Dissociative Identity Disorder - and Multiple Personality Disorder

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A comparison of the differences between DID and MPD; a brief history of its classification in the DSMIII; case studies

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Lisa Lahey, B.Ed. Understanding Dissociative Identity Disorder

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Currently it is believed to be impossible to scientifically prove or disprove the existence of dissociative identity disorder. The name is poorly understood. To dissociate means to regard as disconnected; or to break association with something , permanently or temporarily . It does not imply that a human being can possess many personalities, hence the reason the term MPD was altered to DID. Watch 1993 E mmy Award winning film Multiple Personality Disorder: Documentary

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Watch Woman with 15 personalities – EEG Test Some researchers are attempting to prove the scientific existence of MPD/DID through the use of EEG tests. In one woman who allegedly possesses 15 personalities an EEG test didn’t register distinct brain wave changes between personalities. However muscle tension and heart rate became quite erratic. Distinct, physical differences were registered in the muscle tension and heart, but not in the brain waves.

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As late as the 1970s there was no official entry for multiple personality disorder in the DSM II (Diagnostic and Statistical Manual of Mental Illness and Personality Disorders). It had a minor label “ Hysterical Dissociative Disorder ” and lacked a code number. The DSMIII listed MPD as its own disorder, gave it a code number and defined its characteristics .

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In spite of its inclusion as its own disorder in the DSMIII , MPD remained a controversial and rare diagnosis. Debate continued among international committees of psychiatrists as to whether such a thing as MPD was actually possible and inclusion in the DSMIII did nothing to dispel the continued skepticism.

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A committee of experts was appointed to decide which disorders should be listed in DSM IV . Some experts argued that “everybody is born with only one personality. Therefore, there can be no such thing as a Multiple Personality Disorder . “ These professionals decided that patients believed they had more than one personality, rather than actually possessing multiple personalities. T hus the goal of therapy should not be integrating various (non-existing) personalities , but helping patients recover from the delusion that they had other personalities at all.

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When the decision was reported MPD suddenly ceased to exist. Now all multiples had Dissociative Identity Disorder or DID rather than multiple personalities . Multiples are now told they have a false belief about possessing alters. I n field studies and research, multiples were no longer considered " disorders of the personality " but rather a disorder of Identity or self, that hinged on the element of dissociation, and the whole process of the susceptibility to dissociate under traumatic circumstances before the age of 5.

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At its meeting in Vancouver , BC , Canada , the Executive Council of International Society for the Study of Dissociation (ISSD) adopted the Guidelines for Treating Dissociative Identity Disorder (Multiple Personality Disorder) in Adults . The guidelines proposed treatment for Dissociative Identity Disorder. They allowed that one to 20 percent of patients in psychiatric units, adolescent units, and in substance abuse , and obsessive compulsive disorder treatment, may meet DSM-IV-TR diagnostic criteria for DID .

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Psychologist Nicholas P. Spanos argues that most cases of MPD have been created by therapists with the cooperation of their patients and the rest of society. The experts have created both the disease and the cure. This does not mean that MPD does not exist, but that its origin and development are often, if not most often, explicable without the model of separate but permeable ego-states or "alters" arising out of the ashes of a destroyed "original self."

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The biological-genetic perspective that exists about MPD, is that there needs be an inherited ability to fragment into other selves. Yet a phenomenological analysis of behavior which takes that behavior at face value, or which attributes it to nothing but brain structure and biochemistry, may be missing the most significant element in the creation of the self: the sociocognitive context in which our ideas of self, disease, personality, memory, etc., emerge. Being a social construct does not make the self any less real however. Critics argue that Spanos should not be taken to deny either that the self exists or that MPD exists.

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Philosopher Daniel Dennett . exhibits minimal skepticism about the truth of the MPD accounts, and focuses on how they can be explained metaphysically and biologically. Critics argue that for all his brilliant exploration of the concept of the self, the one perspective Dennett doesn't seem to give much weight to is the one Spanos takes: that the self and the multiple selves of the MPD patient are social constructs, not needing a metaphysical or biological explanation so much as a social-psychological one.

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Abilities of the Human Mind The question of whether or not multiple personalities is possible within one person remains an ongoing debate among professionals. However the human mind is capable of many alternate forms. Consider the existence and effect of hypnosis, psychosomatic illness, catatonia and other alternative, extreme mental states. These are seldom questioned by the psychiatric industry yet the existence of MPD remains relatively unaccepted. Watch The Extraordinary – Multiple Personalities *** warning – may trigger***

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The primary difficulties in diagnosing DID result from lack of education among clinicians about dissociation, dissociative disorders, and the effects of psychological trauma resulting in clinical suspicion about dissociative disorders. Most clinicians have been taught that DID is a rare disorder with a florid, dramatic presentation. In fact, DID is a relatively common disorder which presents with subtle symptoms in a patient who may minimize or conceal symptoms.

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This situation among treating therapists regarding the diagnosis of MPD or DID is understandable considering the ongoing debate in the psychiatric community as to whether these disorders exist. A lack of consensus leaves room for considerable skepticism and confusion about dissociation. Yet there is almost universal acceptance of the diagnosis of dissocative amnesia and the dissociative state of depersonalization .

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In the Journal of the American Academy of Child Psychiatry, Dr. Paul McHugh published how to elicit " alters “ in a person who is not MPD. An alter might reveal itself but likely it will not. So the doctor elicits an alter by questioning such as, "Have you ever felt like another part of you does things you can't control?“ The doctor focuses on a set of behaviours by asking, “Can I talk to the part of you who is taking drives to the country ?” McHugh’s theory states that it is hysteria, suggestibility, and therapist manipulatio n that convinces female patients they are multiples when they are not. THE SKEPTIC

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THE REBUTTAL In the same Journal, Dr. Putnam responded to McHugh that, “hysteria was an epithet not a diagnosis and is now called borderline personality disorder; somatoform disorders, and multiple personality disorder. These patients have high rates of childhood trauma. MPD is not hysteria induced by asking about alters. The question is what can we do to alleviate their distress and help them become functional? These patients have a range of disturbances in self-representations, elevated levels of dissociation, anxiety, somatization, and high rates of suicide.” Watch early case of MPD

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Movies such as Sybil and The Three Faces of Eve, as well as television programs depicting MPD in a dramatic flair, such as The United States of Tara, lead to a misinterpretation of the function and presentation of alters. MPD usually presents as very subtle mood changes, sometimes accompanied by slight changes of facial expression. Very few people are able to detect a new alter. Sometimes MPDs are considered to be “ moody ”. Extreme change in dress, hairstyle and behaviour is rare and emerging only in exceptional circumstances. Watch the Many Faces of Toni Collette in Tara

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DID patients commonly present in a polysymptomatic manner with dissociative and PTSD symptoms embedded in many symptoms such as depression, panic, somatoform symptoms, eating disorder symptoms , that lead only to diagnosis of these co-morbid conditions. This results in long and frequently unsuccessful treatment. The alternate identities are intrapsychic entities with a sense of self, an emotional repertoire, and can process information. They might exhibit "being-in-the world" behaviors. They have aspects of both structure and process.

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One etiological model posits four factors that are required for DID: 1) the capacity for dissociation, 2) experiences that overwhelm the non-dissociative coping of the child, 3) secondary structuring of the DID alternate identities with individualized characteristics and 4) lack of restorative experiences that leave the child to find ways of comforting him/herself after overwhelming experiences. In particular, factor 3 phenomena appears to be very diverse and differs significantly from patient to patient.

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Another theory suggests that there is a failure of integration of systems of ideas and functions of the personality. Following trauma, the personality divides into an " apparently normal part of the personality " (ANP) for daily functioning and an " emotional part of the personality " (EP) for defense. Defense in this context is related to psychobiological functions related to survival in response to life threat such as fight/flight .

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T hese models suggest that DID does not arise from a previously mature, unified mind or "core personality " that becomes "shattered" or fractured . Rather, DID results from a failure of normal integration caused by overwhelming experiences and disturbed caretaker-child interactions leading to the development of discrete, altered behavioral states.

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In other words, the human mind does not begin as a whole which shatters or splinters into alters during extreme trauma. Instead unique behaviour states that have developed for survival are the result of early trauma, meaning there are no multiple personalities, but one personality. This personality exhibits modified reactions to trauma and daily situations that trigger uncomfortable emotions and memories.

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By contrast a clinical example that explains how MPD or DID functions is this: imagine a host personality, a child, who i sn’t confident about her math abilities but must complete math homework. An alter that is good in math would emerge to do the host personality’s homework. Suppose this same child becomes frustrated when she cannot tie her shoes. An alter who is capable of dressing the host and tying the shoes might emerge. Although the child remains functional she can never grow up since all of her learning experiences are performed by others. w atch who we are (drawings of alters) ***warning – may trigger***

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MPD AS A FUNCTIONAL BARRIER In early childhood, MPD or DID (whichever you choose to believe), functions to assist the child in avoiding trauma. Later in life however MPD/DID creates a different kind of fear and trauma in the multiple person. Now that dissociation is no longer needed as a coping mechanism, the alters create confusion as they fight for control over the body. Every now and then an alter “ slips out ” then departs again, leaving the MPD/DID patient bewildered to find him/herself in an unexpected and unrecognizable situation.

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The catch-22 of the situation however is that the core personality (if there is one) has not learned the basic survival instincts and daily functions she needs to succeed. These have been performed by her alters for many years or decades and as costly as their co-existence may be, she would be non-functional without them.

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Everyone Dissociates

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Daydreaming, becoming immersed in a book and unaware of our surroundings, carrying out a simple task while our minds are elsewhere are all mild forms of dissociation. Everyone experiences this type of dissociation. It is a healthy, if temporary escape from our environment. This is exactly the purpose of DID, although on an extreme scale. Other less severe forms of dissociation from trauma include depersonalization and psychogenic or dissociative amnesia.

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Range of Dissociative Disorders

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A case study of dissociative amnesia

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Mrs. CP experienced a milder dissociative amnesia. She is a 64-year-old widowed Filipino woman who came to see a psychiatrist at an outpatient mental health clinic. S he described episodes of “ sleepwalking ” during the day. She reported walking for blocks past a location and past an appointment time, and did not realize that she had done so until something distracted her. Mrs . CP talked in her sleep, and woke up to find the windows had been opened, or that the television or air conditioner had been turned on without her awareness. Watch Dissociative Amnesia An extremely rare opposite: Watch the Woman Who Can’t Forget

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The patient’s medical history was significant for hypertension, chronic vertigo, osteoarthritis, osteopenia, and gastroesophageal reflux disease. Following the evaluation, the findings were found to be consistent with major depressive disorder, mild cognitive disorder versus dementia, and that she had a history of post-traumatic stress disorder . Most significantly, the patient had a traumatic history and due to PTSD may have been predisposed to developing dissociative amnesia.

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DEPERSONALIZATION

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A feeling of watching oneself act, while having no control over a situation. Sufferers feel they have changed, and the world has become less real , dreamlike, or lacking in significance. Chronic depersonalization is related to individuals who have experienced a severe trauma or prolonged stress/anxiety. Depersonalization is the third most common psychological symptom of major illnesses and disorders. Numb Trailer – Depersonalization Disorder Matthew Perry – Numb - Interview

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Frequently depersonalization occurs as a symptom of a major illness or disorder. Mary is a 23 year old married white female with two children. She was sent to a psychiatrist due to a bad case of insomnia. S he would feel as if she had taken some type of drug. She reported feelings of extreme depersonalization and visual hallucination. She was very depressed. She experienced high levels of anxiety a nd stated she felt funny but could not explain these feelings. M ary suffered from panic attacks . S he had been hospitalized for schizophrenia many times. It was also discovered that she had undergone electro convulsive therapy and sleep treatments . Mary was diagnosed as schizoid – a form of schizophrenia. Watch Johnny Depp in a depersonalization scene. Watch Depersonalization Disorder in the News ***warning – may trigger***

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DISSOCIATIVE IDENTITY DISORDER

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Dissociative Identity Disorder mentally removes a person from the external environment during trauma. It is usually a response to childhood trauma, although a milder variation of it, dissociative amnesia , or a fugue state , can develop in adulthood .

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Self adherence occurs early in human development. It begins in early infancy . The effect other people and environment have on an infant defines the infant’s s elf, who she is as a person, and her place in the world. Severe and ongoing trauma during this essential process can cause such intensive damage that self adherence fails to occur and a single Ego or Self does not form. Watch Stop child abuse:

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To dissociate from one’s own identity implies splitting or disconnecting from the Self ; the absence of a single Ego in Freudian terms; a failure to achieve self adherence. (Adherence means to stay together, or to remain whole). SELF ADHERENCE Watch trauma and dissociation in children

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To further explain multiplicity, the process of ongoing trauma and the child’s dissociation prevents self adherence yet also protects the child from remaining in a situation that is too overwhelming for him or her. The child is unable to leave the situation physically so an alter is created to take his or her place, removing the child from trauma.

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Childhood Dissociation through Repetitive Trauma

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The most extreme means of escape in an unavoidable, traumatic situation is full dissociation. It is the ability to turn off an aspect of the external environment; trauma is not experienced as part of the Self. T his process prevents self-adherence and self-cohesion, resulting in more than one identity and frequently causing a break in reality. Trauma may be caused by childhood sexual and physical abuse however it may also be generated in other forms in the external environment (example child survivors of war).

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On the positive side, dissociation serves a variety of functions that protect the psyche: Removal of trauma Dissociation from physical pain Escape from overwhelming emotions, events, memories Amnesic response to ongoing trauma Creation of alters to deal with various daily situations and relationships Sustains ability to function within daily roles: work, home, community Watch I refer to myself as we

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Dissociation protects not only the psyche but the body too. During extreme pain dissociation removes the sufferer from the experience, acting as an anesthetic. An alter forms who accepts the abuse and pain, meaning the brain and body are still brutalized. Watch Multiple Personality Disorder - amazing stories – 2/5 *** warning – may trigger ***

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Trauma does not have to be ongoing, ritualistic or repetitive in order to result in a dissociative personality. A single episode of severe trauma can cause a split in identity . A classic example of this is Christine Sizemore’s experience as a 2-year-old who first dissociated after witnessing a man’s death in a sawmill. Watch multiple personality disorder on hard talk 1 of 3 – BBC interviews Christine Sizemore

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TREATING THE MPD/DID Individuals with DID fall into one of three categories: low, middle, or high trajectory groups . T he low trajectory group is not ready to work on traumatic memories. The middle trajectory group can deal with trauma work occasionally. The high trajectory group can deal with trauma work although not within an uninterrupted structure. R esearch revealed that treating traumatic memories is one of the most important and painful parts of therapy. Patients often require hospitalization during this time. The therapist should not attempt to deal with the trauma early in therapy rather, to first establish safety and trust.

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In the 1950s, Christine Sizemore’s experience was documented in a flawed fictional film entitled The Three Faces of Eve. Here is an original documentary of Christine in her 20’s while receiving therapy. The phenomenon of multiple personality disorder gained significant exposure after the movie’s release. However years later S izemore revealed that her two therapists misled the public and herself in terms of the extent of her illness . Watch project Eve the Three Faces of Eve

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Children who live in the foster care system or in orphanages may be susceptible to DID. Ongoing abuse, frequent moves and a lack of bonding in foster care triggers the progress of multiplicity. Institutions such as orphanages unknowingly employ workers who sexually abuse children. Even children who aren’t sexually abused in orphanages and other institutions can become victims of DID . Watch I am Annora : A True Story of Surviving Multiple Personality Disorder ***warning – may trigger***

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In large institutions, babies may not receive enough eye contact, physical contact, and stimulation to promote proper physical, social or cognitive development. This is particularly true of infants under three years of age. In the worst cases, orphanages can be dangerous and unregulated places where children are subject to abuse and neglect . The Bucharest Early Intervention Study reports to the severe side effects of the institutionalization of children .

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Orphanages are places that lack nurturing and bonding. Prison orphanages, where children whose parent/s are in prison are housed, exist in various parts of the world. T he treatment of these children is substandard. Infants are tended to but not loved. As children age they are expected to participate in significant household maintenance chores. Rules are rigid, punishment is severe, and there is little time for play and recreation. The Willowbrook video reflects inhumane treatment of institutionalized “mentally retarded” children. Watch willowbrook – the last great disgrace preview ***warning may trigger***

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Early Infant Development We learn more in our first few years than we will in the rest of our lives. Between 4 and 7 months , babies differentiate between strangers and people they know. During this time babies manifest anxiety when exposed to inconsistent or poor parenting. Some researchers believe that newborns have the ability to remember and that a baby can remember his mother's smell at 10 days old. Bonding Tip: Giggles have serious benefits

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Infants and toddlers manifest signs of trauma through bedwetting, long periods of crying, a failure to thrive, a failure to bond with one or both caregivers, low weight, a reluctance to participate in social activities, and general anxiety. Watch bonding tip: there ‘s never too much closeness

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As early as a few weeks old, newborns understand tone of voice , and an infant becomes soothed by a calm voice, and distressed by a loud voice . Babies use their senses to take in information about the world around them every moment. Although they can't interpret what they take in for the first months, they are storing up knowledge to help them do this later. Watch bonding tip: talk to her

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Bonding during early infancy is essential for self identity and self adherence. Neglected infants, or those with “ failure to thrive ”, don’t achieve the same success as their peers in later years in terms of academics, behaviour and social skills. Even when removed from a neglectful environment, children lack the ability to form successful future relationships. THE IMPORTANCE OF BONDING Watch Bonding Tip: A Mother’s Touch

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An inability to bond and a denial of bonding do not usually result in DID. S evere neglect can result in DID but not as frequently as physical and sexual abuse. Often the victim of neglect lives as a social isolate, making few friends and unable to maintain an intimate long-term relationship. Friendships tend to be superficial, the victim keeps people at “arm’s length”.

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SEVERE NEGLECT AND FERAL CHILDREN

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The effects of profound and ongoing childhood neglect: A girl raised in a kennel by dogs. Watch Ukranian Girl Raised by Dogs l Police discovered a young girl who had been kept in captivity by her parents and raised by their dogs. All of her behaviours were feral – she barked, was unable to talk or stand, moved about on all fours, and exhibited many other bestial behaviours .**warning - video may trigger**

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Genie is the pseudonym for a feral child who spent the first thirteen years of her life locked inside a bedroom strapped to a potty chair. Hers was the most severe case of social isolation ever documented . Genie lived with researchers who studied her, foster homes, her mother's house, and finally a sheltered home for adults with disabilities. S he is a ward of the state — the location of the institution and her name remain undisclosed. ***warning – video may trigger*** Severe Neglect and Lack of Bonding Watch Secret of the Wild Child Part 1

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Upon her discovery, Genie’s parents were arrested under charges of child abuse. Her father believed she was retarded since birth. B elieving he was protecting her, he isolated her for 13 years. He frequently abused Genie and punished her severely any time she made noise, including attempts at speech. Genie’s mother, frail and nearly blind, claimed she was a victim of her abusive husband. Not long after his arrest, Genie’s father committed suicide. Watch sociology – Genie Wiley ***warning – may trigger***

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REACTIVE ATTACHMENT DISORDER

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REACTIVE ATTACHMENT DISORDER Most sexually abused children do not develop DID. RAD is another more common and profound consequence of infant and early childhood abuse. The child seldom learns to trust, becomes physically violent and dangerous toward her family, and learns to sexually abuse others. It is highly unusual for RAD children to heal and become capable of healthy human relationships. Children of Rage – The Documentary details the experience of one such child abuse victim and her adoptive family . ***warning – may trigger***

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Effects of Childhood Sexual Abuse

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Forms of Abuse s exual abuse p hysical abuse s ilent treatment insults mockery annihilation accusing threatening n ame-calling denial l tactlessnes s humiliation lying exploitation Watch signs of emotional abuse

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Watch extraordinary people: the woman with 7 personalities: part 1 d elinquency criminal behaviour drug abuse failed relationships self-destructive behaviour s elf-mutilation suicide d ropping out of schoo l prostitution l ow self-esteem s exual assault against others Effects of trauma during early childhood ***warning - video may trigger***

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A Case Study of a Woman with DID/MPD Watch dissociative identity disorder part 1 of 2 Ms. ME was referred to a psychiatrist by her pastor when he decided he was unable to provide her with suitable counselling. Ms ME self-injured by slashing her arms, legs and abdomen with a razor and she had no memories of her life prior to the age of 14. During initial counselling sessions with her therapist Ms ME registered no emotion and spoke about herself almost from a third person perspective. Ms ME stated that strangers often approached her calling her by different names, while she had no knowledge of them.

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Ms ME’s therapist requested that she keep a journal of her daily activities and to bring it with her to her sessions. As suspected, Ms ME registered several distinctly different handwritings and mentioned a number of different names that seemed to belong to one body. Miss ME remembered only an ordinary family as she grew up, with no recall of abuse or anything dysfunctional in the family dynamic. She was often accused of lying about things she had done since she had no recollection of them.

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WHAT ARE ALTERS? Alters are the alternate personalities or selves that reside inside a MPD or DID person. An alter is the entity that steps in to handle trauma or stressors from daily encounters and tasks while the “ host ” or “ core ” personality retreats into the mind. This process is known as switching. The core personality has no idea or memory of what the alter experiences while she is “ inside ”. Some psychiatrists believe this to be a type of amnesia or memory repression rather than the segregation of selves in a multiple.

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WHY DO ALTERS EXIST? To protect the core or host personality (if there is one) from trauma, and to shield the host from past trauma experienced during early childhood. The alters are so successful at stepping in for the core personality that switching and transference is nearly impossible to detect by other people, including family and friends. Even people who live with a MPD or DID are usually unaware of the disorder.

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Where do alters go when they aren’t “ outside?” Many enter into rooms of their own, with walls like a membrane: they see shadows and hear muffled voices through it. Somehow they know when they are needed and emerge to take over the body. One alter described the experience as being in a play, waiting in the wings for her turn to make an appearance. Watch Inside Dissociative Identity Disorder ***warning – may trigger***

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A lters are not fully developed, real people. They are superficial, two-dimensional people who perform a specific function, then go “ back inside ” until they are again needed. One alter might perform accounting and balance the cheque book, another might clean the house and cook, and still another might give birth to and care for a child. ***warning – video may trigger*** ALTERS: CHARACTERISTICS Watch clip from the film identity 2003

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Over time most “ singletons ” (people with one personality), mature, grow, and change. However a multiple’s alters never grow up, remain the same age as when they were “born,” or when they fragmented from the core, and forever maintain their own trauma and/or functions.

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INTEGRATION Usually the goal of therapy for a MPD or DID person is that of integration of the selves. This process fuses the fragmented selves into one unified personality. In that manner, recovered MPDs and DIDs can attempt to live a relatively “normal” life. Yet integrated multiples report that there are occasions when they feel the “ghost” of a fragmented self in certain situations. ***warning – video may trigger*** Watch haunted by myselves

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WHEN NOT TO INTEGRATE The multiple is unaccepting of the MPD/DID diagnosis. The abusers maintain a significant role in the multiple’s life. The multiple’s job performance is compromised by intensive therapy. The multiple has dependent children or spouse. The multiple has no support system. d octors/therapists disagree on the diagnosis. The multiple exhibits self-injury or suicidal ideation

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REMAINING FRAGMENTED Not all MPDs or DIDs wish to become a unified self. Some feel more functional as separate selves and refuse integration. There may or may not be a reduction of the number of selves during therapy. In this case the goal of therapy is improved communication among the selves . Ongoing therapy and the refusal of integration has proven successful. MPD

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Watch DID – Dissociative Identity Disorder – 1/2 Herschel Walker – Former Professional Football Player Herschel Walker penned a book about his experiences as a multiple. Growing up in rural Georgia, Walker was bullied for being overweight and a severe stutter. He turned those taunts into motivation, becoming a superior athlete . Walker self-trained by doing 5,000 pushups and sit-ups every day after school and running barefoot in 100-degree heat while pulling a 50-pound tire . Watch Herschel trailer

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One aspect of MPD or DID that has not been examined as thoroughly as their victims is the abuser. One therapist, Dr. Sam Vaknin , suggests that even the abusers are in a sense, multiples, due to their split personalities in public and private. Their acts reflect their inner world, a place of fear, insecurity and self-hatred. In addition, they see their victims as 2-dimensional caricatures rather than people. THE ABUSER Watch The Abuser’s Mind

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The abuser is motivated by low self-esteem and a lack of self confidence . They are vulnerable to criticism and so have a fear of being mocked, betrayed and abandoned . Abuse is a “last-ditch effort ” to exert control and re-establish oneself by annihilating the victim and possessing him or her. The abuser punished the victim for being a separate entity with her own needs, goals and values. Krandan : A Short Film ***warning – may trigger***

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The Adolescent Abuser Adolescent sex abusers typically are unaware that their actions against another child is unethical and damaging to the victim. The adolescent abuser doesn’t consider their sexual involvement with a child to be sexual abuse. She or he believes their actions are based on love and even insist that the two will be married one day. The prognosis for an adolescent abuser is very good. Watch new film tackles child abuse

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The Opportunist Typically this offender is on his second marriage with a stepdaughter or stepson. W hile drinking and alone in the evening the abuser finds an opportunity for sexual contact with his stepchild. This abuse is atypical of the offender and the prognosis is generally good. Watch abuser profiles 1 of 3

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THE ANTI-SOCIAL PERSONALITY DISORDERED CHILD MOLESTER A young person who rapes a child one day, robs a bank the next day, and breaks many other serious laws. This person feels society has cheated him or her; therefore he or she will take whatever is wanted without concern for others. Prognosis: poor w atch boyhood shadows clip 1 **warning – may trigger**

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MENTAL ILLNESS In rare cases mental illness accounts for the reason a perpetrator molests a child. Frequently this person has bipolar disorder and commits the rape/molestation during a full-blown mania. During full-blown mania the bipolar person doesn’t have self-control and is unaware of the right and wrong of his or her actions.

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Psychopathy and the Abuser The type of abuse committed against a multiple is extreme and ritualistic, much more so than “ domestic” or “ typical ” child abuse. Usually torture and participation in satanic cults are used in producing multiple mind states in a child. The abuse tends to continue for several years and is often undetected by extended family members, and people outside the family. Abusers take satisfaction in victimizing and humiliating the child. His or her main means of control is warning the child not to tell anyone or the child will be further harmed or killed. Watch satanic ritual abuse and secret societies ***warning - may trigger***

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THE RECESSION AND CHILD ABUSE Watch spotlight on child abuse ***warning – may trigger*** J ob loss and financial strain sometimes leave inexperienced child care givers at home with children, leading to severe child abuse injuries. During the national financial crisis, child abuse cases increased by 20 – 27%. However experts insist it is not the recession but increased reporting by hospitals that account for the increased stats in child abuse reports. The abuse cases at some hospital s became so numerous that counsellors had to turn away families seeking psychological counselling. Watch police find 4 children in filthy home

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Who Are Abusers? “ Pillars of the community ”, blue-collar workers, white-collar business people, anyone can be an abuser. Judge William Adams , who tries child abuse cases, is accused of child abuse after he delivered 17 lashes with his belt to his 16-year-old daughter after she pirated music on her computer. Adams insists “ I haven’t done anything wrong”. Watch When is discipline child abuse?

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The Abuser and Denial Even after being videotaped severely abusing his daughter, the judge made a public statement about his actions... The video circulating the internet and showing two parents disciplining their 16 year old daughter was posted for [false] reasons. William Adams regrets the inconvenience the post caused the Aransas County , Texas community. Judge Adams is confident that when the work ahead has taken it’s course with an opportunity for all sides to ask and answer questions, it will be concluded that Hillary Adam’s actions in 2011 were misguided and misleading.

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The Non-Offending Parent: The Silent Co-Conspirator? The judge's wife insists she was emotionally abused herself and that she was severely manipulated into assisting the beating . The judge's wife left the marriage due to the abuse, and has apologized and repented her part against her daughter. Mrs. Adams is quoted, " I am praying for my daughters and me and my family to heal in all ways from emotional and physical abuse, for the current and continuing abuse of my children and me that has been ongoing to end.” Yet showing signs of ongoing psychological disturbance Mrs. Adams suggested her daughters seek family counselling with their father’s approval.

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The “Non-Offensive” Parent This parent enables the abuser to abuse the child by assisting, ignoring, or approving of the sexual and/or physical abuse of the child. She or he claims not to be involved in the abuse since their role is not as the primary abuser, however their silent consent is as devastating to the child’s well-being as the abuser’s ritual abuse. Further, after disclosure of abuse from the child, the non-abusive parent typically tries to convince the child that she or he is mistaken or falsely accusing the offending parent. The child’s admission may result in emotional or physical abuse by the “non-offensive” parent. Watch she married a child sex abuser ***warning - may trigger***

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CYCLIC AL ABUSE Not surprisingly enablers are often themselves victims of child sexual and physical abuse. They have no concept of a healthy father or mother-child relationship and fail to recognize warning signs. Once disclosure occurs, this parent may feel very remorseful and filled with guilt. Often this parent avoids contacting authorities right away, hoping that the child is mistaken. Watch a true story of child sex abuse ***warning – may trigger***

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SIGNS OF SEXUAL ABUSE unusual interest in or avoidance of all things of a sexual nature Some non-offending parents, usually the mother, fail to recognize child sexual abuse, however the following are crucial signs: depression or withdrawal from friends or family seductiveness aspects of sexual molestation in drawings, games, fantasies fear there is something wrong with their genitals refusal to go to school s uicidal behaviour s etting fires

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Watch stop child abuse (all 3 videos) HEALING the FAMILY Family counselling is essential for child abuse victims to heal. The ritual abuse the child has suffered victimizes everyone in the family. Further, siblings need to understand that the parent-child relationship the victim and possibly themselves have had is unnatural and abusive. Above all the victim needs to understand that that s/he was not at fault.

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HOUSE TREE PERSON TEST The sexually abused child often draws a house without windows or doors, or with windows coloured in so no one can see inside. Red crayon tends to outline the house. Stark geometric shapes define the house. When prompted to add a chimney some psychologists interpret it as a phallic symbol.

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SELF-PORTRAITS Young children who have been sexually abused usually use geometric shapes when drawing a self-portrait. The figure has no arms although it may have legs. Often it is encapsulated, showing a lack of escape. w atch signs of abuse

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MPD AND THE FAMILY Usually disclosing MPD to the family is difficult for the multiple or DID. The family does not interpret symptoms accurately and refuses to accept the diagnosis. Accusations and anger can result from both the multiple and her or his family. Watch Mom defends boyfriend charged with abuse

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ACCEPTING THE DIAGNOSIS The diagnosis of MPD or DID may prove traumatic to the patient. Proof of childhood abuse, denial, feelings of helplessness, loss of control, and a grim view of the future are typical responses. Drug and alcohol abuse, and termination of therapy may result.

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CONFRONTATION C onfronting the childhood abuser(s) occurs under specific conditions: in the therapist’s office . patient does not abuse drugs or alcohol . patient accepts diagnosis of MPD/DID p atient is willing to confront the abuser(s) a busers no longer have power over the victim patient has a support system p atient is not suicidal w atch confronting your abuser p atient has examined her/his expectations

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AVOIDING CONFRONTATION MPD/DIDs shouldn’t confront childhood abusers when: s/he has unrealistic expectations a busers are involved in patient’s life p atient abuses alcohol or drugs patient may revert to “victim” behaviours patient is a teenager or younger p atient is homeless p atient is in an unstable/abusive relationship

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