Article On Spectrum Of Dissociation

[anthony]

From my knowledge, many diagnoses overlap within one another... which is a huge cause of why so much confusion reigns from www self-diagnosing persons who read and list, check the box numbers and tell themselves they got something they haven't.

So yes... I completely agree that many overlap, and that includes trauma.

That should not ever be taken though that trauma is a root, because that is not the case in many diagnoses that trauma is already recognised, like you're highlighting... it is only highlighted typically that trauma can be a factor within other diagnoses, not the actual cause, which is succinctly different.

 

[jka37]

Not even close... DID and PTSD are nothing even close to similar in diagnostic criterion.

PTSD is the extreme end of anxiety disorders based on trauma.

DID is an extreme disorder at the dissociative spectrum. Whilst DID patients are typically based on trauma, the two are not synonymous.

One has nothing to do with the other.

Anthony, I'd have to disagree with your statement that my comment is "not even close." I also disagree with your statement that PTSD and DID don't have anything to do with each other. Nearly all the materials I have read about DID include PTSD on the dissociative spectrum...meaning they have at least SOMETHING to do with each other.

Notice the location of PTSD on the dissociative spectrum chart below.

Taken from Link Removed, the website listed in the first post of this thread.

I agree that the two are not synonymous, but I affirm a relationship between the two. The diagnostic criteria is not the way I was thinking of it, and is not the only way to consider similarities between disorders. Most DID sufferers also have PTSD symptoms, and as I said earlier, flashbacks (a major feature of PTSD) can be considered a form of dissociation. For me at least, PTSD symptoms are what lead me to my DID, and I still deal with those symptoms each day.

Anyway, just wanted to let you know I disagree, I have read otherwise, and I wish you hadn't picked out a fragment of my sentence in the middle of a complete thought to pick at. I'm not sure why you did that.

 

[ericaboo]

No matter how you choose to define things - spectrums, cause and effect, genetic predispositions, it's all still in a process of scientific debate.

It can seem upsetting when you find a theory that resonates and helps one to make sense of what they are going through - only to find it is just one piece in a larger debate that is ever changing. I've been stung with that on multiple occasions.

What matters to me as a patient, is what current diagnosis and treatment plan serves my healing process and symptom management best at this point in time. I avoid talking about my diagnosis (label) to non-professionals because I know definitions or new realizations about my case could change the picture at any time, making me or my treatment team seem inept.

Yes, it's frustrating. I look forward to a future where the science becomes more solid.

 

[evergreen]

Glad to see more work being done in the way of disocciation.

 

[Loveneverfails]

This article was fascinating. I have just barely been able to admit to myself(and my T agrees) that I dissociate A LOT in my every day life. I would love to read more reputable information on this so I can better understand the levels of it to be able to better identify the patterns in my own life.

 

[anthony]

Taken from Link Removed, the website listed in the first post of this thread.

This is something an M.D. has created and made-up themselves. This has absolutely zero psychiatric viability. An MD decided to make an image including PTSD within dissociative disorders for their article.

It means nothing and is just another webpage on the world wide web with zero validity.

When the APA puts PTSD in a dissociative spectrum, then I will take notice. Until then... you have no chance on getting me to take notice of some random webpage created by an MD, who has no psychological / psychiatric qualifications to make such a statement.

The APA have put PTSD somewhere... on the anxiety spectrum, far far away from dissociative spectrum.

 

[Powder]

After doing further digging into the Spectrum presented in the article, I'd agree that it is not standard or APA, as Anthony states. Instead, it is a theoretical model or simple tool used by clinicians to help them recognize the levels of dissociation they see in patients with the diagnoses coming from psychiatrist's offices.

This doesn't mean I agree/disagree yet with this spectrum, as so far, I don't see any way to see it as unlikely; I just thought it was a starting place for inquiry, but I am not starting with as much education as Anthony. As Anthony said correctly, the placement of PTSD on this dissociation spectrum is irregular; PTSD doesn't always come with Dissociative symptoms. Therefore, this model is misleading if you want to be a purist and only look at PTSD.

I think it has merit from the standpoint of looking at levels of Dissociation for the M.D. which is what it was developed for.

I dug up the reference on Bennett G. Braun, a Psychiatrist who founded the first MPD unit in Chicago at a large hospital. He came under fire for his methods, and the model above is his BASK model. From what I can find on the web about him and his unit, he was sued by many patients. I see him as a psychiatrist desperate to be the forerunner on the MPD (DID) front before it's proper time. Since not much was known about DID then (in the late 70's) when he started work on the unit, he was premature in starting to offer expensive therapy for a diagnosis that still needs more study.

On the positive side, I learned that his attention into the DID field sparked professional interest and led to other discoveries and therapies that exceed his progress. So in that sense, it's good he "got the ball rolling." However, I think he ripped off some people in the zeal to go down in history as a great psychiatrist.

 

[anthony]

What annoys me about these hacks who do such silly things in the first place, is that you could put a myriad of diagnoses on that spectrum if you're going to take dissociative symptoms as your quantifier for including a disorder on a symptomatic spectrum. They only put PTSD on it to make a point, a point which is biased to try and make their cause.

IMHO, I would see dissociative amnesia, which is listed below PTSD, as far worse as a dissociative symptom those the minor dissociate symptom that is encompassed within PTSD itself. Geez, I could put the dissociative episodes contained in Bipolar and sleep disorders ahead of the one minor dissociative symptom of PTSD.

Such a scale is very assumptive IMO and extremely biased in trying to sway people towards untrue information.

I agree with everything on that scale, except for PTSD being upon it... as PTSD is primarily anxiety based due to trauma, with one dissociative symptom. Again, if that is the reasoning for inclusion, then it should have bipolar, sleep disorder, personality disorders and so forth on the scale, as many often have a dissociative symptom within them due to cross-over.

The above even explains why the APA can remove PTSD from anxiety disorders, because on the anxiety spectrum other anxiety disorders exist without any real cause. PTSD however is very specific, in that it cannot exist with an abnormally traumatic event occurring that causes the anxiety. The anxiety does not exist by itself without that traumatic effect, unlike other anxiety disorders.

If PTSD had anything remotely to do with dissociation, it would have been shifted to a dissociative disorder, which it isn't even close to.

 

[freeanimal]

Here is a passage from an actual APA abnormal psych book, without the flux of the world wide web.

"You may have noticed that DID seems very similar in its etiology to post traumatic stress disorder. Both conditions feature strong emotional reactions to experiencing a severe trauma. But remember that not everyone goes on to experience PTSD after severe trauma. Only people who are biologically and psychologically vulnerable to anxiety are at risk for developing PTSD in response to moderate levels of trauma. However, as the severity of the trauma increases, a greater percentage of people develop PTSD as a consequence. But some people do not become victims of the disorder even after the most severe traumas, suggesting that individual and psychological and biological factors interact with the trauma to produce PTSD.

There is a growing body of opinion that DID is a very extreme subtype of PTSD, with a much greater emphasis on the process of dissociation than on symptoms of anxiety, although both are present in each disorder.

Some evidence also shoes that the developmental window of vulnerability to the abuse that leads to DID closes at approximately 9 years of age. After that, DID is unlikely to develop, although severe PTSD might."


Understanding DID's etiology is extremely important as so much of the research accumulated is through case studies rather than on a prospective examination after a trauma has occurred. Almost all (97%) of the cases of DID are patients who had experienced severe trauma, specifically sexual or physical abuse.
The correlation between the two is more helpful in diagnosing/treating DID than PTSD.

 

[jka37]

Here is a passage from an actual APA abnormal psych book, without the flux of the world wide web.

"....There is a growing body of opinion that DID is a very extreme subtype of PTSD, with a much greater emphasis on the process of dissociation than on symptoms of anxiety, although both are present in each disorder."

Thanks for posting this. The opinion that DID is an extreme subtype of PTSD is something I have read in many places, and this explains it much better than I did.

 

[Eleanor]

Very helpful, thank you! And goes some way to explaining the ongoing debate. The gestalt is different depending on the population you focus on. If you focus on survivors of childhood abuse - the DID springs out and PTSD looks like one thing - if you focus on vets and adult trauma victims - the anxiety springs out and PTSD looks slightly different. "Its a duck! No, it's a rabbit!" Yes. That's what it are.

 

[maddog]

I have just returned hoem from 3.5 weeks in an in-patient trauma and dissociation programme. Almost all of my fellow patients had a DID diagnosis, a fact which shocked me very much. Those who did not, in most instances, carried another dissociative disorder diagnosis. To my knowledge, I was the only one with a PTSD diagnosis.

Nonetheless, again to my knowledge, everyone had extensive childhood trauma histories and many, many of the symptoms, issues, struggles, behaviours, feelings, thoughts etc were very common to all of us.

There was a large focus on the management of dissociative symptoms within the programme, and also on living with "alters". This was, to say the least, eyeopening for me.

I am not entering into the debate as to where certain diagnoses belong in the DSM or anywhere else, merely pointing out my own recent observations, and noting that one thing I did learn from the programme was that I do dissociate more than I had initially thought, and that true DID, while sharing many characteristics in common with PTSD, is very, very different.

Maddog