Friday, April 6, 2012

The Rule of Abuse in Dissociative Identity Disorder

 Some Background on DID:
     Dissociative Identity Disorder starts as a way to cope with being helpless, with being unable to change a traumatic situation that occurs repetitively or over a long period of time, typically at a young age.  In persons with DID, the mind has created a way to try and change their reality inside because they could not change unbearable realities on the outside.   Dissociation that has reached it's most severe form as a system of multiple personalities is a form of protection.  Each personality comes out to handle a job that is overwhelming or harmful for the core or "main" personality.  Each personality has their specific job to do, and they only come out to do that job.  This is an efficient solution to cope with a really bad situation as long as the system lasts.  Once an alter system develops it continues indefinitely without anyone the wiser until a significant life change, or additional high stress may cause the system to break down.  When this happens alters are still present, but no longer come out for one specific function or share and block knowledge making their presence unnoticeable.  After a system collapse the presence of alters can become very noticeable as they are no longer able to regulate who comes out for what.  In the core personality of the person who has no knowledge of alters, this often presents as memory loss, extreme confusion, pieces of their life that just don't fit or make sense, reports of them acting out of character, losing control of their body and thoughts, "out of body" experiences.  They may experience headaches, dizziness, and temporary loss of senses such as vision.

 How the Cycle of Abuse Is Present in DID

     -An Inability to React
     Although a protective mechanism from one or many traumatic situations, outside of those situations and later in life, DID can also be seen as a severe inability to react.  This is especially true during the time period between a Multiple System collapse and recovery- whether that recovery be integration or simply awareness and open communication between alters.  In Dissociative Identity Disorder, the ability to react is stifled.  Instead of recognizing a problem, considering their options and taking action to deal with it, a person with DID will either automatically dissociate to numb themselves from any awareness or feeling, or switch alters.  With a switch happens at the first indication of a problem, the core personality is often never even aware that there was a problem to begin with.  If the alter that switched out deals with it, it is possible the core personality will never be aware the problem ever existed.

     -The Connection to Abuse
     Because these coping techniques, dissociation and switching, have been developed out of an inability to change unbearable situations, the core personalities' ability to problem solve is never developed.  Because persons with DID usually come from an abusive background, their being afraid and unable to solve problems is key to remaining part of an abusive cycle.  Cruel, violent, and manipulative people do not encourage their victims to think or pay attention.  They certainly do not encourage them to assess, research, or network their way into a fulfilling life.  DID is the extreme of dissociation, but it also seems to encompass the extreme of an abusive mentality.  People with DID that have may not at one time been "allowed" to respond to problems or fend for themselves are often now not capable of doing so.  Their lives often seem catastrophic because numerous tiny problems have snowballed out of control simply because of their low ability to recognize and respond to problematic situations.  

     -Abuse Encourages the Impediments of DID
     If they are still in the same environment as when the DID developed, sadly the ability of a DID patient to react and respond will probably not be encouraged.  More likely it will be suppressed and thwarted for the purpose of keeping them under the control of someone else.  This is an excessive and dangerous method of control, because it completely stumps a persons' ability to care for and protect themselves- from emotional abuse, from physical violence, for proper nourishment, hygiene, and a number of problems that an inability to react and respond can lead to, from a misunderstanding with a grocery clerk to a collision on the freeway.  The person or persons encouraging this impediment cannot and usually will not even attempt to protect these people who cannot protect themselves.  It is a selfish motive with seriously negative effects on their victim.  

     -Disease and the Link to Abuse in DID
      Disease deserves it's own paragraph writing about the connection of abuse to DID.  So many people with DID come with a ridiculously long list of ailments and diseases rarely seen in a person living in a region with modern medical care.  The extreme level of dissociation in DID can make it extremely difficult to be aware of the body, notice discomfort, or consistently stay with a routine of treatment.  Most DID patients come from an abusive background that caused the long term trauma resulting in DID.  If they grew up with severe neglect, it may not occur to them to seek medical treatment for anything from a burn to a broken leg.  They may not think they are worth helping, or that nothing short of immediate death is worth mentioning to anyone.  This is a continuation of the denial they grew up around.  If they were victims of physical or sexual abuse, the person has likely learned to minimize life threatening situations, and ignores disease just as they were trained to ignore assault.  
     Many alters of DID patients are conditioned to keep secrets.  They may hide medical conditions, or be unable to speak about them or ask for help.  By their nature alternate personalities hide information from other alters, especially the core personality.  Combined with alters "switching" in and out, it is very difficult for a person with DID to notice if something is wrong, make an appointment, keep the appointment, and be able to stay with a treatment program.  Also due to frequent switching and dissociation, it may be difficult for persons with DID to maintain even the most basic hygiene, nourishment, and first aide.  Added to all that is the fact that nearly every System of alters has at least one alter who is self destructive, or destructive of the body.  Self inflicted punishment and mutilation are extremely common.  The overall health picture of someone with DID is one of general neglect, frequent illness and injury, and extreme difficulty getting and maintaining medical care.

     -Communication is Cut
     In every cycle of abuse there is the rule of silence- don't talk about it, don't ask questions, don't tell anyone, don't speak up.  Nowhere is this more true than in Dissociative Identity Disorder.  A core personality who has suffered any degree of mistreatment usually cannot talk about it because their memory of it has been delegated to a different part of the brain- to another personality.  Some alters have complete or partial inability to see or speak, preventing them from observing or telling others what they know.  This includes other people but it may include other alters in their system as well.  Some alters were created as a vault for fear, anger, or knowledge.  They have been specifically designed by the brain to keep what they know and feel locked away from everyone else.  With severe trauma being inflicted on a child, -in this case usually by someone they depend on- there is always a spoken or unspoken message not to talk about it.  A child may at first try to seek help or stop it, but they are always very inherently aware of how vulnerable they are.  Since in these cases there is no help to be had, alternate personalities develop to help the child survive.  

     -In DID, the Rule of Silence is Literally Binding
     Unless they learn differently later in life and recognize the pattern and become aware of what they are doing and the effect it has and make a conscious effort to change, people taught an abusive cycle will take the rule of silence to their graves.  In the case of people with DID, the rules of silence always accompanies a severe inability to function, and unless they can overcome the silence, this too will never change.

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