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Hey, welcome back to The Testing Psychologist podcast. Glad to be here. Today we’re tackling a topic that is the source of much debate in our field. We’re talking about dissociative identity disorder and all things [00:01:00] related to that. My guest, Dr. Chrissy Mannion, is an EMDR Certified Therapist and Consultant-in-Training who has a group practice, Mindful Psychology in Rochester, New York.
She splits her time providing trauma-based therapy for adolescents and adults with complex trauma and dissociation, psychological assessments, professional consultation, and presentations. Her assessments are usually focused on complex presentations, often including trauma, ADHD, and or autism.
Chrissy and I talk through many aspects of DID including the history and the debate around DID’s authenticity, so to speak. We talk about the relationship between DID and trauma. We talk about red flags to look for when assessing for DID and treatment options for individuals who’ve been diagnosed with dissociative identity disorder. So lot to take away from this episode as usual. I’m very grateful for Chrissy’s time and expertise on [00:02:00] a topic that I admittedly don’t know much about.
As we transition to the episode, I of course invite any practice owners out there to consider a Testing Psychologist mastermind group. New cohorts are starting in July-ish at the beginner and intermediate and advanced levels. These are group coaching experiences where you’re in a group with 4 or 5 other psychologists at your level of practice. There’s accountability, there’s support and people make some great strides in these groups. You can go to thetestingpsychologist.com/consulting to get more information and sign up for a pre-group call to see if it’s a good fit.
Let’s get to my conversation with Dr. Chrissy Mannion.
Hey, Chrissy, welcome to the podcast.
Dr. Chrissy: Thanks for having me.
Dr. Sharp: I’m glad to have you. Yes, we have a topic today that is a hot topic in our field and something that we haven’t really talked about on the podcast before somehow, yet another of those topics. I’m always amazed how we can go six years without talking about some of these things, but here we are. I’m glad to have you. We’re going to be talking about dissociative identity disorder. So, thank you for being here.
Dr. Chrissy: Thank you so much. I’m glad to be here and talk about it. I know that it is something that comes up as a pretty hot topic in the Facebook group frequently. I’m glad that there’ll be more avenues for longer discussions.
Dr. Sharp: Absolutely. Let’s start with the question that I always start with, which is why this is important to you. Of all the things you could care about [00:04:00] in the world of psychology and assessment, why focus on this?
Dr. Chrissy: I think I’ve always had an interest in this. I think most people who run across the information of dissociative identity disorder and trauma have an interest in it in some way just because it’s fascinating how our brains work and can do different things. I’ve run into a lot of colleagues that, at least in graduate school, had a lot of interest.
I don’t know everyone else’s experience, but my experience in undergraduate and graduate school was, you’ll never ever see it. Don’t make this your area. You’ll never ever see it. You’ll only see it if you’re in one of these very specialty clinics that it’s so hard to get into. So don’t even go there.
I’ve always been interested in trauma as well, so I’ve built my therapeutic practice around trauma, which then blends itself well to dissociation because of the connection. I fell into getting some dissociative clients, both for [00:05:00] testing and for therapy, and I’ve really enjoyed that work. And so then I’ve continued to pursue additional education. My name’s gotten out there in certain communities where I have people contacting me specifically to work with me because of my dissociative experience.
So, both interest and fell into. That’s where I’m at. I do a lot of work with dissociation in my day-to-day therapy practice. It always presses some buttons when I read things that I feel are misinformed or otherwise incorrect.
Dr. Sharp: That’s fair. The story that you told about your undergraduate experience of you’ll never see this, really resonated with me. I had a similar thing where, I remember I was in my abnormal psychology class in college and we had to do a research [00:06:00] project of some sort. I chose dissociative identity disorder and read this book called First Person Plural, was the name of it.
I remember trying to do that thing that they tell undergraduates to do and go to professor’s office hours and make a connection and all of that. And so I went and was trying to talk about this book with the professor and he very dismissively was like, oh yeah, we don’t even think that’s a real thing. I was like, oh. Well, glad I did this project and that didn’t go anywhere and I didn’t make any connection with him but it really seems to overlap with your experience and probably the experience of a lot of folks out there.
Dr. Chrissy: Right. And how dismissive, right? Here you a young student trying to learn more and really getting excited about this. And not only do I not want to talk about it, but like, it [00:07:00] probably doesn’t even exist anyway. Essentially, you just wasted your time.
Dr. Sharp: Oh, sure. Yeah. It was not a great experience in that class but I moved on as we are going to do.
Let’s move to some information around dissociative identity disorder. I would love it if you could dive into some of the history around DID. There is a rich history from my understanding. I’d love to hear your perspective on that.
Dr. Chrissy: Yeah, I can definitely go into some of that. I will likely be making some comparisons to schizophrenia throughout our podcast today. I’m going to start out doing that because I think there are some comparisons to be made, both in the way people respond to schizophrenia as well as some of the history and information.
So, I will tell you, the first documentation of schizophrenia happened in 1887, and I wanted you to guess when [00:08:00] the first documentation of dissociative disorders or dissociative identity disorder occurred. What would you guess the year would be?
Dr. Sharp: I would probably guess it’s similar to schizophrenia and a few other things that I just happen to know about and say late 19th, early 20th century.
Dr. Chrissy: 1586.
Dr. Sharp: Oh.
Dr. Chrissy: Few hundred years off. 1586 is when we have the first documentation. There was a Dominican nun, Jeanne Fery, who wrote her own account of her own exorcism. She had an exorcism because of these multiple personalities or, I’m not sure exactly what they called that in that documentation at the time. Her exorcist also wrote detail about her identity fragmentation and past history of trauma. And this was later described in later writing, I think in the the1800s as doubling of [00:09:00] personality, which was the term for what we would now call the dissociative identity disorder.
There have been since then other writings that have occurred throughout the years. The one that I am aware of is in 1623. There was another documentation of possession. In this case, it was another nun, it was Sister Benedetta. And there was possession by three angelic boys who had to “take over her body”. Each speak in a different dialect, had different facial expressions, and different tones of voice that would then later deem to likely be a case of dissociative identity disorder. There’s a case of exchanged personality documented in 1791.
So, there are a lot of these accounts that either at the time or looking back we can look at the features of what’s been happening with the person in question and say, okay, this is what looks like modern-day dissociative identity disorder. This is what we would qualify that as. And [00:10:00] continuing records all the way up to the present. And certainly, more and more records as we get closer to the present.
I do think it’s also notable that dissociation and dissociative disorders and things like depersonalization and a few states and things like that were all documented in the first DSM. In the first edition in 1952, it was considered under psychoneurotic disorders. And that included, like I said, dissociated personality, depersonalization, fugue, amnesia among other things.
So, we’ve had this documented throughout history. We’ve had this documented throughout our diagnostic manual. Certainly, it’s changed names a bit and had different criteria but it’s existed for a long time, which is what really confuses me when I hear people talk about, we don’t even know if it exists. I’m like, really? I’m confused. There’s certainly things that have happened since then or newer [00:11:00] diagnoses than this one, and we have documentation. I’m not quite sure why people don’t think it exists.
Dr. Sharp: That’s fair. That is a longer history than I would’ve anticipated certainly. This is so interesting. We could go off on a whole tangent, I think, about history of psychiatric disorders and how they came about and that whole can of worms, but it seems like when you really dig in and look at historical accounts, there are accounts of many things that we see present day all way back through history. They may not use the same language of course or conceptualize it the same way, but there are hints. There’re signs.
Dr. Chrissy: Yeah. I do think it gets tricky with dissociative identity disorder because some of the examples that I just gave are talking about possession. And so that’s also a religious experience. It’s also cultural experience.
I know the DSM tries to word it as if this is seen as [00:12:00] “normal” or otherwise part of a culture, then maybe we’re not putting a diagnostic label on it. But because it fits into this category of something that, I don’t want to say normal because I don’t think there’s culture where possession is normal per se, but where it’s something that fits in and can be explained by this other experience, we don’t want to be westernizing and medicalizing this experience, but I do think that it is showing that there is history of similar symptom presentations throughout history. We’re currently understanding that as dissociative identity disorder but we can also see it in these other documents and experiences.
Dr. Sharp: That’s fair. Well, let’s bring it to the present day a little bit more and talk about prevalence and how often we do see DID.
Dr. Chrissy: Yeah, that’s another one that really gets me. Like I said before, I’ve been told [00:13:00] it’s rare. You’ll never ever see it. So rare. Most of the information I have here, both from the DSM, from the National Institute of Health, are saying that DID in the global population is somewhere around 1.5%. That is higher than schizophrenia. That is higher than autism. That is higher than both bipolar I and bipolar II. So this rare diagnosis is more prevalent than these other diagnoses that we don’t talk about as rare.
Dr. Sharp: What do you think that’s about?
Dr. Chrissy: Not going off of research, going off my own experience and knowing this, it happens to women and it happens to women because of childhood trauma that we like to pretend doesn’t happen. So yeah, women have never had trouble being believed about any of these things ever.[00:14:00] Dr. Sharp: Yeah, that’s fair. That’s such an important point. Psychiatry and medical field in general has not done a great job with being respectful and honoring of women’s experience. We tend to pathologize way more than is reasonable.
Dr. Chrissy: Or just ignore and deny. I didn’t go down this particular rabbit hole in our research but there is a potential link between the hysteric and the hysteric women in the 1800s to dissociative disorders as well.
Dr. Sharp: Sure. Yeah, that’s a thread. It might be a loose thread but it’s definitely occurring to me. We’ve got this whole thing around certainly, the hysteria, the possession, the Salem witch trials. It seems like there’s a lot of similarities with some of these historical events and I’m guessing that’s not a coincidence.
Dr. Chrissy: I wouldn’t guess it [00:15:00] is either.
Dr. Sharp: Yeah. So we got the prevalence. I think it is worth spending some time on or more time on this controversy around DID and like we alluded to in the beginning, is it a thing? Is it not a thing? What has that argument looked like over the past few decades?
Dr. Chrissy: I think there are a few arguments that are suggestive that it either doesn’t exist or that it’s not real in some way. The one I see most often is just, I’ve never seen it. I think if I talked to another professional and said, I’ve never seen schizophrenia, I don’t think it exists. They would question my credibility as a psychologist.
It’s unclear to me why it is so okay to do that for dissociative identity disorder and other dissociative disorders. That’s the one I see and hear most often is, [00:16:00] well, I’ve never seen it. My reactions are, as I just said, I’ve never seen things, doesn’t mean they don’t exist. And also, do you know what you’re looking for? Because I don’t think it looks like people think it looks if they don’t have experience, if they aren’t looking through the research, if they aren’t knowledgeable in this way.
And if someone’s saying, I don’t think it exists because I’ve never seen it, I’m assuming maybe they haven’t done the research in that way. I haven’t really dove into those experiences, worked in settings where they might have more exposure or supervision to understand what that might look like.
So those are the colloquial conversation points that I hear. In general, the more formal arguments, if you were about whether or not dissociative identity disorder and related disorder exist, are the idea that it’s somehow bad. And if that’s the case, that’s a fad that we keep returning [00:17:00] to. Every century or so, we return to this fad. So by definition, I think that makes enough fad […].I think by definition that doesn’t work.
One of the other arguments is that this is something, it’s a diagnosis that’s primarily diagnosed in North America by the DID experts who are over-diagnosing it. When you dive into research studies, it shows that the prevalence rates across different countries across the world really, it doesn’t vary. It’s about the same. Most people that are diagnosing DID aren’t DID experts. They’re people in hospitals and clinics and other experiences where they’re coming across it and recognizing it for what it is, and that’s how they’re diagnosing.
Specifically, there was a research study I looked at that showed that across Canada, Germany, Israel, the Netherlands, Switzerland, Turkey, and the US, through those structured assessments with individuals that were thought to possibly have it, and then as well as [00:18:00] people who didn’t, the prevalence rates were about the same. So it’s really not a North American specific diagnosis.
Also very interesting, and this goes into some of the other arguments, there were two studies that were done, gosh, I think it was in the 1990s, in China, and in Turkey. And at the time, DID was not something that was known in those regions. It didn’t exist in the diagnostic manual in China. So it wasn’t a diagnosis that could be made.
In Turkey, it was not something that was known at all. And when researchers went in and they were doing structured interviews on mental health patients, they found similar prevalence rates. These people had no exposure to the diagnosis or diagnostic criteria, yet we were finding people who met that at the same rate as in countries who did.[00:19:00] Dr. Sharp: It’s fascinating and telling.
Dr. Chrissy: Yeah. And that does go into the next and probably biggest argument for why people think it doesn’t exist is that they think it’s an iatrogenic disorder. It’s socially based. It’s referred to as a social cognitive model of dissociative identity disorder.
Essentially, there are various influences and factors such as suggestibility or media exposure, reinforcement through social interactions or other goal-directed experiences that these all shaped and created different personality states that then were exaggerated consciously or unconsciously and that this is a manifestation of these experiences, but not a “true” developmental or trauma-based disorder. And so that’s one of the arguments but those studies from [00:20:00] Turkey and China disagree with that.
Also the fact that there’s been research done where there has been individuals identified with the DID, individuals not identified, just control group. And then people who were familiar with DID criteria and were acting as DID simulators. And when the researchers didn’t know which group was which obviously, they were going through and they were interviewing and they were using these structured measures, they were able to accurately tell who had DID and who didn’t.
So they were able to accurately tell when there were people part of the study that were trying to emulate DID. They could tell the difference and they were accurate in identifying who had the diagnosis and who did not. So that’s suggestive to me that our measures can tell what’s happening when we’re using them appropriately.[00:21:00] Dr. Sharp: Yeah, that’s a good point certainly. I appreciate the perspective here and some of the research. I’ve heard these arguments. I’ve read a little bit around this topic and it is tough, especially the first one, that I haven’t seen it, so it’s not real, it’s just flawed logic. That’s a terrible reason to say that anything doesn’t exist.
Dr. Chrissy: Right. I agree. Glad we’re on the same page with that. The other big one that I’ve heard is just that, oh, well it’s actually something else. It’s not dissociative identity disorder, it’s borderline personality disorder, which has a lot of overlapping criteria. But again, there’s research into that as well, and it shows that there are differences with people who have bipolar or borderline personality disorder versus have dissociative identity disorder, as well as there can be overlap.[00:22:00] Again, my very snarky and defensive self goes well, maybe borderline personality disorder doesn’t move it because I can explain almost all those symptoms by PTSD and complex trauma, and dissociative disorder, maybe borderline personality disorder doesn’t exist. And maybe you should reevaluate that disorder. That’s my knee-jerk one is that was, if you’re going to make crazy arguments, here we go, let’s make that one too. But that […] is that dissociative identity disorder is actually something else.
Dr. Sharp: Sure. This is just one of those moments to reflect on the imposition of our diagnostic system and how we are so far from understanding what’s going on with people. And so much of it is left to these relatively subjective perceptions.
Dr. Chrissy: I tend to fall back in those moments and go, well, we made it all up.
Dr. Sharp: Oh yeah, sure.
Dr. Chrissy: We made it all up. We made the book that makes the rules. We made it all up and yes, I didn’t flip it. There are reasons why we have these categories. There’s research behind it. There’s evidence behind it. There’s a reason why we came to where we [00:23:00] are and we’re always growing and always reexamining and things like that. But it’s like, okay, well if we’re going to be that flipping, let’s tell people we made it all up. None of it exists. All of it exists. I don’t know.
Dr. Sharp: Yeah. Throw it all out. I’m with you. Do we have any research around functional differences, structural differences in the brain or the neurology involved with DID? Anything that theoretically you would call more hard data to support its existence.
Dr. Chrissy: There is. This is where I am less knowledgeable because that type of information does not like to stay inside my brain. But yes, there is a growing area of research that is suggesting that there is brain differences when you’re looking at people who have dissociative identity disorders versus control groups.
I know that there are some differences in the hippocampus, amygdala, [00:24:00] in frontal structures. I don’t actually know what that means, but I know that it is there because I wrote it down from the article. There’s also differences in white matter.
Again, my brain not well suited to make sense of those things, but for anyone who’s interested, yes, you can look that up. There’s a lot of research going into that now and I think that’s going to be one of the bigger areas of research that comes out in the next 10 years on dissociative identity disorder.
Dr. Sharp: That makes sense. I think that’s where we always turn if we’re trying to validate something or legitimize in one of our diagnoses.
Dr. Chrissy: Because if we can see it, it’s real. And if we don’t see it, it’s not real.
Dr. Sharp: Right. Yeah, of course, you still run into the problem of is it really specific. Are these differences specific enough to describe DID or any diagnosis to them, but that’s another conversation. It’s good to know that folks are digging into that and we’re starting to have some [00:25:00] “hard data” from brain stuff.
Okay, so we talked about the prevalence, we talked about is it real, is it not real, some of the arguments on either side of those. Clearly, you fall on the side of yes, this is a real thing and there is a fair amount of overlap between DID and trauma and borderline and some other things certainly.
Dr. Chrissy: And schizophrenia and those diagnoses as well.
Dr. Sharp: Yeah, many things. I would love to talk about the diagnostic criteria as we understand it now and what we’re looking for with DID.
Dr. Chrissy: Sure. I think it’s important to note that DID is not the only dissociative diagnosis. A lot of clients who have dissociative diagnosis would be in that other category, wouldn’t meet all full criteria for [00:26:00] dissociative identity disorder, but still have enough symptoms and significant impairment that would meet threshold for something else. We’ll focus on DID because I think that’s what the arguments are most against and what tends to be most known or not known.
As far as those criteria, I think the hallmark criteria that most people have at least some awareness of is the idea that the person has two or more distinct personality states. And it says right in the criteria, which may be described in some cultures as an experience of profession. So we can get the history right there as well.
When we’re looking at those two or more distinct states, the disruption in identity can cause impairment in a lot of ways and is marked or noticed by discontinuity in the sense of self and can have alterations in affect, behavior, consciousness, memory, perception, cognition and or sensory-motor functioning. And a very important line here at the end of this criteria, these [00:27:00] signs and symptoms may be observed by others or reported by the individual. They do not have to be noticed by others in order for them to meet these criteria.
Dr. Sharp: Right. That’s a tricky point. Again, so many doors that we could open here but yes, this idea that someone can be experiencing something that is distressing and impairing, that is not noticeable to others, especially something like this where there are theoretically different personality elements.
Dr. Chrissy: Yes. I think it’s important too that most often there will be something noticed by others. There will be something that’s noticed in different ways when there are different personality states that are coming out. I don’t think that the norm is that nothing is able to be [00:28:00] noticed by others, but I also think it’s not going to look like you think it does.
It’s not going to be, oh wow, this person just completely changed everything about themselves right in front of my eyes, now I know it’s DID. The likelihood of that happening is very, very small, I would say.
So when we’re looking at those differences, because I think collateral interview is so important in diagnosis of DID, it’s talking to the people who know them best and be like, do you ever notice them seeming to act different? Do you feel like they have mood swings? Tell me what the mood swings look like because maybe the mood swings are more of a temperament shift. Maybe they’re more of a behavioral shift. Maybe it’s a different dialect or a way of using language. Maybe it’s a different tone of voice that’s coming across. What is it that you’re seeing that you are identifying as a mood shift because that’s what you have conceptualization and language for, but I can see it as something else [00:29:00] because I have more language for what you might be noticing.
Dr. Sharp: Yeah. Let’s dig into that a little bit. Can you talk through the distinction there or the way that you might look at some of these behaviors a little bit differently but it’s not “just a mood shift”.
Dr. Chrissy: Yeah. I think for me, and I’ll be honest, I’m doing this much more therapeutically than I’m doing in an assessment scenario just because I do more therapy than assessment and people come to me for therapy for DID and they’re not always coming for assessment for that. So when I’m thinking about it in that setting, I’m always trying to pick up on themes.
Okay, so you act this particular way, when does that happen? How does that happen? Is that always around your family? Is that always in school? Is that always around this person? Is that always right after you got really stressed? What [00:30:00] is the theme or pattern of that change? And can I make conceptual sense of why that might be occurring?
Many people with DID, the idea is that they have a trauma background, so is there a trauma trigger that they have that creates what we would understand as a PTSD response but maybe seems a little bit more or different or lasts longer or something like, I’m just going to be curious in asking questions and just keeping things in the back of my head to say, okay, what do I think this means? What do I think it looks like and how does it come about? I’m keeping all of that information in mind and those are the types of questions that I’m asking.
Dr. Sharp: I think a central component of all this is the dissociative part, obviously.
Dr. Chrissy: Right.
Dr. Sharp: There are so [00:31:00] many…
Dr. Chrissy: That is very important.
Dr. Sharp: It is important. Okay, I’ve got that right. That’s good to know. There are so many different types of dissociation. I think it’s probably worth talking through those. We’ve got DID maybe at the top of the pyramid but then there’s also, like you said, the other specific dissociative diagnoses that we have. Then we have…
Dr. Chrissy: Yes. Dissociative fugue, dissociative amnesia.
Dr. Sharp: Yes. The ones that actually have dissociation in the name. But then we have PTSD, then we have anxiety. There are many types of dissociation and flavors with dissociation. I wonder if it’s worth talking a little bit about how each of those differs from one another and how we might distinguish them from a DID [00:32:00] presentation.
Dr. Chrissy: Absolutely. And so I think this conversation goes really well, talking about both dissociation as well as parts of self. So just to get basic bare-level knowledge down there, everybody dissociates. Everybody has parts of itself, that is a very normal, natural thing. I’d probably be on the other end of the spectrum. You’d have to show it to me, for me to believe it, if someone says they don’t because it just seems to be a natural part of the human experience.
I can’t talk about the parts of self, but association is also something that happens with animals so it’s part of nature. And to talk about the, if we’ll call it the bottom rung of the pyramid or whatever we’re looking at as far as dissociation that most people can recognize, I always use the example of going on autopilot when you’re driving.
So if you drive, if you’ve ever had the experience of going on an autopilot, which again, as long as you’re not someone who just started driving, I imagine you’ve [00:33:00] done this before, where you got from A to B. You clearly did so safely. You made some turns. You knew you stopped at the red lights, but you don’t actually remember doing those things. You know you did them, part of you was present but the part of you that you think of as you that has that information, was not there for that experience. So that is dissociation and ever everybody does it.
The next time you find yourself “zoning out” during conversation, you are dissociating. These are not things that we are concerned that someone does as long as they don’t do it too much or that is it’s impairing. So that is one end of the spectrum of dissociation. DID would be at the other end of that spectrum because another very important criteria for DID is recurrent gaps in memory. It’s not just the personality state but that you are losing time.
And so I think a [00:34:00] lot of times, we forget about that one. That it’s not just, oh, I act these different ways. I have these different parts of self. It’s I lose time. I do not recall important events, personal information, other data when I’m in certain states. When I am in certain parts, I don’t remember certain things. So that I think is an important part of the discussion as well.
And since we’re talking about parts, we’ll go right into that too. We all have parts of self. There is probably the very rare person, maybe that is the exact same person in every setting they have ever walked into. And I’ll believe it when I see it. Most of us have multiple parts of self.
Using myself as an example, I act differently when I am my mom’s self, than I do when I’m my therapist self, than I do when I’m my testing psychologist self, than I do when I am my friend’s self or my daughter’s self, or my soccer player self, or any [00:35:00] number of other versions of me. I like to think that I’m pretty cohesive in the sense that if you see me in one setting or another, maybe if there’s two very different settings, you’ll feel jarred for a moment. And like, wow, that person on the slacker field is not the person that did my testing last week. She curses a lot more.
That might be a thing but the core of myself is still very recognizable in any setting, even though I am different and full different ways and act differently. Someone with dissociative identity disorder would have that to a more extreme degree where their versions of self are much less recognizable in different settings. And note that each one is completely a different person.
I didn’t see the movie Split but from what I understand, the part of it that that person’s split parts are so drastically different and none of them are all that similar. [00:36:00] That’s not necessarily the case. There might be many parts that are similar or on similar threads or have similarities or some core characteristics, and then other parts that are very different.
It might also be that certain parts know how they’re “supposed to act” and then they keep acting that way even though that’s not how they want to act. And that’s not their impulse and natural experience but they know for the collective good of that human’s experience, they need to mask in that way, so they do.
Dr. Sharp: There’s a lot to digest there. Pardon me while I digest for a second.
Dr. Chrissy: You are in your critical-thinking self right now.
Dr. Sharp: Yes. Oh, good observation. I totally am. That description makes intuitive sense to me. I think we can all identify with that process of presenting differently in different circumstances. That totally rings true.
I [00:37:00] think where it gets a little harder to understand certainly is then like the more severe distinction between these different parts and how these more significant “personalities” develop and how they may know about one another. They may not know about one another. There’s all the variation in how these parts interact and how they present to the world that causes my head to spin a little bit and maybe others too. I wonder if we could talk about that.
Dr. Chrissy: Yeah. We can go into how it develops a little bit, or at least the theory of how it develops. We’ve mentioned before that the thought is that it comes from trauma and it generally thought to be severe childhood trauma that would cause it.
I think there’s some offshoot theories about the brain being more malleable in childhood through the development. And so this is maybe why it’s [00:38:00] more likely to happen at that point versus if someone experiences severe trauma later in life. I also think the idea is that severe childhood trauma oftentimes is repetitive. It’s not just one event. So it’s not a single-event trauma, it’s a complex trauma. I often think that it’s relational trauma as well. This is where it might help to bring in some of that nature piece and having dissociation occur outside of the human experience. Have you heard of animals playing dead?
Dr. Sharp: Oh, sure.
Dr. Chrissy: They think they’re going to die, they play dead. What happens when they don’t die?
Dr. Sharp: Great question, Chrissy. You tell me.
Dr. Chrissy: They keep living. They somehow stop playing dead. They determine that they don’t need to play dead anymore and then they walk away. I would guess if we followed that animal around, they might not be quite the same animal that they were before. I don’t know. I haven’t done it, but I would guess not.
And so if you have a child that’s going through [00:39:00] severe stress and trauma, their brain goes, okay, I got to shut down. This is too much. I can’t handle this. I’m going to have an out-of-body experience, or I’m going to play dead in whatever way that means or I’m going to leave because I cannot do whatever that’s happening, but they’re not gone. And this gets into the I don’t know what I mean by they’re not parts of self.
However, you want to conceptualize this experience, there’s a part of them that’s present and there’s a part of them that’s not. So the idea is that then these are then two different personality states and the more a certain trauma happens, the more the part that got pulled in for that period of time gets pulled in and developed and gets stronger and whatever else.
And if there’s lots of different type of trauma and lots of different type of experiences, there might be more parts that develop and or someone who has that type of fragmented identity may then be more likely to [00:40:00] fragment further, even in circumstances that not quite as dire. And so there’s all these different, we know, Fight, Flight, Freeze, Or Fawn. So if you can’t fight or flee, which I think would be difficult for most children to do, you’re going to freeze, fawn.
You’re either going to play dead freeze, or you’re going to, I’m going to do whatever I can to get out of this situation. I’m going to try to please this person or this experience. And so that’s also, I think, a way of that parts developing. I’m going to develop this part that really as a young kid doesn’t want to have sex, but I need to get through this. So I’m going to develop a part that really wants to have sex right now even though I’m child.
So it’s these types of experiences that really reinforce these different parts of self because then when the part who left the brain in that moment comes back, they don’t have to remember the experience. They don’t have to have, they didn’t just live through it, a different part of them [00:41:00] did. It’s this really elaborate compartmentalizing of those experiences.
Sometimes all parts are aware that things happened. Sometimes parts are aware but don’t know a lot. Sometimes a lot of parts don’t know anything, and there’s only one or two parts that hold that information. Maybe adults that I’m talking to in therapy can say, I don’t remember a lot of my childhood. I don’t remember it. And I think something happened or I think something like this happened or I know I hated this neighbor or whatever the case may be, but I don’t remember, and I don’t know that I want to.
Dr. Sharp: Let’s take a quick break to hear from our featured partner.
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Alright, let’s get back to the podcast.
That’s reasonable. Thanks for elaborating on that. I think that was a great explanation of how some of this can happen. I would love to talk about how we [00:43:00] actually assess it as formally as we can get with that process and what it may look like in our office.
Dr. Chrissy: Absolutely. And before I go into that, I’ll just add too, one of the reasons why it irks me as well why people dismiss dissociative identity disorder, it just conceptually makes sense to me. It just makes sense that this is what, from what we do know, the hard science versus a soft science, it just makes sense, whereas I would argue other diagnosis make less conceptual sense and not saying those things don’t exist but DID makes total sense to me in a way that maybe schizophrenia doesn’t make sense to me.
Dr. Sharp: Yeah, that’s fair. Well, I think especially with the trauma background that you have and working with a lot of folks who’ve experienced pretty significant trauma that at least the way that we conceptualize it now, that [00:44:00] flows pretty logically from our understanding of trauma. I get that.
Dr. Chrissy: Yeah. Speaking of assessing, then we can certainly talk about that. I do think DID, especially when you’re coming at it from an evaluator standpoint, I don’t know about you Jeremy, but I am more skeptical when I’m in my evaluator head than I am in my therapist head. So I think it can be really tricky and I know that there is a lot of information on social media right now, and it is “popular” in Lexicomp right now and it’s coming up more and in ways maybe we wouldn’t expect. So it makes our job a lot harder.
But before I go into someone comes to you and says, hey, I have the DID, assess me and prove it, we can take a step back and think about how this has been diagnosed in the past [00:45:00] and when it’s been diagnosed and not successfully diagnosed. Overall, individuals with dissociative identity disorder spend approximately 10 years in the mental health system before they’re appropriately diagnosed.
So they have had a lot of mental health treatments. They’ve had a lot of struggles. They’ve been probably diagnosed with a lot of different things. I think it’s something we need to keep in the back of our mind, just like we would any other rule out. And specifically looking at the things that are more common to be misdiagnosed.
A lot of those misdiagnoses come in the form of a borderline personality disorder, which we already mentioned, histrionic personality disorder, different trauma-based disorders, although that’s a little bit less of a misdiagnosis as we just didn’t capture the full picture. And then psychotic disorders such as schizophrenia or schizoaffective disorder.
Those can all be mistaken as those diagnoses instead of [00:46:00] dissociative identity. I think especially when you are working in a more intense setting, so if you’re working in a hospital setting or you’re working in a setting where you know the person has had a lot of mental health treatment and they’ve had any of those diagnoses in the past or currently, if you’re reassessing them, I think you should absolutely be screening for dissociative identity disorder.
Dr. Sharp: Okay, good to know. And how do we screen for dissociative identity disorder?
Dr. Chrissy: So my go-to is to start with the trauma because the idea is that DID doesn’t exist without trauma. So hopefully, most evaluators are also screening for trauma. They are doing whatever their favorite trauma assessment is.
You can be doing a PCL-5, you can be looking at ACEs, you can be doing the TSCC, any of those really, whatever your go-to is to assess for trauma and specifically checking for [00:47:00] childhood trauma. So that’s why I like looking at the answers to the ACEs because sometimes some of those trauma measures don’t quite get at what we’re looking at.
I want to make sure that doing a good clinical interview, good clinical history, which again, from records, from the client, from client’s family or other people that are close to them, assessing for that trauma piece. And then I don’t see why it wouldn’t be common practice to throw a DES in. So the DES-II, Dissociative Experiences Scale or the adolescent version, it’s 28 questions. It’s not long. It doesn’t take long to do.
And so I think that using that as a screener just to check out where someone’s dissociation is and that’s not to say that someone who’s fourth high definitely has a dissociative disorder. It could be that you have PTSD with dissociative symptoms. It could be that you have borderline personality disorder and dissociative symptoms that are associated with that are more present.[00:48:00] Honestly, a lot of those questions can be, I don’t want to say misinterpreted because you’re not supposed to clarify the interpretation, but can be misattributed. I’ve had someone who didn’t meet threshold for dissociative diagnosis score high on it. And then once we picked through the answers, it was often an ADHD thing. It was often something that was more related to ADHD and that experience of forgetting in this organization and things like that picked off a few of the questions.
I think there are certainly questions on that measure that I’d be like, I don’t know how this would go to another diagnosis, like the out-of-body experience. Like you think you’re looking at yourself from outside of your body, how often of the time do you experience that? If that one’s rated high, I have a hard time imagining maybe a psychotic disorder but other than that, that doesn’t scream ADHD to me. That doesn’t just scream depression or anxiety or any [00:49:00] other thing it could be, whereas there is the example of zoning out during a conversation.
I would guess most people would mark that as something that they experience. And to be clear, this is an assessment that you can get free online and it’s identified in percentages. So it’s 0% of the time in 10-degree increments to 100% of the time. Someone says 0% of time they’re zoning out on a conversation, I actually see that as a red flag. I don’t want to see someone scoring zero on this measure and I don’t want to see someone scoring higher than 30 is the cutoff to look more into potential dissociative symptoms.
Dr. Sharp: Great. That sounds reasonable.
Dr. Chrissy: Yeah, and with it being such a brief measure, it’s important to look at the numbers but then also looking at what they’re marking off and to what degree, and asking those follow-up questions. That’s really important.
Dr. Sharp: Yeah. I think that’s a great principle [00:50:00] for any of the assessment we do. Not to take the answers at face value but to look at the answers and use that as a springboard to ask more questions.
Dr. Chrissy: Absolutely. We can certainly go into what it looks like if someone does come presenting saying they think they have a dissociative disorder or maybe they’re coming for a trauma-based assessment or something where the connection’s a little bit more clear and you know from the beginning that this is a question mark that you want to look into.
Dr. Sharp: Great. Yeah, let’s do that.
Dr. Chrissy: As we’ve already mentioned, the clinical interview and collateral interviews are very important. I’m often working with adults both for assessment and for therapy. So sometimes that collateral interview isn’t going to be apparent. As you can imagine, if someone’s experienced a lot of hurt and trauma, parents might be a factor in that in some way. They might not have close enough relationships with their parents that they would want or be able to access information from the parents.[00:51:00] So I’m going to be talking to siblings or close friends or partners or whoever else can give me that collateral data. Even if it’s just, I just want to know what another person who has eyes on this person, what they see. What they see as a problem or as a positive or as an area of concern or as, oh, that’s just that person. They’re just like that. Like, oh, tell me more about that.
I don’t know that I could reasonably do an assessment that’s ruling in or out a dissociative diagnosis without some type of collateral information.
Dr. Sharp: I’m with you.
Dr. Chrissy: From there, standard measures, we’re probably doing some type of personality assessment. So a PAI or an MMPI or something like that because we want to look at this, what are our possibilities? What are our rule outs? What are the patterns showing us?
Again, I’m doing probably then [00:52:00] more than just a screener for trauma. I’m doing something a little bit more in depth. I tend to do the CAPS. That’s one measure but I know everyone has their own favorites. I’m also always doing a TOMM or something similar. I try to incorporate a TOMM into all of my assessments and especially when I am doing something that is very much in the popular lexicon and that might have potential for, I don’t want to say malingering, but misunderstanding or misattributing certain symptoms in that way.
I just want to see where the baseline is at, if they’re putting forth the effort that I think would be necessary for me to feel confident in my decision so I’m always going to include that. And then I’m going to include some type of measure specific to dissociation.
So as good as the DES is for screener, it’s not sufficient for an evaluation that’s focused on that. So, I’m going to [00:53:00] do something a bit lengthier and more specific. There’s the MID, which is the Multidimensional Inventory of Dissociation. There’s also the DDIS, the Dissociative Disorders Interview Scale or the SCID-D, the semi-structured clinical interview for dissociative symptoms and disorders.
Those are probably the three that I’ve seen most use in the research. The ones I use as well; I often use the MID because I’ll also use that in therapy. It’s also free. You just have to email the author and say, “Hey, I’m a professional, I have credentials, can I please have this? Thank you.” And then he sends it to you.
A lot of these things are free and accessible, so there’s no reason not to add them to a comprehensive assessment or a screener to another assessment if you think that’s the way I should.
Dr. Sharp: That’s great. You mentioned two times the [00:54:00] idea that DID is in the social milieu right now. We run into this, I would say at least once every three months or so, where someone presents for an assessment and there’s a, for lack of a better term, TikTok component. They’ve seen it on TikTok. They come in with a certain presentation.
What’s my question here? My question is, are there any, almost like red flags for certain presentations? Anything that we should look for that would pick our interest to say, this does not sound like what we think DID looks like.
Dr. Chrissy: Yes. Before I answer that, I’m going to answer a question you didn’t ask. I think the popularity of it. [00:55:00] And to be fair, I’m not on TikTok. I haven’t seen this. I’ve heard enough from my clients and from other professionals that I have the gist but I do not know what’s going on at TikTok, I don’t want to know.
But I think there’s a reason it has become popular and certainly yes, it’s sensational. You can exaggerate it. I think that’s why in the general media, it gets so misportrayed because it looks cooler if someone has nine different personalities that they’re showing off in the span of two hours. And it’s dramatic in that way.
I think on a visual medium like TikTok and other social media, I think that’s one reason why people might flock to that. I also think there is a very natural reason why it might be getting a lot more popularity. I really think that, from what I understand, a lot of this is coming from younger people, teenagers or young adults or somewhere in that general age category.
And we know from child development that that [00:56:00] is identity formation. We are figuring out our identities. We are trying on different hats. We are tapping into different parts of self. So when your high schooler self goes, I don’t know where I fit in. I’m going to try being on the football team, but then I’m also going to try the chess club, and then I’m going to join the band, and then I’m going to do all these things.
I bet that person shows up slightly differently in each of those settings and are trying on different roles and seeing what fits, what they get the best reinforcement from and the far of, like did I make friends in one of those groups and not the others? The one I made friends in, if I’m speaking connection is probably the one I want to lean more towards. Maybe that’s chess club, and maybe I also really do feel athletic, and I didn’t get the social component from football, but I like the movement base. I’m going to do both.
And so you have these different versions [00:57:00] of self that you’re trying on and figuring out, and then the idea is that helps form your cohesive identity that you carry off into adulthood.
So I think when someone goes, oh wow, there’s a name for the fact that I act very differently in these different settings to the point that I might not be recognizable or, it almost gives a freedom to do that.
Yeah, I can try to be very different from me because this thing says that I can, it’s a thing and then I can go do that and it gives me permission even more so to try out these different versions of myself. I think there’s something that’s really attractive about that. And then I’m just going to put it on for show, for the internet, and people like it. So then they’re going to like my views and then that’s going to give me reinforcement.
I get where that social cognitive model can say that type of reinforcement can perpetuate a diagnosis that doesn’t exist but I think in these cases, what’s often missing is a discussion of trauma. [00:58:00] One of the complaints I hear from individuals who do have the dissociative identity that are seeing these TikTok stars or whatever it’s happening there, they’re like, you don’t know what you’re admitting to.
If you say you have DID, you don’t know what you’re saying. And if you are, and you’re okay with that, and that’s cool, fine, whatever. The clients that I hear from talk about, they’re not going to judge one way or the other, but if you’re talking about DID without talking about trauma, there’s a piece missing.
Dr. Sharp: Do you think it’s possible for someone to develop DID without having experienced trauma?
Dr. Chrissy: I do not. I am open to be proven wrong but I do not. I don’t know how I would conceptualize that happening.
Dr. Sharp: Got you. I know that there are any number of ways to define trauma and [00:59:00] it can be personal and it’s not necessarily objective. I just want to put that asterisk beside my question. I’m fully aware that people define trauma differently and what looks like it for one, may not match for another. But if we could somehow say this person has not experienced anything traumatic, is it still possible?
Dr. Chrissy: Again, I would be open to figuring that out or learning or whatever may be the case but I think I go to, are you losing time? If you’re not losing time, it’s not DID. If you are losing time and you didn’t experience trauma, I want to know why you’re losing time.
Dr. Sharp: Great question. Sure.
I appreciate you talking through this. I think we’re all so wary of TikTok diagnoses these days, [01:00:00] and we turn an extra magnifying glass toward any folks who present with, I’d say there’s like a big five. There’s ADHD, there’s autism, there’s DID, there’s tic disorders, I don’t know. Maybe it’s a big four. I couldn’t think of the fifth one.
There’s just a little extra scrutiny and when I found out maybe six months ago, that there are apps out there to track all of your alters and different personalities, that really gave me pause and maybe there’s a market for it and maybe someone has really invented an app that’s super helpful.
Dr. Chrissy: They so useful for my clients.
Dr. Sharp: Yes. Okay.
Dr. Chrissy: I’ll get through that. They’re so useful for my clients.
Dr. Sharp: Oh my gosh. Okay. That’s fair. Well, I’m open to being wrong or not wrong. I don’t know if I’m trying to…
Dr. Chrissy: 1.5%, Jeremy.
Dr. Sharp: 1.5%, okay. That begs the question though, [01:01:00] do we have an idea of the typical number of personalities or alters that we might reasonably expect from a presentation of DID? Are we talking like, is it in the single digits? Is it tens? Is it hundreds? Because I’ve seen all of it.
Dr. Chrissy: I’m not going to pretend to know I have the answer to that. I think I’ve seen a few numbers thrown out there in different articles but I don’t know that I, no, I do know that I don’t know what the current confess is. I’ve seen things like seven or 15 or something like that but I honestly, I don’t know. I think anecdotally my experience with the clients that I’ve worked with, is somewhere between 7 to 15, actually those numbers I just said. Somewhere around there but if someone has 6 or if someone has 20, I’m not necessarily ruling it out.
What will give me pause, we can get into those red [01:02:00] flags now, the first one being what we’ve already mentioned is that there’s no longer time and there’s no dissociative amnesia. So for me that’s one of the core criteria. If that’s not happening, that’s not DID. Doesn’t mean there’s not something else going on but that’s not DID.
I’m also looking as a red flag if there is very obvious rapid or dramatic switching. I think with media and doing things visually, that becomes sensationalized that like, oh, I always roll my eye backwards and then I suddenly have this different posture and different effect. I do that several times a day or I faint every time or something.
And that’s not to say that those things can’t or don’t happen, that there’s not little eye movements or little almost kicks or something that can happen often when someone is going through a switch, [01:03:00] but I think there’s an idea that the switches are obvious. They’re not. They might be maybe occasionally but generally, I think you could be talking to someone and not notice that they’ve switched.
And so for me it like that is a core feature that is making me have some question mark in my brain. I’m going to want to know more. I also think when we’re talking about that lost time, if someone always talks about that their lapse in time is a complete lapse, they are either present or absent, that raises a red flag for me because I think there are often times where consciousness is a little bit more fluid in DID and so someone might feel like their memory’s blurry or as if they were there but not there.
Or I know I was at work and I know I went to this meeting, but I can’t remember the details of it. Or this idea of [01:04:00] being co-conscious where I was there but another part was there and the other part was in charge of the body. I was fully present so I was there. Or I remember basic things but I don’t remember being present in the body for it, but I know it happened. I think a part pulled me what happened or filled me in or shared their memory or something.
The idea that there’s like I’m present or I’m not present and that’s always how it happened, that makes me question things further too because I think it’s more common to have other experiences.
The last thing that I can think of, at least, that’s a red flag for me is I’ll often, in addition to what we’ve talked about as far as the assessment battery goes, if I have the time, often the all three times I’ve done this, if I’m assessing someone for DID, I’ll go through a therapeutic exercise called Fraser’s Table where that [01:05:00] is essentially creating a meeting space in your brain and inviting all parts to show up. And then let me know who comes to the meeting space. And tell me about them.
So they’re going to tell me about their different parts. I’m going to ask questions. I might ask if there’s a way you refer to that part, let me know. If’s no other reason that I can ask you follow-up questions about that part later, and you’ll know who I’m referring to.
For some people they have names. Just let you know first names of people. For some people, they refer to them by role. This is my school part, this is my whatever part, this is it. Some people, it’s a combination. I’ll often ask about general ages, gender, what does that part know? When do they come out? What parts are they connected to? Who are the parts that are most often present?
And so for me, the red flag is if someone, however many parts they identify, if they know the exact same [01:06:00] type of information for every single part, I know that person’s name, age, gender, what they do, this role. I’ve got my five key facts about them and I’ve got that for all nine people that showed up. That’s a red flag for me because that’s not usually how it works.
Usually, it’s I know lots and lots about x, y, and Z parts. I know a little bit about these. I know that this one’s connected to this one. I actually don’t know if this part is one part or two parts, I’m not sure. They feel like two, but I think they’re one. I have another part that, I know they must exist because I feel them, but I don’t know them. I just know that there’s another one there.
In therapeutic work, we might discover even more parts as we go along. For me, I’m looking at and I’m trying to see if someone only has two parts, if they have 50 parts, those extremes, I’m just questioning. And then if they know all the same amounts and all the same things. Also if there’s no [01:07:00] age variation, they all found the same or similar. Again, it’s not going to make me say you, you can’t have DID but I’m going to have lots more questions if that’s the way it’s presenting.
Dr. Sharp: Thank you. That was super informative and helpful. I think a lot of folks are wondering about these different presentations, what we should actually being into.
Dr. Chrissy: I also love hearing when clients don’t like certain parts or don’t like certain aspect of parts. I hope things like this person loves this type of food and I hate it. Whenever they’re in my body, they eat this type of food and I smell it afterwards and it drives me nuts.
Stupid, silly little things like that really make it feel more credible, and maybe that’s my own gullibility. I don’t know. That’s why I’m going to do a standardized measure if I’m doing an assessment and not when I’m doing therapy. But those little nuances and details, those are the types of things that I think can [01:08:00] really help push whether or not a diagnosis is occurring or whether there’s something else going on.
Dr. Sharp: Got you. Well, I know our time is running out so fast, but do we have a moment just to touch on treatment options for folks with DID?
Dr. Chrissy: Absolutely. I think for DID, there’s a number of different models that can be used. I think there’s three steps that are largely identified as what you would want to, with someone who has dissociative identity disorder. The first one being should be probably for all clients establishing safety stabilization and symptom reception.
Oftentimes if you’re seeing someone with DID in some type of mental health clinic, they have impairment in some way. Especially if someone overlaps a lot with borderline personality disorder or trauma, we know that safety is really important. Certainly, not everyone is suicidal or self-harms or anything like that, but if those [01:09:00] symptoms do exist, we want to stabilize those symptoms first. So this is where things like DBT or CBD or other resourcing, coping skills methods could be really helpful. That’s always the place to start.
The next step is usually considered confronting, working through, or integrating traumatic memories. I would argue, I don’t know that that should always be the second step, but that’s the one that research lists.
And the third step being identity integration and rehabilitation. I’ll often swap those a little bit. I’m going to want to do some soft work first, whether I’m pulling from internal family systems or ego state interventions or whatever your parts model is. I’m often doing some of that work because I think that’s important for that stabilization piece. And wanting to make sure that the client is stable enough to be confronting and integrating those traumatic memories. Also making sure that the parts that hold those memories are ready and well-equipped to [01:10:00] address them.
I’m biased towards specific trauma models, so I’m going to say recommend things like EMDR or brain spotting or something like that for that trauma processing piece. Certainly, there are other models. There’s cognitive processing therapy. There’s other things that you can do for that.
So really, whatever your trauma model is, you’d be wanting to do that someplace after the stabilization phase. You really want to make sure that you’re not jumping into trauma processing until the parts themselves are all stable, not just safety, oh, this person isn’t going to cause themselves harm, but oh, I can dive into trauma memories and not completely disrupt the system and cause the person to dissociate and cause their parts to come out in ways that are not the ways that they need it to do to function the rest of their lives because contrary to popular opinion, there is mental emotional impairment but people with DID work jobs and go to school and are not [01:11:00] otherwise identifiable as having mental health diagnosis unless you really know them or see them closely or things like that.
Dr. Sharp: It’s a great point. Yes, I feel like that comes full circle to what we chatted about in the beginning, that a lot of folks are very functional and it’s not necessarily going to be super obvious or observable to us as clinicians.
Dr. Chrissy: Yeah, and a lot of people with DID don’t know they have it.
Dr. Sharp: Yes. That reminds me of the thing you said about the social component of this and the idea that sometimes people present with concerns that they may not know what they’re signing up for. DID is not necessarily a positive experience. I’m reading between the lines there [01:12:00] that it is something that can be pretty distressing to folks and sometimes they may not even know that it’s happening and that’s important for us to keep in mind.
Dr. Chrissy: Right. Yeah, and hopefully they can get their system working and collaborating and coordinating. We’re not making parts disappear, if that’s your definition of integration, we shouldn’t be doing that. We want all parts to be communicating and working well together but if they’re not, which is how they might show up in your office, they might not know what’s happening? They know that they lose time sometimes. They know that they have distressing reactions. They know they react very differently in certain circumstances, but they haven’t named their parts.
They don’t understand what they’re doing as a part situation. They don’t know what’s going on unless they have this knowledge in another way, they just know that they are having a really hard time. They don’t know how to “get it together”. [01:13:00] They don’t know what’s going on.
A lot of the distressing things that they experience, they might even be afraid to say because they know it sounds bad or that, oh, wow. When I realized other people didn’t just lose chunks of their day, that made me really worried about my brain. So I don’t tell people about that because what if I have dementia or what if there’s something “truly wrong with me”.
A lot of times people who have dissociative identity disorder, they’re not coming in asking for the diagnosis. They don’t know what’s wrong. They know that they have a lot of problems that they’re trying to get help for, and they don’t know why things aren’t working.
Dr. Sharp: True. Well, we play a really powerful role in this process to potentially help some folks.
Well, I really appreciate your time and willingness to dive into something that is relatively controversial in our field and talking through all the ins and outs. I’m guessing that people are going to take a [01:14:00] lot away from our conversation. Thank you for being here.
Dr. Chrissy: Thank you so much for having me. I clearly love talking about this, so I really appreciate the opportunity to do so.
Dr. Sharp: All right, y’all. Thank you so much for tuning into this episode. Always grateful to have you here. I hope that you take away some information that you can implement in your practice and in your life. Any resources that we mentioned during the episode will be listed in the show notes, so make sure to check those out.
If you like what you hear on the podcast, I would be so grateful if you left a review on iTunes or Spotify or wherever you listen to your podcasts.
And if you’re a practice owner or aspiring practice owner, I’d invite you to check out The Testing Psychologist mastermind groups. I have mastermind groups at every stage of practice development; beginner, intermediate, and advanced. We have homework, we have accountability, we have support, we have resources. These groups are amazing. [01:15:00] We do a lot of work and a lot of connecting. If that sounds interesting to you, you can check out the details at thetestingpsychologist.com/consulting. You can sign up for a pre-group phone call and we will chat and figure out if a group could be a good fit for you. Thanks so much.
The information contained in this podcast and on The Testing Psychologist website are intended for informational and educational purposes only. Nothing in this podcast or on the website is intended to be a substitute for professional, psychological, psychiatric, or medical advice, diagnosis, or treatment. Please note that no doctor-patient relationship is formed here. And [01:16:00] similarly, no supervisory or consultative relationship is formed between the host or guests of this podcast and listeners of this podcast. If you need the qualified advice of any mental health practitioner or medical provider, please seek one in your area. Similarly, if you need supervision on clinical matters, please find a supervisor with expertise that fits your needs.