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DID: How Is Dissociative Identity Disorder Diagnosed & Treated? · RECOVERable: Mental Health and Addiction Experts Answer Your Questions

• 0:13
  SPEAKER_01: There's all these DID questions that they ask that regular mental health professionals just don't ask.
• 0:19
  SPEAKER_02: Psychiatrist and associative identity disorder specialist Dr.
• 0:22
  SPEAKER_02: Colin Ross joins us to discuss the diagnosis and treatment of DID.
• 0:28
  SPEAKER_01: A person said to me, wait a minute.
• 0:30
  SPEAKER_01: You mean I'd wake up in the morning, I'd brush my teeth, I'd have breakfast, I'd go to work, I'd have lunch, and I'd be the same person all the way through.
• 0:39
  SPEAKER_01: I don't want to do that.
• 0:44
  SPEAKER_02: Welcome to Recoverable.
• 0:45
  SPEAKER_02: I'm your host, Terry McGuire.
• 0:47
  SPEAKER_02: Today we continue our deep dive into dissociative identity disorder or DID.
• 0:53
  SPEAKER_02: Now that we have cleared away the pop culture myths and defined what dissociative identity disorder actually is and is not, today we're focusing on the path forward, how clinicians diagnose the condition, what effective trauma-informed treatment looks like, and how we can truly support a loved one or navigate recovery for ourselves.
• 1:14
  SPEAKER_02: To continue our discussion here again is trauma expert and psychologist Dr.
• 1:18
  SPEAKER_02: Colin Ross.
• 1:19
  SPEAKER_02: Well, thanks very much for having me.
• 1:21
  SPEAKER_02: I look forward to continuing the discussion.
• 1:23
  SPEAKER_02: So for people who may not have heard the original episode or need a review, could you please just re-describe what dissociative disorder is?
• 1:33
  SPEAKER_01: So there's a group of disorders in the section called dissociative disorders.
• 1:38
  SPEAKER_01: The most severe complex one is dissociative identity disorder, DID, formerly multiple personality disorder, MPD.
• 1:46
  SPEAKER_01: We changed the name.
• 1:48
  SPEAKER_01: I was on the committee that changed the name, just to get away from the idea that there's literally different personalities or people in there.
• 1:54
  SPEAKER_01: And it's basically a way of coping with and surviving severe, complex childhood trauma almost all the time.
• 2:01
  SPEAKER_01: And the basic features are you've got distinct separate parts of yourself, often with different names and ages, who feel and believe that they're separate people.
• 2:11
  SPEAKER_01: You've got switching, which is one part comes out, takes control, and you've got amnesia, which is the usual outfront person doesn't remember what's happened during that period of time.
• 2:21
  SPEAKER_01: That's the basic picture.
• 2:23
  SPEAKER_02: Okay.
• 2:24
  SPEAKER_02: Thank you.
• 2:25
  SPEAKER_02: So we are going to start again with the lightning round of myth or fact questions.
• 2:29
  SPEAKER_02: Some of these we will dive into more deeply as we do the internet questions.
• 2:33
  SPEAKER_02: Dr.
• 2:34
  SPEAKER_02: Myther Fact, it typically takes five to seven years to get properly diagnosed with dissociative identity disorder.
• 2:40
  SPEAKER_01: Aaron Powell Well, that's a fact based on a number of research studies.
• 2:44
  SPEAKER_01: So that's the average time in the mental health system before the diagnosis is made.
• 2:48
  SPEAKER_01: In the meantime, depression, substance abuse, anxiety, et cetera, are getting diagnosed.
• 2:54
  SPEAKER_02: Dr.
• 2:54
  SPEAKER_02: Mithurfact, it typically takes five to seven years to get properly diagnosed with dissociative identity disorder.
• 3:00
  SPEAKER_01: Aaron Powell That's true.
• 3:01
  SPEAKER_01: And that's based on a number of research studies.
• 3:04
  SPEAKER_01: And so what that means is from the time you enter the mental health system for depression, anxiety, whatever, until the DID actually gets diagnosed, it's many years.
• 3:14
  SPEAKER_01: That doesn't mean you've had it for that many years before you enter the mental health system.
• 3:19
  SPEAKER_02: Aaron Powell But are most people who come in for treatment still children?
• 3:24
  SPEAKER_02: Or is it decades later as adults that someone enters the mental health system?
• 3:28
  SPEAKER_01: Aaron Powell It depends on its variables.
• 3:31
  SPEAKER_01: So most people come in and get diagnosed as adults.
• 3:35
  SPEAKER_01: Okay.
• 3:36
  SPEAKER_01: But they may have been in the mental health system for ADHD, anxiety, behavior problems, all kinds of different things as children and adolescents.
• 3:52
  SPEAKER_01: Yes, no, but not exactly.
• 3:54
  SPEAKER_01: So you can certainly do online quizzes that will lead you to conclude a pretty good chance, but not actually confirm and verify.
• 4:05
  SPEAKER_02: A medication exists to directly treat dissociative identity disorder.
• 4:09
  SPEAKER_01: Aaron Powell A myth, 100% for sure.
• 4:11
  SPEAKER_01: There's no medication for dissociation as such, but people with dissociative disorders commonly have depression, anxiety, other things that can be treated with meds.
• 4:22
  SPEAKER_02: Myth or fact.
• 4:23
  SPEAKER_02: For dissociative identity disorder therapy to succeed, it must fuse all alters into one single personality.
• 4:34
  SPEAKER_01: So getting all fused together into one is a good outcome, but you don't have to get all the way to totally fused together into one.
• 4:42
  SPEAKER_01: If you have parts that know each other, talk to each other, communicate with each other, there's no chaotic switching.
• 4:48
  SPEAKER_01: That can be a very good outcome.
• 4:50
  SPEAKER_02: Okay.
• 4:51
  SPEAKER_02: Myth or fact, Doctor.
• 4:52
  SPEAKER_02: Brain scans and blood tests are used to diagnose dissociative identity disorder.
• 4:58
  SPEAKER_01: A myth.
• 4:59
  SPEAKER_01: So it says in DSM 5, in the revised vision from uh just a few years ago, there's no blood test, brain scan, biological test for diagnosing any mental disorder.
• 5:13
  SPEAKER_01: There's research, there's clues, there's hope for the future, but currently you cannot use brain scans or anything else to diagnose.
• 5:22
  SPEAKER_02: Myth or fact.
• 5:23
  SPEAKER_02: Trauma processing is the first step in treating dissociative identity disorder.
• 5:28
  SPEAKER_01: Aaron Ross Powell Half fact, but probably more than 50% myth.
• 5:32
  SPEAKER_01: So the first step obviously is got to identify the problem.
• 5:36
  SPEAKER_01: Trauma therapy is normally divided into three stages, stage one, two, three.
• 5:41
  SPEAKER_01: Stage one is confirming the diagnosis, making a commitment to treatment, forming a good working relationship with a therapist.
• 5:48
  SPEAKER_01: And then if you're terminally ill with cancer, that's probably a higher priority, right?
• 5:54
  SPEAKER_01: Or if you're in a severe battering relationship.
• 5:57
  SPEAKER_01: So you've got to be in a stable, reasonable life situation.
• 6:01
  SPEAKER_01: And getting you over to the battered post shelter and getting social sports and so on, you got to do that before you start diving into DID therapy.
• 6:10
  SPEAKER_01: Then stage two is the actual act of therapy work.
• 6:14
  SPEAKER_01: And then stage three is a sort of consolidation, really locking it in and learning how to live with what's called single personality disorder, which is how to cope in the world without DID.
• 6:26
  SPEAKER_02: We all have that.
• 6:27
  SPEAKER_01: Yeah, pretty much.
• 6:28
  SPEAKER_02: Myth or fact.
• 6:29
  SPEAKER_02: When people with dissociative identity disorder seek help, it is usually specifically for their alters.
• 6:36
  SPEAKER_01: That's a myth.
• 6:37
  SPEAKER_01: Usually people come in with depression, anxiety, substance abuse, relationship problems, some traumatic event happened recently.
• 6:45
  SPEAKER_01: A minority of people will come in.
• 6:47
  SPEAKER_01: I want therapy for DID.
• 6:49
  SPEAKER_01: But some people already have been diagnosed by somebody else or have figured it out themselves.
• 6:54
  SPEAKER_02: Myth or fact, Doctor.
• 6:55
  SPEAKER_02: People with dissociative identity disorder can live productive and successful lives.
• 7:00
  SPEAKER_01: Absolutely.
• 7:01
  SPEAKER_01: And I've seen many examples of that.
• 7:02
  SPEAKER_01: It's not guaranteed.
• 7:04
  SPEAKER_01: Just like somebody with substance abuse problem, big drug or alcohol problem, it's possible to recover and live a great life.
• 7:11
  SPEAKER_01: Not everybody makes it.
• 7:12
  SPEAKER_02: Which is true with or without any condition, right?
• 7:16
  SPEAKER_01: Right.
• 7:16
  SPEAKER_02: Yeah.
• 7:17
  SPEAKER_02: So, Dr.
• 7:18
  SPEAKER_02: Russ, let's start with how is dissociative identity disorder diagnosed?
• 7:23
  SPEAKER_01: Well, the first point is it's most often not.
• 7:26
  SPEAKER_01: Because uh social work, psychology, medical school, all those places are massively deficient on training, teaching, explaining DID.
• 7:38
  SPEAKER_01: And that need obviously needs to change.
• 7:40
  SPEAKER_01: There's a series of questions.
• 7:42
  SPEAKER_01: So you don't just meet somebody for the first time, they come into their office and you don't just go, Do you have DID?
• 7:48
  SPEAKER_01: Mm-hmm.
• 7:49
  SPEAKER_01: Right?
• 7:49
  SPEAKER_01: You have to lead into it and build up to it.
• 7:52
  SPEAKER_01: So you take a general psychiatric history, like where were you born?
• 7:56
  SPEAKER_01: How far do you go in school?
• 7:58
  SPEAKER_01: Are you married?
• 7:59
  SPEAKER_01: What what's your work history and so on?
• 8:01
  SPEAKER_01: And then why are you here?
• 8:03
  SPEAKER_01: And then do you have trouble with anxiety, trouble with depression?
• 8:06
  SPEAKER_01: Tell me about that.
• 8:07
  SPEAKER_01: And that may lead to depression, panic disorder, whatever diagnoses.
• 8:12
  SPEAKER_01: But once you're launching into the dissociation part, you start with open-ended questions, and then you narrow down down to more closed-ended specific questions.
• 8:22
  SPEAKER_01: And this is after you've taken the child abuse history.
• 8:24
  SPEAKER_01: Uh, do you have any trouble with your memory?
• 8:27
  SPEAKER_01: No.
• 8:28
  SPEAKER_01: Okay, so we're we're off of the path of leading us to DID.
• 8:32
  SPEAKER_01: Well, the answer is yes.
• 8:34
  SPEAKER_01: I have a terrible memory.
• 8:35
  SPEAKER_01: I can't remember anything.
• 8:37
  SPEAKER_01: Okay, well, tell me a little bit more about that.
• 8:39
  SPEAKER_01: So then they just give you a little bit more of an explanation, and then you'll narrow down to specific questions.
• 8:45
  SPEAKER_01: Do you ever have not counting drugs or alcohol?
• 8:48
  SPEAKER_01: Do you ever have clear chunks of missing time?
• 8:51
  SPEAKER_01: Not just a minute or two, like could be hours, sometimes days, sometimes even longer, where you're completely gone, you have no idea what happened.
• 8:59
  SPEAKER_01: The answer is yes, and they don't have epilepsy, they don't have a drug or alcohol problem, they don't have a brain injury.
• 9:06
  SPEAKER_01: You've got a dissociative disorder pretty well locked in right there.
• 9:10
  SPEAKER_01: And these in in a standardized interview I developed, like these are called secondary features of DID.
• 9:16
  SPEAKER_01: So, okay, you have these blank spells.
• 9:20
  SPEAKER_01: How old when yes they started, how often do they happen?
• 9:24
  SPEAKER_01: How often do they happen recently?
• 9:25
  SPEAKER_01: How long?
• 9:26
  SPEAKER_01: Is there any sort of pattern to when that happens?
• 9:29
  SPEAKER_01: So you get just a little more detail.
• 9:31
  SPEAKER_01: And then uh, do you ever have the experience of you come out of a blank spell and you're somewhere else and you don't know how you got there?
• 9:38
  SPEAKER_01: No, never, yes, often, frequently, okay, what kind of places do you come to in?
• 9:44
  SPEAKER_01: Sometimes I'm just in another part of the house.
• 9:46
  SPEAKER_01: And then that can be hard to tell the difference between just spacing out for a while and switching.
• 9:52
  SPEAKER_01: But if you come to at the shopping center and it's four hours later, and you've got a bunch of groceries and a bunch of clothes or whatever that you've bought, that's not normal forgetting.
• 10:03
  SPEAKER_01: Do people ever tell you about stuff that you've done that you don't remember?
• 10:06
  SPEAKER_01: Okay, it could be some little thing, it could be normal.
• 10:09
  SPEAKER_01: But somebody comes up to you and says, Boy, I really enjoyed having lunch with you last week, and you don't remember at all, and you don't even know who the person is, because so that's not regular forgetting.
• 10:19
  SPEAKER_01: Um, do people ever describe you behaving differently during times you don't remember?
• 10:24
  SPEAKER_01: No, yeah, sometimes.
• 10:26
  SPEAKER_01: And how do they describe you behaving?
• 10:28
  SPEAKER_01: Do they ever describe you seeming like a scared child or really, really angry?
• 10:33
  SPEAKER_01: Or the life of the party, which way more extroverted and gregarious than you normally are?
• 10:38
  SPEAKER_01: Often, yeah.
• 10:40
  SPEAKER_01: Do you have large parts of your childhood that you don't remember?
• 10:44
  SPEAKER_01: So everybody does remember most of their childhood.
• 10:46
  SPEAKER_01: But so it can be vague, but when it's clear, it's uh I don't remember anything at all before age 13.
• 10:53
  SPEAKER_01: And what happened at age 13.
• 10:55
  SPEAKER_01: Uh my mom split up with my stepdad, who was very abusive.
• 10:59
  SPEAKER_01: So they're already going, oh, I think I know what that's all about.
• 11:02
  SPEAKER_01: So that's the memory amnesia part of it.
• 11:05
  SPEAKER_01: Different behavior, which is all clues that there's switching to other parts.
• 11:09
  SPEAKER_01: And then another big part of it is voices.
• 11:12
  SPEAKER_01: Do you have voices talking out loud inside your head?
• 11:15
  SPEAKER_01: Yes, no, unsure.
• 11:17
  SPEAKER_01: And so the person will say, Oh yeah.
• 11:19
  SPEAKER_01: Do those voices seem to come from inside you?
• 11:22
  SPEAKER_00: Yeah.
• 11:23
  SPEAKER_01: But in DID and in psychosis, voices can seem like they're coming from outside or inside.
• 11:29
  SPEAKER_01: So there's a sort of clinical myth that voices from outside equals schizophrenia, voices from inside equals DID.
• 11:36
  SPEAKER_01: Research does not support that at all.
• 11:39
  SPEAKER_01: Okay, so do the voices seem to have genders?
• 11:44
  SPEAKER_01: Some male, some female?
• 11:46
  SPEAKER_01: Oh yeah.
• 11:47
  SPEAKER_01: So describe that a little bit.
• 11:49
  SPEAKER_01: Well, there's a female voice, what does the female voice say to you?
• 11:52
  SPEAKER_01: Do the voices seem to have different ages?
• 11:54
  SPEAKER_00: Mm-hmm.
• 11:56
  SPEAKER_01: But sometimes it's yeah, there's the I've got a seven-year-old voice, a twelve-year-old voice, it can be very detailed and specific.
• 12:03
  SPEAKER_01: And then sometimes it's I don't know the ages.
• 12:06
  SPEAKER_01: Well, could you say that the angry male voice that you described seems like a child or a teenager or an adult?
• 12:14
  SPEAKER_01: And sometimes I can narrow it down to, mm, seems like an angry teenager.
• 12:19
  SPEAKER_01: What kind of stuff does the voice say to you?
• 12:21
  SPEAKER_01: And you want a bunch of detail about that, as opposed to the stereotypical, oh, you hear voices, all right, here's your medication.
• 12:29
  SPEAKER_01: You want to take a full inventory of it's like there's little people inside, knowing that they're not literary people.
• 12:36
  SPEAKER_01: What's their names, what are their ages, how do they interact with each other?
• 12:40
  SPEAKER_01: What do you know about them?
• 12:40
  SPEAKER_01: Do you like them?
• 12:41
  SPEAKER_01: Do you not like them?
• 12:42
  SPEAKER_01: How long have they been around?
• 12:44
  SPEAKER_01: How often do you hear the voices?
• 12:46
  SPEAKER_01: And are there voices that are sort of kind and supportive or hostile, angry, putting you down?
• 12:53
  SPEAKER_01: Do the voices talk to each other?
• 12:55
  SPEAKER_01: And what kind of conversations do they have?
• 12:57
  SPEAKER_01: Do they have disputes about you and what you're doing?
• 13:01
  SPEAKER_01: So that's a you know full inventory of all the different types of voices.
• 13:05
  SPEAKER_01: And then the I explain that it can be very tricky to tell the difference between voices and thoughts sometimes.
• 13:11
  SPEAKER_01: Sometimes it's out loud, it's not me, I would never say that.
• 13:15
  SPEAKER_01: I can't turn the voice on, I can't turn it off.
• 13:17
  SPEAKER_01: But as in all examples of spectrum, if the voice gets quiet, quiet, quiet, quiet, so I say there's there's two dials in your brain.
• 13:27
  SPEAKER_01: One's a volume dial.
• 13:29
  SPEAKER_01: You turn the volume down, down, down, starts to seem more like a thought than a voice.
• 13:34
  SPEAKER_01: Then the other I call the ego alien dial, which is jargon for how much it doesn't seem like it's me.
• 13:40
  SPEAKER_00: Okay.
• 13:41
  SPEAKER_01: So if it's way up on the volume, way up on the ego alien, okay, that's a voice.
• 13:45
  SPEAKER_01: But if we turn the volume down and we turn the ego alien down, then it gets to, well, I think it's just me thinking to myself inside my head.
• 13:54
  SPEAKER_01: But sometimes it doesn't seem like it's me thinking, it seems like there's somebody else's thinking inside my head.
• 13:59
  SPEAKER_01: But it's not a voice, it's a thought.
• 14:01
  SPEAKER_01: So that's equally possibly DID, because it's not always voices, sometimes it's the parts of thinking, and the thoughts intrude into the outfront person.
• 14:12
  SPEAKER_01: Um and like everything, all the time, it's when did it start?
• 14:15
  SPEAKER_01: How often is it?
• 14:17
  SPEAKER_01: What do you think those voices are?
• 14:20
  SPEAKER_01: And it can be, I don't know, or it can be, I think they're evil spirits, or it could be, I think I'm crazy, or you want what's the person's understanding of what these voices are?
• 14:30
  SPEAKER_01: And you don't want to, like like I said, you don't want to come in for the first session and go, oh, do you have different people inside with different names and ages?
• 14:38
  SPEAKER_01: And you want to leave that till later, right?
• 14:40
  SPEAKER_01: So after the voices, then do you ever get the feeling there's like another person or a very separate part of yourself inside?
• 14:47
  SPEAKER_01: You just directly ask.
• 14:49
  SPEAKER_01: Any of those parts have their own names and ages?
• 14:52
  SPEAKER_01: Do you think that these parts of yourself and the voices have something to do with each other?
• 14:57
  SPEAKER_01: Well, I don't know.
• 14:58
  SPEAKER_01: Or, yeah, well, those are the parts talking.
• 15:00
  SPEAKER_01: And so people can have different degrees of insight, understanding.
• 15:04
  SPEAKER_01: Yeah.
• 15:05
  SPEAKER_01: That's the those are the basic screen questions.
• 15:07
  SPEAKER_02: Aaron Powell So they're basic for someone who specializes in this, right?
• 15:11
  SPEAKER_02: Because if if the medical community isn't being well trained and educated on dissociative identity disorder, I'm thinking of someone listening or watching right now and thinking, he's talking about me, or he's talking about somebody I know and care about.
• 15:24
  SPEAKER_02: Where do they go?
• 15:25
  SPEAKER_02: Or is there a way that you can improve your odds of a correct diagnosis when you don't have access to a specialist?
• 15:32
  SPEAKER_01: Well, how do you get access is the question.
• 15:35
  SPEAKER_01: Um So the website for the International Society for the Study of Trauma and Dissociation, which I'm a past president of.
• 15:44
  SPEAKER_01: What is that website called?
• 15:46
  SPEAKER_01: ISST-D.org.
• 15:49
  SPEAKER_01: Okay.
• 15:50
  SPEAKER_01: And the hyphen's in there because there's also an International Society for the Study of Sexually Transmitted Diseases.
• 15:56
  SPEAKER_01: That's different.
• 15:57
  SPEAKER_01: That's not the one to go to.
• 15:58
  SPEAKER_01: Okay.
• 15:59
  SPEAKER_01: Um there's uh all kinds of information on there, and they have trainings and seminars and workshops.
• 16:05
  SPEAKER_01: But there's a find a therapist right on the main page.
• 16:09
  SPEAKER_01: You click on find a therapist, and then you can enter where you are and do on a 25-mile radius, 100-mile radius, and click, and it comes up with all the members of that society within that geographical area.
• 16:24
  SPEAKER_01: And then you can call one of them or email, whichever, and commonly you'll get, well, you might get no response, but you'll get, I'm full, I'm not taking any new clients.
• 16:34
  SPEAKER_01: Do you know somebody who is?
• 16:36
  SPEAKER_01: So just use that as into the referral network.
• 16:40
  SPEAKER_02: What percentage if somebody were to go to a site like recovery.com and put in dissociative identity disorder, what percentage of therapists actually know enough to help you?
• 16:50
  SPEAKER_01: If you're the ones who belong to that society Okay, belong to that society.
• 16:54
  SPEAKER_01: Okay.
• 16:55
  SPEAKER_01: If you go to like psychology.com, it's throwing a dart at a very large dartboard.
• 17:01
  SPEAKER_01: Okay.
• 17:01
  SPEAKER_01: And there's people who being trauma-informed, nobody talked about that 15 years ago.
• 17:08
  SPEAKER_01: And then uh there's definitions of trauma-informed and official government definitions.
• 17:14
  SPEAKER_01: So now it became we're trauma-informed because we want more income for us, so we can suck people in by saying we're trauma-informed.
• 17:23
  SPEAKER_01: And sometimes it's real, and sometimes it's just marketing baloney.
• 17:28
  SPEAKER_01: So just because somebody claims to be trauma-informed, as on psychology today, people say they treat trauma, but they really aren't very skilled.
• 17:37
  SPEAKER_01: So you always have to watch out.
• 17:39
  SPEAKER_01: You just have to be an informed consumer and check the person out and see if they actually do know what they're talking about.
• 17:44
  SPEAKER_02: But if you don't know what you have, isn't that kind of hard?
• 17:47
  SPEAKER_01: Yeah, it's very hard.
• 17:48
  SPEAKER_01: But you know, I mean, people don't have no idea what's wrong with them.
• 17:52
  SPEAKER_01: People know that they had a lousy childhood, people know they feel depressed, they know they have anxiety, they know there's some kind of trouble.
• 18:00
  SPEAKER_01: Okay.
• 18:01
  SPEAKER_01: And then there's the International Society for Traumatic Stress Studies, ISTSS.
• 18:07
  SPEAKER_01: And they're very PTSD oriented.
• 18:10
  SPEAKER_01: So if you just have, quotes, just regular PTSD, you can go there and try and find therapists there.
• 18:18
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• 18:22
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• 18:28
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• 18:32
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• 18:35
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• 18:42
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• 18:51
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• 18:57
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• 19:02
  SPEAKER_02: How is dissociative identity disorder different from schizophrenia or borderline personality disorder?
• 19:08
  SPEAKER_02: And why does pop culture constantly confuse the three?
• 19:12
  SPEAKER_01: Well, it's not just pop culture that confuses them, it's psychiatry.
• 19:16
  SPEAKER_01: So back in a little history lesson here.
• 19:20
  SPEAKER_01: So back at the end of the 19th century, beginning of the 20th century, there was no schizophrenia anywhere ever, because the term hadn't been invented yet.
• 19:28
  SPEAKER_01: And a guy named Eugen Bloiler wrote a book in 1906-8, somewhere in there, called Dementia Precoc, or the group of schizophrenia.
• 19:39
  SPEAKER_01: So the idea was very much it's a form of dementia.
• 19:43
  SPEAKER_01: Precox means it starts early in life, but it doesn't really look anything like dementia.
• 19:47
  SPEAKER_01: Dementia precocks evolved into schizophrenia.
• 19:51
  SPEAKER_01: And what was the which schizophrenia means split mind.
• 19:55
  SPEAKER_01: So split mind disorder is what schizophrenia says.
• 19:59
  SPEAKER_01: So what's the difference between split mind disorder and DID?
• 20:03
  SPEAKER_01: Very murky.
• 20:04
  SPEAKER_01: And in the book, which I've read and quoted from at length, he says that that the core of schizophrenia is splitting, which is why it's split mind disorder in Latin.
• 20:16
  SPEAKER_01: And by splitting he means the same thing as quoting other professionals mean by dissociation.
• 20:25
  SPEAKER_01: So he says that splitting is the same thing as dissociation, and splitting is the fundamental basis of split mind disorder equals schizophrenia.
• 20:33
  SPEAKER_01: So this is already like what's going on here.
• 20:35
  SPEAKER_01: And then when you read the case histories, there's case histories of clearly not DID, but there's multiple case histories which are clear classical DID case histories that he's now calling schizophrenia.
• 20:48
  SPEAKER_01: And he says that splitting doesn't involve just one thing.
• 20:53
  SPEAKER_01: There's about twelve or so different psychic functions that can be split.
• 20:58
  SPEAKER_01: So it's memory, feelings, knowledge, skills.
• 21:02
  SPEAKER_01: So it's a very broad set of splitting equals dissociation-based symptoms.
• 21:07
  SPEAKER_01: And when you look at the people, they have trauma histories, they have you know different names that they go by.
• 21:12
  SPEAKER_01: And he says, he kind of poo-poos the different names, but they often claim to have different names and ages.
• 21:18
  SPEAKER_01: He describes the whole thing in detail.
• 21:20
  SPEAKER_01: And then everybody goes, that's schizophrenia.
• 21:23
  SPEAKER_01: And then it evolves into, well, schizophrenia is a genetic brain disease.
• 21:27
  SPEAKER_01: And DID fell out of favor politically.
• 21:30
  SPEAKER_01: And so then if you have those symptoms that Bloyler described, that equals schizophrenia.
• 21:34
  SPEAKER_01: And then we turn schizophrenia into a biological brain disease that has nothing to do with trauma.
• 21:39
  SPEAKER_01: So last 40, 50 years, people in the dissociative disorders field can differentiate whether this seems to be schizophrenia or DID because there's all these DID questions that they ask that regular mental health professionals just don't ask.
• 21:54
  SPEAKER_01: So they just go voices, schizophrenia.
• 21:57
  SPEAKER_01: Right.
• 21:57
  SPEAKER_01: I'm oversimplifying a bit, but not too much.
• 22:00
  SPEAKER_01: So people with schizophrenia the funny thing is I published a paper myself, it was um 12 studies, I think it was, of how often do people with schizophrenia hear voices.
• 22:13
  SPEAKER_01: By schizophrenia experts.
• 22:15
  SPEAKER_01: And then three papers on which I was the author on one, how often do people DID hear voices?
• 22:22
  SPEAKER_01: And actually, the percentage of people with schizophrenia who hear voices is lower than the percentage of people with DID who hear voices.
• 22:28
  SPEAKER_01: So voices are actually more characteristic of complex dissociative disorders, complex PTSD.
• 22:35
  SPEAKER_01: There's people who clearly have schizophrenia or something in that general ballpark.
• 22:41
  SPEAKER_01: Schizophrenia is not just one thing, it's a label for a group of disorders, which all the schizophrenia field agrees is the case.
• 22:48
  SPEAKER_01: So there's what's called the positive symptoms and the negative symptoms of schizophrenia.
• 22:53
  SPEAKER_02: The positive symptoms of schizophrenia positive meaning you do have them and you have to have them to have that diagnosis.
• 22:58
  SPEAKER_01: Not exactly.
• 22:59
  SPEAKER_01: Okay.
• 23:00
  SPEAKER_01: Positive symptoms are things that you have that quotes normal people don't have, such as hallucinations, delusions, very disorganized behavior and speech.
• 23:08
  SPEAKER_01: The negative things, symptoms, are things you're missing that normal people would have.
• 23:13
  SPEAKER_01: Okay.
• 23:13
  SPEAKER_01: Such as being emotionally alive, connected to other people, attached to other people, uh, functioning okay.
• 23:21
  SPEAKER_01: So people with schizophrenia have more negative symptoms than people with DID.
• 23:27
  SPEAKER_01: People with DID have more positive symptoms of schizophrenia than people with schizophrenia.
• 23:32
  SPEAKER_02: Well, what is the primary treatment for dissociative identity disorder?
• 23:37
  SPEAKER_01: Everybody agrees the primary treatment is psychotherapy.
• 23:41
  SPEAKER_01: Depression for your anti-de antidepressants for your depression, anti-anxiety meds, mood stabilizers, all those things can help out because it's complex PTSD.
• 23:51
  SPEAKER_01: So those are elements of the PTSD.
• 23:53
  SPEAKER_01: But the section of PTSD, complex PTSD that equals complex dissociation, the meds don't help with that.
• 24:01
  SPEAKER_01: Unless you dissociate a little less because you're not as anxious.
• 24:06
  SPEAKER_01: So it could help a bit.
• 24:07
  SPEAKER_01: Okay.
• 24:08
  SPEAKER_01: So it's not that DID, therefore, meds are totally useless.
• 24:12
  SPEAKER_01: They're not just don't target the DID itself.
• 24:15
  SPEAKER_02: Aaron Powell So let's talk about the goals of therapy for dissociative identity disorder.
• 24:20
  SPEAKER_02: Is the goal to merge all of the alters or identities into one single one or to have compatibility among the different parts?
• 24:29
  SPEAKER_01: Aaron Powell Well, that depends on circumstances, which includes how much insurance does the person have, how much ability do they have to pay cash for therapy, how close are they driving-wise to a DID therapist, or a therapist who will do virtual therapy.
• 24:46
  SPEAKER_01: So there's a whole bunch of supply questions.
• 24:48
  SPEAKER_01: So if you can only afford 10 sessions a year, you can have to have limited treatment goals.
• 24:54
  SPEAKER_01: But if you you're not in a battering relationship, you're not terminally ill, you're not homeless, you're not so far into drug abuse that you can't focus on anything.
• 25:04
  SPEAKER_01: So you're financially able, you are focused enough and together enough to participate in therapy.
• 25:12
  SPEAKER_01: Okay, so then what's the goal?
• 25:14
  SPEAKER_01: So the goal could be the theory ideal goal, and the therapist could say, uh, we're going to treat you to full integration.
• 25:22
  SPEAKER_01: Well, that's good.
• 25:23
  SPEAKER_01: If you're fully blended back into one, you're not hearing voices, no blank spells, no war inside your psyche, obviously that's good.
• 25:31
  SPEAKER_01: But not everybody wants to go all the way.
• 25:33
  SPEAKER_01: A lot of people want to stop at uh the parts are cooperating together as a team, they know each other, there's no chaotic switching, and life is manageable and tolerable.
• 25:44
  SPEAKER_01: What's wrong with that?
• 25:45
  SPEAKER_02: Why would someone prefer that?
• 25:47
  SPEAKER_01: For a number of reasons.
• 25:48
  SPEAKER_01: One is there could still be some stuff to deal with that they don't want to deal with.
• 25:52
  SPEAKER_01: Another is a person uh said to me, Wait a minute.
• 25:57
  SPEAKER_01: You mean I'd wake up in the morning, I'd brush my teeth, I'd have breakfast, I'd go to work, I'd have lunch, and I'd be the same person all the way through.
• 26:08
  SPEAKER_01: I don't want to do that.
• 26:09
  SPEAKER_00: Wow.
• 26:10
  SPEAKER_01: So I just don't want to deal with life as a single person.
• 26:13
  SPEAKER_01: So I don't tell the person you're on cooperative bad person, I just say, okay, well, let's get to work on it.
• 26:18
  SPEAKER_01: And a lot of the times it's integration is sort of the a byproduct of the therapy work.
• 26:24
  SPEAKER_01: You don't directly work on integration 99% of the time.
• 26:28
  SPEAKER_01: It's just when you work on communication between parts, cooperation, sharing memories, sharing feelings, helping each other to manage outside and inside.
• 26:37
  SPEAKER_01: You just sort of gradually de-differentiate and head in the direction of being more integrated.
• 26:42
  SPEAKER_02: So for someone who would prefer that or doesn't have the option of getting to, you know, fusion to one person, does it feel, in the example you gave, like I have a whole team dealing with life as opposed to just me?
• 26:57
  SPEAKER_02: And it can be a positive?
• 26:59
  SPEAKER_01: Yeah, that's the the problem is the team is not functioning as a team.
• 27:03
  SPEAKER_01: It's an internal civil war.
• 27:05
  SPEAKER_01: So, but if everybody's on the same team, knows they're in the same body, some people prefer music and some people prefer sports, and but they all share the time.
• 27:15
  SPEAKER_01: Sounds good to me.
• 27:16
  SPEAKER_01: The list of sad facts is 99%, 99.999% of people with DID, if we go on all around the world, Asia, Africa, how many people have access to DID skill therapy?
• 27:32
  SPEAKER_01: Almost zero.
• 27:34
  SPEAKER_01: So why do we think that the world's not getting healed?
• 27:37
  SPEAKER_01: Well, it's not just because there's not enough DID therapists.
• 27:40
  SPEAKER_01: There's not enough mental health psychotherapy healing that people can actually get to and participate in.
• 27:47
  SPEAKER_01: And then yet on, you know, there's war and natural disasters and AIDS epidemic and all we're not going to fix all of that with just individual psychotherapy.
• 27:57
  SPEAKER_01: So there's huge trauma breeding conditions in the world everywhere.
• 28:02
  SPEAKER_02: Can you give us some actionable, respectful guidelines for supporting a partner or a friend with dissociative identity disorder?
• 28:10
  SPEAKER_01: Uh sure, that's easy, in one sense, which is, and I always tell family members, you you don't have to be a therapist, you don't have to use techniques, just be yourself, assuming that it's a decent person.
• 28:23
  SPEAKER_01: Just be there, be supportive, don't freak out, don't let the person get away with everything and anything and have all kinds of outrageous behavior that's destroying the world around you.
• 28:33
  SPEAKER_01: That's it.
• 28:35
  SPEAKER_01: Spend time doing normal stuff.
• 28:37
  SPEAKER_01: Listen to the the ugly, disturbing stories, some but not too much.
• 28:42
  SPEAKER_01: Make sure the person goes to therapy.
• 28:45
  SPEAKER_01: If they have a substance abuse problem, probably a good idea to go to a substance abuse program or go to AA meetings at least.
• 28:51
  SPEAKER_01: So just all the ways you can be a supportive human being that are no different from normal life.
• 28:57
  SPEAKER_02: So other than setting the bar too low, what are some mistakes you know that people frequently make that we should avoid when trying to support someone with DID?
• 29:07
  SPEAKER_01: Aaron Powell So there's little mistakes and big mistakes, right?
• 29:10
  SPEAKER_01: Okay.
• 29:10
  SPEAKER_01: So smarten up, stop being an idiot, that's not a good approach, right?
• 29:16
  SPEAKER_01: But people do say all this stuff.
• 29:18
  SPEAKER_01: Not helpful.
• 29:19
  SPEAKER_01: Even if it is actually going on, that sort of nasty, accusing, put-down feedback is not helpful in any relationship.
• 29:27
  SPEAKER_01: If they switch to a child alter personality who doesn't know who you are and is scared, where's my dad or where's my mom?
• 29:34
  SPEAKER_01: Or then you might have to explain a little bit.
• 29:36
  SPEAKER_01: It's okay, you're safe.
• 29:38
  SPEAKER_01: Uh why don't you just let Susie come back?
• 29:42
  SPEAKER_01: So you can do a little bit of kind of like therapist switching behavior, but you don't want to get carried away with that.
• 29:48
  SPEAKER_02: So as we wrap up this conversation, if somebody sees themselves or someone they know and care about in this conversation, what are their next best steps?
• 29:59
  SPEAKER_01: The next best steps are make sure that you, the supporting person, have supports for you.
• 30:06
  SPEAKER_01: Because if you crash and burn out as a support person, that's not good.
• 30:11
  SPEAKER_01: Uh in terms of getting help, the International Society for the Study of Trauma and Dissociation, ISST-D.org, you can go on there and there's a list of therapists that you can search by geographical location.
• 30:26
  SPEAKER_01: Uh, if you can't find a DID specialist, then I would go a therapist who says I do internal family systems, an EMDR therapist, eye movement desensitization reprocessing, which is emdri.org, or somebody who s doesn't just say they treat trauma, but they actually for real seem to be knowledgeable complex PTSD therapist.
• 30:52
  SPEAKER_01: You're much better off there than nowhere.
• 30:56
  SPEAKER_01: And you know, a huge chunk, like the majority of the work of therapy and recovery, is not DID focused and specific.
• 31:04
  SPEAKER_01: So you can get a lot of what you need from a skilled general therapist.
• 31:09
  SPEAKER_02: But it's best to look for someone who deals with the specialties that you mentioned, including.
• 31:14
  SPEAKER_01: It's better to have a specialist, but it's not game over if you can't find one.
• 31:18
  SPEAKER_01: Okay.
• 31:18
  SPEAKER_01: You can still get substantial benefit and support from a good solid therapist who's trauma aware.
• 31:25
  SPEAKER_02: So as we finish up, can someone with dissociative identity disorder lead a healthy and productive life?
• 31:34
  SPEAKER_01: Um I've know multi, multi, multi-multi-millionaire people who've started poor, built that up all themselves.
• 31:44
  SPEAKER_01: They didn't inherit it with DID, functioning very well, a little bit chaotic in their personal lives, but not that far away from average level of chaos.
• 31:55
  SPEAKER_01: Um so I've met lots of professionals with PhDs, MDs, MAs working in complex jobs who are doing a good job.
• 32:05
  SPEAKER_02: If someone wants to learn more about what you do, where can they get a hold of you or learn that?
• 32:10
  SPEAKER_01: Uh a number of different websites.
• 32:11
  SPEAKER_01: So they just search Dr.
• 32:13
  SPEAKER_01: Colin Ross, uh trauma modeltherapy.com, RossInst, or which is short for the Ross Institute, R-O-S-S-I-N-S-T.com, or uh Get Out of Your Head Therapy.
• 32:27
  SPEAKER_01: That's the therapy group that I work within in Texas.
• 32:30
  SPEAKER_02: Final thoughts before we wrap here.
• 32:33
  SPEAKER_01: Uh well, if you go to trauma modeltherapy.com, there's a whole very structured training program for professionals, and it delivers the message that most of the work is general human being work, general trauma work.
• 32:46
  SPEAKER_01: DID is a little bit on top.
• 32:49
  SPEAKER_01: It's important, but it's not the whole package.
• 32:51
  SPEAKER_01: So you can get the rest of the package from a non-DID trauma specialist.
• 32:57
  SPEAKER_00: Good.
• 32:57
  SPEAKER_01: And you're not crazy and you're not insane.
• 33:00
  SPEAKER_01: You have an understandable injury from trauma, just like a person with a broken leg from a car wreck.
• 33:06
  SPEAKER_02: And it's amazing how the brain can adapt.
• 33:09
  SPEAKER_01: It's astounding.
• 33:10
  SPEAKER_01: It's an amazing skill.
• 33:11
  SPEAKER_01: It's very creative.
• 33:13
  SPEAKER_01: Why would you want to go through childhood without dissociation?
• 33:16
  SPEAKER_01: Why would you want to feel it all, know it all?
• 33:19
  SPEAKER_01: I wouldn't.
• 33:20
  SPEAKER_01: But then now you're 25 or 30 and you know you're switching and doing chaotic behavior and that needs a little work.
• 33:28
  SPEAKER_02: Yeah.
• 33:28
  SPEAKER_02: It begins as protective and then can turn into something that no longer serves you.
• 33:32
  SPEAKER_01: Right.
• 33:33
  SPEAKER_01: And the way I compare that is to like IBM or whatever company you want to choose.
• 33:38
  SPEAKER_01: Okay, they were making machines, but they don't seem to be selling the same machines now that they were in 1980.
• 33:46
  SPEAKER_01: Certainly not.
• 33:47
  SPEAKER_01: So things had to change.
• 33:48
  SPEAKER_01: You have to adapt to the times.
• 33:50
  SPEAKER_01: Just doing the same pattern, the same tasks, the same organization that you did when you were a kid is not going to fit the modern world or the adult world.
• 33:59
  SPEAKER_02: And that sounds way less shaming.
• 34:01
  SPEAKER_01: Right.
• 34:02
  SPEAKER_01: So it doesn't mean what you're using is stupid, it just means it needs to be updated.
• 34:06
  SPEAKER_02: Okay.
• 34:07
  SPEAKER_02: Thank you very much for your time.
• 34:08
  SPEAKER_02: I appreciate it.
• 34:08
  SPEAKER_01: You're welcome.
• 34:09
  SPEAKER_01: Greatly appreciate the opportunity.
• 34:11
  SPEAKER_01: Thanks.
• 34:12
  SPEAKER_02: And we will be back next week with a dive into another behavioral health topic.
• 34:16
  SPEAKER_02: Please join us.