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1 " FLATOW: So you would - how would you treat a patient like Sybil if she showed up in your officeBRAND: Well, first I would start with a very thorough assessment, using the current standardized measures that we have available to us that assess for the range of dissociative disorders but the whole range of other psychological disorders, too. I would need to know what I'm working with, and I'd be very careful and make my decisions slowly, based on data about what she has. And furthermore, with therapists who are well-trained in dissociative disorders, we do keep an eye open for suggestibility. But that research, too, is not anywhere near as strong as what the other two people in the interview are suggesting.It shows - for example, there's eight studies that have a total of 11 samples. In the three clinical samples that have looked at the correlation between dissociation and suggestibility, all three clinical samples found non-significant correlations. So it's just not as strong as what people think. That's a myth that's not backed up by science." Exploring Multiple Personalities In 'Sybil Exposed' October 21, 2011 by Ira Flatow "
2 " Dissociation is the ultimate form of human response to chronic developmental stress, because patients with dissociative disorders report the highest frequency of childhood abuse and/or neglect among all psychiatric disorders. The cardinal feature of dissociation is a disruption in one or more mental functions. Dissociative amnesia, depersonalization, derealization, identity confusion, and identity alterations are core phenomena of dissociative psychopathology which constitute a single dimension characterized by a spectrum of severity.Clinical Psychopharmacology and Neuroscience 2014 Dec; 12(3): 171-179The Many Faces of Dissociation: Opportunities for Innovative Research in Psychiatry "
― Verdat Sar
3 " People with dissociative disorders are like actors trapped in a variety of roles. They have difficulty integrating their memories, their sense of identity and aspects of their consciousness into a continuous whole. They find many parts of their experience alien, as if belonging to someone else. They cannot remember or make sense of parts of their past. "
4 " Alterations in regulation of affect (emotion) and impulse:Almost all people who are seriously traumatized have problems in tolerating and regulating their emotions and surges or impulses. However, those with complex PTSD and dissociative disorders tend to have more difficulties than those with PTSD because disruptions in early development have inhibited their ability to regulate themselves.The fact that you have a dissociative organization of your personality makes you highly vulnerable to rapid and unexpected changes in emotions and sudden impulses. Various parts of the personality intrude on each other either through passive influence or switching when your under stress, resulting in dysregulation. Merely having an emotion, such as anger, may evoke other parts of you to feel fear or shame, and to engage in impulsive behaviors to stop avoid the feelings. "
― , Coping with Trauma-Related Dissociation: Skills Training for Patients and Therapists
5 " Changes in the Perception of Self:People who have been traumatized in childhood are often troubled by guilt, shame, and negative feelings about themselves, such as the belief they are unlikable, unlovable, stupid, inept, dirty, worthless, lazy, and so forth. In Complex Dissociative disorders there are typically particular parts that contain these negative feelings about the self while other parts may evaluate themselves quite differently. Alterations among parts thus may result in rather rapid and distinct changes in self perception. "
6 " when a child is ridiculed, shamed, hurt or ignored when she experiences and expresses a legitimate dependency need, she will later be inclined to attach those same affective tones to her dependency. Thus, she will experience her own (and perhaps others’) dependency as ridiculous, shameful, painful, or denied. - Dependency in the Treatment of complex PTSD and Dissociative Disorders 2001Authors: Kathy Steele, Onno van der Hart, Ellert R. S. Nijenhuis "
― Kathy Steele
7 " Treating Abuse Today (Tat), 3(4), pp. 26-33Freyd: I see what you're saying but people in psychology don't have a uniform agreement on this issue of the depth of -- I guess the term that was used at the conference was -- " robust repression." TAT: Well, Pamela, there's a whole lot of evidence that people dissociate traumatic things. What's interesting to me is how the concept of " dissociation" is side-stepped in favor of " repression." I don't think it's as much about repression as it is about traumatic amnesia and dissociation. That has been documented in a variety of trauma survivors. Army psychiatrists in the Second World War, for instance, documented that following battles, many soldiers had amnesia for the battles. Often, the memories wouldn't break through until much later when they were in psychotherapy.Freyd: But I think I mentioned Dr. Loren Pankratz. He is a psychologist who was studying veterans for post-traumatic stress in a Veterans Administration Hospital in Portland. They found some people who were admitted to Veteran's hospitals for postrraumatic stress in Vietnam who didn't serve in Vietnam. They found at least one patient who was being treated who wasn't even a veteran. Without external validation, we just can't know --TAT: -- Well, we have external validation in some of our cases.Freyd: In this field you're going to find people who have all levels of belief, understanding, experience with the area of repression. As I said before it's not an area in which there's any kind of uniform agreement in the field. The full notion of repression has a meaning within a psychoanalytic framework and it's got a meaning to people in everyday use and everyday language. What there is evidence for is that any kind of memory is reconstructed and reinterpreted. It has not been shown to be anything else. Memories are reconstructed and reinterpreted from fragments. Some memories are true and some memories are confabulated and some are downright false.TAT: It is certainly possible for in offender to dissociate a memory. It's possible that some of the people who call you could have done or witnessed some of the things they've been accused of -- maybe in an alcoholic black-out or in a dissociative state -- and truly not remember. I think that's very possible.Freyd: I would say that virtually anything is possible. But when the stories include murdering babies and breeding babies and some of the rather bizarre things that come up, it's mighty puzzling.TAT: I've treated adults with dissociative disorders who were both victimized and victimizers. I've seen previously repressed memories of my clients' earlier sexual offenses coming back to them in therapy. You guys seem to be saying, be skeptical if the person claims to have forgotten previously, especially if it is about something horrible. Should we be equally skeptical if someone says " I'm remembering that I perpetrated and I didn't remember before. It's been repressed for years and now it's surfacing because of therapy." I ask you, should we have the same degree of skepticism for this type of delayed-memory that you have for the other kind?Freyd: Does that happen?TAT: Oh, yes. A lot. "
8 " Treating Abuse Today 3(4) pp. 26-33Freyd: The term " multiple personality" itself assumes that there is " single personality" and there is evidence that no one ever displays a single personality.TAT: The issue here is the extent of dissociation and amnesia and the extent to which these fragmentary aspects of personality can take executive control and control function. Sure, you and I have different parts to our mind, there's no doubt about that, but I don't lose time to mine they can't come out in the middle of a lecture and start acting 7 years old. I'm very much in the camp that says that we all are multi-minds, but the difference between you and me and a multiple is pretty tangible.Freyd: Those are clearly interesting questions, but that area and the clinical aspects of dissociation and multiple personalities is beyond anything the Foundation is actively...TAT: That's a real problem. Let me tell you why that's a problem. Many of the people that have been alleged to have " false memory syndrome" have diagnosed dissociative disorders. It seems to me the fact that you don't talk about dissociative disorders is a little dishonest, since many people whose lives have been impacted by this movement are MPD or have a dissociative disorder. To say, " Well, we ONLY know about repression but not about dissociation or multiple personalities" seems irresponsible.Freyd: Be that as it may, some of the scientific issues with memory are clear. So if we can just stick with some things for a moment; one is that memories are reconstructed and reinterpreted no matter how long ago or recent.TAT: You weigh the recollected testimony of an alleged perpetrator more than the alleged victim's. You're saying, basically, if the parents deny it, that's another notch for disbelief.Freyd: If it's denied, certainly one would want to check things. It would have to be one of many factors that are weighed -- and that's the problem with these issues -- they are not black and white, they're very complicated issues. "
9 " Those with dissociative disorders face a big enough battle living as multiples and dealing with past trauma. Like everyone else, they deserve to be heard and recognised, not stigmatised. "
― , Living with the Reality of Dissociative Identity Disorder: Campaigning Voices
10 " Many people with Dissociative Disorders are very creative and used their creative capacities to help them cope with childhood trauma.p55 "
― , Interviewer's Guide to the Structured Clinical Interview for Dsm-IV (R) Dissociative Disorders (Scid-D) (REV)
11 " Although Dissociative Disorders have been observed from the beginnings of psychiatry, the Structured Clinical Interview for DSM-III-R Dissociative Disorders (Steinberg 1985) was the first diagnostic instrument for the comprehensive evaluation of dissociative symptoms and to diagnose the presence of Dissociative Disorders. "
― , Structured Clinical Interview for Dsm-Iv(r) Dissociative Disorders (Scid-D-R)
12 " Early identification of patients who suffer from dissociative symptoms and disorders is essential for successful treatment, because these disorders do not resolve spontaneously. In addition, dissociative disorders are not alleviated by treatment directed toward an intercurrent disorder. However, because the dissociative disorders are among the few psychiatric syndromes that appear to respond favorably to appropriate treatment (Spiegel, 1993), improved accuracy in differential diagnosis is critical. "
13 " Despite the growing clinical and research interest in dissociative symptoms and disorders, it is also true that the substantial prevalence rates for dissociative disorders are still disproportional to the number of studies addressing these conditions. For example, schizophrenia has a reported rate of 0.55% to 1% of the normal population (Goldner, Hus, Waraich, & Somers, more or less similar to the prevalence of DID. Yet a PubMed search generated 25,421 papers on research related to schizophrenia, whereas only 73 publications were found for DID-related research. "
― , Oxford Textbook of Psychopathology
14 " The lifetime prevalence of dissociative disorders among women in a general urban Turkish community was 18.3%, with 1.1% having DID (ar, Akyüz, & Doan, 2007). In a study of an Ethiopian rural community, the prevalence of dissociative rural community, the prevalence of dissociative disorders was 6.3%, and these disorders were as prevalent as mood disorders (6.2%), somatoform disorders (5.9%), and anxiety disorders (5.7%) (Awas, Kebede, & Alem, 1999). A similar prevalence of ICD-10 dissociative disorders (7.3%) was reported for a sample of psychiatric patients from Saudi Arabia (AbuMadini & Rahim, 2002). "
15 " Some mental healthcare workers are aware of clients with high needs, such as dissociative disorders and personality disorders, who have histories of sexual abuse (contact offences), usually from early childhood, involving two or more adults acting together and multiple child victims (Gold et al., 1996; McClellan et al., 1995; Middleton & Butler, 1998). This has been defined as “organised abuse” (Bibby, 1996; La Fontaine, 1993). Excluded from this definition arecases where a child is sexually abused by multiple perpetrators who are unaware of one another, such as survival sex amongst homeless youths, or where abuse is limited to a single household or family and there are no extra-familial victims (La Fontaine, 1 "