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emdrhypno January 9th, 2007 12:06 PM

Dissociation red flags
Sandra, thanks again for your response(s) to my previous question. I am still chewing on much of it, and doing related reading to help me clarify some of the things you wrote.
One allusion you made was to telltale signs of "non-florid" dissociation. I would love more specificity from you on this matter.
Other than asking a client questions from the DES casually, or formally administering the test, I feel a little clueless in this regard.
Such an important issue! I'd love any and all feedback.

Sandra Paulsen January 9th, 2007 02:49 PM

Re: Dissociation red flags
Non-florid switching in a DID person is very interesting. First let me talk about a related subject, which is "switching" (though we don't generally use that word) in a non-DID person.

Lets say Joe and Mary are having a discussion about the weather at the water cooler. Its good natured and pleasant, so each of them is in a socially engaged state, smiling and relaxed. Then Mary says something political rolling her eyes about a particular politician, thinking Joe would surely agree. Joe, however, has different politics, and is instantly shocked by her comment, he switches into an adrenaline state, and struggles with his anger, trying to stay polite. LeeAnn, an observer, sees his facial flushing, his jaw muscles tightening, and hears his voice constrict. She knows, as we all do, that there has been a mood change, or you could state, a state change or switch. One neural network had been activated, but somehow, the associations triggered by the political comment precipitated another coalition of neurons to become activated, and therefore the neural networks that were active turned off and another turned on. It wasn't a smooth transition; we know that he struggled to hide his anger and stay cheerful.

In DID the neural networks are not entirely fluid, but are bound by relatively impermeable barriers so that there is amnesia for what is experienced when one state is executive, while in another state. If Joe were DID, when in his affable mood he may not even remember the angry part of the conversation.

In our offices, DID clients switch states in very subtle manners most of the time, indistinguishable from non-DID state changes. The distinction turns not on the presence of florid signs of switching, but on amnesia for the prior state.

Some DID folks switch in ways that are characteristic to themselves, and which become recognizable over time as the light slowly dawns on the therapist. For example, one person might cough, or sigh as she switches, or another might shift weight from one elbow to the other, or another person might turn her head just so as she switches. This behavioral cue is the next step in the chain that enables the state switch to occur. I keep seeing this picture of someone climbing out of a boat onto a dock. They have to add a little oomph, a little extra something, to hoist themselves out. The behavioral ritual of the small cough is that extra something that's needed to effect the switch.

Must close, a patient is waiting.

emdrhypno January 9th, 2007 07:34 PM

Re: Dissociation red flags
Is this kind of amnesia unique to DID? I have known people who can only access specific memories while in the state related to those memories. Does this warrant a diagnosis of DID for these people? My impression was that DID entails much more extreme symptoms, such as the parts having different identities/names/ages...

Sandra Paulsen January 9th, 2007 09:57 PM

Re: Dissociation red flags
State dependent learning is a basic human filing strategy -- we all do it. You may recall (or not, depending on your state) the study that found that students who studied while stoned scored better on tests when they were stoned than if they weren't stoned, and I think conversely for those who studied straight. Recall is easiest from the state in which the experience was stored.

Its much more salient a matter in DID.

If one can rule out alcohol/drugs and organic problems like temporal lobe epilepsy, then lost time is a possible indicator of a dissociative disorder, one of which is DID.

In DID, the separation is distinct, but not necessarily extreme. There may not be separate names and wardrobes. It may be entirely covert.

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