Archive of ‘Dissociative Identity Disorder’ category

Why Choose EMDR Therapy?

By: Susanna Wetherington, LPC

By: Susanna Wetherington, LPC

Since the birth of the psychological field, there have been dozens of therapeutic approaches that have been developed to help individuals work through their struggles. One therapy that is relatively new, at least in relation to how long others have been around, is known as a therapy called EMDR. EMDR stands for Eye Movement Desensitization and Reprocessing. I’m going to tell you a little bit about what EMDR is and how it can be used in therapy to treat a wide array of difficulties.

What is EMDR?

EMDR is a therapy developed by psychologist Dr. Francine Shapiro in 1989. In 1987 Dr. Shapiro stumbled upon the observation that eye movements can lessen the intensity of disturbing thoughts and used this observation to fuel research that led to her publication in The Journal of Traumatic Stress, establishing EMDR as a therapy used to treat post traumatic stress. Since then researchers have gone on to show how EMDR is not only very effective in treating trauma and PTSD, but can also treat other difficulties such as:

  • performance anxiety
  • panic attacks
  • body dysmorphic disorders
  • painful memories
  • phobias
  • complicated grief
  • dissociative disorders
  • personality disorders
  • pain disorders

How Does EMDR Work?

There is no way to know how any psychotherapy works on the neurological level, but there are some things we do know. When a person is very upset and under duress, the brain cannot process information as it would under normal conditions. (See my previous blog about how trauma affects the brain). So parts of the memory get stored separately and “frozen in time.” When the memory is then activated, it can feel very much like the person is experiencing the memory as if it is currently happening: the same feelings, thoughts and body sensations can resurface with the same intensity as when the event occurred because those things never processed through adequately and thus remain unchanged. These memories interfere with the way a person reacts to and views the world and others.

It appears that EMDR has an effect on how your brain processes information and allows the “frozen” material a chance to process through in a functional manner. Once the memory has been processed adequately, it no longer has the same effect on the person. Many individuals come away feeling neutral about the memory. By using bilateral stimulation (meaning both the left and right hemispheres are alternately stimulated), that’s where the eye movements come in, these “stuck” memories get activated and normal information processing can be resumed. This is similar to what happens naturally in REM (rapid eye movement) sleep, the cycle of sleep in which information taken in through the previous day is processed and sorted into short-term and long-term memory networks. If you have ever observed someone during the REM sleep cycle, you may have noticed that their eyes are darting back and forth underneath the eyelids. So really this is different from other therapies that work toward the same goals because it works on the physiological level.

Why Choose EMDR Therapy

So, Why Choose EMDR Therapy?

In short, EMDR therapy is optimal because it can usually achieve the same goal as similar therapies with fewer sessions. It can also be useful when talk therapy has not proven to be effective. Since some experiences seem to get “frozen” in the memory networks, talking about them may not be enough. EMDR works on the neurological level to access those memories in a way that talk therapy may not be able to, so then the memory can be worked through. Survivors of trauma have also reported that EMDR therapy was optimal because it is not necessary to talk in detail about the traumatic event in order for EMDR to be effective. That doesn’t mean that it may not still be painful and difficult to bring up, but the whole narrative does not need to be given and once the memory is activated the person can move through the process with less difficulty. The brain moves towards healing just like our bodies do. If you cut your hand, your body works to heal itself. The brain does the same thing, and EMDR helps remove those barriers so it can.

This has been a brief description of what EMDR is and how it works. EMDR has been shown to be effective with children, teens, and adults. I hope it has been helpful and I hope you will consider EMDR therapy for yourself and your loved ones in the future! If you would like more information on EMDR you can visit http://www.EMDRIA.org and http://www.EMDR.com.


Dissociation and Dissociative Disorders

Now that we have explored the various experiences of dissociation and dissociative disorders, how do dissociative disorders develop? The short answer is trauma. There is about a zero percent likelihood that dissociative tendencies are genetic. Dissociative disorders are most commonly associated with repetitive childhood physical and/or sexual abuse and other forms of trauma. These other forms include severe neglect or emotional abuse. Children may become dissociative in families in which the parents are unpredictable, frightening, or are dissociative themselves and do not have their own methods of coping in a healthy way with dissociation.

By: Susanna Wetherington, LPC-Intern Supervised by Lora Ferguson, LPC-S

By: Susanna Wetherington, LPC-Intern
Supervised by Lora Ferguson, LPC-S

To reiterate from before, dissociation is considered adaptive because it reduces the overwhelming distress that is created by trauma. The trauma is just too much to handle, and so in a protective response, parts of the brain shut down and others become activated so the experience does not overwhelm the individual. This is survival at its best. It’s truly amazing that our minds can protect us in these ways. Difficulty arises when dissociation continues to be used in adulthood, when the original threat no longer exists, and it can then be seen as maladaptive. A dissociative adult may disconnect in situations that are perceived as threatening, because aspects of the situation trigger the former trauma(s), without determining whether or not there is any real danger. This can leave the person “tuned out” in various ordinary situations and unable to adequately protect themselves in times of real danger. When we think of the fear responses produced by the amygdala, “fight, flight and freeze,” this is a version of the “freeze” response.

Dissociative disorders can also develop in adulthood. This tends to be related to the intensity of dissociation during a traumatic event experienced as an adult. The more severe the dissociation experienced at the time of the event, the greater likelihood that these dissociative mechanisms will generalize to subsequent events. And again, if trauma is frequently experienced, such as abuse experienced in adulthood, there is a greater likelihood that a dissociative disorder may develop. The experience of ongoing trauma in childhood also greatly increases the likelihood of developing dissociative disorders in adulthood.

Treatment

Before seeking treatment, it is important to find a licensed professional who is well versed in treating dissociative disorders. There are various ways to treat dissociative disorders and treatment will be specific to the type of dissociative disorder that is diagnosed. However, there are key components that are central to these treatments. The first is stabilization. This is important in all areas of therapy, with the focus being creating safety and stability in the individual’s life. This includes creating coping skills specific to the individual in order to help them cope with their symptoms, ranging from anxiety to depression. Sometimes this includes safety planning, which pertains to coming up with a plan with the individual if the individual believes they may be in danger of harming themselves or others or if the individual is engaging in risky or dangerous behaviors. Stabilization also involves normalizing the individual’s experience, helping them understand that dissociation is a common response and that more severe dissociation is actually an adaptive response that helped them cope with overwhelming distress. This is extremely important. Many people assume that because someone suffers from a mental health disorder that there is something “wrong” with them. I reiterate to my clients this is not the case. Our brains are amazing and complicated organs. Sometimes they ways in which our brain protects us can also lead to problems in day-to-day functioning down the road. The primary function of therapy is to help individuals get back to a balance that works for them.

Since trauma is the most common cause of dissociative disorders, part of the treatment involves trauma work. This means processing through the memories of the trauma experienced by the individual. This takes time and it is imperative this is done at the pace of the individual. Continued stabilization and development of coping skills may continue throughout treatment.

This concludes my discussion on dissociation. I hope you have gained insight into dissociation and all its facets. Please visit the International Society for the study of Trauma and Dissociation for more information.

 

 

 

References:

http://www.isst-d.org

Haddock, Deborah Bray (2001) The Dissociative Identity Disorder Sourcebook, McGraw-Hill.


Dissociation: The Experiences of Disconnection, Part 2

Welcome back! Today I am going to continue the discussion on dissociation I began last time. To recap, dissociation is most simply explained as disconnection. For clinical purposes, dissociation is a disconnection between things that are often associated together. Dissociation experiences lie on a spectrum, and most people can relate to experiencing at least mild forms of dissociation. Last week I discussed a few mild experiences of dissociation, such as “zoning out” on a routine drive and missing your exit on the highway, otherwise known as “highway hypnosis.” Now I would like to discuss more severe forms of dissociation. There are 4 main categories of dissociative disorders, as defined in the catalogue of psychological diagnoses created by the American Psychiatric Association, the Diagnostic Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR). These are:

By: Susanna Wetherington, LPC-Intern Supervised by Lora Ferguson, LPC-S

By: Susanna Wetherington, LPC-Intern
Supervised by Lora Ferguson, LPC-S

  • Dissocaitive Amnesia
  • Dissociative Fugue
  • Depersonalization Disorder
  • Dissociative Identity Disorder (formerly known as Multiple Personality Disorder)

A clinical dissociative disorder is suggested if there is a strong presence of 5 features: amnesia, depersonalization, derealization, identity confusion, and identity alteration.

1. Amnesia

Amnesia is defined as the inability to recall important personal information that is so extensive it cannot be explained by forgetfulness or an organic disorder. In the realm of dissociation, the amnesias are commonly important events in ones life that are forgotten. These forgotten events are often traumatic, such as experiencing abuse or a troubling incident. These lost blocks of time can span from minutes to years. Most often experienced are micro-amnesias, where a discussion is not remembered or the content of a conversation is forgotten from one moment to the next.

2. Depersonalization

Depersonalization is the sense of being “not in” one’s body, being detached from it. It is often described as an “out-of-body” experience. This experience can be so profound that the individual does not recognize their face in the mirror or does not feel “connected” to their bodies in a way that is difficult to put into words.

3. Derealization

Derealization is sensing the world is not real. Individuals describe this as seeing the world as if they were watching a movie. The world is often described as looking foggy, far away, or as being seen through a veil of sorts.

4. Identity Confusion

Identity confusion is simply feeling confusion about whom a person is. An example would be engaging in activities an individual would normally detest and finding them thrilling. Generally, the individual does something that is very out of character for them and the behavior cannot otherwise be explained by the influence of drugs or an organic disorder.

5. Identity Alteration

Identity alteration is the sense that one has markedly different parts of oneself. This is a feature that was formerly referred to as having multiple personalities. This can be very troubling for the individual and the loved ones of individual who have this experience. A person may shift into an alternate personality and experience confusion about where they are and whom they are with. Their voice, facial expression and body language may change. The individual can experience distortions in time, situation, and place. Often the individual is unaware of the identity alteration, however this is not always the case.

Dissociative Fugue, which was not directly discussed above, is characterized by a sudden and unexpected departure from one’s home or place of work and is accompanied by an inability to recall one’s past and confusion about one’s personal identity or the assumption of a new identity. The individual is generally unaware of the amnesia and often appears “normal” to others. (DSM–IV–TR (2000) 4th ed., text rev.)

Come back for the final piece where I will discuss how dissociation and dissociative disorders develop and how they are treated!

 

References:

The International Society for the Study of Trauma and Dissociation – http://www.isst-d.org

American Psychiatric Association. (2000). Diagnostic and statistical
manual of mental disorders
(4th ed., text rev.).
doi:10.1176/appi.books.9780890423349.

Steinberg, M. (2008). In-Depth: Understanding Dissociative Disorders. Psych Central. Retrieved on March 20, 2015, from http://psychcentral.com/lib/in-depth-understanding-dissociative-disorders/0001377


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