Trauma is an event or series of events that are so overwhelming and threatening to life or sanity that a person cannot cope. The mind may switch off (dissociate) during the event or, at the very least, it will not be able to hold together the different elements of the event afterwards and ‘integrate’ them or join them together.
The way we respond to trauma is not a matter of choice – it is a biologically preprogrammed set of responses which happen in a predictable sequence. Here we look at the five ‘F’ responses to trauma.
There are many ways to describe dissociation, and we look here at dissociation as it pertains to dissociative identity disorder and trauma.
Dissociative identity disorder is a creative survival mechanism for coping with overwhelming and chronic childhood trauma.
For dissociative identity disorder (DID) to develop, there is usually chronic trauma in early childhood along with significant problems in the child-parent relationship.
Diagnosis of dissociative disorders is by no means straightforward, mainly due to a lack of training and knowledge. The main diagnostic criteria can be found in the DSM-5 and this article explains how diagnosis is made.
There are a number of diagnostic tools available for assessing dissociative disorders. This article lists the principle ones.
Dissociative disorders appear as diagnostic categorisations in both the American-based DSM-5 produced by the American Psychological Association (APA, 2013), and the other ‘diagnostic’ bible used more widely in Europe, the World Health Organisation’s ICD-10.
DDNOS is seen by many people as a ‘not yet’ or ‘a not quite’ version of dissociative identity disorder and although it is supposed to be a ‘residual category’ and only given to a few people, in fact the vast majority of people diagnosed with a dissociative disorder fall into this category.
I have dissociative identity disorder. I have many separate, distinct and unique ‘parts’ of my personality. My ‘parts’ or ‘alters’ collectively add up to the total person that is me. I am the sum of all my parts. They are each a letter, and I am a sentence.
Physical symptoms are a big part of life for me with DID. Yes, I have ‘multiple personalities’, the “two or more distinct identities that recurrently take control of the body” and I’m not for one moment denying the significance of that or the impact it has on my day-to-day life. But I would say that physical symptoms such as chronic, unexplained pain, headaches and nausea have been and still remain far more distressing and life-impacting for me than the presence of parts.
Crisis makes sense. The adrenaline of it can become addictive, or be all we’ve known. Life doesn’t feel right if things aren’t frantic, if relationships aren’t disastrous. Crisis can be an attachment cry. Crisis is the language of emotions that we don’t know how to regulate.