Dissociative Disorders Quotes

Perfectionism is the unparalleled defense for emotionally abandoned children. The existential unattainability of perfection saves the child from giving up, unless or until, scant success forces him to retreat into the depression of a dissociative disorder, or launches him hyperactively into an incipient conduct disorder. Perfectionism also provides a sense of meaning and direction for the powerless and unsupported child. In the guise of self-control, striving to be perfect offers a simulacrum of a sense of control. Self-control is also safer to pursue because abandoning parents typically reserve their severest punishment for children who are vocal about their negligence.

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.

Mind control is built on lies and manipulation of attachment needs. Valerie Sinason, (Forward)

Beneath the surface of the protective parts of trauma survivors there exists an undamaged essence, a Self that is confident, curious, and calm, a Self that has been sheltered from destruction by the various protectors that have emerged in their efforts to ensure survival. Once those protectors trust that it is safe to separate, the Self will spontaneously emerge, and the parts can be enlisted in the healing process

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?

Triggers are like little psychic explosions that crash through avoidance and bring the dissociated, avoided trauma suddenly, unexpectedly, back into consciousness.

Dissociation is the common response of children to repetitive, overwhelming trauma and holds the untenable knowledge out of awareness. The losses and the emotions engendered by the assaults on soul and body cannot, however be held indefinitely. In the absence of effective restorative experiences, the reactions to trauma will find expression. As the child gets older, he will turn the rage in upon himself or act it out on others, else it all will turn into madness.

Self-destructiveness may be a primary form of communication for those who do not yet have ways to tame their excruciating inner conflicts and feelings and who cannot yet turn to others for support.

Theirs was the eternal youth of an alternating self, a youth with the constant although unfulfilled promise of growing up

It is a rare person who can cut himself off from mediate and immediate relations with others for long spaces of time without undergoing a deterioration in personality.

Unspeakable feelings need to find expression in words. However... verbalization of very intense feelings may be a difficult task.

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.

The ORDINARY RESPONSE TO ATROCITIES is to banish them from consciousness. Certain violations of the social compact are too terrible to utter aloud: this is the meaning of the word unspeakable. Atrocities, however, refuse to be buried. Equally as powerful as the desire to deny atrocities is the conviction that denial does not work. Folk wisdom is filled with ghosts who refuse to rest in their graves until their stories are told. Murder will out. Remembering and telling the truth about terrible events are prerequisites both for the restoration of the social order and for the healing of individual victims. The conflict between the will to deny horrible events and the will to proclaim them aloud is the central dialectic of psychological trauma. People who have survived atrocities often tell their stories in a highly emotional, contradictory, and fragmented manner that undermines their credibility and thereby serves the twin imperatives of truth-telling and secrecy. When the truth is finally recognized, survivors can begin their recovery. But far too often secrecy prevails, and the story of the traumatic event surfaces not as a verbal narrative but as a symptom. The psychological distress symptoms of traumatized people simultaneously call attention to the existence of an unspeakable secret and deflect attention from it. This is most apparent in the way traumatized people alternate between feeling numb and reliving the event. The dialectic of trauma gives rise to complicated, sometimes uncanny alterations of consciousness, which George Orwell, one of the committed truth-tellers of our century, called "doublethink," and which mental health professionals, searching for calm, precise language, call "dissociation." It results in protean, dramatic, and often bizarre symptoms of hysteria which Freud recognized a century ago as disguised communications about sexual abuse in childhood. . . .

when a child is ridiculed, shamed, hurt or ignored when she experiences and expresses a legitimate dependency need, she will later be inclined to attach those same affective tones to her dependency. Thus, she will experience her own (and perhaps others’) dependency as ridiculous, shameful, painful, or denied. - Dependency in the Treatment of complex PTSD and Dissociative Disorders 2001 Authors: Kathy Steele, Onno van der Hart, Ellert R. S. Nijenhuis

With respect to the acceptance of dissociative disorders, as with most issues in life, it is counterproductive to spend time trying to convince people of things they don't want to know.

She's terrified that all these sensations and images are coming out of her — but I think she's even more terrified to find out why." Carla's description was typical of survivors of chronic childhood abuse. Almost always, they deny or minimize the abusive memories. They have to: it's too painful to believe that their parents would do such a thing.

How can I put this? There's a king of gap between what I think is real and what's really real. I get this feeling like some kind of little something-or-other is there, somewhere inside me... like a burglar is in the house, hiding in a wardrobe... and it comes out every once in a while and messes up whatever order or logic I've established for myself. The way a magnet can make a machine go crazy.

Chronic trauma (according to the meaning I propose) that occurs early in life has profound effects on personality development and can lead to the development of dissociative identity disorder (DID), other dissociative disorders, personality disorders, psychotic thinking, and a host of symptoms such as anxiety, depression, eating disorders, and substance abuse. In my view, DID is simply an extreme version of the dissociative structure of the psyche that characterizes us all.

Dissociation appears to be... the internal mechanism by which terrorized people are silenced.

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.

In response to threat and injury, animals, including humans, execute biologically based, non-conscious action patterns that prepare them to meet the threat and defend themselves. The very structure of trauma, including activation, dissociation and freezing are based on the evolution of survival behaviors. When threatened or injured, all animals draw from a "library" of possible responses. We orient, dodge, duck, stiffen, brace, retract, fight, flee, freeze, collapse, etc. All of these coordinated responses are somatically based- they are things that the body does to protect and defend itself. It is when these orienting and defending responses are overwhelmed that we see trauma. The bodies of traumatized people portray "snapshots" of their unsuccessful attempts to defend themselves in the face of threat and injury. Trauma is a highly activated incomplete biological response to threat, frozen in time. For example, when we prepare to fight or to flee, muscles throughout our entire body are tensed in specific patterns of high energy readiness. When we are unable to complete the appropriate actions, we fail to discharge the tremendous energy generated by our survival preparations. This energy becomes fixed in specific patterns of neuromuscular readiness. The person then stays in a state of acute and then chronic arousal and dysfunction in the central nervous system. Traumatized people are not suffering from a disease in the normal sense of the word- they have become stuck in an aroused state. It is difficult if not impossible to function normally under these circumstances.

Dissociation can enable us to withstand pain and loss under which we would otherwise break. It enables us to survive and pull through. But, a habit of continual dissociation – especially after the trauma has passed – leads to the shut-in feeling I was experiencing. While I imagined I was being strong in the face of pain, in reality, I was merely hiding.

It is so much more threatening to have something out of hand than to believe that at any moment I can stop (I started to say "This foolishness") any time I need to.

The capacity for dissociation enables the young child to exercise their innate life-sustaining need for attachment in spite of the fact that principal attachment figures are also principal abusers.

The return of the voices would end in a migraine that made my whole body throb. I could do nothing except lie in a blacked-out room waiting for the voices to get infected by the pains in my head and clear off. Knowing I was different with my OCD, anorexia and the voices that no one else seemed to hear made me feel isolated, disconnected. I took everything too seriously. I analysed things to death. I turned every word, and the intonation of every word over in my mind trying to decide exactly what it meant, whether there was a subtext or an implied criticism. I tried to recall the expressions on people’s faces, how those expressions changed, what they meant, whether what they said and the look on their faces matched and were therefore genuine or whether it was a sham, the kind word touched by irony or sarcasm, the smile that means pity. When people looked at me closely could they see the little girl in my head, being abused in those pornographic clips projected behind my eyes? That is what I would often be thinking and such thoughts ate away at the façade of self-confidence I was constantly raising and repairing. (describing dissociative identity disorder/mpd symptoms)

Why do I take a blade and slash my arms? Why do I drink myself into a stupor? Why do I swallow bottles of pills and end up in A&E having my stomach pumped? Am I seeking attention? Showing off? The pain of the cuts releases the mental pain of the memories, but the pain of healing lasts weeks. After every self-harming or overdosing incident I run the risk of being sectioned and returned to a psychiatric institution, a harrowing prospect I would not recommend to anyone. So, why do I do it? I don't. If I had power over the alters, I'd stop them. I don't have that power. When they are out, they're out. I experience blank spells and lose time, consciousness, dignity. If I, Alice Jamieson, wanted attention, I would have completed my PhD and started to climb the academic career ladder. Flaunting the label 'doctor' is more attention-grabbing that lying drained of hope in hospital with steri-strips up your arms and the vile taste of liquid charcoal absorbing the chemicals in your stomach. In most things we do, we anticipate some reward or payment. We study for status and to get better jobs; we work for money; our children are little mirrors of our social standing; the charity donation and trip to Oxfam make us feel good. Every kindness carries the potential gift of a responding kindness: you reap what you sow. There is no advantage in my harming myself; no reason for me to invent delusional memories of incest and ritual abuse. There is nothing to be gained in an A&E department.

DID is about survival! As more people begin to appreciate this concept, individuals with DID will start to feel less as though they have to hide in shame. DID develops as a response to extreme trauma that occurs at an early age and usually over an extended period of time.

Changes in Meaning: Finally, chronically traumatized people lose faith that good things can happen and people can be kind and trustworthy. They feel hopeless, often believing that the future will be as bad as the past, or that they will not live long enough to experience a good future. People who have a dissociative disorder may have different meanings in various dissociative parts. Some parts may be relatively balanced in their worldview, others may be despairing, believing the world to be a completely negative, dangerous place, while other parts might maintain an unrealistic optimistic outlook on life

I spent many years trying to make up reasons about why I had the flashbacks, memories, continuous nightmares. When I finally decided to quit trying to hide from truth, I began to heal.

Changes in Relationship with others: It is especially hard to trust other people if you have been repeatedly abused, abandoned or betrayed as a child. Mistrust makes it very difficult to make friends, and to be able to distinguish between good and bad intentions in other people. Some parts do not seem to trust anyone, while other parts may be so vulnerable and needy that they do not pay attention to clues that perhaps a person is not trustworthy. Some parts like to be close to others or feel a desperate need to be close and taken care of, while other parts fear being close or actively dislike people. Some parts are afraid of being in relationships while others are afraid of being rejected or criticized. This naturally sets up major internal as well as relational conflicts.

I honestly didn't believe I could bear any more suffering. I was convinced that the child within me was just too young to endure all this, much less understand it. She just wanted to be normal. But another part of me knew that to become normal, all the pieces of this puzzle had to become conscious. p164

Dissociation, in a general sense, refers to a rigid separation of parts of experiences, including somatic experiences, consciousness, affects, perception, identity, and memory. When there is a structural dissociation, each of the dissociated self-states has at least a rudimentary sense of "I" (Van der Hart et al., 2004). In my view, all of the environmentally based "psychopathology" or problems in living can be seen through this lens.

Dissociation is adaptive: it allows relatively normal functioning for the duration of the traumatic event and then leaves a large part of the personality unaffected by the trauma.

Shame plays a huge part in why you hate who you are.

I felt like I had been numb most of my life, and now I craved being able to have real feelings: the joy, the sadness, and everything in between.

Alterations in regulation of affect (emotion) and impulse: Almost all people who are seriously traumatized have problems in tolerating and regulating their emotions and surges or impulses. However, those with complex PTSD and dissociative disorders tend to have more difficulties than those with PTSD because disruptions in early development have inhibited their ability to regulate themselves. The fact that you have a dissociative organization of your personality makes you highly vulnerable to rapid and unexpected changes in emotions and sudden impulses. Various parts of the personality intrude on each other either through passive influence or switching when your under stress, resulting in dysregulation. Merely having an emotion, such as anger, may evoke other parts of you to feel fear or shame, and to engage in impulsive behaviors to stop avoid the feelings.

The child who attends school does not remember the abuse that happens at home or via the family; those memories are held in another part of the child's mind. The child does not even remember abuse that happened the preceding night.

Being in a state of denial is a universally human response to situations which threaten to overwhelm. People who were abused as children sometimes carry their denial like precious cargo without a port of destination. It enabled us to survive our childhood experiences, and often we still live in survival mode decades beyond the actual abuse. We protect ourselves to excess because we learned abruptly and painfully that no one else would.

Escape from reality. In some instances, dissociation induces people to imagine that they have some kind of mastery over intractable environmental difficulties. Dissociation is often implicated in magical thinking or self-induced trance states. This aspect of dissociation is frequently found in abuse survivors. It is not uncommon for abused children to engage in magical thinking to retain an illusion of control over the situation (e.g., believing that they "cause" the perpetrator to act out).

That is the problem with repressed memory and dissociative identity disorder. Your mind represses certain traumas for reasons of pure survival. And then you learn that to survive as an adult, you must uncover the memories, find the parts, and relieve the traumas. The contradiction is almost too much for the mind to comprehend and for the heart and soul to endure.

Since the 1980s, therapists have reported encountering clients or patients who had experienced extreme abuses featuring physical, sexual, emotional, spiritual, and cognitive aspects, along with a premeditated structure of torture-enforced lessons. The phenomena was first labeled "ritual abuse," and, later, as our understanding developed, "mind control.

It’s hard to feel supported when you can’t tell people everything. People haven’t really got a clue what it’s like. It’s hard to trust anyone. It’s hard to believe people won’t let you down. I’m feeling like I want to cry. My body feels hollow. Empty. I don’t feel like I’m 17. I feel young. I’m not sure how old, maybe about 10 yrs. It’s hard to accept that I can’t get all the support I need from one person. From any person. It’s hard that no one can fully understand. It’s hard for me to admit that inside I feel a really lonely person. What do I need to do to take care of myself right now? Well I need to cuddle my teddies — it sounds silly, but I need some comfort... I was still cuddling teddies when I should have been cuddling boys. The sick imagery in my mind, rather than making me sexually active, had closed that door completely.

Changes in the Perception of Self: People who have been traumatized in childhood are often troubled by guilt, shame, and negative feelings about themselves, such as the belief they are unlikable, unlovable, stupid, inept, dirty, worthless, lazy, and so forth. In Complex Dissociative disorders there are typically particular parts that contain these negative feelings about the self while other parts may evaluate themselves quite differently. Alterations among parts thus may result in rather rapid and distinct changes in self perception.

It all made sense — terrible sense. The panic she had experienced in the warehouse district because of not knowing what had happened had been superseded at the newsstand by the even greater panic of partial knowledge. And now the torment of partly knowing had yielded to the infinitely greater terror of knowing precisely

And if we do speak out, we risk rejection and ridicule. I had a best friend once, the kind that you go shopping with and watch films with, the kind you go on holiday with and rescue when her car breaks down on the A1. Shortly after my diagnosis, I told her I had DID. I haven't seen her since. The stench and rankness of a socially unacceptable mental health disorder seems to have driven her away.

I spent most of my life believing l was crazy because all the crazy things I experienced in childhood were treated as nonexistent or normal. This belief colored every decision made, from something so basic as what to wear today, to the more esoteric boundaries of whether I should kill myself. I understood very well that killing myself under the wrong circumstances would establish my insanity forever. So I analyzed every word, every gesture, before committing myself. (Which probably accounts for why I am alive today.)

One concrete way in which we all landscape our sanity is by having our experience of reality confirmed by others. When our experience of reality is disconfirmed by others, our confidence in our own sanity can be undermined. (page 125, Chapter 9, Graeme Galton)

The reality is, no matter what you were told, whatever happened to you as a child was not legally or morally your fault. Abused children are instilled with guilt regarding their "participation." It's an especially complex issue if the abuser is a family member. The child is told and believes that by his word his family will disintegrate, or harm may descend upon other loved ones. He fears he will lose more by telling than not.

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.

Well, it would have been easier if it were put on. But the only ruse of which I'm guilty is to have pretended for so long before coming to you that nothing was wrong. Pretending that the personalities did not exist has now caused me to lose about two days.

Complex PTSD consists of of six symptom clusters, which also have been described in terms of dissociation of personality. Of course, people who receive this diagnosis often also suffer from other problems as well, and as noted earlier, diagnostic categories may overlap significantly. The symptom clusters are as follows: Alterations in Regulation of Affect ( Emotion ) and Impulses Changes in Relationship with others Somatic Symptoms Changes in Meaning Changes in the perception of Self Changes in Attention and Consciousness

no recovery from trauma is possible without attending to issues of safety, care for the self, reparative connections to other human beings, and a renewed faith in the universe. The therapist's job is not just to be a witness to this process but to teach the patient how.

As an undergraduate student in psychology, I was taught that multiple personalities were a very rare and bizarre disorder. That is all that I was taught on ... It soon became apparent that what I had been taught was simply not true. Not only was I meeting people with multiplicity; these individuals entering my life were normal human beings with much to offer. They were simply people who had endured more than their share of pain in this life and were struggling to make sense of it.

Carla's description was typical of survivors of chronic childhood abuse. Almost always, they deny or minimize the abusive memories. They have to: it's too painful to believe that their parents would do such a thing. So they fragment the memories into hundreds of shards, leaving only acceptable traces in their conscious minds. Rationalizations like "my childhood was rough," "he only did it to me once or twice," and "it wasn't so bad" are common, masking the fact that the abuse was devastating and chronic. But while the knowledge, body sensations, and feelings are shattered, they are not forgotten. They intrude in unexpected ways: through panic attacks and insomnia, through dreams and artwork, through seemingly inexplicable compulsions, and through the shadowy dread of the abusive parent. They live just outside of consciousness like noisy neighbors who bang on the pipes and occasionally show up at the door.

Trapped within the confines of his mind, he is too aware of every thought passing through it, as if he were outside, looking in. At night he often lies awake ruminating endlessly about what’s wrong with him, about death, and about the meaning of existence itself. At times his arms and legs feel like they don’t belong with his body. But most of the time, his mind feels like it is operating apart from the body that contains it.

Controlling my environment was still a compelling need for me. I did everything I could to not be surprised by anything... Looking back, I think that my need to predict how my day was going to unfold was a direct response to the amount of chaos in my childhood.

Why did I allow the abuse to continue? Even as a teenager? I didn’t. Something that had been plaguing me for years now made sense. It was like the answer to a terrible secret. The thing is, it wasn’t me in my bed, it was Shirley who lay the wondering if that man was going to come to her room, pull back the cover and push his penis into her waiting mouth it was Shirley. I remembered watching her, a skinny little thing with no breasts and a dark resentful expression. She was angry. She didn’t want this man in her room doing the things he did, but she didn’t know how to stop it. He didn’t beat her, he didn’t threaten her. He just looked at her with black hypnotic eyes and she lay back with her legs apart thinking about nothing at all. And where was I? I stood to one side, or hovered overhead just below the ceiling, or rode on a magic carpet. I held my breath and watched my father pushing up and down inside Shirley’s skinny body.

Dissociation leaves us disconnected from our memories, our identities and our emotions. It breaks the trauma into digestible components, so that different aspects of the trauma get stored in different compartments in our brain. What happens as a result is that the information from the trauma becomes disorganized and we are not able to integrate these pieces into a coherent narrative and process trauma fully until, hopefully, with the help of a validating, trauma-informed counselor who guides us to the appropriate therapies best suited to our needs, we confront the trauma and triggers in a safe place.

Specific parts of you personality may be angry and are usually easily evoked. because these parts are dissociated, anger remains an emotion that is not integrated for you as a whole person. Even though individuals with dissociative disorder are responsible for their behavior, just like everyone else, regardless of which part may be acting, they may feel little control of these raging parts of themselves. Some dissociative parts may avoid or even be phobic of anger. They may influence you as a whole person to avoid conflict with others at any cost or to avoid setting healthy boundaries out of fear of someone else’s anger; or they may urge you to withdraw from others almost completely.

Parts of you are phobic of anger and generally terrified and ashamed of angry dissociative parts. There is often tremendous conflict between anger-avoidant and anger-fixated parts of an individual. Thus, an internal and perpetual cycle of rage-shame-fear creates inner chaos and pain.

People with Complex PTSD suffer from more severe and frequent dissociation symptoms, as well as memory and attention problems, than those with simple PTSD. In addition to amnesia due to the activity of various parts of the self, people may experience difficulties with concentration, attention, other memory problems and general spaciness. These symptoms often accompany dissociation of the personality, but they are also common in people who do not have dissociative disorders. For example everyone can be spacey, absorbed in an activity, or miss an exit on the highway. When various parts of the personality are active, by definition, a person experiences some kind of abrupt change in attention and consciousness.

Some people with DID present their narratives of sadistic abuse in a quite matter-of-fact way, without perceptible affect. This may sometimes be done as a way of protecting themselves, and the listener, from the emotional impact of their experience. We have found that people describing trauma in a flat way, without feeling, are usually those who have been more chronically abused, while those with affect still have a sense of self that can observe the tragedy of betrayal and have feelings about it. In some cases, this deadpan presentation can also be the result of cult training and brainwashing. Unfortunately, when a patient describes a traumatic experience without showing any apparent emotion, it can make the listener doubt whether the patient is telling the truth. (page 119, Chapter 9, Some clinical implications of believing or not believing the patient)

Those of us who work in the field of trauma and abuse, whether psychologists, psychoanalysts, social workers, doctors, counselors, or psychotherapists, have been provided with beautiful tools for understanding the impact of trauma. We become adept at understanding the dynamic of why the messenger is always shot and broadcast the Bionic insight of why the visionary is not bearable to the group. However, when it comes to military mind control, abuse within religious belief groups or cults, and deliberately created dissociative identity disorder, we enter the least resourced field of all.

I want everyone that has been abused by someone in their childhood to know that you can get past it. Having DID is not the end of the world; it's the beginning of your new life. DID allows the victim of exceptional abuse the ability to “forget” the abuse and continue living. Without it, I may have gone crazy as a teen and spent my life in a as a teen and spent my life in a psychiatric hospital.

When I wrote the previous letter, I had made up my mind I would show you how I could be very composed and cool and not need to ask you to listen to me nor to explain anything to me nor need any help. By telling you that all this about the multiple personalities was not really true but just put on, I could show, or so I thought, that I did not need you. Well, it would have been easier if it were put on.

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.

At cocktail parties, I played the part of a successful businessman's wife to perfection. I smiled, I made polite chit-chat, and I dressed the part. Denial and rationalization were two of my most effective tools in working my way through our social obligations. I believed that playing the roles of wife and mother were the least I could do to help support Tom's career. During the day, I was a puzzle with innumerable pieces. One piece made my family a nourishing breakfast. Another piece ferried the kids to school and to soccer practice. A third piece managed to trip to the grocery store. There was also a piece that wanted to sleep for eighteen hours a day and the piece that woke up shaking from yet another nightmare. And there was the piece that attended business functions and actually fooled people into thinking I might have something constructive to offer. I was a circus performer traversing the tightwire, and I could fall off into a vortex devoid of reality at any moment. There was, and had been for a very long time, an intense sense of despair. A self-deprecating voice inside told me I had no chance of getting better. I lived in an emotional black hole. p20-21, talking about dissociative identity disorder (formerly multiple personality disorder).

How do we find words for describing levels of betrayal and emotional, physical, sexual and spiritual torture that fragment and destroy a child or cast and case traumatic shadows over the whole of adult life? We might, as a society, slowly find it possible to accept that one in four citizens are likely to have experience some form of emotional, psychical, sexual or spiritual abuse (McQueen, Itzin, Kennedy, Sinason, & Maxted, 2008), in itself a figure unimaginable and hidden twenty years ago. However, accepting the way a hurt and hurting parent or stranger re-enacts their disturbance with a vulnerable child or children remains far easier to digest than to consider the intellectually planned, scientific, methodical, procedures of organized child-abusing perpetrators-in other words, torture.

Secret ceremonies in which malevolent men and women cloaked in hooded robes, hiding behind painted faces and chanting demonic incantations while inflicting sadistic wounds on innocent children lying on makeshift alters, or tied to inverted crosses, sounds like the stuff of which B-grade horror movies are made. Some think amoral religious cults only populate the world of Rosemary's Baby, but don't exist in real life. Or, do they? Ask Jenny Hill.

A child who is being abused on an ongoing basis needs to be able to function despite the trauma that dominates his or her daily life. That becomes the job of at least one ANP [apparently normal part of the personality], whom the child creates to be unaware of the abuse and also of the multiplicity, and to “pass as normal” in the real world. The ANP is just an alter specialized for handling the adult world—in other words, the “front person” for the system.

Dissociative symptoms—primarily depersonalization and derealization—are elements in other DSM-IV disorders, including schizophrenia and borderline personality disorder, and in the neurologic syndrome of temporal lobe epilepsy, also called complex partial seizures. In this latter disorder, there are often florid symptoms of depersonalization and realization, but most amnesia symptoms derive from difficulties with focused attention rather than forgetting previously learned information.

Somatic Symptoms: People with Complex PTSD often have medical unexplained physical symptoms such as abdominal pains, headaches, joint and muscle pain, stomach problems, and elimination problems. These people are sometimes most unfortunately mislabeled as hypochondriacs or as exaggerating their physical problems. But these problems are real, even though they may not be related to a specific physical diagnosis. Some dissociative parts are stuck in the past experiences that involved pain may intrude such that a person experiences unexplained pain or other physical symptoms. And more generally, chronic stress affects the body in all kinds of ways, just as it does the mind. In fact, the mind and body cannot be separated. Unfortunately, the connection between current physical symptoms and past traumatizing events is not always so clear to either the individual or the physician, at least for a while. At the same time we know that people who have suffered from serious medical, problems. It is therefore very important that you have physical problems checked out, to make sure you do not have a problem from which you need medical help.

It was that culture of denial that allowed my abuse to take place to start with. Did you know that it wasn't until 1984 that the Department of Health added the category of "sexual abuse" to its list of harms that can befall children? When I was being raped and made pregnant at the age of 11, it wasn't just my own dissociative process that told me that it wasn't happening; it was society too. "We don't have a category for that. Computer says no."͏

My body was a Pandora’s box of aches and pains. When Grandpa died all the ailments came jumping out. I was forever twitching and shaking. I had a persistent sore throat and had difficulty swallowing except when I was taking nips from my illicit cocktail. I was constantly constipated, holding everything in — a disorder that had started when I was two years old. It burned when I passed urine, and my migraines were so severe it felt on occasions as if I were going blind.

As a therapist, I have many avenues in which to learn about DID, but I hear exactly the opposite from clients and others who are struggling to understand their own existence. When I talk to them about the need to let supportive people into their lives, I always get a variation of the same answer. "It is not safe. They won't understand." My goal here is to provide a small piece of that gigantic puzzle of understanding. If this book helps someone with DID start a conversation with a supportive friend or family member, understanding will be increased.

After writing the letter Sybil lost almost two days. "Coming to," she stumbled across what she had written just before she had dissociated and wrote to Dr. Wilbur as follows: It's just so hard to have to feel, believe, and admit that I do not have conscious control over my selves. It is so much more threatening to have something out of hand than to believe that at any moment I can stop (I started to say "This foolishness") any time I need to. When I wrote the previous letter, I had made up my mind I would show you how I could be very composed and cool and not need to ask you to listen to me nor to explain anything to me nor need any help. By telling you that all this about the multiple personalities was not really true I could show, or so I thought, that I did not need you. Well, it would be easier if it were put on. But the only ruse of which I'm guilty is to have pretended for so long before coming to you that nothing was wrong. Pretending that the personalities did not exist has now caused me to lose about two days.

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.

Dissociation is numbness and nothingness; it is a feeling of being lost; it is floating on a cloud that threatens to suffocate; it is automatic speech and action without awareness or control; it is looking at the world and blinking to try to remove the blurry fog; it is hearing and seeing the immediate world and simultaneously feeling very far away; it is raw fear; it is unfamiliarity in familiar places; it is possession; it is being haunted everyday by unknown monsters that can be felt but not seen (at least not by others); it is looking in the mirror and not knowing who is looking back; it is fantasy and imagination; and, above all else, it is survival. Dissociation is all of these things and none of them at once.

Patients with complex trauma may at times develop extreme reactions to something the therapist has said or not said, done or not done. It is wise to anticipate this in advance, and perhaps to note this anticipation in initial communications with the patient. For example, one may say something like, "It is likely in our work together, there will be a time or times when you will feel angry with me, disappointed with me, or that I have failed you. We should except this and not be surprised if and when it happens, which it probably will." It is also vital to emphasize to the patient that despite the diagnosis and experience of dividedness, the whole person is responsible and will be held responsible for the acts of any part. p174

Dissociative identity disorder is conceptualized as a childhood onset, posttraumatic developmental disorder in which the child is unable to consolidate a unified sense of self. Detachment from emotional and physical pain during trauma can result in alterations in memory encoding and storage. In turn, this leads to fragmentation and compartmentalization of memory and impairments in retrieving memory.2,4,19 Exposure to early, usually repeated trauma results in the creation of discrete behavioral states that can persist and, over later development, become elaborated, ultimately developing into the alternate identities of dissociative identity disorder.

It is so much more threatening to have something out of hand than to believe that at any moment I can stop (I started to say "This foolishness") any time I need to. When I wrote the previous letter, I had made up my mind I would show you how I could be very composed and cool and not need to ask you to listen to me nor to explain anything to me nor need any help. By telling you that all this about the multiple personalities was not really true but just put on, I could show, or so I thought, that I did not need you. Well, it would have been easier if it were put on. But the only ruse of which I'm guilty is to have pretended for so long before coming to you that nothing was wrong. Pretending that the personalities did not exist has now caused me to lose about two days. Three weeks later Sybil reaffirmed her belief in the existence of her other selves in a letter to Miss Updyke, the school nurse of undergraduate days.

Persons Are Turned against Themselves Evil also turns a person against herself so that self is used against self. The case of the woman who received a dismissal letter from her pastor comes to mind again. The psychological decompensation she suffered was successfully used by her husband to intercede with a psychiatrist of his choosing to commit her to the mental unit of a hospital for an extended involuntary stay, which further worsened her condition. Additional examples abound. Some patients report cults using induced hypnotic states to encourage a subject's dissociated hands and arms to do something hurtful to someone else. In such cases, the subject is encouraged to watch the hand that is hers but not hers (because it is dissociated from her). The end result is often extreme guilt. self-loathing, and distrust of one's self and motives.An incestuous parent may use a child's own natural bodily responses to repeated sexual stimulation to make the point that the child really "wants and enjoys“ what is being forced upon her.

Posttraumatic stress disorder (PTSD) also has dissociative symptoms as an essential feature. PTSD has been classically seen as a biphasic disorder, with persons alternately experiencing phases of intrusion and numbing... [T]he intrusive phase is associated with recurrent and distressing recollections in thoughts or dreams and reliving the events in flashbacks. The avoidant/numbing phase is associated with efforts to avoid thoughts or feelings associated with the trauma, emotional constriction, and social withdrawal. This biphasic pattern is the result of dissociation; traumatic events are distanced and dissociated from usual conscious awareness in the numbing phase, only to return in the intrusive phase.

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.

When I was cooking I enjoyed a sense of being ‘out’ of myself. The action of dicing vegetables and warming oil made my hands tingle and my thoughts switch to a different hemisphere, right brain rather than left, or left rather than right. In my mind there were many rooms and, just as I still got lost in the labyrinth of corridors at college, I often found myself lost, with a sense of déjà vu, in some obscure part of my cerebral cortex, the part of the brain that plays a key role in perceptual awareness, attention and memory. Everything I had lived through or imagined or dreamed appeared to have been backed up on a video clip and then scattered among those alien rooms. I could stumble into any number of scenes, from the horrifically sexual, horror-movie sequences that were crude and painful, to visualizing Grandpa polishing his shoes.

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]

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.

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.

Further evidence for the pathogenic role of dissociation has come from a largescale clinical and community study of traumatized people conducted by a task force of the American Psychiatric Association. In this study, people who reported having dissociative symptoms were also quite likely to develop persistent somatic symptoms for which no physical cause could be found. They also frequently engaged in self-destructive attacks on their own bodies. The results of these investigations validate the century-old insight that traumatized people relive in their bodies the moments of terror that they can not describe in words. Dissociation appears to be the mechanism by which intense sensory and emotional experiences are disconnected from the social domain of language and memory, the internal mechanism by which terrorized people are silenced.

Other personalities are created to handle new traumas, their existence usually occurring one at a time. Each has a singular purpose and is totally focused on that task. The important aspect of the mind's extreme dissociation is that each ego state is totally without knowledge of the other. Because of this, the researchers for the CIA and the Department of Defense believed they could take a personality, train him or her to be a killer and no other ego stares would be aware of the violence that was taking place. The personality running the body would be genuinely unaware of the deaths another personality was causing. Even torture could not expose the with, because the personality experiencing the torture would have no awareness of the information being sought. Earlier, such knowledge was gained from therapists working with adults who had multiple personalities. The earliest pioneers in the field, such as Dr. Ralph Alison, a psychiatrist then living in Santa Cruz, California, were helping victims of severe early childhood trauma. Because there were no protocols for treatment, the pioneers made careful notes, publishing their discoveries so other therapists would understand how to help these rare cases. By 1965, the information was fairly extensive, including the knowledge that only unusually intelligent children become multiple personalities and that sexual trauma endured by a restrained child under the age of seven is the most common way to induce hysteric dissociation.

Janna knew - Rikki knew — and I knew, too — that becoming Dr Cameron West wouldn't make me feel a damn bit better about myself than I did about being Citizen West. Citizen West, Citizen Kane, Sugar Ray Robinson, Robinson Crusoe, Robinson miso, miso soup, black bean soup, black sticky soup, black sticky me. Yeah. Inside I was still a fetid and festering corpse covered in sticky blackness, still mired in putrid shame and scorching self-hatred. I could write an 86-page essay comparing the features of Borderline Personality Disorder with those of Dissociative Identity Disorder, but I barely knew what day it was, or even what month, never knew where the car was parked when Dusty would come out of the grocery store, couldn't look in the mirror for fear of what—or whom—I'd see. ~ Dr Cameron West describes living with DID whilst studying to be a psychologist.

I had a bizarre rapport with this mirror and spent a lot of time gazing into the glass to see who was there. Sometimes it looked like me. At other times, I could see someone similar but different in the reflection. A few times, I caught the switch in mid-stare, my expression re-forming like melting rubber, the creases and features of my face softening or hardening until the mutation was complete. Jekyll to Hyde, or Hyde to Jekyll. I felt my inner core change at the same time. I would feel more confident or less confident; mature or childlike; freezing cold or sticky hot, a state that would drive Mum mad as I escaped to the bathroom where I would remain for two hours scrubbing my skin until it was raw. The change was triggered by different emotions: on hearing a particular piece of music; the sight of my father, the smell of his brand of aftershave. I would pick up a book with the certainty that I had not read it before and hear the words as I read them like an echo inside my head. Like Alice in the Lewis Carroll story, I slipped into the depths of the looking glass and couldn’t be sure if it was me standing there or an impostor, a lookalike. I felt fully awake most of the time, but sometimes while I was awake it felt as if I were dreaming. In this dream state I didn’t feel like me, the real me. I felt numb. My fingers prickled. My eyes in the mirror’s reflection were glazed like the eyes of a mannequin in a shop window, my colour, my shape, but without light or focus. These changes were described by Dr Purvis as mood swings and by Mother as floods, but I knew better. All teenagers are moody when it suits them. My Switches could take place when I was alone, transforming me from a bright sixteen-year-old doing her homework into a sobbing child curled on the bed staring at the wall. The weeping fit would pass and I would drag myself back to the mirror expecting to see a child version of myself. ‘Who are you?’ I’d ask. I could hear the words; it sounded like me but it wasn’t me. I’d watch my lips moving and say it again, ‘Who are you?

The major goal of the Cold War mind control programs was to create dissociative symptoms and disorders, including full multiple personality disorder. The Manchurian Candidate is fact, not fiction, and was created by the CIA in the 1950’s under BLUEBIRD and ARTICHOKE mind control programs. Experiments with LSD, sensory deprivation, electro-convulsive treatment, brain electrode implants and hypnosis were designed to create amnesia, depersonalization, changes in identity and altered states of consciousness. (p. iii) “Denial of the reality of multiple personality by these doctors [See page 114 for names] in the mind control network, who are also on the FMSF [False Memory Syndrome Foundation] Scientific and Professional Advisory Board, could be disinformation. The disinformation could be amplified by attacks on specialists in multiple personality as CIA conspiracy lunatics” (P.10) “If clinical multiple personality is buried and forgotten, then the Manchurian Candidate Programs will be safe from public scrutiny. (p.141)

Dr. Talbon was struck by another very important thing. It all hung together. The stories Cheryl told — even though it was upsetting to think people could do stuff like that — they were not disjointed They were not repetitive in terms of "I've heard this before". It was not just she'd someone trying consciously or unconsciously to get attention. really processed them out and was done with them. She didn't come up with them again [after telling the story once and dealing with it]. Once it was done, it was done. And I think that was probably the biggest factor for me in her believability. I got no sense that she was using these stories to make herself a really interesting person to me so I'd really want to work with her, or something. Or that she was just living in this stuff like it was her life. Once she dealt with it and processed it, it was gone. We just went on to other things. 'Throughout the whole thing, emotionally Cheryl was getting her life together. Parts of her were integrating where she could say,"I have a sense that some particular alter has folded in with some basic alter", and she didn't bring it up again. She didn't say that this alter has reappeared to cause more problems. That just didn't happen. The therapist had learned from training and experience that when real integration occurs, it is permanent and the patient moves on.

Cheryl was aided in her search by the Internet. Each time she remembered a name that seemed to be important in her life, she tried to look up that person on the World Wide Web. The names and pictures Cheryl found were at once familiar and yet not part of her conscious memory: Dr. Sidney Gottlieb, Dr. Louis 'Jolly' West, Dr. Ewen Cameron, Dr. Martin Orne and others had information by and about them on the Web. Soon, she began looking up sites related to childhood incest and found that some of the survivor sites mentioned the same names, though in the context of experiments performed on small children. Again, some names were familiar. Then Cheryl began remembering what turned out to be triggers from old programmes. 'The song, "The Green, Green Grass of home" kept running through my mind. I remembered that my father sang it as well. It all made no sense until I remembered that the last line of the song tells of being buried six feet under that green, green grass. Suddenly, it came to me that this was a suicide programme of the government. 'I went crazy. I felt that my body would explode unless I released some of the pressure I felt within, so I grabbed a [pair ofl scissors and cut myself with the blade so I bled. In my distracted state, I was certain that the bleeding would let the pressure out. I didn't know Lynn had felt the same way years earlier. I just knew I had to do it Cheryl says. She had some barbiturates and other medicine in the house. 'One particularly despondent night, I took several pills. It wasn't exactly a suicide try, though the pills could have killed me. Instead, I kept thinking that I would give myself a fifty-fifty chance of waking up the next morning. Maybe the pills would kill me. Maybe the dose would not be lethal. It was all up to God. I began taking pills each night. Each-morning I kept awakening.

In 1953, Allen Dulles, then director of the USA Central Intelligence Agency (CIA), named Dr Sidney Gottlieb to direct the CIA's MKULTRA programme, which included experiments conducted by psychiatrists to create amnesia, new dissociated identities, new memories, and responses to hypnotic access codes. In 1972, then-CIA director Richard Helms and Gottlieb ordered the destruction of all MKULTRA records. A clerical error spared seven boxes, containing 1738 documents, over 17,000 pages. This archive was declassified through a Freedom of Information Act Request in 1977, though the names of most people, universities, and hospitals are redacted. The CIA assigned each document a number preceded by "MORI", for "Managament of Officially Released Information", the CIA's automated electronic system at the time of document release. These documents, to be referenced throughout this chapter, are accessible on the Internet (see: abuse-of-power (dot) org/modules/content/index.php?id=31). The United States Senate held a hearing exposing the abuses of MKULTRA, entitled "Project MKULTRA, the CIA's program of research into behavioral modification" (1977).

Having DID is, for many people, a very lonely thing. If this book reaches some people whose experiences resonate with mine and gives them a sense that they aren't alone, that there is hope, then I will have achieved one of my goals. A sad fact is that people with DID spend an average of almost seven years in the mental health system before being properly diagnosed and receiving the specific help they need. During that repeatedly misdiagnosed and incorrectly treated, simply because clinicians fail to recognize the symptoms. If this book provides practicing and future clinicians certain insight into DID, then I will have accomplished another goal. Clinicians, and all others whose lives are touched by DID, need to grasp the fundamentally illusive nature of memory, because memory, or the lack of it, is an integral component of this condition. Our minds are stock pots which are continuously fed ingredients from many cooks: parents, siblings, relatives, neighbors, teachers, schoolmates, strangers, acquaintances, radio, television, movies, and books. These are the fixings of learning and memory, which are stirred with a spoon that changes form over time as it is shaped by our experiences. In this incredibly amorphous neurological stew, it is impossible for all memories to be exact. But even as we accept the complex of impressionistic nature of memory, it is equally essential to recognize that people who experience persistent and intrusive memories that disrupt their sense of well-being and ability to function, have some real basis distress, regardless of the degree of clarity or feasibility of their recollections. We must understand that those who experience abuse as children, and particularly those who experience incest, almost invariably suffer from a profound sense of guilt and shame that is not meliorated merely by unearthing memories or focusing on the content of traumatic material. It is not enough to just remember. Nor is achieving a sense of wholeness and peace necessarily accomplished by either placing blame on others or by forgiving those we perceive as having wronged us. It is achieved through understanding, acceptance, and reinvention of the self.

THE RETURN OF THE REPRESSED: RELIVING DISSOCIATED EXPERIENCES The reexperiencing of previously dissociated traumatic events presents in a variety of complex ways. The central principle is that dissociated experiences often do not remain dormant. Freud's concept of the “repetition compulsion” is enormously helpful in understanding how dissociated events are later reexperienced. In his paper, "Beyond the Pleasure Principle," Freud (1920/ 1955) described how repressed (and dissociated) trauma and instinctual conflicts can become superimposed on current reality. He wrote: The patient cannot remember the whole of what is repressed in him, and what he cannot remember may be precisely the essential part of it. .. . He is obliged to repeat the repressed material as a contemporary experience instead of remembering it as something in the past. (p. 18) If one understands repression as the process in which overwhelming experiences are forgotten, distanced, and dissociated, Freud posited that these experiences are likely to recur in the mind and to be reexperienced. He theorized that this "compulsion to repeat" served a need to rework and achieve mastery over the experience and that it perhaps had an underlying biologic basis as well. The most perceptive tenet of Freud’s theory is that previously dissociated events are actually reexperienced as current reality rather than remembered as occurring in the past. Although Freud was discussing the trauma produced by intense intrapsychic conflict, clinical experience has shown that actual traumatic events that have been dissociated are often repeated and reexperienced.

CONSENSUS PROPOSED CRITERIA FOR DEVELOPMENTAL TRAUMA DISORDER A. Exposure. The child or adolescent has experienced or witnessed multiple or prolonged adverse events over a period of at least one year beginning in childhood or early adolescence, including: A. 1. Direct experience or witnessing of repeated and severe episodes of interpersonal violence; and A. 2. Significant disruptions of protective caregiving as the result of repeated changes in primary caregiver; repeated separation from the primary caregiver; or exposure to severe and persistent emotional abuse B. Affective and Physiological Dysregulation. The child exhibits impaired normative developmental competencies related to arousal regulation, including at least two of the following: B. 1. Inability to modulate, tolerate, or recover from extreme affect states (e.g., fear, anger, shame), including prolonged and extreme tantrums, or immobilization B. 2. Disturbances in regulation in bodily functions (e.g. persistent disturbances in sleeping, eating, and elimination; over-reactivity or under-reactivity to touch and sounds; disorganization during routine transitions) B. 3. Diminished awareness/dissociation of sensations, emotions and bodily states B. 4. Impaired capacity to describe emotions or bodily states C. Attentional and Behavioral Dysregulation: The child exhibits impaired normative developmental competencies related to sustained attention, learning, or coping with stress, including at least three of the following: C. 1. Preoccupation with threat, or impaired capacity to perceive threat, including misreading of safety and danger cues C. 2. Impaired capacity for self-protection, including extreme risk-taking or thrill-seeking C. 3. Maladaptive attempts at self-soothing (e.g., rocking and other rhythmical movements, compulsive masturbation) C. 4. Habitual (intentional or automatic) or reactive self-harm C. 5. Inability to initiate or sustain goal-directed behavior D. Self and Relational Dysregulation. The child exhibits impaired normative developmental competencies in their sense of personal identity and involvement in relationships, including at least three of the following: D. 1. Intense preoccupation with safety of the caregiver or other loved ones (including precocious caregiving) or difficulty tolerating reunion with them after separation D. 2. Persistent negative sense of self, including self-loathing, helplessness, worthlessness, ineffectiveness, or defectiveness D. 3. Extreme and persistent distrust, defiance or lack of reciprocal behavior in close relationships with adults or peers D. 4. Reactive physical or verbal aggression toward peers, caregivers, or other adults D. 5. Inappropriate (excessive or promiscuous) attempts to get intimate contact (including but not limited to sexual or physical intimacy) or excessive reliance on peers or adults for safety and reassurance D. 6. Impaired capacity to regulate empathic arousal as evidenced by lack of empathy for, or intolerance of, expressions of distress of others, or excessive responsiveness to the distress of others E. Posttraumatic Spectrum Symptoms. The child exhibits at least one symptom in at least two of the three PTSD symptom clusters B, C, & D. F. Duration of disturbance (symptoms in DTD Criteria B, C, D, and E) at least 6 months. G. Functional Impairment. The disturbance causes clinically significant distress or impairment in at least two of the following areas of functioning: Scholastic Familial Peer Group Legal Health Vocational (for youth involved in, seeking or referred for employment, volunteer work or job training)

I resolved to come right to the point. "Hello," I said as coldly as possible, "we've got to talk." "Yes, Bob," he said quietly, "what's on your mind?" I shut my eyes for a moment, letting the raging frustration well up inside, then stared angrily at the psychiatrist. "Look, I've been religious about this recovery business. I go to AA meetings daily and to your sessions twice a week. I know it's good that I've stopped drinking. But every other aspect of my life feels the same as it did before. No, it's worse. I hate my life. I hate myself." Suddenly I felt a slight warmth in my face, blinked my eyes a bit, and then stared at him. "Bob, I'm afraid our time's up," Smith said in a matter-of-fact style. "Time's up?" I exclaimed. "I just got here." "No." He shook his head, glancing at his clock. "It's been fifty minutes. You don't remember anything?" "I remember everything. I was just telling you that these sessions don't seem to be working for me." Smith paused to choose his words very carefully. "Do you know a very angry boy named 'Tommy'?" "No," I said in bewilderment, "except for my cousin Tommy whom I haven't seen in twenty years..." "No." He stopped me short. "This Tommy's not your cousin. I spent this last fifty minutes talking with another Tommy. He's full of anger. And he's inside of you." "You're kidding?" "No, I'm not. Look. I want to take a little time to think over what happened today. And don't worry about this. I'll set up an emergency session with you tomorrow. We'll deal with it then." Robert This is Robert speaking. Today I'm the only personality who is strongly visible inside and outside. My own term for such an MPD role is dominant personality. Fifteen years ago, I rarely appeared on the outside, though I had considerable influence on the inside; back then, I was what one might call a "recessive personality." My passage from "recessive" to "dominant" is a key part of our story; be patient, you'll learn lots more about me later on. Indeed, since you will meet all eleven personalities who once roamed about, it gets a bit complex in the first half of this book; but don't worry, you don't have to remember them all, and it gets sorted out in the last half of the book. You may be wondering -- if not "Robert," who, then, was the dominant MPD personality back in the 1980s and earlier? His name was "Bob," and his dominance amounted to a long reign, from the early 1960s to the early 1990s. Since "Robert B. Oxnam" was born in 1942, you can see that "Bob" was in command from early to middle adulthood. Although he was the dominant MPD personality for thirty years, Bob did not have a clue that he was afflicted by multiple personality disorder until 1990, the very last year of his dominance. That was the fateful moment when Bob first heard that he had an "angry boy named Tommy" inside of him. How, you might ask, can someone have MPD for half a lifetime without knowing it? And even if he didn't know it, didn't others around him spot it? To outsiders, this is one of the most perplexing aspects of MPD. Multiple personality is an extreme disorder, and yet it can go undetected for decades, by the patient, by family and close friends, even by trained therapists. Part of the explanation is the very nature of the disorder itself: MPD thrives on secrecy because the dissociative individual is repressing a terrible inner secret. The MPD individual becomes so skilled in hiding from himself that he becomes a specialist, often unknowingly, in hiding from others. Part of the explanation is rooted in outside observers: MPD often manifests itself in other behaviors, frequently addiction and emotional outbursts, which are wrongly seen as the "real problem." The fact of the matter is that Bob did not see himself as the dominant personality inside Robert B. Oxnam. Instead, he saw himself as a whole person. In his mind, Bob was merely a nickname for Bob Oxnam, Robert Oxnam, Dr. Robert B. Oxnam, PhD.