Latest / RECOVERable: Mental Health and Addiction Experts Answer Your Questions / DID Trauma Response: Why Dissociative Identity Disorder Is a Survival Skill

Transcript

DID Trauma Response: Why Dissociative Identity Disorder Is a Survival Skill · RECOVERable: Mental Health and Addiction Experts Answer Your Questions

• 0:13
  SPEAKER_00: Dissociative identity disorder is in the DSM V.
• 0:16
  SPEAKER_00: So it's basically the existence of separate identities, personality states, alter personalities, parts that have their own separate names, usually ages, functions, memory banks, and so on.
• 0:28
  SPEAKER_00: Number one.
• 0:29
  SPEAKER_00: Number two is their switching, which different parts come out and take control.
• 0:33
  SPEAKER_00: And number three is when one part's out, the regular person has amnesia and doesn't remember.
• 0:38
  SPEAKER_03: Psychiatrist and dissociative identity disorder specialist Dr.
• 0:42
  SPEAKER_03: Colin Ross joins us to discuss the diagnosis and treatment of DID.
• 0:47
  SPEAKER_00: So you got to dissociate all that and stay very, very focused.
• 0:51
  SPEAKER_00: You use it in this complicated kind of way to cope with childhood trauma.
• 0:55
  SPEAKER_00: And it's repeated and repeated and repeated, and you can't escape it.
• 0:58
  SPEAKER_00: So where can you escape to?
• 1:00
  SPEAKER_00: Your mind's the only place to go.
• 1:02
  SPEAKER_00: So that's a survival skill.
• 1:08
  SPEAKER_03: Welcome to Recoverable.
• 1:10
  SPEAKER_03: I'm your host, Terry McGuire.
• 1:11
  SPEAKER_03: Today we begin a deep dive into dissociative identity disorder or DID, a condition that is often wildly misunderstood and heavily sensationalized in pop culture.
• 1:23
  SPEAKER_03: We're joined by psychiatrist and leading trauma expert Dr.
• 1:26
  SPEAKER_03: Colin Ross to unpack what DID actually is and just as importantly, what it is not.
• 1:33
  SPEAKER_03: A quick note: if you see yourself or someone you know in what you hear today, please be sure to tune in for part two when we'll discuss diagnosis, treatment, support, and reasons for hope.
• 1:44
  SPEAKER_03: Dr.
• 1:44
  SPEAKER_03: Ross, welcome to Recoverable.
• 1:46
  SPEAKER_03: Thank you for having me.
• 1:48
  SPEAKER_03: Before we jump into the questions, I wanted to ask you if you have a message or a takeaway or an understanding that you want the audience to have at the end of this conversation about dissociative identity disorder.
• 2:02
  SPEAKER_00: Paul Parkish, same as schizophrenia bipolar disorder.
• 2:07
  SPEAKER_00: It's a normal reaction to trauma, but it requires the ability to dis to dissociate.
• 2:12
  SPEAKER_00: Not everybody's good at that.
• 2:14
  SPEAKER_00: And if you roll up your sleeves, stick with it, work hard, you can make amazing recovery.
• 2:20
  SPEAKER_00: Good to know.
• 2:21
  SPEAKER_03: We're going to start with our lightning round of myth or fact questions.
• 2:24
  SPEAKER_03: These are just short answers.
• 2:25
  SPEAKER_03: And as you'll notice later when we get into it, some of these same questions will come up, but then we'll have time to dive into it more.
• 2:32
  SPEAKER_03: So, Dr.
• 2:32
  SPEAKER_03: Ross, myth or fact.
• 2:34
  SPEAKER_03: Dissociative identity disorder is the newer medical term for what we used to call multiple personality disorder.
• 2:39
  SPEAKER_00: Aaron Powell That's a fact.
• 2:41
  SPEAKER_00: So it was called multiple personality disorder and several other things back to the 19th century.
• 2:47
  SPEAKER_00: I was on the committee for DSM IV, which was the 1994 edition of the manual, and we had a bunch of discussion.
• 2:54
  SPEAKER_00: Should we change the name, not change the name?
• 2:56
  SPEAKER_00: And the reasoning behind it was it's sending all kinds of people off into incorrect thoughts about multiple personality disorder.
• 3:05
  SPEAKER_00: There's not literally separate people or personalities in there.
• 3:08
  SPEAKER_00: So we thought that DID dissociative identity disorder sound a little more sensible, straightforward.
• 3:15
  SPEAKER_03: We'll get into that more.
• 3:16
  unknown: Dr.
• 3:17
  SPEAKER_03: Mitherfact, dissociative identity disorder is actually a child's brain defense tool.
• 3:23
  SPEAKER_00: Yes and no.
• 3:24
  SPEAKER_00: It's yes that it develops in childhood usually as a way of coping with severe, complex trauma, but it doesn't stop in childhood.
• 3:33
  SPEAKER_00: Now you're 30 years old, you still have it.
• 3:35
  SPEAKER_00: So it's child, adolescent, and adult disorder.
• 3:38
  SPEAKER_03: Aaron Ross Powell Myth or fact people with dissociative identity disorder are highly dangerous and prone to violence.
• 3:44
  SPEAKER_00: Aaron Ross Powell That's definitely a myth.
• 3:46
  SPEAKER_00: And it's true of schizophrenia, bipolar mental illness in general.
• 3:50
  SPEAKER_00: There's a lot of research showing, uh, and it's the official position of American Psychiatric Association, that people with mental illness are more likely to be assaulted than to assault somebody else.
• 4:01
  SPEAKER_00: And if you sort of statistically control for substance use, there's a slightly increased rate of violence in mentally ill people, but it's all due to the substance abuse, not the mental disorder itself, which is also true of dissociative identity disorder.
• 4:16
  SPEAKER_03: Aaron Powell Myth or fact.
• 4:18
  SPEAKER_03: Dissociative identity disorder is the exact same thing as schizophrenia.
• 4:22
  SPEAKER_00: That's a myth.
• 4:24
  SPEAKER_00: And we could do the quick explanation or the five-minute explanation, but uh they have overlapping symptoms, which is hearing voices.
• 4:33
  SPEAKER_00: And a lot of psychiatrists just go voices, schizophrenia, medication.
• 4:37
  SPEAKER_00: But actually they're distinct and separate.
• 4:39
  SPEAKER_03: And we will get into that distinction in more detail when we get to the longer questions.
• 4:43
  SPEAKER_03: Myth or fact, Doctor, you can suddenly develop dissociative identity disorder as an adult due to a major shock or trauma.
• 4:50
  SPEAKER_00: Aaron Powell It's a fact, but also kind of a myth.
• 4:53
  SPEAKER_00: So the huge majority of cases, it's a childhood trauma that's chronic, that went on for a long time, was severe, and you develop whatever number of altar personalities.
• 5:05
  SPEAKER_00: As an adult, if you already have DID, you can spit off a new altar because the salt or something happens.
• 5:11
  SPEAKER_00: No DID whatsoever, big trauma happens, you create a new part for the first time.
• 5:17
  SPEAKER_00: Rare but not impossible.
• 5:19
  unknown: Okay.
• 5:20
  SPEAKER_03: Myth or fact, Doctor.
• 5:21
  SPEAKER_03: Dissociative identity disorder is extremely rare and affects almost no one.
• 5:26
  SPEAKER_00: That's absolutely a myth.
• 5:27
  SPEAKER_00: And there's really hostile mental health professionals who say that that's the case, which is entirely based on attitude, not the literature or the statistics.
• 5:36
  SPEAKER_00: It's about as common, and there's research in many different countries, many different languages.
• 5:41
  SPEAKER_00: It's about ballpark as common as bipolar disorder schizophrenia.
• 5:47
  SPEAKER_00: About 1% of the general population.
• 5:49
  SPEAKER_03: Mytherfact, there is a specific prescription medication available that can cure dissociative identity disorder.
• 5:56
  SPEAKER_00: Aaron Powell That's a myth.
• 5:57
  SPEAKER_00: I wish it was true.
• 5:58
  SPEAKER_00: I wish it was true.
• 5:59
  SPEAKER_00: But there's no medications for dissociation as such.
• 6:11
  SPEAKER_00: Aaron Powell That's sometimes the case, uh but not always.
• 6:15
  SPEAKER_00: Sometimes the original person there's different language, so the birth personality, the original personality sometimes goes away at age four, five, six, and other parts take over then.
• 6:26
  SPEAKER_00: Uh sometimes the original birth personality just stays out front for the whole life.
• 6:31
  SPEAKER_00: It's variable.
• 6:32
  SPEAKER_03: Interesting.
• 6:33
  SPEAKER_03: Myth or fact, Doctor.
• 6:34
  SPEAKER_03: When people with dissociative identity disorder switch alters, it is always dramatic and obvious.
• 6:41
  SPEAKER_00: That's a myth.
• 6:42
  SPEAKER_00: Most of the time it's quite subtle.
• 6:44
  SPEAKER_00: And that's why it's often not diagnosed.
• 6:46
  SPEAKER_00: If it was so obvious, it would be diagnosed all the time.
• 6:48
  SPEAKER_03: Myth or fact.
• 6:49
  SPEAKER_03: A person with dissociative identity disorder or DID is always completely aware of what their altars do.
• 6:56
  SPEAKER_00: Aaron Powell That's a myth.
• 6:57
  SPEAKER_00: So part of the definition of DID is there's amnesia for when another part's out.
• 7:02
  SPEAKER_00: So if you have distinct other parts, they come out and take over, but there's no amnesia, then we call that other specified dissociative disorder, which is kind of three-quarters DID.
• 7:14
  SPEAKER_03: Myth or fact.
• 7:14
  SPEAKER_03: Integrating all altars into one single personality is the only way for a person with dissociative identity disorder to heal.
• 7:22
  SPEAKER_00: A myth.
• 7:23
  SPEAKER_00: But it depends a little bit on your definition.
• 7:25
  SPEAKER_00: If your definition is entirely integrated back into one person, then that's true.
• 7:30
  SPEAKER_00: But that's not necessarily the person's goal.
• 7:33
  SPEAKER_00: It's not necessarily necessary.
• 7:35
  SPEAKER_00: And there's kind of a cooperative group of people who all know each other, share all the information.
• 7:41
  SPEAKER_00: There's no amnesia, there's no chaotic switching.
• 7:45
  SPEAKER_00: That looks like recovery to me.
• 7:47
  SPEAKER_03: All right, we're going to get into the longer answers now, and you'll let be able to let it fly.
• 7:51
  SPEAKER_03: What is dissociative identity disorder?
• 7:53
  SPEAKER_03: And is it the same as multiple personality disorder?
• 7:57
  SPEAKER_00: Dissociative identity disorder is in the DSM 5, the official diagnostic manual of the American Psychiatric Association, also in ICD 11, which is the International Classification of Diseases, 11th edition, which is the World Health Organization.
• 8:13
  SPEAKER_00: So it's recognized all around the world officially.
• 8:16
  SPEAKER_00: And there's tons of publications and research support and so on.
• 8:20
  SPEAKER_00: So it's basically the existence of separate identities, personality states, alter personalities, parts.
• 8:27
  SPEAKER_00: There's a whole list of names that people use.
• 8:29
  SPEAKER_00: Some it could be your people, could be your inside people, could be your littles, could be your others, but more professional literature, it's identity states, alter personalities, that have their own separate names, usually ages, functions, memory banks, and so on, and are quite distinct and separate from each other.
• 8:50
  SPEAKER_00: That's number one.
• 8:51
  SPEAKER_00: Number two is their switching, which different parts come out and take control.
• 8:55
  SPEAKER_00: And number three is when one part's out, the regular person has amnesia and doesn't remember.
• 9:03
  SPEAKER_00: So there has to be distinct parts, switching, amnesia.
• 9:06
  SPEAKER_00: That's the official picture of it.
• 9:09
  SPEAKER_03: That sounds like the diagnostic things you're looking for.
• 9:13
  SPEAKER_03: What is it?
• 9:14
  SPEAKER_03: Why does it happen?
• 9:15
  SPEAKER_00: So my my answer to that is DID is a little girl imagining that the abuse is happening to somebody else.
• 9:22
  SPEAKER_00: That's my like normal language explanation.
• 9:25
  SPEAKER_00: So basically, kids can play this and that and take on these identities and be a superhero or be a space person or whatever.
• 9:33
  SPEAKER_00: That's just imaginative play, totally normal.
• 9:36
  SPEAKER_00: And not everybody is really, really good at that, but most people can do it some.
• 9:42
  SPEAKER_00: So that's like the whole human race foundation of it.
• 9:46
  SPEAKER_00: Then you step that up a little bit, you imagine it even more intensely, and you kind of get drawn into it, and it starts to seem to be a bit real to you.
• 9:54
  SPEAKER_00: And then along that track, you can have imaginary playmates, which you visualize, you talk to, they talk back to you, and you tell your family about them.
• 10:04
  SPEAKER_00: Family goes, Oh, that's her imaginary friend.
• 10:07
  SPEAKER_00: And usually that fades out, you know, by age 10-ish or so.
• 10:11
  SPEAKER_00: But if the imaginary friend is part of a kid who's being abused, neglected, all kinds of violence, then that can get reinforced, reinforced, reinforced.
• 10:20
  SPEAKER_00: And it's like the mind goes, This is too much, you handle that.
• 10:24
  SPEAKER_00: So the imaginary friend becomes a structured part inside.
• 10:28
  SPEAKER_00: And then there's way too much for one part to deal with, so then two, three, four, five, six, however, part, whatever the count is.
• 10:36
  SPEAKER_00: So it's basically just a this is too much, this is too overwhelming.
• 10:40
  SPEAKER_00: I gotta split it up into pieces.
• 10:42
  SPEAKER_03: So dissociative identity disorder is a is a coping mechanism, a trauma response for a child?
• 10:48
  SPEAKER_00: Yeah, it's absolutely a trauma response.
• 10:50
  SPEAKER_00: Not 100.0% of the time, but like 97 plus percent of the time.
• 10:55
  SPEAKER_00: I compare the basic foundation is the ability to dissociate, which is dissociate equals disconnect.
• 11:02
  SPEAKER_00: So disconnect from your memories, from your feelings, from your physical body sensations.
• 11:07
  SPEAKER_00: So somebody has been sexually assaulted many, many times, and they're trying to have healthy, normal sex with their boyfriend, but they freeze up emotionally.
• 11:16
  SPEAKER_00: They don't move.
• 11:17
  SPEAKER_00: That's the fight, flight, freeze response that mammals do.
• 11:21
  SPEAKER_00: But you can also not feel anything from your waist down because you've blocked out the physical sensation, because it's activating the trauma.
• 11:29
  SPEAKER_00: And you can split the trauma up into all kinds of different pieces.
• 11:32
  SPEAKER_00: So you can have a rush of fear, anger, out of nowhere for no apparent reason.
• 11:38
  SPEAKER_00: That's that little chunk of the total PTSD picture.
• 11:42
  SPEAKER_00: You can have the information, and you go, yes, Dr.
• 11:45
  SPEAKER_00: Ross, on the following date, an alarming effect occurred, which uh you may not want to hear all the details, but I could tell you, so it's just mental, intellectual, but all the trauma feelings are not there.
• 11:56
  SPEAKER_00: Or you can have the body sensation, so all these different bits and pieces, and they can come rushing back in different combinations.
• 12:04
  SPEAKER_00: So if you have DID and you have part that holds the memory and a part that holds the feeling, and a part that holds the body sensation, those things can intrude from inside where the part doesn't come out fully, or there can be a full switch where now that part's out front, and whatever it holds is now front-center stage.
• 12:23
  SPEAKER_03: Is there a reason some people would develop dissociative identity disorder and other people would react to childhood trauma differently?
• 12:30
  SPEAKER_03: Is it it's not a choice, I'm assuming?
• 12:32
  SPEAKER_00: Uh no, nobody sits down at age four and goes, hmm, I think I will develop the following.
• 12:37
  SPEAKER_00: Right.
• 12:38
  SPEAKER_00: So it's all the unconscious mind coping with things.
• 12:41
  SPEAKER_00: And the the basic skill was illustrated not on purpose when I was in medical school.
• 12:47
  SPEAKER_00: We watched a video of a woman having surgery, abdominal surgery, and she's, of course, lying down flat.
• 12:54
  SPEAKER_00: There's a curtain in front of her, in between her and where the surgery's happening.
• 12:59
  SPEAKER_00: Uh, her blood pressure is normal, her pulse is normal, she feels fine.
• 13:02
  SPEAKER_00: There's a nurse handing her little pieces of orange, no anesthesia whatsoever, just hypnosis.
• 13:08
  SPEAKER_00: So if you're really, really, really, really skilled at that, you can literally have surgery or childbirth or whatever with no pain at all.
• 13:17
  SPEAKER_00: If you're a Inuit hunter 200 years ago, it's 40 below, the wind's blowing.
• 13:23
  SPEAKER_00: You're standing at the seal hole, which is where the seal comes up to get air, and there's multiple holes, so you don't know when and at which hole the seal will come up.
• 13:32
  SPEAKER_00: So you've got to wait there with your spear for hours and hours and hours.
• 13:36
  SPEAKER_00: It's 40 below winds howling.
• 13:38
  SPEAKER_00: The snow will creak, as people in Wisconsin know, if it's really wind-packed.
• 13:43
  SPEAKER_00: So you can't be moving around, you can't take a bathroom break, your muscles are gonna be all aching.
• 13:49
  SPEAKER_00: You can't have your mind wander and the seal comes up and you miss it.
• 13:53
  SPEAKER_00: So you got to dissociate all that and stay very, very focused.
• 13:56
  SPEAKER_00: So that's a survival skill, and you better be good at it or your family's not gonna make it.
• 14:02
  SPEAKER_00: So it's basically a skill which is handy to have in all kinds of situations, and it's even required in combat.
• 14:09
  SPEAKER_00: So if you go into full PTSD panic mode, you're not gonna survive in the combat situation.
• 14:16
  SPEAKER_00: You have to dissociate.
• 14:18
  SPEAKER_00: So it's not a uh like a default, a fault, a failure, an abnormality, something wrong with your brain.
• 14:25
  SPEAKER_00: It's a skill, survival skill.
• 14:27
  SPEAKER_00: And then you use it in this complicated kind of way to cope with childhood trauma.
• 14:32
  SPEAKER_00: And childhood trauma doesn't mean just, you know, the neighbor did something once when you're nine.
• 14:37
  SPEAKER_00: It's uh physical abuse, sexual abuse, emotional abuse, neglect, family violence.
• 14:43
  SPEAKER_00: This is just inside the family before we get to what's going on in a lot of countries in the world.
• 14:48
  SPEAKER_00: Um, and it's repeated and repeated and repeated, and you can't escape it.
• 14:52
  SPEAKER_00: So where can you escape to?
• 14:55
  SPEAKER_00: Your mind's the only place to go.
• 14:57
  SPEAKER_03: It sounds like actually a pretty remarkable adaptation versus uh, I don't know, something freakish which it can be portrayed as in popular culture.
• 15:06
  SPEAKER_00: Aaron Powell Yeah, the movie Split is not good PR for dissociative identity disorder, and it's obviously not factual.
• 15:14
  SPEAKER_00: So I've never met somebody who bulked up by 80 pounds when the beast came out.
• 15:19
  SPEAKER_00: So it it makes it look scary, crazy, insane, dangerous, frightening.
• 15:26
  SPEAKER_00: But actually, most people with DID just seem like regular people.
• 15:30
  SPEAKER_00: And you may notice they seem to change their moods a lot or change their facial expression.
• 15:35
  SPEAKER_00: And then sometimes, especially if you're a family member, then it's an obvious switch and the person's like talking like they're 11 years old and they have a different name.
• 15:44
  SPEAKER_00: And but usually in life in general, it's quite subtle.
• 15:47
  SPEAKER_03: Aaron Ross Powell What is the biggest public misconception created by the old term multiple personalities?
• 15:53
  SPEAKER_00: The misconception and the reason for changing the name to dissociative identity disorder is we're saying that it's literally separate personalities or separate people inside.
• 16:02
  SPEAKER_00: None of that's literally true.
• 16:04
  SPEAKER_00: So it's that's similar to schizophrenia.
• 16:07
  SPEAKER_00: So somebody with schizophrenia hears voices talking, but they're not actually literally hearing voices talking.
• 16:13
  SPEAKER_00: There's not actually somebody there.
• 16:14
  SPEAKER_00: It's a symptom.
• 16:16
  SPEAKER_00: It's very real internally, subjectively, just not objectively real.
• 16:20
  SPEAKER_00: Same with DID.
• 16:21
  SPEAKER_00: These different parts are very subjectively real.
• 16:24
  SPEAKER_00: They take over, they behave differently, but they're not literally separate people.
• 16:28
  SPEAKER_00: So we wanted to get away from the literal.
• 16:31
  SPEAKER_03: Okay.
• 16:31
  SPEAKER_03: What are the causes of dissociative identity disorder?
• 16:35
  SPEAKER_00: Aaron Powell Almost all the time.
• 16:36
  SPEAKER_00: So in mental health, nothing's 100% uh, but almost all the time it's severe, chronic, inescapable childhood trauma.
• 16:44
  SPEAKER_03: Aaron Powell Is dissociative identity disorder only developed in children and only as a result of trauma, or just the vast majority?
• 16:51
  SPEAKER_00: Aaron Powell The vast majority of the time it's childhood, like below age 10, it starts with severe, complex, inescapable trauma.
• 16:59
  SPEAKER_00: As you get older and older and older, and the trauma gets less and less and less, the odds of developing DID go down.
• 17:04
  SPEAKER_00: And if you do develop it, it's going to be fewer personalities, less complicated, less internal conflict.
• 17:11
  SPEAKER_03: Aaron Powell Why do some people who experience childhood trauma develop dissociative identity disorder and others CPTSD or something else?
• 17:20
  SPEAKER_00: I believe that CPT complex PTSD, CPTSD, is itself a form of dissociative disorder, but it's not classified that way.
• 17:29
  SPEAKER_00: But everybody with complex PTSD has a bunch of dissociation going on.
• 17:34
  SPEAKER_00: And almost everybody with DID has complex PTSD.
• 17:38
  SPEAKER_00: So complex PTSD is, quotes, regular PTSD, flashbacks, nightmares, reliving triggers, numbing out and shutting down.
• 17:48
  SPEAKER_00: And all of that's got a lot of dissociation built into it to start.
• 17:52
  SPEAKER_00: So almost everybody with DID has complex PTSD, but not the other way around.
• 17:57
  SPEAKER_00: And they're both adaptations to severe complicated trauma.
• 18:01
  SPEAKER_00: Not everybody with X amount of trauma develops DID or PTSD or complex BTSD.
• 18:08
  SPEAKER_00: The difference between regular PTSD and complex BTSD is complex BTSD is quotes regular PTSD with a bunch of other stuff, like depression, anxiety, substance abuse, relationship problems, identity problems.
• 18:23
  SPEAKER_00: So it's all part of one big universe of complex trauma coping style.
• 18:28
  SPEAKER_00: And not everybody can do it.
• 18:30
  SPEAKER_00: So some people are better at math, some people not so good, some people are more athletic, some people are more musical, and some people are more skilled at dissociating.
• 18:40
  SPEAKER_00: It's just an inborn skill, kind of like hypnotizability, where some people can block out a memory or do whatever skill hypnosis requires.
• 18:51
  SPEAKER_00: Other people just can't do it.
• 18:52
  SPEAKER_00: And most people can kind of do it some a little bit.
• 18:55
  SPEAKER_00: So you have to be born with that pro-genetically based ability to dissociate.
• 19:00
  SPEAKER_03: Level 101 here.
• 19:01
  SPEAKER_03: But w what happens in your brain?
• 19:04
  SPEAKER_03: What physically is happening when you dissociate?
• 19:07
  SPEAKER_00: Well, a lot of things about what happens in the brain are unknown.
• 19:11
  SPEAKER_00: Okay.
• 19:11
  SPEAKER_00: So there's theories, there's research, there's some evidence, there's brain scans and so on.
• 19:16
  SPEAKER_00: But it it's a disconnection between one sector of the brain and another sector.
• 19:21
  SPEAKER_00: And that doesn't mean this physical location and that physical location.
• 19:25
  SPEAKER_00: Because most things in mental health are network problems where there's multiple brain areas involved.
• 19:31
  SPEAKER_00: And it's the communication between two areas.
• 19:34
  SPEAKER_00: So if you interrupt the communication, then you're going to have dissociation.
• 19:38
  SPEAKER_03: And it sort of automatically happens?
• 19:41
  SPEAKER_00: Uh it happens automatically when you're a kid.
• 19:44
  SPEAKER_00: You don't sit down and plan it out.
• 19:46
  SPEAKER_03: But you can't I mean, do you call on an altered?
• 19:49
  SPEAKER_03: Do you say, like, oh, I need this one now?
• 19:51
  SPEAKER_03: Or is are those shifts, are those changes going on automatically?
• 19:55
  SPEAKER_00: Before diagnosis, before treatment, there can be where the system, the different parts, are kind of shut down and there's not much switching.
• 20:04
  SPEAKER_00: And then you get into an abusive marriage or a bunch of stuff happens and all of a sudden they start coming up and switching, and you have amnesia.
• 20:12
  SPEAKER_00: Uh, so it can be triggered.
• 20:14
  SPEAKER_00: It can just sort of hop and happen automatically, and you're not sure why, it being switched to another part.
• 20:21
  SPEAKER_00: And you can also, uh, some people consciously go, Oh, I'm out of here.
• 20:26
  SPEAKER_00: So-and-so, you need to come and take over.
• 20:28
  SPEAKER_00: And then in therapy, you want to, you, the therapist, get to know the parts, help the parts to get to know each other, and get the switching much more agreed upon, much less chaotic with less amnesia.
• 20:39
  SPEAKER_00: So somebody who's been in therapy for a while, I can just go, uh, can I talk to so-and-so now?
• 20:45
  SPEAKER_00: There the person is.
• 20:46
  SPEAKER_00: Or another technique is called talking through, where I've met the part who's been out front before.
• 20:53
  SPEAKER_00: Or I've never met the part, but I've communicated with the person when they're inside.
• 20:57
  SPEAKER_00: So talking through is, hey, uh, Susie, are you you there, you're listening?
• 21:04
  SPEAKER_00: So tell Mary, the outfront part, that you're there and listening.
• 21:07
  SPEAKER_00: Yeah, she said she's listening.
• 21:09
  SPEAKER_00: So then you're gonna have a conversation with the part, with the part just in the background.
• 21:13
  SPEAKER_00: So it doesn't require full switching necessarily.
• 21:17
  SPEAKER_03: So we're gonna talk about the internet fascination with dissociative identity disorder or DID.
• 21:26
  SPEAKER_03: And I'm hearing, you know, you'll see people they're on camera and all of a sudden they have a baby voice or a male voice or whatever it might be.
• 21:34
  SPEAKER_03: How do you know the difference between somebody who I I hesitate to word use the word faking it, but it does look that way on social media sometimes, and somebody who actually has this disorder?
• 21:45
  SPEAKER_00: It's a complicated question, and you can't just snap your fingers and know.
• 21:50
  SPEAKER_00: So sometimes it's just incredibly obvious, but say it's not incredibly obvious, how do you tell whether it's faking consciously or sort of faking unconsciously or actually real?
• 22:04
  SPEAKER_00: But if it's actually real, it's never actually real.
• 22:07
  SPEAKER_00: So it's kind of a subtle to figure out the difference.
• 22:09
  SPEAKER_00: And basically you have to get to know the person, spend time with them and Try and figure it out.
• 22:14
  SPEAKER_00: And sometimes it's not clear.
• 22:16
  SPEAKER_00: And sometimes it doesn't really make any difference anyway.
• 22:19
  SPEAKER_00: Because nobody, in my experience, nobody comes into treatment, quotes faking dissociative identity disorder when they have no mental health problems at all.
• 22:30
  SPEAKER_00: It just never happens.
• 22:32
  SPEAKER_00: So then the question isn't let's obsess about is it real, not real, figure it out, point a finger at the person, call them a faker.
• 22:39
  SPEAKER_00: It's okay, what's bother where's this all coming from?
• 22:42
  SPEAKER_00: What's the trouble?
• 22:43
  SPEAKER_00: Why is the person doing this?
• 22:44
  SPEAKER_00: Whether it's real, half real, three-quarters real.
• 22:47
  SPEAKER_00: And then what's the actual target of treatment?
• 22:49
  SPEAKER_00: Because the the DID is the symptom.
• 22:52
  SPEAKER_00: A lot of the treatment is directed at the trauma, not the symptom as such.
• 22:55
  SPEAKER_03: Aaron Powell If someone comes to you in that scenario and you treat the trauma, do the symptoms of dissociative identity disorder go away or lessen?
• 23:04
  SPEAKER_00: Aaron Powell It's all part of a package.
• 23:06
  SPEAKER_00: So you never treat just the trauma or just the symptoms.
• 23:10
  SPEAKER_00: It's it's all one big package.
• 23:13
  SPEAKER_00: Sometimes you shift to more on, okay, what happened when you were nine, tell me about that.
• 23:17
  SPEAKER_00: But then that'll shift to, okay, and whose fault was that?
• 23:21
  SPEAKER_00: It was my fault.
• 23:22
  SPEAKER_00: Okay, and you're how old?
• 23:23
  SPEAKER_00: And the perpetrator was how old?
• 23:25
  SPEAKER_00: Do you think there's kids who go, I really want to be sexually abused when I mate?
• 23:29
  SPEAKER_00: So then we get into self-blame as a normal child response.
• 23:33
  SPEAKER_00: And so we're talking about, it's cognitive therapy now, the incorrect beliefs that are driving the depression, driving the self-blame, the self-punishment.
• 23:42
  SPEAKER_00: And the diagnosis of DID is not really the focus.
• 23:45
  SPEAKER_00: But then you shift back to, okay, this part is the one that's holding all the self-blame, so we've got to work with this part.
• 23:52
  SPEAKER_00: So it's not just separate little boxes.
• 23:55
  SPEAKER_03: What does switching between identities or parts feel like for the person themselves with dissociative identity disorder?
• 24:04
  SPEAKER_00: So for the person who has the DID who's doing the switching, it can feel a whole lot of different ways.
• 24:10
  SPEAKER_00: One way is it doesn't feel any uh there's nothing because it's instantly gone and then instantly back.
• 24:16
  SPEAKER_00: And like, and sometimes the person really doesn't even register that they've been gone for a while.
• 24:22
  SPEAKER_00: Other times it's sort of this foggy, dreamy, oh, I'm shh going into the background, oh, I'm gone now.
• 24:29
  SPEAKER_00: Uh, and then kind of foggy return.
• 24:32
  SPEAKER_00: And other times it's just a big headache, and then okay, the headache's over, I'm back.
• 24:38
  SPEAKER_00: What happened the last two hours?
• 24:40
  SPEAKER_00: So it's not just one pattern.
• 24:41
  SPEAKER_03: Aaron Powell That loss of two hours sounds like it could be incredibly problematic if you were, say, driving or in a foreign country or working or taking care of children or kind of almost any scenario.
• 24:55
  SPEAKER_00: Aaron Powell Yeah, this is one of the reasons why DID needs treatment, because it's embedded in complex PTSD.
• 25:01
  SPEAKER_00: So all the reasons that PTSD needs treatment.
• 25:04
  SPEAKER_00: But it can be very discombobulating and risky and dangerous if you don't know where you are, what you're doing, who you're hooked up with.
• 25:12
  SPEAKER_00: Some people have literally like bought racks of clothes that they don't remember buying that they don't want to wear because it's the style that the teenage part wants.
• 25:23
  SPEAKER_00: And anyway, it's the wrong size because they've put on 30 pounds since they were a teenager.
• 25:27
  SPEAKER_00: So it's completely a waste of money.
• 25:29
  SPEAKER_00: That's just and that's a mild example of things that can go wrong.
• 25:35
  SPEAKER_03: This podcast is a production of recovery.com.
• 25:38
  SPEAKER_03: Getting help for an addiction or mental health concern is one of the best decisions you will ever make.
• 25:45
  SPEAKER_03: But once you make that decision, it can be tough to know what to do next.
• 25:49
  SPEAKER_03: That's why we built recovery.com.
• 25:51
  SPEAKER_03: It's the best place to find mental health and addiction treatment for anyone, anywhere.
• 25:57
  SPEAKER_03: Here's how it works.
• 25:59
  SPEAKER_03: Search over 22,000 facilities, compare your options, and connect directly with treatment providers that meet your needs.
• 26:08
  SPEAKER_03: So if you need treatment that goes beyond an occasional therapy session, go to recovery.com.
• 26:14
  SPEAKER_03: Your recovery starts today.
• 26:18
  SPEAKER_03: From the outside, if you're with somebody with dissociative identity disorder and they switch, do you know?
• 26:25
  SPEAKER_00: Uh yes, no, maybe sometimes not sure, because sometimes it's so incredibly subtle that there isn't actually any outside change of voice, facial expression, maybe something really subtle about how their eyes look.
• 26:40
  SPEAKER_00: But and other times it's like, hi, I'm Susie.
• 26:43
  SPEAKER_00: I'm 12.
• 26:44
  SPEAKER_00: How are you?
• 26:45
  SPEAKER_00: And it's like screamingly obvious, and then all degrees in between, where it can just look like a person's a little moody, kind of change their facial expression a bit within what it seems to be the range of normal.
• 26:58
  SPEAKER_00: So there's no one pattern or no one appearance.
• 27:01
  SPEAKER_03: Before somebody with dissociative identity disorder is diagnosed, what do they think is going on?
• 27:08
  SPEAKER_00: That's very variable.
• 27:09
  SPEAKER_00: So some people just think that's the way everybody is, and they're quite surprised to find out that's not the way everybody is.
• 27:15
  SPEAKER_00: Some people are, I'm crazy and I'm not going to tell anybody about what's going on because I don't want to be viewed as crazy.
• 27:22
  SPEAKER_00: Other people are, oh, I read about it or I saw it later, and I know this is DID.
• 27:26
  SPEAKER_00: I knew I had DID before I was diagnosed.
• 27:29
  SPEAKER_00: And sometimes uh husband, friend, family member knew parts by name before anybody ever made the diagnosis.
• 27:38
  SPEAKER_00: So there's a lot of different patterns.
• 27:41
  SPEAKER_03: So if you're in a relationship with yourself or somebody else and you have distinct enough parts of yourself that you have names for them or other people have names for them, wouldn't that be a or can that be a clue that you should maybe see a a therapist and see if you need a diagnosis?
• 28:01
  SPEAKER_03: I don't know how to ask that gently.
• 28:03
  SPEAKER_00: So if you are suspicious, semi-aware, kind of aware, but not sure that you might have dissociative identity disorder, which is on a spectrum.
• 28:13
  SPEAKER_00: So you can have full dissociative identity disorder.
• 28:16
  SPEAKER_00: You can have zero, which that means you're a very boring person if you have zero, because you don't have any variability, you're just like exactly the same every second.
• 28:25
  SPEAKER_00: But you can be like half or two-thirds DID, where you have parts, they're separate and distinct, maybe they don't have separate names.
• 28:33
  SPEAKER_00: They come out to the front, but there's no amnesia, or they only come out part way.
• 28:38
  SPEAKER_00: So once you're out on that spectrum, it's kind of the same.
• 28:40
  SPEAKER_00: I call it DID three-quarters as much.
• 28:43
  SPEAKER_00: Once you're out there, it's sort of the same treatment no matter what.
• 28:46
  SPEAKER_00: And sometimes people over-obsess about is this full DID or just OSD, other specified dissociative disorder, which is just a big avoidance strategy.
• 28:58
  SPEAKER_00: Let's stop obsessing about that because here's the therapy task.
• 29:02
  SPEAKER_00: Let's get to work on the actual therapy tasks.
• 29:04
  SPEAKER_00: But if you it never hurts to go have a consultation.
• 29:08
  SPEAKER_00: Problem there is most mental health professionals are like out to lunch on DID that don't know how to diagnose it, don't think about it, and sometimes are very hostile and dismissive towards it.
• 29:18
  SPEAKER_00: So you have to select a therapist who at least knows about complex PTSD.
• 29:23
  SPEAKER_00: Maybe does internal family systems work, which is a closely related method.
• 29:28
  SPEAKER_03: So when you bring up internal family system, it doesn't sound all that different than dissociative identity disorder therapy.
• 29:34
  SPEAKER_03: So what is the difference?
• 29:36
  SPEAKER_00: Aaron Powell Well the difference between internal family systems is a method of therapy.
• 29:40
  SPEAKER_00: The difference between internal and there's books and trainings and so on.
• 29:45
  SPEAKER_00: Uh the difference between internal family systems work and DID work is a little foggy and unclear.
• 29:52
  SPEAKER_00: And some people talk as if, no, they're totally separate.
• 29:55
  SPEAKER_00: We don't do DID work, we do IFS work.
• 29:58
  SPEAKER_00: But I think they're closely related and overlapping.
• 30:01
  SPEAKER_00: So IFS is like everybody has parts of themselves, which is true.
• 30:06
  SPEAKER_00: But the question is how separate and d distinct other parts, how much internal conflict and how much dysfunction is there?
• 30:14
  SPEAKER_00: So in IFS vocabulary, there's the uh exiles, that would be the usually child-adolescent parts in DID, who hold the trauma, who hold the PTSD, who hold the anger.
• 30:27
  SPEAKER_00: And then there's the uh there's several different categories.
• 30:31
  SPEAKER_00: There's the outfront regular person, there's managers inside.
• 30:35
  SPEAKER_00: Uh so they have their own vocabulary, but why would you need psychotherapy if it's all fine and working okay?
• 30:42
  SPEAKER_00: Right?
• 30:42
  SPEAKER_00: So people only need IFS therapy because something's not working okay.
• 30:46
  SPEAKER_00: So what's the difference between that and DID?
• 30:49
  SPEAKER_00: Seems kind of similar to me.
• 30:50
  SPEAKER_03: That's what I was wondering.
• 30:52
  SPEAKER_00: Yeah, so I'm I'm at the school of thought that it's a professional TERF mission.
• 30:58
  SPEAKER_00: Like we're the IFS people, we do IFS, we've got our own TERF, which is true.
• 31:03
  SPEAKER_00: And there's CBT people, cognitive behavioral people, there's the Freudians, there's this, that, there's all these different camps, and they all carve out their own territory and often act as if you gotta be in this camp doing this therapy, and this is the only real one.
• 31:19
  SPEAKER_00: And they're and the cognitive behavioral people are big on that because the university professors have tons of research and so on.
• 31:26
  SPEAKER_00: The others have less research.
• 31:28
  SPEAKER_00: So there's kind of CBT snobbery.
• 31:30
  SPEAKER_00: We're the real ones, we're the only evidence-based ones.
• 31:35
  SPEAKER_00: And they'll knock down the amount of evidence-based that other schools have.
• 31:40
  SPEAKER_00: So it's a like a little adolescent warfare going on, basically.
• 31:44
  SPEAKER_00: Uh but I'm much more uh what's called a lumper rather than a splitter, which is funny since I work with people who are split.
• 31:52
  SPEAKER_00: But I just see the commonalities and not so obsessed with the differences.
• 31:56
  SPEAKER_03: Aaron Powell So if dissociative identity disorder is often misdiagnosed, how does someone differentiate between it and other mental health conditions?
• 32:07
  SPEAKER_00: Well, that's a complicated question.
• 32:09
  SPEAKER_00: But basically, if you read the criteria for bipolar disorder, substance use, eating disorder, nowhere in there are they talking about distinct parts that come out and take control and the person has amnesia.
• 32:22
  SPEAKER_00: It just doesn't exist in other disorders.
• 32:24
  SPEAKER_02: Okay.
• 32:25
  SPEAKER_00: The confusion is that people with DID.
• 32:28
  SPEAKER_00: I did a study in first half of the 90s, which was MPD multiple personality disorder at that time, with standardized interviews, and 95% met criteria for depression, uh, 70% for PTSD, two-thirds for uh substance abuse, two sixty percent, two-thirds for borderline personality, forty percent for psychosomatic disorder.
• 32:55
  SPEAKER_00: So that's called the comorbidity.
• 32:57
  SPEAKER_00: Morbid means ill, co-means going along with.
• 33:01
  SPEAKER_00: So the comorbidity of DID is the average person meets criteria for 12 different DSM disorders, which is ridiculous.
• 33:10
  SPEAKER_00: You can't what are the odds that you've got 12 distinct separate disorders all at once?
• 33:14
  SPEAKER_00: So it's all actually part of a complex PTSD.
• 33:17
  SPEAKER_00: Unless they have like severe autism, that's a separate thing.
• 33:22
  SPEAKER_00: But the depression, the anxiety, the substance abuse, the borderline personality, I see it all as part of complex PTSD.
• 33:28
  SPEAKER_00: But if you have just depression, then you have just depression.
• 33:31
  SPEAKER_00: You don't have complex PTSD.
• 33:33
  SPEAKER_00: But that's where the confusion comes in.
• 33:35
  SPEAKER_00: The regular mental health person will diagnose the substance abuse, the depression, the eating disorder, and the DID just goes flying by and they don't even think about it because they haven't been trained how to ask about it.
• 33:49
  SPEAKER_00: And they've been taught that it's very, very rare.
• 33:51
  SPEAKER_00: So what are the odds?
• 33:52
  SPEAKER_00: So why bother?
• 33:53
  SPEAKER_03: I did look up what 1%, what else, you know, affects 1% of the I said US population.
• 34:00
  SPEAKER_03: And it was natural red hair and celiac disease.
• 34:03
  SPEAKER_03: And menus in restaurants across the country have changed because of celiac disease.
• 34:07
  SPEAKER_03: Nobody would say it's an extremely rare thing, but yet dissociative identity disorder we say is.
• 34:12
  SPEAKER_03: So it is interesting.
• 34:13
  SPEAKER_00: Thankfully, red hair is also treatable.
• 34:17
  SPEAKER_03: I used to have it.
• 34:18
  SPEAKER_03: Um when we talk about dissociation, how is that different from normal daydreaming?
• 34:24
  SPEAKER_03: Where you might, you know, be driving and say, like, oh, I I I sort of Well, it is and it isn't different.
• 34:30
  SPEAKER_00: So it's all a matter of degree and frequency.
• 34:33
  SPEAKER_00: Okay.
• 34:33
  SPEAKER_00: So uh I was driving home and next thing I woke up and I was in the next town.
• 34:38
  SPEAKER_00: I have no idea how I got there.
• 34:39
  SPEAKER_00: That's not normal.
• 34:41
  SPEAKER_00: But I zoned out for three blocks and the car didn't crash.
• 34:45
  SPEAKER_00: So some part of me was in control and doing things okay.
• 34:48
  SPEAKER_00: That's normal, right?
• 34:49
  SPEAKER_02: Mm-hmm.
• 34:50
  SPEAKER_00: So it's all a matter of how often, how severe, and what are the consequences.
• 34:55
  SPEAKER_00: I I had a seizure and I crashed the car and broke my leg.
• 34:59
  SPEAKER_00: But that's a physical seizure.
• 35:01
  SPEAKER_00: So if it's not a physical seizure and it's psychological, uh as it and everything, there's a little bit normal, a little bit more.
• 35:11
  SPEAKER_00: Hmm.
• 35:11
  SPEAKER_00: I guess that's still normal.
• 35:13
  SPEAKER_00: Well, that's going to be kind of not exactly normal.
• 35:16
  SPEAKER_00: And then it's like 100% that's not normal.
• 35:19
  SPEAKER_00: All symptoms, anxiety, depression, some disabuse are like that.
• 35:22
  SPEAKER_03: And not normal means problematic.
• 35:25
  SPEAKER_03: It's causing a problem in your life now.
• 35:27
  SPEAKER_00: Right.
• 35:28
  SPEAKER_00: So the the stigma part of mental illness is you're not normal.
• 35:32
  SPEAKER_00: But somebody comes into the ER and they've got a broken femur and sticking out through their skin.
• 35:39
  SPEAKER_00: The doctor doesn't go, we're not going to stigmatize you.
• 35:42
  SPEAKER_00: We're not saying it's abnormal.
• 35:44
  SPEAKER_00: That's ridiculous, right?
• 35:45
  SPEAKER_00: It's clearly abnormal, but it's a normal response to getting hit by the drunk driver.
• 35:50
  SPEAKER_00: So that's how I view all of this stuff.
• 35:52
  SPEAKER_00: It's an understandable injury from psychological trauma.
• 35:56
  SPEAKER_00: It's not normal to have the broken leg, but it's normal if you've been through the trauma.
• 36:00
  SPEAKER_00: That's my view.
• 36:01
  SPEAKER_03: Aaron Powell It's much less stigmatizing, and I appreciate that.
• 36:04
  SPEAKER_03: Way less.
• 36:05
  SPEAKER_03: Are there normally triggers that would cause a dissociative episode to start?
• 36:09
  SPEAKER_00: Aaron Powell Sometimes a dissociative episode is just who knows, it's out of the blue, which can also be true of panic attacks, which are classically divided into cued and spontaneous.
• 36:20
  SPEAKER_00: So spontaneous panic attack is every time I go to the flippin' drugstore, I have a panic attack because I had a panic attack there before, so I'm expecting to have a panic attack, so lo and behold, it happens.
• 36:31
  SPEAKER_00: And then spontaneous is just there's nothing going on, it just came out of the blue.
• 36:36
  SPEAKER_00: And so it's generally the rule in mental health, and same with dissociative episodes.
• 36:41
  SPEAKER_00: There can be an obvious trigger, which may not be obvious until you figure it out.
• 36:46
  SPEAKER_00: So how come you have a flashback every time you see somebody wearing a blue baseball cap?
• 36:53
  SPEAKER_00: Blue baseball caps are not a threat to your survival.
• 36:55
  SPEAKER_00: Yeah, well, Uncle Jim who abused me was wearing a blue baseball cap at the time.
• 37:00
  SPEAKER_00: So the trigger can be perfectly innocent in the present day.
• 37:05
  SPEAKER_00: And if you have this reaction, you look like a hysterical, overreacting person, and then you get stigmatized for that.
• 37:12
  SPEAKER_00: But once you understand, okay, it's obviously directly connected, it makes sense.
• 37:18
  SPEAKER_00: It's not fun, it's not good.
• 37:20
  SPEAKER_00: You want treatment for it, but it's not just being ridiculous for no reason.
• 37:23
  SPEAKER_03: Aaron Powell Can severe stress cause someone without dissociative identity disorder to temporarily dissociate?
• 37:30
  SPEAKER_00: Uh people can temporarily dissociate.
• 37:33
  SPEAKER_00: Well, so there's temporary five seconds, temporary thirty seconds, temporary four hours.
• 37:39
  SPEAKER_00: So once you're dissociated, like totally gone, amnesia, that's not exactly a normal reaction.
• 37:46
  SPEAKER_00: But kind of gone, but I was there, but I was watching, but I felt like I was not exactly in my body.
• 37:53
  SPEAKER_00: And assault victims commonly described I was up there, and I felt sorry for that person down there who's getting assaulted.
• 38:00
  SPEAKER_00: So uh depending on your paranormal viewpoint, that may not be literally true that you're literally out of your body, but it's an exact description of what you experienced.
• 38:12
  SPEAKER_00: Who wants to be in that body for that period of time?
• 38:14
  SPEAKER_00: It's smart, it's survival.
• 38:16
  SPEAKER_00: Thank goodness you could get out of your body.
• 38:18
  SPEAKER_00: And so you can be out of your body just a little bit.
• 38:22
  SPEAKER_00: You kind of you're there, you're watching, you're aware, but you're not exactly in control of what your body's doing and saying.
• 38:28
  SPEAKER_00: So you're way back, to you're mostly gone, to you're all gone.
• 38:33
  SPEAKER_03: Online, they use the word alters all the time.
• 38:35
  SPEAKER_03: It's not the one you're using.
• 38:36
  SPEAKER_03: What is your preferred verbiage for?
• 38:39
  SPEAKER_00: I prefer parts, alters, people, littles, others.
• 38:44
  SPEAKER_00: Okay.
• 38:45
  SPEAKER_00: So when I'm in therapy, I don't why do I care how the person refers to their parts?
• 38:51
  SPEAKER_00: And people have all kinds of different names.
• 38:53
  SPEAKER_00: If I'm writing a professional paper in a journal, I'm probably not going to say their peeps.
• 38:58
  SPEAKER_03: Right, or they're littles.
• 38:59
  SPEAKER_03: Yeah.
• 38:59
  SPEAKER_00: Yeah.
• 38:59
  SPEAKER_00: So I got to sound like I'm a professional, so I can say they're dissociated identity states.
• 39:06
  SPEAKER_00: But it's all just different.
• 39:07
  SPEAKER_00: Basically, in therapy, I don't care which terms you use.
• 39:10
  SPEAKER_03: Yeah.
• 39:11
  SPEAKER_03: So when we're talking here about the different parts, and a lot of the social media searches were very specifically about that.
• 39:18
  SPEAKER_03: And it was can the parts have different accents, different sizes, different sexual orientation, different, all the things.
• 39:28
  SPEAKER_03: And I started to write them down on these cards.
• 39:31
  SPEAKER_03: And then I found myself having a reaction which was very protective of these children because I'm thinking, hey, these kids went through enough trauma that it altered the way their brain developed.
• 39:40
  SPEAKER_03: And here we are saying, like, oh my God, you can have different, you know, accent.
• 39:45
  SPEAKER_03: It doesn't seem to be the important part of this.
• 39:47
  SPEAKER_03: Is that am I being an overreactive, protective person here?
• 39:51
  SPEAKER_03: Or is there like a voyeuristic, uh, dehumanizing aspect to that curiosity?
• 39:57
  SPEAKER_00: Well, let me tell you something amazing.
• 39:59
  SPEAKER_00: There's a place in the United States, I think it's in California, called Hollywood.
• 40:04
  SPEAKER_00: And there's a bunch of people there who can act like totally different people with totally different accents, right?
• 40:10
  SPEAKER_00: Because they're very, very skilled actors.
• 40:12
  SPEAKER_00: Yes.
• 40:13
  SPEAKER_00: If I tried to do that, I don't think anybody would be hiring me.
• 40:16
  SPEAKER_00: So you can act like very convincingly that you have a different accent, that you're a different person with different name, different age, different one person's a spy, the other person's this.
• 40:27
  SPEAKER_00: So that's not some from outer space, you know, disconnected from normal human life skill.
• 40:33
  SPEAKER_00: It's a skill.
• 40:35
  SPEAKER_00: And so you harness that skill to take on different roles and have different identities as a kid to cope with trauma.
• 40:43
  SPEAKER_00: But it's clearly that's kind of related.
• 40:45
  SPEAKER_00: Um there's nothing supernatural about having a different accent at different times of the day.
• 40:51
  SPEAKER_00: So it's not like these people are from some other planet or something.
• 40:57
  SPEAKER_00: And yet I call it the central paradox of DID.
• 41:00
  SPEAKER_00: The central paradox of DID is it's real and not real at the same time.
• 41:04
  SPEAKER_00: The way I if I'm talking to somebody who has DID and I say it that way, it's like, oh my God, you're saying it's not real.
• 41:11
  SPEAKER_00: Hold on.
• 41:12
  SPEAKER_00: It's not real in the sense that there's not literally separate human beings in there with their own bodies.
• 41:17
  SPEAKER_00: So if we took an X-ray of your head, we wouldn't see a whole bunch of little skeletons in there.
• 41:22
  SPEAKER_00: And if there were little skeletons in there running around, your brain would be mush.
• 41:26
  SPEAKER_00: So it's not literally concretely real.
• 41:28
  SPEAKER_00: And nobody goes, oh yeah, you'd see skeletons in there.
• 41:30
  SPEAKER_00: So nobody debates that.
• 41:32
  SPEAKER_00: But it's perfectly psychologically real.
• 41:34
  SPEAKER_00: You really do have periods of missing time, you really do have voices, you really do have parts.
• 41:39
  SPEAKER_00: So some professionals and people are way over on the it's not real side.
• 41:44
  SPEAKER_00: They're right, but they're half wrong because they're missing the psychological reality of it.
• 41:49
  SPEAKER_00: If you get too far into the psychological reality and it's concretely real, that's I couldn't help it because the devil made me do it.
• 41:58
  SPEAKER_00: Good luck having that work as a defense in a court of law, right?
• 42:01
  SPEAKER_00: So it's it's real, but it's not real.
• 42:03
  SPEAKER_00: It's not real, but it is real.
• 42:05
  SPEAKER_03: It's a good way to describe it.
• 42:07
  SPEAKER_03: So related to the parts.
• 42:09
  SPEAKER_03: Do parts or altars have different ages, genders, or physical mannerisms from the host body in a person with dissociative identity disorder?
• 42:19
  SPEAKER_00: Uh yes, they often do.
• 42:20
  SPEAKER_00: And the host personality is just a term in the field.
• 42:23
  SPEAKER_00: So that's the part that's out front most of the time these days.
• 42:28
  SPEAKER_00: So the most common is host personality all the way through life, and then parts come in and out.
• 42:33
  SPEAKER_00: But it's not rare that the current host has only been the host for the last five years because something really traumatic happened.
• 42:41
  SPEAKER_00: The host got overwhelmed, who had been the host for 10 years, and the other parts go, that's it, we're putting her inside, and so-and-so's coming out to take over for a while.
• 42:52
  SPEAKER_00: Um not not common, but not rare.
• 42:55
  SPEAKER_00: Another configuration is there's two or three parts who, as a team, do the host functions together in a coordinated fashion.
• 43:02
  SPEAKER_00: So they all answer to the name Susan, but they're actually three or four different parts.
• 43:08
  SPEAKER_00: Uh and then there's sometimes it's just like chaos, and there's no stable, consistent host at all.
• 43:13
  SPEAKER_00: So that's what the host personality is.
• 43:15
  SPEAKER_03: Aaron Ross Powell What is the difference in terms of how it looks and feels?
• 43:20
  SPEAKER_03: A covert versus an overt switching of parts in someone with dissociative identity disorder?
• 43:26
  SPEAKER_00: Aaron Powell Well, most switching is covert or 90% covert.
• 43:31
  SPEAKER_00: So it's either you don't notice anything at all, even if you're the therapist and you know the person well.
• 43:37
  SPEAKER_00: And other times it's uh seems like you're a little different who's here right now?
• 43:44
  SPEAKER_00: And because of just a little subtle change in uh tone of voice or facial expression.
• 43:50
  SPEAKER_00: And then other times it's just right there, obvious anybody could see.
• 43:54
  SPEAKER_03: Aaron Ross Powell Do most of the people who go to therapy with dissociative identity disorder come because of these parts or because of a different mental health conc concern or disorder?
• 44:05
  SPEAKER_00: Aaron Ross Powell It's the reasons for coming to therapy are variable.
• 44:09
  SPEAKER_00: So some people come depression, panic attacks, anxiety.
• 44:14
  SPEAKER_00: Not really aware of having DID at all.
• 44:16
  SPEAKER_00: Other part people come in and say, I think I have DID.
• 44:20
  SPEAKER_00: I've got all this stuff going on.
• 44:22
  SPEAKER_00: Could you figure it out?
• 44:23
  SPEAKER_00: So it's all variable.
• 44:25
  SPEAKER_00: That's a general rule of thumb, is it's variable.
• 44:28
  SPEAKER_03: Yeah.
• 44:29
  SPEAKER_03: In as a therapist for people with dissociative identity disorder, what is the common progression from, is there a common progression from when someone comes in, let's say they believe they have this disorder.
• 44:42
  SPEAKER_03: And where can you get them?
• 44:44
  SPEAKER_03: Where can you help them get?
• 44:46
  SPEAKER_00: Well, it depends who you are as a therapist.
• 44:49
  SPEAKER_00: You for a bunch of me, well, I'm going to trash talk the other therapist for a second.
• 44:54
  SPEAKER_00: So most of the time, like the therapist doesn't think about it, doesn't consider it, doesn't tune into it, doesn't diagnose it, doesn't treat it.
• 45:03
  SPEAKER_00: But for me, it's going to be well, obviously I'm not like just a random mental health professional.
• 45:09
  SPEAKER_00: So people come to me because they think they have DID, somebody told them they have DID, they want a second opinion, or they want specialized treatment.
• 45:18
  SPEAKER_00: So it can be one session, we know for sure.
• 45:22
  SPEAKER_00: There's no doubt.
• 45:23
  SPEAKER_00: In theory, the person could be making it all up and lying, but if so, I'll figure that out later.
• 45:29
  SPEAKER_00: And these are not people who are trying to get out of a legal charge, get money, get a one-up on their spouse.
• 45:38
  SPEAKER_00: These people are coming for help.
• 45:40
  SPEAKER_00: They're not, there's no what's called secondary gain.
• 45:43
  SPEAKER_00: There's no gain that they're running for obvious benefit.
• 45:46
  SPEAKER_00: Attention, yeah.
• 45:48
  SPEAKER_00: If you come to see me with DID, I'm not going to be that excited and thrilled and think you're that special because I've seen bazillion people with DID.
• 45:56
  SPEAKER_00: So, okay, you have DID, let's get to work.
• 45:59
  SPEAKER_00: So you don't get special status because you have DID with me.
• 46:04
  SPEAKER_00: And you don't get to get away with stuff because you have DID.
• 46:07
  SPEAKER_00: And I couldn't help it, my part made me do it.
• 46:10
  SPEAKER_00: Okay, you can try that somewhere else.
• 46:12
  SPEAKER_00: Not the way it works here.
• 46:14
  SPEAKER_00: You're responsible.
• 46:15
  SPEAKER_00: Even if you don't feel responsible, I'm going to hold you responsible for the behavior of all your parts.
• 46:20
  SPEAKER_00: So there's ground rules and there's boundaries.
• 46:23
  SPEAKER_00: We're not going to be friends outside therapy.
• 46:26
  SPEAKER_00: Um and said sort of not shutting down, but kind of shutting down the specialness helps you to focus on okay, this is you're not special because you have renal failure and you need dialysis.
• 46:39
  SPEAKER_00: You need special treatment, but that doesn't make you a special person.
• 46:42
  SPEAKER_00: You're special just because you're you.
• 46:44
  SPEAKER_00: All people are special.
• 46:45
  SPEAKER_00: Same with DID.
• 46:47
  SPEAKER_00: You're not special because you have DID.
• 46:49
  SPEAKER_00: So the person's kind of trying to get a little extra specialness for having DID.
• 46:54
  SPEAKER_00: It doesn't work with me.
• 46:55
  SPEAKER_00: And that's then if I take that attitude, somebody could go, oh, you don't think I'm special, or you don't think DID is special.
• 47:02
  SPEAKER_00: Okay, how many books have I written about DID?
• 47:05
  SPEAKER_00: It's just this whole gradual process of helping the person walk down the road.
• 47:09
  SPEAKER_00: And they have to be motivated, they have to want it, they have to work, stick with it.
• 47:16
  SPEAKER_00: And it's painful.
• 47:17
  SPEAKER_00: There's a lot of bad feelings and bad memories in there that you're going to have to own as your own and process.
• 47:23
  SPEAKER_00: And it's not fun.
• 47:25
  SPEAKER_00: But if you stick with it, I've seen people all the way to fully integrated, or like three-quarters or 80%, where they have a bunch of parts that communicate with each other, they know each other, they coordinate things.
• 47:37
  SPEAKER_00: They don't just randomly take over and go this way or that way.
• 47:41
  SPEAKER_03: Aaron Powell In your experience as a therapist, when you diagnose someone with dissociative identity disorder, is the most common reaction like, oh, I cannot believe I have this, or a relief that there's finally a name and a plan of treatment as a result?
• 47:59
  SPEAKER_00: Not exact numbers, obviously, but I'd say like three-quarters plus of people, it's relief.
• 48:04
  SPEAKER_00: Somebody's understands, somebody's listening, somebody's validated, and they've laid out a plan of action.
• 48:12
  SPEAKER_00: So it's not just floating around with nowhere to go.
• 48:15
  SPEAKER_00: And other people are very resistant.
• 48:18
  SPEAKER_00: Uh, I don't want to have DID.
• 48:20
  SPEAKER_00: That means I'm crazy.
• 48:22
  SPEAKER_00: Or that means there's a whole lot of pain in there that I got to start dealing with.
• 48:26
  SPEAKER_00: The reaction could be, I was hoping it was schizophrenia.
• 48:30
  SPEAKER_00: Because if it's schizophrenia, all I have to do is take medication.
• 48:35
  SPEAKER_00: Uh DID.
• 48:36
  SPEAKER_00: Now we got some painful work to do.
• 48:39
  SPEAKER_00: It's variable, is the motto for everything.
• 48:41
  unknown: Yep.
• 48:42
  SPEAKER_03: What real world harm does the violent alter stereotype cause for people living with dissociative identity disorder?
• 48:49
  SPEAKER_00: Aaron Powell So there are violent altars, and there are violent people who don't have DID, obviously.
• 48:56
  SPEAKER_00: So the percentage of people who are with DID who commit violent crimes is there's no evidence it's more than the general population.
• 49:05
  SPEAKER_00: So DID does not make you violent scary automatically.
• 49:21
  SPEAKER_03: Does that sort of attention distract from the fact that DID is a very real trauma response?
• 49:30
  SPEAKER_00: Well, number one, I'm not on TikTok, so I'm not monitoring all this stuff.
• 49:34
  SPEAKER_00: And I don't really want to monitor it.
• 49:36
  SPEAKER_00: But I think it's a mixed blessing.
• 49:38
  SPEAKER_00: So better awareness of DID.
• 49:41
  SPEAKER_00: It's not just one in a billion people, uh, more publicity, more talk about it.
• 49:47
  SPEAKER_00: Because the medical schools and departments of psychology are not increasing the education on DID at all.
• 49:53
  SPEAKER_00: So that's the upside of it.
• 49:55
  SPEAKER_00: Then the downside of it is it just becomes kind of this ridiculous public theater that makes it look not real and not legit.
• 50:04
  SPEAKER_03: Aaron Powell Does that cause harm to people for whom it is real and legit?
• 50:07
  SPEAKER_00: It could cause harm.
• 50:09
  SPEAKER_00: How much harm is actually being caused, I'm not sure.
• 50:12
  SPEAKER_00: Okay.
• 50:12
  SPEAKER_03: So before we wrap up, I checked with the American Psychiatric Association and found it interesting that they made the point that dissociative identity disorder is a combination of events that felt overwhelming and inescapable to a child, which we've discussed, combined with their specific developmental stage, temperament, support system, and capacity to cope.
• 50:33
  SPEAKER_03: And that explains the difference between two people who can be in the same household and one develops DID and one does not.
• 50:39
  SPEAKER_00: That's one of the explanations.
• 50:41
  SPEAKER_00: The other is that only one child was sexually abused, or the age gap between the kids was like 12 years, and parents got divorced and abusive stepdad came in when this child was 12 and this child was four.
• 50:55
  SPEAKER_00: So the impact's going to be different.
• 50:58
  SPEAKER_00: So there's multiple factors at play.
• 51:00
  SPEAKER_03: But it is that your temperament, your ability to handle, manage, cope with the trauma is a distinct factor in why you might develop DID and someone else might not in the same circumstances.
• 51:19
  SPEAKER_00: Especially temperament, which is your inborn tendency.
• 51:24
  SPEAKER_00: You have to have the temperament of being skilled at dissociation, which not everybody is.
• 51:28
  SPEAKER_00: But I I often tell people, okay, so you have DID and you're very good at dissociating.
• 51:34
  SPEAKER_00: Good job.
• 51:35
  SPEAKER_00: Try getting through that childhood if you can't dissociate.
• 51:39
  SPEAKER_00: What do you think happens to your risk for substance abuse, suicide, homelessness, getting stuck in abusive relationships?
• 51:46
  SPEAKER_00: It all goes up, which is again the protective survival advantage of dissociating.
• 51:52
  SPEAKER_00: So you can, and another thing I say often is it's like you've got this little survival pack inside where your spontaneity, your childlike wonder, your ability to connect, have relationships has been walled off.
• 52:05
  SPEAKER_00: So it didn't get killed.
• 52:08
  SPEAKER_00: Person who couldn't wall it off, it got damaged even more.
• 52:11
  SPEAKER_00: So they may not look as damaged because they don't have DID, but their ability to connect to themselves, connect to others, not be depressed, not be overwhelmed with substance use.
• 52:23
  SPEAKER_03: So that's where dissociative disorders, while we don't want to have them, may in fact have been a very healthy and protective coping strategy.
• 52:32
  SPEAKER_03: Interesting.
• 52:33
  SPEAKER_03: Thank you.
• 52:34
  SPEAKER_03: We will continue our discussion in the next episode focusing on how dissociative identity disorder is diagnosed and treated, as well as the fact that healing with DID will look different for different people, but a fulfilling and productive life with the disorder is absolutely possible.
• 52:51
  SPEAKER_03: Please join us.