Trigger Scale: (2/5)
Learn what a “session splash” is.
hour 2 (part 3)
- Dissociative Continuum from Crackers & Juice
- Dissociative Spectrum & DSM-IV Criteria from Empty Memories
it was the end of the second hour and i was ready to talk more about diagnosis (continued from my last session). my therapist commented that i started looking at my notes continuously as the first hour ended, and the only topic left was the ‘diagnosis issue.’ good thing i scheduled two hour appointments!
Dissociative Continuum from Crackers & Juice
i showed her a printout that i had brought with me (one of two) with one interpretation of a “dissociative continuum” from Crackers & Juice called “Grounding 101”, which i also mentioned in my previous session. we moved to the small table and stools so we could look at it side by side. we normally sit in a couch (me) and chair (her) configuration.
i asked her what she thought of the continuum, prefacing this question with the comment that i knew not everyone agreed that dissociative disorders even occur on a spectrum. i also noted that i knew ptsd shouldn’t really be on the list, as it is not a dissociative disorder. but they do all relate in some ways, and i agreed with where ptsd was placed on this continuum.
she said that she had never thought about it like a continuum. however, she did mostly agree with it’s presentation. she also felt that i did fit somewhere in there. we had discussed ptsd before, but this just did not feel whole to me, or was off somehow.
Dissociative Spectrum & DSM-IV Criteria from Empty Memories
i next showed her the other printout from Empty Memories called “Dissociative Disorders”. i had highlighted areas that stuck out to me or that i wanted to discuss with her, so we started by going through those.
the first section i highlighted is under “Theory Dissociation”, the section “Confusion and wrong words”. i highlighted the first bullet point:
“So dissociation literal means; ‘experiencing detachment from one self, experiencing a reality outside one self’ or ‘a falling apart of the self in segments or personality parts’ (also called alters), who have amnesia for each other.”
this made me feel better…because it made me feel that my ‘freaky’ brain might have an explanation. i experience many of my memories as if they are someone else’s, or from a vantage point other than through my own eyes, such as from the corner of the room, or from the ceiling or sky.
the next highlighted part that we discussed was under “Dissociative Disorders”, under “Note”:
“dissociation is a different process than repression. In genuine cases of DID there is fear (or phobia) and embarrassment about having other personalities.”
at first the first sentence confused me. how can dissociation be different than repression if dissociation leads to repressed memories? i should clarify this next time with my therapist. the second sentence comforted me because, like i mentioned in my previous session splash, i was terrified of something that felt unknown and at the same time known. i felt as if i was always covering something up. so this sentence resonated with me and made me feel better about this unknown.
Depersonalization – Derealization (DP)
the next highlighted area is under “Depersonalization – Derealization (DP)”:
“Depersonalization as a primary dissociative disorder is where a person “looks at themselves from the outside”, and observes their own physical actions or mental processes as if they were an observer instead of themselves.”
again, this statement eased my mind because all of my abuse or highly stressful memories seem to be ‘out-of-body’ experiences. to elaborate on what i mentioned above, not only do i feel as if my memories are someone else’s, but sometimes like my thoughts, feelings, interpretations and reactions are not my own. they feel very foreign to me, like i am watching myself go through the motions, like a sim in a video game.
i next checked off what DSM-IV criteria i felt i fit, which i did for each of the following areas as well. (i wasn’t trying to self-diagnose, only understand what was happening to me, which i couldn’t describe yet.) i will quote WikiPedia though because it includes a more updated version. Here is the DSM-IV criteria quoted from WikiPedia about “Depersonalization Disorder”:
“The diagnostic criteria defined in section 300.6 of the Diagnostic and Statistical Manual of Mental Disorders are as follows:
- Persistent or recurrent feelings of being detached from one’s mental processes or body; as if an observer
- During depersonalization, reality testing is intact
- Depersonalization causes significant distress, and impairment in social, occupational, or other functioning
- Depersonalization is not the result of another disorder, substance use, or general medical condition”
i put check-marks next to 1, 2, & 3, and a question mark (?) next to 4. the first three i can say i fit without issue (although i question if 2 is always true about reality testing), but 4 is why i am discussing everything with my therapist (having another disorder would of course rule this one out).
Post Traumatic Stress Disorder (PTSD)
i did not discuss this section with my therapist, but will share what parts of the DSM-IV i checked off. this is quoted from WikiPedia, “Posttraumatic Stress Disorder”:
“The diagnostic criteria for PTSD, per the Diagnostic and Statistical Manual of Mental Disorders IV (Text Revision) (DSM-IV-TR), may be summarized as:
A. Exposure to a traumatic event
B. Persistent reexperience (e.g. flashbacks, nightmares)
C. Persistent avoidance of stimuli associated with the trauma (e.g. inability to talk about things even related to the experience, avoidance of things and discussions that trigger flashbacks and reexperiencing symptoms fear of losing control)
D. Persistent symptoms of increased arousal (e.g. difficulty falling or staying asleep, anger and hypervigilance)
E. Duration of symptoms more than 1 month
F. Significant impairment in social, occupational, or other important areas of functioning (e.g. problems with work and relationships.)”
i put check-marks next to a, b, (i have nightmares nightly and sweat through my clothing and bedding, but do not remember them) c, d, (all of the ones mentioned) e, (how about 24 years!) and last but not least f. i only have one good friend, although i am recently making more contact.
Dissociative Identity Disorder (DID)
quoted from WikiPedia, dissociative identity disorder section, under “Diagnosis”:
“The diagnostic criteria in section 300.14 (dissociative disorders) of the DSM-IV require:
- The presence of two or more distinct identity or personality states, each with its own relatively enduring pattern of perceiving, relating to, and thinking about the environment and self.
- At least two of these identities or personality states recurrently take control of the person’s behavior.
- Inability to recall important personal information that is too extensive to be explained by ordinary forgetfulness.
- The disturbance is not due to the direct physiological effects of a substance (e.g., blackouts or chaotic behavior during alcohol intoxication) or a general medical condition (e.g., complex partial seizures).”
i put a question mark next to 1, the phrase “past?” (with question mark) next to 2, and check-marks next to 3 and 4. i don’t remember talking about number 1 or reading it with my therapist, but i think i did. i do recall discussing 2, and spouting off into a story about an experience i had one day in 7th grade while in french class.
i remember i kind of ‘woke up’ and was sitting at my desk, except i had a feeling i hadn’t been ‘asleep’ because i was holding a pencil in my hand, midair, and felt i was about to write something. when i looked down at my desk i saw a completed assignment, but in handwriting slightly different than mine. it made me feel like someone was playing a trick on me, so i picked it up and turned to my friend behind me, asking her if she had written it. she gave me a look like i was insane, and told me to stop playing around, that i had been working hard on it all hour. the bell rang, so i moved on. but i never forgot the way she looked at me.
at this point my therapist looked at me and said maybe you had DID… i don’t remember anything else except she looked thoughtful. my next session is not until saturday this week.