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

AmnesiaSchizophreniaDissociativeBorderline Personality DisorderDissociative AmnesiaDissociative DisordersDepersonalizationDerealization
Book:Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders
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“Self-destructiveness may be a primary form of communication for those who do not yet have ways to tame their excruciating inner conflicts and feelings and who cannot yet turn to others for support.”

CuttingEmotional PainSelf HarmBorderline Personality DisorderSelf InjuryInner ConflictTrauma SurvivorsEmotional WoundsCommunication ProblemsInner PainBorderline PersonalityExcruciatingSelf Destructiveness
Book:Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders
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“The term dissociation is ordinarily used to describe the phenomenon of compartmentalization or fragmentation of mental contents. It does not ascribe any particular mechanism by which the dissociative process occurs. Does dissociation occur as a result of automatic, nonconscious processes, or are there other specific mechanisms by which it occurs? Especially in the context of describing amnesia, the term repression is widely used in connection with several different mechanisms. As it is commonly used, it often implies how individuals may block our memories of uncomfortable or conflictual experiences. If done consciously, the mechanism is more accurately called suppression, which results from actively trying not to think about negative experiences.”

PsychologyChild AbuseRapeRepressionDiagnosisDissociationChild Sexual AbuseAbuse SurvivorsPsychotherapySuppressionIncestDefinitionUnconscious MindTraumatizedFragmentationRepressed MemoriesDissociative AmnesiaDissociative DisordersChild Sexual Abuse SurvivorRecovered MemoriesChild Abuse DeniersTrauma MemoriesCompartmentalizationClergy AbuseRape SurvivorsDefence Mechanisms
Book:Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders
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“Switches among identities occur in response to changes in emotional state or to environmental demands, resulting in another identity emerging to assume control. Because different identities have different roles, experiences, emotions, memories, and beliefs, the therapist is constantly contending with their competing points of view. Helping the identities to be aware of one another as legitimate parts of the self and to negotiate and resolve their conflicts is at the very core of the therapeutic process. It is countertherapeutic for the therapist to treat any alternate identity as if it were more “real” or more important than any other. Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision”

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

PtsdNumbDissociationTraumatizedPosttraumatic Stress DisorderAvoidantTraumatic StressFlashbacksDissociatedIntrusive Thoughts
Book:Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders
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“The DID patient should be seen as a whole adult person with the identities sharing responsibility for daily life. Despite patients’ subjective experience of separateness, clinicians must keep in mind that the patient is a single person and generally must hold the whole person (i.e., system of alternate identities) responsible for the behavior of any or all of the constituent identities, even in the presence of amnesia or the sense of lack of control or agency over behavior. From p8 International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision: Summary version. Journal of Trauma & Dissociation, 12, 188–212.”

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

RepetitionCompulsionRepressionTraumatizedFreudInner ConflictRepressed MemoriesDissociative AmnesiaComplex PtsdChild Sexual Abuse SurvivorRecovered MemoriesTraumatic MemoriesRepeating The PastReliving The PastDissociated MemoriesReenactmentRepeating Past Mistakes
Book:Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders
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“Instead of showing visibly distinct alternate identities, the typical DID patient presents a polysymptomatic mixture of dissociative and posttraumatic stressdisorder (PTSD) symptoms that are embedded in a matrix of ostensibly non-trauma-related symptoms (e.g., depression, panic attacks, substance abuse,somatoform symptoms, eating-disordered symptoms). The prominence of these latter, highly familiar symptoms often leads clinicians to diagnose only these comorbid conditions. When this happens, the undiagnosed DID patient may undergo a long and frequently unsuccessful treatment for these other conditions. - Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, p5”

TraumaSubtleTypicalSymptomsPtsdDissociative Identity DisorderDissociationHiddenDissociative DisordersMental DisordersAltersMental Disorder BiasAlternate IdentitiesNot Obvious
Author:James A. Chu
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“Extreme versions of DID occasionally develop in response to particularly horrific ongoing trauma (e.g., children exploited through involvement in years of forced prostitution), with so-called poly-frgamentation, encompassing dozens or even hundreds of personality states. In general, the complexity of dissociative symptoms appears to be consistent with the severity of early traumatiation. That is, less severe abuse will result in fewer dissociative symptoms, and more severe abuse will result in more complex dissociative disorders.”

Dissociative Identity DisorderDissociative DisorderDissociative DisordersPolyfragmentedDissociative SymptomsChild Sex RingChild ProstitutionChild Sexuall Abuse
Book:Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders
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“Unspeakable feelings need to find expression in words. However... verbalization of very intense feelings may be a difficult task.”

CuttingTraumaOverwhelmedUnbearableEmotional PainUnspeakableSelf HarmTraumatizedSelf InjuryTrauma SurvivorsHealing From AbuseHealing TraumaSelf Destructive BehaviorEmotional RegulationSelf DestructivenessVerbalization
Book:Rebuilding Shattered Lives: Treating Complex PTSD and Dissociative Disorders
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“The difficulties in diagnosing DID result primarily from lack of education among clinicians about dissociation, dissociative disorders, and the effects of psychological trauma, as well as from clinician bias. This leads to limited clinical suspicion about dissociative disorders and misconceptions about their clinical presentation. Most clinicians have been taught (or assume) that DID is a rare disorder with a florid, dramatic presentation. Although DID is a relatively common disorder, R. P. Kluft (2009) observed that “only 6% make their DID obvious on an ongoing basis” (p. 600). - Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision, p4-5”

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Author:James A. Chu
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