Why the controversy?

According to Bethany Brand, Ph.D, a professor of psychology at Towson University and an expert in treating and researching dissociative disorders, there are several reasons. DID is associated with early severe trauma, such as abuse and neglect.

This raises the concern over false memories. Some people worry that clients may “remember” abuse that didn’t actually happen and innocent people may get blamed for abuse. (“Most people with DID don’t forget all their abuse or trauma,” Brand said; “sufferers may forget episodes or aspects of some of their trauma,” but it’s “fairly rare not to remember any trauma at all and suddenly recover memories of chronic childhood abuse.”) It also “pries into families’ privacy,” and families may be reluctant to reveal information that might put them in a negative light.

In the mental health field, myths persist because of a lack of education and training about DID. These myths create a mystique around the disorder and perpetuate the belief that DID is bizarre. For instance, one prevalent myth is that there are “different people inside someone with DID,” Brand said. Adding to the problem are poorly trained therapists who promote atypical treatments that aren’t supported by the expert clinical community. “Mainstream, well-trained dissociative experts don’t advocate using bizarre treatment interventions. Rather, they use interventions that are similar to common ones used in treating complex trauma,” she said.

What Is DID?

DID typically develops in childhood as a result of severe and sustained trauma. It’s characterized by different identities or “self-states” (there is no integrated sense of self) and an inability to recall information that goes beyond forgetfulness. Prone to amnesia, people with DID sometimes “can’t remember what they’ve done or said,” Brand said. They have a tendency to dissociate or “space out and lose track of minutes or hours.” For instance, it’s “common [for people with DID] to find they’ve hurt themselves [but] don’t remember doing that,” Brand said. The loss of memory isn’t due to drugs or alcohol, but a switch in self-states, she noted. Here’s a list of the DSM criteria for DID.

7 Common DID Myths

It’s safe to say that most of what we know about DID is either exaggerated or flat-out false. Here’s a list of common myths, followed by the facts.

1. DID is rare. Studies show that in the general population about 1 to 3 percent meet full criteria for DID. This makes the disorder as common as bipolar disorder and schizophrenia. The rates in clinical populations are even higher, Brand said. Unfortunately, even though DID is fairly common, research about it is grossly underfunded. Researchers often use their own money to fund studies or volunteer their time. (The National Institute of Mental Health has yet to fund a single treatment study on DID.)

2. It’s obvious when someone has DID. Sensationalism sells. So it’s not surprising that depictions of DID in movies and TV are exaggerated. The more bizarre the portrayal, the more it fascinates and tempts viewers to tune in. Also, overstated portrayals make it obvious that a person has DID. But “DID is much more subtle than any Hollywood portrayal,” Brand said. In fact, people with DID spend an average of seven years in the mental health system before being diagnosed.

They also have comorbid disorders, making it harder to identify DID. They often struggle with severe treatment-resistant depression, post-traumatic stress disorder (PTSD), eating disorders and substance abuse. Because standard treatment for these disorders doesn’t treat the DID, these individuals don’t get much better, Brand said.

3. People with DID have distinct personalities. Instead of distinct personalities, people with DID have different states. Brand describes it as “having different ways of being themselves, which we all do to some extent, but people with DID cannot always recall what they do or say while in their different states.” And they may act quite differently in different states.

Also, “There are many disorders that involve changes in state.” For instance, people with borderline personality disorder may go “from relatively calm to extremely angry with little provocation.” People with panic disorder may go “from an even emotional state to extremely panicked.” “However, patients with those disorders recall what they do and say in these different states, in contrast to the occasional amnesia that DID patients experience.”

As Brand points out, in the media, there is a great fascination with the self-states. But the self-states are not the biggest focus in treatment. Therapists address clients’ severe depression, dissociation, self-harm, painful memories and overwhelming feelings. They also help individuals “modulate their impulses” in all their states. The “majority [of treatment] is much more mundane than Hollywood would lead us to expect,” Brand said.

4. Treatment makes DID worse. Some critics of DID believe that treatment exacerbates the disorder. It’s true that misinformed therapists who use outdated or ineffective approaches may do damage. But this can happen with any disorder with any inexperienced and ill-trained therapist. Research-based and consensually established treatments for DID do help.

The International Society for The Study of Trauma and Dissociation, the premier organization that trains therapists to assess and treat dissociative disorders, features the latest adult treatment guidelines on their homepage. These guidelines, which Brand helped co-author, are based on up-to-date research and clinical experience. (The website also offers guidelines for kids and teens with dissociative disorders.)

Brand and colleagues recently conducted a review of treatment studies on dissociative disorders, which was published in the Journal of Nervous Mental Disease. While the reviewed studies have limitations—no control or comparison groups and small sample sizes—results revealed that individuals do get better. Specifically, the authors found improvements in dissociative symptoms, depression, distress, anxiety, PTSD and work and social functioning. More research is needed. Brand along with colleagues from the U.S. and abroad are working on a larger scale study to test treatment outcomes.

This is the first image that entered my mind as I began to read Coping with Trauma-Related Dissociation.  Following that were images from the movies Sybil and The Three Faces of Eve.  After not many pages into the book came the realization that dissociative identity disorder, the subject of this book, is what had been portrayed in those movies.  “Dissociative parts of the personality are not actually separate identities in one body, but rather parts of a single individual that are not yet functioning together in a smooth, coordinated, and flexible way.” 

In a collaborative effort by authors Suzette Boon, Ph.D.; Kathy Steele, M.N., C.S.; and Onno van der Hart, Ph.D., patients and their therapists are presented with a skills-training course as another avenue to travel in the treatment of dissociative identity disorder. 

The book is aimed specifically at patients with the disorder and the authors note that it is not intended to be used by anyone who is not currently in therapy even though the content may be helpful on its own.  While it can be utilized in a one-on-one session between a patient and therapist, the skills training was designed to be used in group sessions led by two trainers with a predetermined number of participants that have already been assessed, diagnosed, and are in current treatment for the disorder.

Coping with Trauma-Related Dissociation is divided into eight parts, logically progressing from understanding dissociation and trauma-related disorders, to initial coping skills (reflection), improving daily life (sleep; a healthy daily structure; free time and relaxation), coping with traumatic triggers and memories, understanding emotions and cognitions (core beliefs, cognitive errors), advanced coping skills (anger, fear, shame and guilt, needs of inner child parts, self-harm, inner cooperation), and finally to improving relationships (isolation, loneliness, learning to be assertive, and setting healthy personal boundaries).  Each chapter begins with an agenda so that everyone knows upfront what to expect from the session.  Homework assignments close out each chapter and “are a central part of the training course, because consistent practice is the tried and true way to learn new skills.”  Awareness exercises and imagery exercises are presented throughout to help the patient effectively use what they are learning.  Whereas the majority of the book speaks directly to the individual, the last part focuses on group trainers and contains the necessary information and guidance for assembling and conducting these skills-training groups.

Coping with Trauma-Related Dissociation is almost certainly not the kind of book a casual reader would pick up at the bookstore or library, but may do so out of curiosity nonetheless.  Being neither a patient nor a therapist, it is with some hesitation that I attempt to conclude whether or not Coping with Trauma-Related Dissociation hits its intended mark. With that being said, it is from the perspective of an interested reader only that the following observations are offered, based on the knowledge gained about the disorder by reading this book.

For someone with dissociative identity disorder, having to essentially assume the role of referee with “all the different aspects of personality” on a daily basis would seem to be emotionally demanding.  Add to that the tasks of reading this book and completing the in-depth homework assignments, the emotional demand could be stressful and overwhelming if it were not for the consistent manner in which the authors convey their message with thoughtfulness and understanding.  More importantly, they are very careful to not be graphic about any references to trauma included and thereby demonstrate concern for the reader’s fragility by avoiding potential triggers.  “Be patient with yourself and all parts of yourself” seems to be the underlying skill that is woven into the fabric of the training so that healing can progress.  It is difficult to even begin to imagine how demanding it must be to get all the parts to practice patience and work in concert with each other in helping to heal the whole person.

For the therapist who elects to become one of the group leaders of a skills-training course, or chooses instead to use this book in treating a patient, they may be further educated in responding to these individuals in a different manner.  It is a book worthy of their time, whether or not they use it in its entirety, as they may discover an opportunity to modify aspects of their current therapeutic approach by incorporating something from its pages they feel holds promise.

My conclusion is that if skills-training groups start sprouting up and the participants embarking on the journey together find its content important and mutually beneficial then, yes, the authors’ mission has been accomplished.

Coping with Trauma-Related Dissociation – Skills Training for Patients and Therapists
By Suzette Boon, Kathy Steele, Onno van der Hart
W. W. Norton & Company: March 28, 2011
Paperback, 496 pages
$35

One of my dearest friends, Jane Wright, has been gracious enough to write about her Dissociative Identity Disorder in some (very well-received) posts on my blog. So it occurred to me to ask her whether depression played any role in the development of her DID. Her answer? Oh, yeah!

So here’s our kitchen-table interview:

Depression for me has become very complex over the years. It started when I was born to a depressed mother and depressed father. My mother in fact tried to kill herself when I was five. I did not understand what this meant, but the tension and emotion in the house was very clear. This was my real introduction to mental illness.

By age 14, I had developed over a few years what I thought was a run-of-the-mill adolescent depression, suicide attempt and all. After a hospitalization, I was removed from my home to go to a boarding school. That change from a dysfunctional home to a wonderful school brought out the best in me. I no longer felt the utter despair and fear and caution I always had felt with my parents.

Moving on to college was an easy transition for me. I had lived away from home as most of the freshmen had not.
But the depression came on again my junior year. My father died quite unexpectedly. I had been responsible for saving him from each diabetic reaction since I was 10. Perhaps it was I who had failed?

I found myself walking into busy streets in Boston, with no recollection of doing so. It seemed as if my new depression was trying to kill me. I wrote this line in my journal: the little girl has to remember something. I had no idea what this meant. I found myself increasingly nonfunctional.

I was in and out of psychiatric hospitals for two years, while also participating in a day program. My father had become a god to me after his death. He was perfect in my eyes. I refused to acknowledge the heartache and difficulties he had caused. Therapy tried to allow me to find the gray area of his relationship with me. But my depression continued until graduation.

When I moved away from the Boston area where I had lived most of those horrible years, I recovered once again. I found a job, got married and truly believed I would never become depressed again. Unfortunately, mental illness doesn’t go away with a relocation. And there were things I didn’t know at this time, things that would help to explain all my depressions.

I had two boys. When the oldest turned 6, I suddenly found myself depressed again, and hallucinating, and having flashbacks and cutting and burning myself. Many of these injuries were unexplainable to me. And I didn’t believe what I was now remembering. How could I have been abused by my father and not have known it? I thought I was making this all up. I had an active imagination. Frankly, I thought I was crazy.

I sought the help of a psychiatrist. In those days insurance companies allowed him to provide therapy as well as medication management. I became very frightened by these thoughts and memories and my inability to tell what was real, as well of the self-mutilation. I was told the hallucinations could be a side to the depression.

Supported, I crept forward, telling him of my inner turmoil. He discovered and diagnosed me with Multiple Personality Disorder (later to be called Dissociative Identity Disorder or DID.) This depression had become increasingly complicated. I aggressively fought this in an absolute rejection. I did not have alters! It did explain, however, my loss of time over the years, how I did not know of the abuse until my son turned 6 (the age at which I started being abused) and my depressions.

As it finally turned out, I have an alter that deals with depression. Her name is Otter. Amongst other things, she is depressed. I soon felt that when she became particularly depressed I did too. I felt as if this explained my repeated bouts with depression: Otter was causing them. Though, as I looked at them more carefully, I could see that all the depressions have had legitimate reasons other than Otter.

Now I’m suspecting that perhaps as I became depressed Otter then became more depressed. Perhaps it’s her function to somehow hold my depression or shelter me from the worst of it. I had never thought it might work that way. So I am now entertaining this idea, that perhaps Otter has saved me from worse depressions (though they were pretty bad as it was) by taking some responsibility and taking on some of the feelings herself.

I do not yet know how it all works in my head, but now that I have accepted my diagnosis and past, I am willing to explore depression in a new way and the resulting effects it has had on my life.

Thanks yet again, Jane, for sharing so openly!

Dissociation is a common defense/reaction to stressful or traumatic situations. Severe isolated traumas or repeated traumas may result in a person developing a dissociative disorder. A dissociative disorder impairs the normal state of awareness and limits or alters one’s sense of identity, memory or consciousness. Once considered rare, recent research indicates that dissociative symptoms are as common as anxiety and depression, and that individuals with dissociative disorders (particularly Dissociative Identity Disorder and Depersonalization Disorder) are frequently misdiagnosed for many years, delaying effective treatment. In fact, persons suffering from Dissociative Identity Disorder often seek treatment for a variety of other problems including depression, mood swings, difficulty concentrating, memory lapses, alcohol or drug abuse, temper outbursts, and even hearing voices, or psychotic symptoms. People with dissociation often also seek treatment for a variety of medical problems including headaches, unexplained pains, and memory problems. Many people have symptoms that have gone undetected or untreated simply because they were unable to identify their problem, or were not asked the right questions about their symptoms. Because dissociative symptoms are typically hidden, it is important to see a mental health professional who is familiar with recent advances in the ability to diagnose dissociative disorders through the use of scientifically tested diagnostic tests.

What kind of events or experiences are likely to cause symptoms of dissociation? There are various types of traumas. There are traumas within one’s home, either emotional, physical or sexual abuse. Other types of traumas include natural disasters, such as earthquakes, political traumas such as holocausts, hostage situations, wars, random acts of violence (such as the Oklahoma city bombing and the Columbine shootings), or the grief we feel after the death of a family member or loved one. Dissociation is a universal reaction to overwhelming trauma and recent research with indicates that the manifestations of dissociation are very similar world wide.

Misdiagnosis of People with Dissociative Identity Disorder

Most people with undetected Dissociative Identity Disorder (or the spectrum diagnosis of Dissociative Disorder, Not Otherwise Specified) experience depression and often are treated with antidepressant medications. While antidepressant medications may help some of the feelings of depression, it does not alleviate symptoms of dissociation. Some people suffering from undetected dissociative symptoms are misdiagnosed as having psychotic disorders including schizophrenia and are treated with antipsychotic medication resulting in long term side effects. Some other common diagnosis that people with Dissociative Identity Disorder receive include:

• Bipolar disorder.
  Mood swings is a very common experience in people who have a dissociative disorder. If you seek help with a professional who is not familiar with dissociative disorders they may only consider bipolar disorder as the reason for your mood swings, when symptoms of dissociation may be the underlying cause.

• Attention deficit disorder.
  People with Dissociative Identity Disorder commonly experience problems with attention and their memory. Treatment with medication for ADHD may help some of the symptoms associated with poor attention, but again will not help all the symptoms associated with underlying dissociation.

• Eating disorders.
  People with eating disorders including anorexia, and binging often experience inner feelings of dissociation and may have a coexisting dissociative disorder.

• Alcohol or drug abuse.
  People with undetected dissociative disorders frequently self medicate with alcohol or drugs.

• Anxiety disorders.
  People with undetected dissociative disorders often experience generalized anxiety, panic attacks, obsessive compulsive symptoms. Treating only their anxiety will not help their dissociative symptoms.

Other common clues to a dissociative disorder include the fact that a person seems to experience a lot of different symptoms that come and go, and that they have been in treatment for many years and they still seem to have many of their symptoms.

Some people with undetected dissociative symptoms can function well at work or school. Only close friends or family are aware of the person’s inner struggles or suffering. Some times, a person with undetected dissociation may need to be hospitalized because of feelings of low self esteem, self hatred, self destructive feelings and/or suicidal ideation. The delay in accurate diagnosis results in difficulty maintaining close relationships, working below one’s potential as well as years of unnecessary suffering. This can result in worsening depression and continued mood swings and self destructive behaviors.

An incest survivor, a survivor of a pedophile of 4 years who happened to be my teacher, physical abuse starting at age 2 — being locked in closets and such, neglect, 12 years of marriage to man that battered me, rape survivor from my husband. A Mom that had a chronic health condition with her heart being responsible for her care. And the loss of my beloved grandma, unexpectly at age 17. I held her in my arms as she passed. Five operations before I hit 21. And a very coveted 4 year college degree — Yippee!!.

And yes, did I forget to mention my diagnosis of DID. Received the dx of MPD, 22 years ago. I do believe that was the most devastating day of my life (beyond the death of my grandma). Little did I know, that years later I am very thankful for the dx — the tools that allowed me to live thru so much abuse and neglect in my life.

And a miracle happened in my life. God provided a very small, helpless person in my life that loved me unconditionally. The conception and birth of my son. At 19, I wasn’t “supposed” to survive, I had an ovarian cyst the size of a cantaloupe. The doctors I saw “chalked” my illness at the time to depression. Yep, during that day and age — everything they couldn’t solve was “depression.” So when all my internal systems shut down — I checked into the hospital on a Friday night and heard the news ” you won’t live thru the weekend”. So at 19, I was dying and very alone. With emergency surgery they “patched” me together, several surgeries later they said you will be forever childless.

Fast forward, my son’s birth changed everything. I can remember promising him in the hospital that I would keep him “safe….forever plus a day.” I divorced my husband and endured years of being stalked by him. Fast forward 23 years and I have a wonderful son. And co-consciousness with DID. I am thankful for my mind that allowed me to continue my life that might not have been.

Considering the amount of time I spend confessing my mistakes and shortcomings in therapy, I often think the doc missed his true calling. And therapy would definitely be easier if I could step into his office, confess my sins and leave the rest of the work to God until my next session. I’d leave every session cheerfully if it were that simple.

But it isn’t that simple, and the doc doesn’t let me off the hook that easily. He forgives readily, but he doesn’t let me forget that my behavior needs work, so he always seems to have plans to talk about and explore the behavior that led to my latest confession.

I don’t look forward to these conversations, but I have grown accustomed to them, because we have them regularly. Facing the pain that I inflict upon others remains a daunting task for me, primarily because of two nasty little details: I hurt others more often than I care to admit, and it isn’t always unintentional.

It’s the latter detail that often causes me to wince these days, particularly since the person I currently target most often is also the person who’s trying to help me understand and change my behavior: my therapist. And he does not subscribe to the belief that it’s enough simply to recognize when we hurt others, apologize, and try not to do it again. While that’s a good place to start, it is too easy to make promises we don’t or can’t keep, and simply trying not to do it again is a lesson in the illusion of responsibility, neither one conducive to therapy.

It’s easy to say, I won’t or I’ll try not to do it again, and when I’ve made that promise in the past I always intended to keep it. But a lifetime of not understanding my behavior and being caught off-guard by powerful feelings have left me with some serious deficits in impulse control, particularly in my close relationships. Making promises without making serious attempts to understand my actions leaves everyone around me frustrated and angry, so much of my therapy consists of figuring out why I do what I do.

My long-time favorite and usually truthful answer to that question, “I don’t know”, invites my therapist to challenge me as we begin the task of figuring it out together. But I’ve come to appreciate his expectations of hard work, responsibility, and honesty, just as I appreciate his forgiveness and understanding when I make mistakes, because I make plenty of them. That’s a hard-to-beat combination of values, and knowing I can count on him to uphold those values makes facing the truth about myself less formidable.

It is less distressing now, but it still isn’t easy. I am a trauma survivor, and we trauma survivors often blame ourselves for the pain and abuse inflicted upon us, but we generally find it extremely difficult to accept that we too are capable of hurting others. We tend to hold firmly a belief that we are incapable of hurting others due to knowing and experiencing the pain and terror of abuse. This belief is a protective measure, and its primary purpose is to protect us from the threat of identifying with those who abused us. If we can identify with them in
any way, we might be like them, and the last thing a survivor wants to be like is an abuser.

And so, upon realizing a few years ago that I had indeed hurt people, I was quite upset but not as shocked as I thought I would be. In my attempt to protect my self-image as one who would never hurt others intentionally, I reminded myself that we all hurt people inadvertently sometimes, and, pleased with my acceptance of the truth I was content to believe that my behavior, while hurtful at times, was never abusive because it wasn’t intentional. And as long as it wasn’t intentional, there was little I needed to do except try to avoid making the same mistake again. But that acceptance was short-lived, and whatever discomfort I felt at the time paled in comparison to the shock I felt upon my later discovery—that at times I had hurt people intentionally.

I clearly remember the panic I felt when I realized I could not deny, at least to myself, that I had hurt someone intentionally. I was at home at the time, thinking about the work I was doing in therapy, when an incident involving a friend, an incident that I had long since forgotten suddenly found its way back to my memory, instantly shattering my belief that I was incapable of deliberate harm. My heart raced, my hands trembled and my stomach churned. One word flashed through my mind repeatedly: ABUSER.

PTSD, once referred to as shell shock or battle fatigue, was first brought to public attention by war veterans, but it can result from any number of traumatic incidents. These include kidnapping, serious accidents such as car or train wrecks, natural disasters such as floods or earthquakes, violent attacks such as a mugging, rape, or torture, or being held captive. The event that triggers it may be something that threatened the person’s life or the life of someone close to him or her. Or it could be something witnessed, such as mass destruction after a plane crash.

No matter what trauma was experienced or witnessed, some people with PTSD repeatedly relive the trauma in the form of nightmares and disturbing recollections during the day. They may also experience sleep problems, depression, feeling detached or numb, or being easily startled. They may lose interest in things they used to enjoy and have trouble feeling affectionate. They may feel irritable, more aggressive than before, or even violent. Seeing things that remind them of the incident may be very distressing, which could lead them to avoid certain places or situations that bring back those memories. Anniversaries of the event are often very difficult.

PTSD can occur at any age, including childhood. The disorder can be accompanied by depression, substance abuse, or anxiety. Symptoms may be mild or severe–people may become easily irritated or have violent outbursts. In severe cases they may have trouble working or socializing. In general, the symptoms seem to be worse if the event that triggered them was initiated by a person–such as a rape, as opposed to a flood.

Ordinary events can serve as reminders of the trauma and trigger flashbacks or intrusive images. A flashback may make the person lose touch with reality and reenact the event for a period of seconds or hours or, very rarely, days. A person having a flashback, which can come in the form of images, sounds, smells, or feelings, usually believes that the traumatic event is happening all over again.

Not every traumatized person gets full-blown PTSD, or experiences PTSD at all. PTSD is diagnosed only if the symptoms last more than a month. In those who do have PTSD, symptoms usually begin within 3 months of the trauma, and the course of the illness varies. Some people recover within 6 months, others have symptoms that last much longer. In some cases, the condition may be chronic. Occasionally, the illness doesn’t show up until years after the traumatic event.

Whether the traumatic event is experienced or witnessed, one of the defining characteristics of posttraumatic stress disorder (PTSD) is that the event involves the actual or perceived threat of serious injury or death to the person or others. Traumatic events can include, but are not limited to, the following:

• Human violence (e.g., rape, physical assault, domestic violence, kidnapping or violence associated with military combat)
• Natural disasters (e.g., floods, earthquakes, tornadoes or hurricanes)
• Accidents involving injury or death
• Sudden, unexpected death of a family member or friend
• Diagnosis of a life threatening illness

It should be emphasized that most people who are exposed to traumatic events do not develop PTSD and many people with symptoms after a trauma show gradual improvement with time.

However, in some cases, PTSD symptoms may be present and negatively impact on the person’s life (for example, impairing work, studies or relationships with others). In such cases, PTSD may be present. Persons with posttraumatic stress disorder commonly display three types of symptoms:

• Intrusive re-experiencing symptoms are when a person has memories, flashbacks or nightmares of the event(s).
• Avoidant or numbing symptoms are when a person withdraws from people or activities that are reminders of the traumatic event.
• Hyperarousal symptoms are when a person is easily startled, irritable, on edge or has trouble falling asleep.

When children have PTSD, symptoms are expressed in different ways. For example, children may re-experience the traumatic event through repetitive play (e.g., a child who witnessed a robbery may reenact the robbery again and again using her toys).

Researchers have suggested that PTSD tends to be more intense and lasts longer when the traumatic event involves human violence. They have also found good evidence that the likelihood of developing PTSD increases with the severity, length and proximity of exposure to the traumatic event.

According to The American Psychiatric Association’s official diagnostic manual, a person has chronic PTSD if symptoms last for three months or longer. When PTSD symptoms last less than three months, this is considered acute PTSD. It may also be noted that in some people, PTSD symptoms can begin long after the traumatic event, which is called “delayed-onset PTSD.”

Bipolar Disorder

Bipolar disorder is a fairly common mental disorder compared with the other two disorders. Bipolar disorder is also well-understood and readily treated by a combination of medications and psychotherapy. It is characterized by alternating moods of mania and depression, both of which usually last weeks or even months in most people who have the disorder. People who are manic have a high energy level and often irrational beliefs about the amount of work they can accomplish in a short amount of time. They sometimes take on a million different projects at once and finish none of them. Some people with mania talk at a faster rate and seem to the people around them to be constantly in motion.

After a manic mood, a person with bipolar disorder will often “crash” into a depressive mood, which is characterized by sadness, lethargy, and by a feeling that there’s not much point in doing anything. Problems with sleep occur during both types of mood. Bipolar disorder affects both men and women equally and can be first diagnosed throughout a person’s life.

Bipolar disorder can be challenging to treat because, while a person will take an antidepressant medication to help alleviate a depressed mood, they are less likely to remain on the medications which help reign in the manic mood. Those medications tend to make a person feel “like a zombie” or “emotionless,” which are feelings most people wouldn’t want to experience. So many people with bipolar disorder find it difficult to maintain treatment while in their manic phase. However, most people with bipolar disorder function relatively well in normal society and manage to cope with their mood swings, even if they don’t always keep on their prescribed medications.

For more information about bipolar disorder, please see our Bipolar Guide.

Schizophrenia

Schizophrenia is less common than bipolar disorder and is usually first diagnosed in a person’s late teens or early to late 20’s. More men than women receive a diagnosis of schizophrenia, which is characterized by having both hallucinations and delusions. Hallucinations are seeing or hearing things that aren’t there. Delusions are the belief in something that isn’t true. People who have delusions will continue with their delusions even when shown evidence that contradicts the delusion. That’s because, like hallucinations, delusions are “irrational” — the opposite of logic and reason. Since reason doesn’t apply to someone who has a schizophrenic delusion, arguing with it logically gets a person nowhere.

Schizophrenia is also challenging to treat mainly because people with this disorder don’t function as well in society and have difficulty maintaining the treatment regimen. Such treatment usually involves medications and psychotherapy, but can also involve a day program for people who have more severe or treatment-resistant forms of the disorder.

Because of the nature of the symptoms of schizophrenia, people with this disorder often find it difficult to interact with others, and conduct normal life activities, such as holding down a job. Many people with schizophrenia go off of treatment (sometimes, for instance, because a hallucination may tell them to do so), and end up homeless.

For more information about Schizophrenia, please see our Schizophrenia Guide.

I also had a separate tape that played and gave me specific dates that I needed. I met my soon-to-be-new husband on October 18, moved my current husband out, and the soon-to-be-husband in. In November, I was divorced and engaged on December 23rd. I was remarried on January 26th or 27th, and found out I was pregnant with my second child in February. I had very few still “snapshots,” or still memories, that I could access in my mind to look at and place with the facts.

In a daze, I open my eyes and reality tells me that my thoughts, and the tapes, are real. My bedroom furniture is gone. It’s replaced with new furniture that I’m not familiar with, but am at the same time. I go into my daughter’s bedroom. She’s fine and sleeping. Her room is untouched from change. This body would spend many times curled up in her little bed with her stuffies seeking different sorts of comfort at different times.

I leave my daughter’s room and wander downstairs and reality hits me again. My furniture is gone. The new stuff is there. My pictures that were on the wall are gone; the walls bare. In the kitchen, my table and washer/dryer set are gone. Yes, it’s all true. I may live in the same apartment, but this is not the apartment that I furnished and lived in a short time ago with my husband.

Soon there’s a knock at the door. The thought in my head, “Don’t answer it.” I mind. I hear a car door and know it’s my boss’s car. The tape plays for me that he’s been coming every day to see where I am and to check on me. I don’t open the blinds, answer the phone, or answer the door anymore. My mind tells me, “I don’t work there anymore and he’ll just have to accept that.”

Every day, for many days, was the same. I was in shock. I didn’t know what had happened. I didn’t know why I couldn’t remember. I’d hurt so many people? That was not me! I was stable. I was the young mom who was actually a good mother; one who didn’t run around and party and kept her child clean, fed and nurtured. I’d worked at a job as a legal assistant for two and a half years and was respected for such a young age. I had friends and family. Everything, almost, that I had was gone to me. I’d cracked and I knew it. I didn’t know why, though. All I knew for sure is that my life had changed and I didn’t remember anything but the basic facts.

I couldn’t think about it. I didn’t want to think about it. I wanted to “go away” again but could not. I needed to tend to my daughter and my housework. I needed to get ready for my new husband to come home. I was sick because I was pregnant. I would live my new life, and my children would come first. There was a good explanation somewhere. I just wasn’t aware of it! I’d just had too much stress or something. I’m always making more out of things than they really are. It’s not as bad as it seems. I needed to quit thinking about it. My new husband would be home soon. I couldn’t act continually upset when he came home. I didn’t want to anger him. It was a scary thought.

I did what I was supposed to; what any good woman would do every day. I just wanted to be a good woman and person. Days passed into weeks and weeks into months. I was getting to know my new husband, and father of my second child. Mainly I delved into preparing for my new child and working with my firstborn so she would be ready for kindergarten. I had a role to play and somehow that was very easy for me. In fact, it was easier than just being. I played my role until I became that role in my new life.

I never forgot the facts that my world had completely changed, that I didn’t remember how or why, and that I would make this work because I would not be like the people in my birth family who went around hurting and using. I would make this work somehow. I was, after all, the world’s best actress. That was one of the few things that I truly knew.

Northern Wisconsin had always been my home, until I was old enough to run away. It wasn’t graduating from high school and moving on with my life as it appeared. And now the monster was back in my life, invading the new life I had created because my sisters told me he had changed. And I so desperately wanted to have a normal life, have my children meet their grandparents. I thought I was living a normal life.

From the moment he walked in the door, I was catapulted into a life I thought I had overcome by sheer willpower. My artwork wasn’t as good as my sisters. My sister’s home was nicer than mine. My son’s name had become “the kid” and my daughter the object of his affection. Mom turned a blind eye and smiled her angelic smile that kept me alive for so many years. A blanket of warmth in an otherwise cold world. Did she know? Had she ever known?

I knew what was happening. He made no secret of it and flaunted the dare for me to try and stop him. He knew just as much as I that I was powerless against him. I was still that helpless child and could not touch him. Twenty years later, and I still could not defend myself or my daughter.

After he left, after surviving my fantasies of pushing him down the stairs, I continued to see his presence throughout my home. He was everywhere and everything was stained with his malice. It was during this time that I also found out the person who had helped me create this safe environment had betrayed me – many times over. My world was gone. The person I had created was gone. All safety and trust was nothing but a shadow that grew darker and more powerful than it ever had before. It was then that I knew I could not survive without help.

As I’ve learned throughout the process, not every psychologist or psychiatrist is the same. My first set was not a good fit for me and did not recognize all of the packages I had created for myself over the years. And then one day, after having left therapy for almost a year, I found him. We’ll call him Max. My first session with him, I don’t even remember – how could I be talking about this stuff with a man? Men can’t be trusted! My father and husband proved that to me. But he was a trauma specialist, and the one approved by my insurance company as being certified in EMDR. Eye Movement Desensitization and Reprocessing – the therapy technique I had researched that would help me get past those horrid memories. My last hope.

Working with Max, I discovered many things about myself and the strategies I had created to survive. Everyday, more techniques are uncovered. Some quite painful to remember, some okay to keep using, some are what they are. Baby steps. Every day, baby steps. I had no idea that the sexual abuse I underwent as a child and teen could create so many effects. I created an entire life around a belief system that was tainted with memories from the heinous crimes, disguised under a premise of love.

I thought I was the unloving daughter who, one day, would not submit – Pandora’s Box opened after that. Then I became the outcast, the undeserving child, the child who was no good at anything and useless. The child of everyone’s jibe and ridicule. This began a new belief system. I thought everyone was the same as my family, experienced the same things and that I was the one who was strange. Until Max, gentle, over time, showed me that it wasn’t my fault. That I wasn’t strange and my childhood was not the norm.

Max gave me a list of Assertive Rights to use as a guide to help build a new foundation. I still have trouble accepting them. Why do I deserve these rights? I truly do not understand how someone like me deserves respect or to let my feelings known or to say that I am unhappy. It took six months before I could accept that my life was created around an unhealthy belief system. I hadn’t even known what a belief system was, much less that I could possess one. My life has been one as a reactionary. I’m still grappling with the idea that I have control over where my life goes. That concept is simply beyond my paradigm. For 41 years, I have simply just existed, taken whatever was handed to me and accepted the fact that I could never be loved or cared about because I am unworthy.

We uncovered Dissociative Identity Disorder, which I evidently created as a small child to protect myself from the hurtful things that my father was doing. I’ve always wondered where those “mood swings” came from. To date, there are six of us inside this body, which I still do not claim as my own. Max uses hypnosis as a way to deal with their thoughts and behaviors because I have realized that it is much safer to look at these gruesome memories in the safer environment of hypnosis. He is showing them and teaching me, that they are valuable and validating them through homework assignment. Something as simple as coloring for the younger ones and journaling for the older ones.

Although I’d begun to have memories of being sexually abused by my father before I began therapy, I didn’t think that had a whole lot to do with my problem, which was the tortured reaction I experienced when I heard certain everyday sounds: breathing, chewing, sniffling… I would go from being almost catatonic in my depressed withdrawal to, at other times, a fit-throwing rage to self injury to plans for a quick and painless suicide. I found a therapist whom I believe was God-sent, with whom I still work.

During sessions, sometimes I would feel as if I were being sucked into a big, gray cloud; other times as though I were falling into a deep, black velvety hole. I’d fight hard and make it back to continue whatever we’d been discussing. This “going away” happened at other times; I’d just never really talked about it before. One time, the grayness pulled me away, but I didn’t come back. Instead of me, a 30-year-old, extremely depressed and repressed woman, a 15-year-old, bubbly and happy girl named Katie started talking to my therapist who, God bless her, never missed a beat, and spoke respectfully to Katie, listening to her complaints about me, of which she had many!

Over the next several months, I learned that I had a dissociative identity disorder (DID). Different “parts” of me (who had memories that I did not ) would come out in therapy and at home. They revealed a life of abuse and torture that I had kept hidden from myself. These parts experienced things that my mind could not bear at that time and remain sane. They split off from me and kept me functioning in the everyday world while my father and, later, people in a satanic cult, performed horrible acts upon my mind, body and emotions.

Over the course of uncovering the memories, I struggled with desperate doubts. Who would want to believe that such things could happen? It wasn’t until I read about other survivors of such abuse that I knew I wasn’t alone, and that these atrocities really did happen. I was hospitalized several times during really rough patches, when the memories would trigger suicide plans and increased self harming. Once I was on a psych unit with other survivors of satanic ritual abuse (SRA). Developing relationships with these men and women was very healing (although the hospital program itself wasn’t as helpful). But, to talk to people who had experienced atrocities similar to me and who I saw as wonderful, creative, intelligent and compassionate, helped me to see myself as more than the slime I’d been programmed to see when I looked at myself.

Throughout all this, my therapist has been my strongest support. She disagrees with my self-assessments when I am brutal about myself and redirects self-hatred to anger towards the people who hurt me. She has helped me see that I am not who the abusers programmed me to become, and that I am stronger than they told me I was. She has not given up on me. She has, step by step, helped me to uncover the lies I have believed all my life because the abusers, who had such power over me, told them to me.

I believed that I would die if I remembered.
I remembered, and I’m still alive.
I believed that I would die if I told.
I told, and I’m still alive.
I believed I was worthless and disgusting.
I’m still working on that one.

As their stories became mine, various alters were absorbed into the whole of the real me; they also are the real me. As I continue to draw and write and cry and remember and rage and take three steps forward and two steps back, different parts of me perform different functions. As I raised my daughter, an alter called “Good Mom” took over sometimes. When I was teaching in the public schools, the extremely organized “Monica” taught my students when I couldn’t. When I needed to experience anger but was too afraid, “Sofya” got angry for me.