Diagnosing Dissociation

Doctors and therapists have been trained to believe that DID (multiplicity) is very rare. They have also been trained that “when you hear hoof beats, look for horses, not zebras.” In other words, look first for the most common explanation of a set of symptoms. Once you have ruled out common diseases or conditions, start looking for the rarer ones. That’s common sense, but multiples are hardly zebras — they are far too numerous.

In the past, the most common misdiagnosis of multiplicity was schizophrenia. Why? Because both multiples and schizophrenics often hear voices. For multiples, it’s the voices of their alters or an auditory memory and the voices are usually heard inside the head. For schizophrenics, it’s auditory hallucinations and the voices usually seem to come from outside the head. This is not a hard and fast rule, because multiples sometimes hear the voices of their alters outside themselves, but it’s a good guideline.

Other things besides hallucinations – autism, flat affect and loose associations –  characterize schizophrenia and are not commonly associated with multiplicity (except if one particular alter has been made to be schizophrenic.) Autism in this context means extreme self-absorption, an inability to take other people into account, or not using words in the way other people do. Flat affect means that emotions are toned down to the point of seeming non-existent a lot of the time. And loose associations means being all over the place in one’s speech; rhyming, making up words, jumping from one thing to another. A description slang term is “word salad.”

Multiples are not misdiagnosed as schizophrenic as often these days, but it still happens. I believe that, today, the more common misdiagnoses are bipolar disorder, cyclothymic disorder (rapidly cycling mood changes), and borderline personality disorder. This is just my opinion and is not based on studies that I have read.

In this case, the therapist is not focusing on whether the client hears voices or not, but on mood changes. The main characteristic of bipolar and cyclothymic disorders is mood swings from elation, often to the point of mania, to depression. In borderline personality disorder, the mood changes are secondary to changes in perception and/or beliefs. Another person may be seen as all-good for a while and then suddenly seen as all-bad, with the emotions changing accordingly. (Look for a blog entry on borderlines on July, 2011.)

If somebody has DID, mood changes can be traced to switching alters.  Naturally, alters have different moods. Some are even created to ”hold” one emotion or another. Those that experienced the abuse tend to be depressed, hopeless, grieving, while those that dealt with the non-abusive world are more competent, social, and optimistic. So it makes sense that therapists, if they missed the multiplicity, would make these mood-based diagnoses.

PS. Andreas Laddis published “Dissociation and Psychosis in Dissociative Identity Disorder and Schizophrenia” in the Journal of Trauma and Dissociation, Vol. 13 No. 4, pp.397-413. I don’t have a citation for mood disorders and dissociation.

A Free Verse Villanelle

The calendar of events has been updated.

A villanelle consists of five three-line stanzas and one four-line stanza. In the first stanza, the first and last lines rhyme, and the first line of all the other stanzas rhymes with the first line of the poem. The middle lines of the first five stanzas all rhyme. The first line of the poem is repeated as the last line of stanzas two and four and the last line of the first stanza is repeated in stanzas three and five. Finally, the sixth stanza ends with the first and last line of the first stanza.

Got it? It’s really hard to do. By the way, it should make sense, too.

Mine has the right number of stanzas and the repetitions are correct. Nothing at all rhymes, which made it a lot easier.

To My Many

Memories resting on the sidelines
Ever present, never seen
One is many, many one.

Clothed in shades of tawn and russet
Decaying thoughts and fading blood
Memories resting on the sidelines.

Tawn and russet crusted bodies
All the same and all unique
One is many, many one.

Just below an opaque surface
Firmly past still yet present
Memories resting on the sidelines.

Slide along, you russet alters,
Your beings blend in tawny grace
One is many, many one.

Every alter once a body
Every body binding time
Memories resting on the sidelines
One is many, many one.

This doesn’t count as a villanelle, but I’m pretty sure it’s the best poem I have ever written. I love it because the horror that shattered my soul is only alluded to. Characteristics of alters are described, as well as how they function over time. The form of the poem places constraints on the expression of ideas and feelings, echoing the constraints that shaped my mental processes.

I wish I could write more poems like this. Actually, I wish I could write more poems, period. But, like memories, poems come when they feel like it, stay a while, and then become memories themselves. I am just an extension of my pen, a vessel that the poem uses to create itself.


If you would like some information on Halloween, there is an article in October of the 2011 archives.

Internal integration has never been a personal goal of mine. First, for years I didn’t believe I was multiple – just spacey. Then, when I started to conceptualize myself as multiple, I felt so fragmented that the concept just didn’t make sense. My fragments blend together to accomplish something, then blend back into the background. They integrate and disintegrate like drops in the ocean waves. No names, no personalities, just little bits and pieces in the vastness of my mind.

But I desperately wanted to integrate the ritual abuse into my daily life. I wanted to be able to hold the two realities in my mind at the same time; I had been abused in a Satanic context, and I was an average middle-class white lady. I would have been a soccer Mom if soccer had been popular back when my kids were little. I wanted both realities to be equally real to me.

My goal was to have RA woven seamlessly into my present. I wanted to be able to talk about it without having a panic attack. I wanted to feel sane if I didn’t talk about it for a few days. I wanted the little mini-flashbacks (flicks, as Trudy Chase calls them in When Rabbit Howls) to feel as normal as deciding to have a cup of coffee.

Now, after more than twenty years, the two realities are in constant motion, blending and unblending like my fragments. It feels much more comfortable.

My bookshelves reflected the stages I went through to accomplish my goal. Before I remembered, there wasn’t a single book on Satanism or ritual abuse. Then I started buying every book in sight until they crowded the novels, the cookbooks, and the reference books off my shelves. After many years, I said, “Enough!” and sent most of them off to a friend in order to form the core of a research library. Now 10%, at the most 20%, of the books on my shelves have to do with my abuse. There is room on my shelves and in my life for other interests. Both my books and my life are integrated.

I think this is an unusual definition of integration — and of multiplicity, for that matter — but then I am sure it means many things to many people. If you have integrated, partly or completely, what is it like for you? And if you haven’t, what do you imagine it to be?

Adapted from Survivorship Notes, Vols. 8/9 Nos. 12/1