been adequately established Krakauer moves to what she calls Stage Two.

During this second stage of therapy the hope is to move into a phase of dealing with the painful memories. The goals of this stage are simply stated, yet difficult to complete. The client should move into a place where she can begin to "further dismantle the dissociative barriers between the personalities through sharing, and emotional processing, of previously withheld memories" (Krakauer, 2001, p. 58). As the barriers dissolve there is to be more communication between the personalities as they "internally challenge the perceived authority of the abuser (s) " (Krakauer, 2001, p. 58). This needs to be done carefully as to not loose any ground that was gained in Stage One. There needs to be deliberate progress as well in "asserting needs and [paying] ongoing attention to [the] safety and self-validation" (Krakauer, 2001, p. 58) of the patient.

This well help increase the feeling of control for the patient gently encouraging the eventual "spontaneous joining of the alters as their separateness ceases to serve a useful function" (Krakauer, 2001, p. 58). The joining of the final alter signifies the end of Stage Two, and immediately brings Stage Three into effect. This stage starts quit abruptly, but serves a significant purpose. Here in Stage Three the client is relearning how to live in her environment. The desire is for her to have an increased ability to handle the daily stresses without using dissociative defenses.

Also there needs to be significant healing from any anger and grief that may remain. As this healing takes place, she also needs to discover who she is as a whole person, as she is no longer fragmented. With this renewed sense of identity she will be able to integrate into society more fluidly and finally move out of therapy. Krakauer calls this model of therapy the Collective Heart Model. The idea with this is that the client is constantly taking a look "insider herself [to] see what it is that she needs" (Krakauer, 2001, p. 67). Though this is a viable option for those who are not Christian, the Christian method, however, includes something that is not mentioned here, God.

Ultimately it is God who is the healer, in Exodus 15: 26, God names himself "Jehovah Rapha", or "the LORD, who heals" (Hawkins, 2003, p. 141) The greatest challenge during the healing process often is that of identity. Even for those who do not have DID the struggle to know who they are. Throughout Christian therapy the same principles apply as outlined about, however God is much more involved. It's important not simply to define the client by who they think they are, but it is important to begin to think on God's terms. It is not simply good enough to look inside oneself to find out who you are, but it is important to learn from God, who He made you to be. Once healing has taken place, a full acceptance of personal history has taken place as well.

Hawkins says: " 'Denial' is no longer needed as a separate function, 'Confusion' is not torn by conflict, and 'Pain' is not overwhelmed with unfinished issues" (Hawkins, 2003, p. 141). Once God has had His healing hand on the life of the patient, and the patient is healed, the state of being that the person is in is that of the "Healed Self" (Hawkins, 2003, p. 141). This is the state of the original person, all the alter joined together, with "no hidden footholds for the powers of darkness" (Hawkins, 2003, p. 141). A person can come to complete healing, there will always be struggle, but with the perspective and healing of Christ "we are able to experience the spiritual, emotional and mental victory described in Romans 8" (Hawkins, 2003, p. 141). DID is a major issue. It is not simply a psychological disorder to be overlooked, but is a major problem for the abused individual.

It must be taken seriously. As we continue to grow in our knowledge of DID, we cannot help but to be awed by the incredible adaptive capabilities that God has placed in us, as well as the destructive sins of mankind. We must make every attempt to encourage healing in those with DID, not from simply secular healing, but each person needs full healing in Christ. Only God can truly heal every aspect of an individual with DID. Thus when a person comes through the other side of DID, praise goes out to God for: God gets the glory for He is Yahweh RAPHA-the I AM who brings Healing" (Hawkins, 2003, p. 141). ReferencesBerzoff, J.N., Cohen, L.M. & Elin, M.R. (Eds.) (1995).

Dissociative Identity Disorder. New Jersey: Jason Aronson Inc. Costello, J. (n. d.) Dissociative Identity Disorder: An Analytical Overview. Retrieved January 16, 2005 from York College of Pennsylvania Website: web 2. htm Dissociative Identity Disorder. (n. d.) Retrieved January 16, 2005, from The Center for Mental Health's Website: web D. (2004).

Multiple Identities: Understanding and Supporting the Severely Abused. Grottoes VA: Restoration in Christ Ministries. Hawkins, T.R. & Hawkins, D.W. (2003). Restoring Shattered Lives. Krakauer, S.Y. (2001).

Treating Dissociative Identity Disorder. Ann Arbor, MI: Edwards Brothers. McHugh, P.R. (n. d.) Retrieved January 16, 2005, from Psy com. net Website: web C.A. (1997). Toronto: John Wiley & Son's, Inc. Spira, J.L. (Ed.

). (1996). San Francisco: Jossey-Bass Publishers. Appendix Type of Identities Quoted from: Restoring Shattered Lives Tom R. Hawkins, Ph. D. & Diane W. Hawkins, M.A. Grottoes, Virginia: Restoration in Christ Ministries (c) 2003 pp. 9-11 a. Core The original self conceived in the womb from which all of the other identities have split. b. Host The identity who is executive control of the body the most; usually a primary identity representing the Core. c.

Primary identities The parts of the person who carry the strongest sense of "self", being most closely related to the Core, both in derivation and view of life. They carry the primary beliefs and commitments of the Core; usually includes the Host. d. Presenters The group of alters who normally handles daily living in non-traumatic circumstances; includes the Host. e. Function alters Alters created to perform specific functions unhindered by the effects of the trauma or to "protect" certain talents or encapsulate certain emotions, positive or negative; often serve as presenters. f. Victims Alters whose sole purpose was to handle trauma. g.

Protectors Alters created to protect the person from any perceived danger and / or further abuse; may intervene to take abuse in place of weaker alters; often carry a lot of anger and can be aggressive. h. Controllers Alters who determine which alter will come out at a given time to handle a given situation i. Persecutors Alters who have identified with the motives and agenda of the abuser and punish the other alters, internally or externally, in the absence of the abuser when the alters fail to measure up to the abuser's expectations. j. Reporter An alter who serves to keep track of the facts and relate them without emotion; may also be called narrator,"moderator,"historian", etc. k. Inner Self Helper (ISH) An internal alter who is devoted to the good of the person and works to maintain internal stability and well-being within the system of alters; often provides helpful information to guide therapy. l.

Caretaker An alter who watches over, and may speak for, very young alters. m. Fragment An identity with an extremely brief life history and role, without a fully developed personality. n. Shell An alter through whom the personalities and perspectives of other alters can present. The resulting "hand in glove" type of presentation serves to maintain a sense of consistent identity to the outside world and a continuous short-term memory for the individual, thus minimizing the sense of time loss and switching. While the shell functions as the speaker, it usually has no developed personality of its own. Sometimes a shell may serve solely to provide "housing" for a demon, which can then express itself through a human voice.

Appendix DID Screening Sheet Symptoms of Dissociative Identity Disorder (Formerly Known as: Multiple Personality Disorder) This Survey has been adapted from: Restoring Shattered Lives Tom R. Hawkins, Ph. D. & Diane W. Hawkins, M.A. Grottoes, Virginia: Restoration in Christ Ministries (c) 2003 Note: This response sheet is for educational purposes only and should not be taken as a clinical diagnosis. Results need to be confirmed by professionals qualified in your state / province. For each "yes" answer, put the indicated percentage on the line to the left. A. 1 (17%) Do you have difficulties with insomnia, sleepwalking, traumatic nightmares, and / or night terrors? 2 (17%) Do you have intrusive thoughts or imagery of traumatic events repeatedly coming into your mind during the day? 3 (17%) Do you tend to startle easily, over-react emotionally or feel numbed out? 4 (17%) Are you easily overwhelmed or have difficulty staying focused on a task or conversation?

5 (17%) Do you seem to have an unusual number of physical symptoms which may lack a known cause? 6 (17%) Do you consider yourself accident prone or find yourself repeatedly in abusive relationships or in other ways bringing harm to yourself or others? % Sum total percentages for AB. 1 (14%) As you think about your life, has there been a prolonged period of time during which you felt you were under the strong domination or control of another person or group of persons? 2 (14%) Do your emotions sometimes seem out of control resulting in any of the following: o Persistent unpleasant feelings or depression o Chronic suicidal preoccupation o Self-injury o Explosive or extremely inhibited anger (may alternate) o Compulsive or extremely inhibited sexuality (may alternate) 3 (14%) Do you find yourself experiencing any of the following: o Periods of amnesia or gaps in consciousness and / or memory Times of unusually vivid recall of traumatic event so Episodes of trance-like state so Times of feeling unreal or that the world is unreal o Reliving past experiences or being preoccupied with mentally rehearsing them?

4 (14%) Does your sense of self alternate with times of feeling any of the following: o Totally helpless or paralyzed in being able to act on your own Intense shame, guilt and self-blame Sense of being defiled or bearing a negative stigma o Completely different from others (may include sense of special ness, utter aloneness, belief no other person can understand, or non-human identity) 5 (14%) Does the way you view your perpetrator alternate to include any of the following: o Preoccupation with relationship with perpetrator (including preoccupation with revenge) o Unrealistic attribution of total power to perpetrator (caution: victim's assessment of power realities may be more realistic than clinician's) o Idealization or undeserved gratitude o Viewing perpetrator as extremely special or even as "god"o Rationalization or acceptance of perpetrator's belief system? 6 (14%) Do you have problems relating to others, such as: o Isolation and withdrawal o Avoidance of, or inability to maintain, intimate relationship so Repeated search for rescuer o Persistent distrust o Repeated failure of self-protection 7 (14%) Do you have alterations in major belief systems, such as: : o Faith in God Purpose in life Worldview % Sum total percentages for BC. 1 (17%) Do you have little or no memories of the events of your childhood? 2 (17%) Are there significant events in your life, even as an adult, for which you have no memory? 3 (17%) Do you find yourself frequently experiencing any of the following: o Staring off into space or being lost in deep though to Losing the train of thought in conversation Having a "wandering mind"o Losing concentration while listening? 4 (17%) Do you find yourself experiencing any of the following: o Inconsistencies in perspective, feelings and logic o Changes in habits, handedness, or handwriting o Use of the pronoun "we" or "us" when speaking of self?

5 (17%) Do you hear voices, arguments or unusually "loud thoughts" inside your head? 6 (17%) Do you find yourself easily loosing touch with your physical surroundings or feel like you could be easily hypnotized? % Sum total percentages for CD. 1 (100%) Do you exhibit any of the following: : o Extreme mood swing so Depression (may be intermittent) o Episodes of explosive anger Unusual or exaggerated fear so Consistent anxiety o Inability to feel emotions or cry Display of inappropriate emotions (for example, laughing when crying would be normal cultural response to a situation like at a funeral)?

% Sum total percentages for DE. 1 (25%) Do you have frequent headaches? 2 (25%) Do you have pain or other physical symptoms for which there seems to be no medical cause? 3 (25%) Do you have medical symptoms which are present some times but not at others, such as: o Need for glasses Allergies o Blood sugar and need for insulin 4 (25%) Have you ever had bruises, welts, scratches, burns, pain or sensations of touch or pressure that cannot be explained by current experience? % Sum total percentages for EF. 1 (20%) Have you ever had an eating disorder or severe disruption in normal eating habits, such as: o Refusing to eat normal amounts of foo do Consistent overeating o Binging o Purposely inducing vomiting o Taking inordinate amounts of laxatives?

2 (20%) Have you ever struggled with consistent or intermittent addictive behaviors, such as: o Alcohol Drugs Sexo Food Gambling Work? 3 (20%) Have you ever thought about, or tried t, commit suicide or purposely injure your body?? 4 (20%) Do you ever experience any of the following: o Repeated failures in schooling, jobs and relationships in spite of feeling capable Functioning well externally but feeling like you are falling apart inside Feeling an inconsistent ability to function in various aspects of life Feeling generally unable to "pull life together?" 5 (20%) Has your ability to function decreased seemingly without cause? : % Sum total percentages for FG. 1 (12.5%) Have you experienced any unexplained fluctuation in your intellectual and creative skills? 2 (12.5%) Are you sometimes confused about whether something "just happened" or took place days or weeks ago?

3 (12.5%) Have you ever seemed to acquire or lose possessions without conscious knowledge? 4 (12.5%) Are you frequently accused of saying or doing things you do not feel you have said or done? 5 (12.5%) Do you have any abnormal fears which you may hesitate to admit? 6 (12.5%) Do you have pictures of traumatic events flash in you r mind while fully awake for which you have no conscious memory? 7 (12.5%) Have you ever found yourself suddenly remembering strange behaviour's by friends or family members which seemingly make no sense? 8 (12.5%) Do you experience consistent or intermittent low self-esteem?

% Sum total percentages for F Add sum totals: A.B.C.D.E.F.G. % Total% Total: 7 = Score (Sum total of percentages divided by 7 = Score) Note: This response sheet is for educational purposes only and should not be taken as a clinical diagnosis.