Ddnos Quotes

Punishments include such things as flashbacks, flooding of unbearable emotions, painful body memories, flooding of memories in which the survivor perpetrated against others, self-harm, and suicide attempts.

Denial is commonly found among persons with dissociative disorders. My favorite quotation from such a client is, "We are not multiple, we made it all up." I have heard this from several different clients. When I hear it, I politely inquire, "And who is we?

It appears that DDNOS is the intentional goal of these abusers, but DID sometimes results from a failure of programming. In DDNOS, the ANP is always present, even when another part is in control of the behavior and feelings.

Fear and anxiety affect decision making in the direction of more caution and risk aversion... Traumatized individuals pay more attention to cues of threat than other experiences, and they interpret ambiguous stimuli and situations as threatening (Eyesenck, 1992), leading to more fear-driven decisions. In people with a dissociative disorder, certain parts are compelled to focus on the perception of danger. Living in trauma-time, these dissociative parts immediately perceive the present as being "just like" the past and "emergency" emotions such as fear, rage, or terror are immediately evoked, which compel impulsive decisions to engage in defensive behaviors (freeze, flight, fight, or collapse). When parts of you are triggered, more rational and grounded parts may be overwhelmed and unable to make effective decisions.

Amnesia, which is a loss of memory, is a symptom of many different trauma and/or dissociative disorders, including PTSD, Dissociative Fugue, Dissociative Disorder Not Otherwise Specified and Dissociative Identity Disorder. Amnesia can affect both implicit and explicit memory.

Many ritually abusive cults deliberately divide the personality system down the middle of the head, making sure that there is no communication between the two sides. “Left side" parts might be instructed to speak to no one other than the perpetrators.

Dissociative Disorders have a high rate of responsiveness to therapy and that with proper treatment, their prognosis is quite good.

The human brain has a safety switch that gets engaged by traumatic exposure and experiences. It’s similar to being in shock but we remain there until it’s long over. We detach. We create degrees of separation between ourselves and what we feel, think, perceive, and ultimately, this impacts not only our worldview but also our perception of self. Clinically, this is called “Dissociation.

Those who are aware of their condition and experience themselves as "multiple" might refer to themselves as "we" rather than "I." I shall use the term "multiple" at times, in respect for their internal experience. It is important to point out, however, that I recognize that someone who is multiple is actually a single fragmented person rather than many people. On the outside, a multiple is probably not visibly different from anyone else. But that image is only an imitation: people who are multiple cannot think like the rest of us, and we cannot think like them. (In fact, since it is difficult for the multiple to understand how singletons think, some of them might think that is is you who are strange). Just as a singleton cannot become a multiple at will, a multiple cannot become a singleton until and unless the barriers between the parts of the self are removed. Those barriers were put up to enable the child to tolerate, and so survive, unavoidable abuse. p20 [Multiple: a person with dissociative identity disorder (DID) or DDNOS. Singleton: a person without DID or DDNOS, i.e with a single, unified personality]

I recently consulted to a therapist who felt he had accomplished something by getting his dissociative client to remain in her ANP throughout her sessions with him. His view reflects the fundamental mistake that untrained therapists tend to make with DID and DDNOS. Although his client was properly diagnosed, he assumed that the ANP should be encouraged to take charge of the other parts at all times. He also expected her to speak for them—in other words, to do their therapy. This denied the other parts the opportunity to reveal their secrets, heal their pain, or correct their childhood-based beliefs about the world. If you were doing family therapy, would it be a good idea to only meet with the father, especially if he had not talked with his children or his spouse in years? Would the other family members feel as if their experiences and feelings mattered? Would they be able to improve their relationships? You must work with the parts who are inside of the system. Directly.

In my view, the spurning of DID is highly connected with knowing and not knowing about child sexual abuse. Side by side with denial of childhood trauma and of severe dissociation, is an unmistakable cognizance of dissociative processes as they are embedded in our language. We regularly say things such as, "pull yourself together", "he is coming unglued", "she was beside herself", "don't fall apart", "he's not all there", "she was shattered", and so on.

Finally, those who do not meet the SCID-D-R standard for "distinct identities or personality states," but who do meet the SCID-D-R's other four standards (for DSM-IV's Criterion A and Criterion B) for DID, receive a SCID-D-R diagnosis of DDNOS-1a.

We propose that BPD involves secondary structural dissociation. Consistent with this, Golynkina and Ryle (1999) found that patients with BPD encompassed a dissociative part of the personality that seems to represent an ANP (a coping ANP) and more than one EP (abuser rage, victim rage, passive victim, and zombie). Some patients with BPD have severe dissociative symptoms, and may actually border on DDNOS or DID. Our clinical observations suggest that dissociative parts in BPD patients have less emancipation and elaboration, and less distinct sense of self than in DDNOS or DID.

We therapists often make inaccurate assumptions about people living with DID and DDNOS. They often appear to be “just like us,” so we often assume their experience of life reflects our own. But this is profoundly untrue. It results in a communication gap, and, as a consequence, treatment errors. Because the dominant culture is one of persons with a single sense of self, most with multiple “selves” have learned to hide their multiplicity and imitate those who are singletons (that is, have a single, non-fragmented personality). Therapists who do not understand this sometimes describe their clients' alters without acknowledging their dissociation, saying only that they have different “moods.” In overlooking dissociation, this description fails to recognize the essential truth of such disorders, and of the alters. It was difficult for me to comprehend what life was like for my first few dissociative clients.

SELFHOOD AND DISSOCIATION The patient with DID or dissociative disorder not otherwise specified (DDNOS) has used their capacity to psychologically remove themselves from repetitive and inescapable traumas in order to survive that which could easily lead to suicide or psychosis, and in order to eke some growth in what is an unsafe, frequently contradictory and emotionally barren environment. For a child dependent on a caregiver who also abuses her, the only way to maintain the attachment is to block information about the abuse from the mental mechanisms that control attachment and attachment behaviour.10 Thus, childhood abuse is more likely to be forgotten or otherwise made inaccessible if the abuse is perpetuated by a parent or other trusted caregiver. In the dissociative individual, ‘there is no uniting self which can remember to forget’. Rather than use repression to avoid traumatizing memories, he/she resorts to alterations in the self ‘as a central and coherent organization of experience. . . DID involves not just an alteration in content but, crucially, a change in the very structure of consciousness and the self’ (p. 187).29 There may be multiple representations of the self and of others. Middleton, Warwick. "Owning the past, claiming the present: perspectives on the treatment of dissociative patients." Australasian Psychiatry 13.1 (2005): 40-49.

Sadly, psychiatric training still includes far too little on the very serious psychiatric sequelae of childhood trauma, especially CSA [child sexual abuse]. There is inadequate recognition within mental health services of the prevalence and importance of Dissociative Disorders, sufferers of which are frequently misdiagnosed as Borderline Personality Disorder (BPD), or, in the cases of DID, schizophrenia. This is to some extent understandable as some of the features of DID appear superficially to mimic those of schizophrenia and/or Borderline Personality Disorder.

Trauma-related structural dissociation should be distinguished from more ubiquitous phenomena that are often termed dissociation, but likely have a different underlying process. Over the past several decades the original meaning of dissociation has been quite extended by the addition of other phenomena not typically considered to be dissociative. These include alterations in consciousness such as absorption, daydreaming, imaginative involvement, altered time sense, trance-like behavior, and “highway hypnosis” (e.g., Bernstein & Putnam, 1986).

Although it is important to be able to recognise and disclose symptom of physical illnesses or injury, you need to be more careful about revealing psychiatric symptoms. Unless you know that your doctor understands trauma symptoms, including dissociation, you are wise not to reveal too much. Too many medical professionals, including psychiatrists, believe that hearing voices is a sign of schizophrenia, that mood swings mean bipolar disorder which has to be medicated, and that depression requires electro-convulsive therapy if medication does not relieve it sufficiently. The “medical model” simply does not work for dissociation, and many treatments can do more harm than good... You do not have to tell someone everything just because he is she is a doctor. However, if you have a therapist, even a psychiatrist, who does understand, you need to encourage your parts to be honest with that person. Then you can get appropriate help.

What daily life is like for “a multiple” Imagine that you have periods of “lost time.” You may find writings or drawings which you must have done, but do not remember producing. Perhaps you find child-sized clothing or toys in your home but have no children. You might also hear voices or babies crying in your head. Imagine that you can never predict when you will be able to have certain knowledge or social skills, and your emotions and your energy level seem to change at the drop of a hat, and for no apparent reason. You cannot understand why you feel what you feel, and, if you are in therapy, you cannot explore those feelings when asked. Your life feels disjointed and often confusing. It is a frightening experience. It feels out of control, and you probably think you are going crazy. That is what it is like to be multiple, and all of it is experienced by the ANPs. A multiple may also experience very concrete problems, even life-threatening ones.

Due to previous lack of systematic assessment of dissociative symptoms, many subjects experience the SCID-D as their first opportunity to describe their symptoms in their own words to a receptive listener.

Secondary structural dissociation involves one ANP and more than one EP. Examples of secondary structural dissociation are complex PTSD, complex forms of acute stress disorder, complex dissociative amnesia, complex somatoform disorders, some forms of trauma-relayed personality disorders, such as borderline personality disorder, and dissociative disorder not otherwise specified (DDNOS).. Secondary structural dissociation is characterized by divideness of two or more defensive subsystems. For example, there may be different EPs that are devoted to flight, fight or freeze, total submission, and so on. (Van der Hart et al., 2004). Gail, a patient of mine, does not have a personality disorder, but describes herself as a "changed person." She survived a horrific car accident that killed several others, and in which she was the driver. Someone not knowing her history might see her as a relatively normal, somewhat anxious and stiff person (ANP). It would not occur to this observer that only a year before, Gail had been a different person: fun-loving, spontaneous, flexible, and untroubled by frightening nightmares and constant anxiety. Fortunately, Gail has been willing to pay attention to her EPs; she has been able to put the process of integration in motion; and she has been able to heal. p134

Now that she had the diagnosis to explain her sense of reality, she sorted some of the chaotic jumble of thoughts and memories. "I'd feel funny having 'daydreamed' my way through whole seasons," Jo said, "but then I'd hear someone say, 'Time flies,' or 'How did it get to be three o'clock already?' and I'd think that everyone was like me.

It is not unusual for subjects diagnosed with a Dissociative Disorder on the SCID-D to be surprised at having their symptoms validated by a clinician who understands the nature of their disorder.

000-x02 Dissociative reaction This reaction represents a type of gross personality disorganization, the basis of which is a neurotic disturbance, although the diffuse dissociation seen in some casts may occasionally appear psychotic. The personality disorganization may result in aimless running or "freezing." The repressed impulse giving rise to the anxiety may be discharged by, or deflected into, various symptomatic expressions, such as depersonalization, dissociated personality, stupor, fugue, amnesia, dream state, somnambulism, etc. The diagnosis will specify symptomatic manifestations. These reactions must be differentiated from schizoid personality, from schizophrenic reaction, and from analogous symptoms in some other types of neurotic reactions. Formerly, this reaction has been classified as a type of "conversion hysteria.

Deliberately placed triggers for learned behaviours (programmes) Although all abuse and trauma survivors may be “triggered” into intrusive flashbacks by present-day experiences that remind them of the trauma, the triggers deliberately installed by mind controllers are different, in that they are cues for conditioned behaviours. Some of these are behaviours such as going home, going outside (where someone is waiting), coming to the person who uses the trigger, or switching to a particular insider. Others are psychiatric symptoms such as flashbacks, self-harm, or suicide attempts, which are actually punishments given by insiders for disobedience or disloyalty. For many survivors, every trigger causes a switch to a part programmed to perform a particular behaviour associated with that trigger. For others, the front person remains present in the world but has an irresistible compulsion to perform the behaviour.

Delusions Dissociative disorders, even those created by mind controllers, are not psychosis, but this program will create the most common symptom used to diagnose schizophrenia. The child is hurt while on a turntable, with people and television sets and cartoons and photographs all around the turntable. New alters created by the torture are instructed that they must obey their instructions and become the people around them, people on television, or other alters when they are told to. When this program is triggered, the survivor will hear “voices” of the people whom the "copy alters” are imitating, or will have many confused alters popping out who think they are actually other people or movie stars. The identities of the copy alters change when the survivor's surrounding change.

The SCID-D-R's standard for "distinct identities or personality states" (DSM-IV, p. 487) is: "Persistent manifestations of the presence of different personalities, as indicated by at least four of the following: a) ongoing dialogues between different people; b) acting or feeling that the different people inside of him/her take control of his/her behavior or speech; c) characteristic visual image that is associated with the other person, distinct from the subject; d) characteristic age associated with the different people inside of him/her; e) feeling that the different people inside of him/her have different memories, behaviors, and feelings; f) feeling that the different people inside of him/her are separate from his/her personality and have lives of their own" (Steinberg, 1994, p. 106). [The author believes that it is of considerable importance that none of the SCID-D-R's six criteria for "distinct personalities or personality states" are observable signs; each of the six is a subjective symptom or experience that must be reported to the test administrator. This striking fact supports the contention that assessment of dissociation should be based on subjective symptoms rather than signs (Dell, 2006b. 2009b).]

The DSM concept of pathological dissociation has evolved from the early inclusive concept of a dissociative reaction in DSM-I to five distinct dissociative disorders in DSM-IV: dissociative amnesia, dissociative fugue, depersonalization disorder, DDNOS, and MPD/DID [Dissociative Identity Disorder]. The first four disorders are rarely challenged, but the existence of MPD/DID has been more or less continually under attack for more than a century. I perceive many of these attacks as misdirected at a mass media stereotype that does not resemble the actual clinical condition.

Comparing the hippocampal volume of mentally healthy subjects and patients with PTSD, DDNOS, and DID, thus patients with increasing levels of dissociation, an increasingly smaller volume is observed: PTSD (primary structural dissociation), approximately -10%; DDNOS (secondary structural dissociation), approximately -15%; and DID (tertiary structural dissociation), approximately -20%. These findings are characterized by a remarkable relationship: the more severe the structural dissociation of the personality, the smaller the hippocampal volume. Furthermore, Ehling et al. (2008) found high correlations between the volume of these brain structures and psychoform and somatoform symptoms, as well as with the severity of the reported potentially traumatizing events. Correlations between the volume of these brain structures and the degree of general psychopathology and fantasy-proneness were lower or statistically nonsignificant.

The SCID-D may be used to assess the nature and severity of dissociative symptoms in a variety of Axis I and II psychiatric disorders, including the Anxiety Disorders (such as Posttraumatic Stress Disorder [PTSD] and Acute Stress Disorder), Affective Disorders, Psychotic Disorders, Eating Disorders, and Personality Disorders. The SCID-D was developed to reduce variability in clinical diagnostic procedures and was designed for use with psychiatric patients as well as with nonpatients (community subjects or research subjects in primary care).

We strongly recommend that anyone using this manual become familiar with the updated International Society for the Study of Trauma and Dissociation Treatment Guidelines for DID and DDNOS (ISSTD Treatment Guidelines, 2011).