Living Day-to-Day with DID/MPD
online conference transcript
What's it like living day-to-day with DID/MPD (Dissociative Identity Disorder, Multiple Personality Disorder)? There are many issues for DID patients.
Psychologist, Randy Noblitt, Ph.D. specializes in the treatment of DID patients. He says because of the experience of abuse in childhood (child abuse), many are suffering from disturbing flashbacks, dissociative switching (switching alters), and losing time. Then there's the depression and mood swings, thoughts of suicide, and lonliness that accompanies many serious mental illnesses.
Along with the above subjects, we discussed managing dissociation and getting your alters to work together, treatment for DID and integration (integrate your alters), what is life like after integration, hypnosis and EMDR treatment for DID, how to get your partner to understand MPD and how a significant other can help their DID partner.
David Roberts is the HealthyPlace.com moderator.
The people in blue are audience members.
David: Good Evening. I'm David Roberts. I'm the moderator for tonight's conference. I want to welcome everyone to HealthyPlace.com. Our topic tonight is "Living Day-to-Day with DID, MPD (Dissociative Identity Disorder, Multiple Personality Disorder)." Our guest is Randy Noblitt, Ph.D. In private practice in Dallas, Texas USA, Dr. Noblitt specializes in the treatment of individuals who suffer from the psychological aftermath of childhood trauma with special interest in dissociative disorders, PTSD, and reports of ritual abuse.
Over the past 15 years, Dr. Noblitt has evaluated, treated or supervised the treatment of more than 400 MPD/DID patients. He also co-authored the book Recovery from Dissociative Identity Disorder, a consumer's manual for finding and obtaining competent therapy, social services and legal assistance.
Dr. Noblitt lectures widely on the existence of ritual cults and mind-control techniques, and has served as an expert witness in a number of child abuse cases. He is also a founding member of The Society for the Investigation, Treatment and Prevention of Ritual and Cult Abuse.
Good evening, Dr. Noblitt, and welcome to HealthyPlace.com. We appreciate you being our guest tonight. Is it difficult for people with DID to find competent treatment for their disorder?
Dr. Noblitt: Hello, David. Thanks for inviting me. Yes, it is difficult and getting more so all the time.
David:Why is that?
Dr. Noblitt: Managed care is increasingly limiting funding for adequate treatment. Additionally, the very real threat of litigation has caused many excellent therapists to leave this field.
David: I'm also wondering if there is an abundance of skilled therapists to treat Dissociative Identity Disorder or are there relatively few?
Dr. Noblitt: There are fewer therapists than needed. As you probably know, there is a prejudice in the mental health field regarding DID (MPD) so fewer people are going into this area. This is extremely unfortunate since individuals with DID have significant needs. They are often known to fall between the cracks not only in the realm of mental health but in the social services arena as well.
David: In my introduction, I had mentioned that you have treated, or supervised the treatment of, some 400 DID (MPD) patients. In your experience, what are the most difficult issues for DID patients to cope with on a day-to-day basis?
Dr. Noblitt: The difficulties experienced by DID/MPD patients vary. One significant problem is suicidal and self-destructive impulses. Many individuals with DID/MPD also experience clinical depression, mood swings, and disability causing unemployment and poverty which further restricts their quality of life.
David: The depression and the mood swings are very difficult to cope with. What are your suggestions for dealing with that?
Dr. Noblitt: Individuals with depression often rely on psychoactive medications, although a high percentage with Dissociative Identity Disorder (Multiple Personality Disorder) do not get adequate relief from medications alone. The development of caring and supportive relationships and psychotherapy is often helpful.
David: Many with DID, and this is from email that I receive, live a pretty lonely life, in that they find it difficult to share their DID with others.
Dr. Noblitt: Yes, this is common. Isolation tends to increase a sense of hopelessness and depression. Taking the risk to develop caring relationships can go a long way in reducing one's depression and sense of isolation.
The reason that many DID patients experience loneliness and isolation stems from their experience of abuse in childhood by family members or other trusted individuals. This early betrayal of trust is devastating.
David: We have a lot of audience questions, Dr. Noblitt. Let's get to a few and then I want to talk about coping with flashbacks and other day-to-day issues.
teesee: Why the prejudice within the mental health field?
Dr. Noblitt: This prejudice goes back to a time even before mental health was considered an independent profession and has to do with the prejudices associated with trance states and other states of mind that resemble "possession." Additionally, there has been prejudice against dealing with child abuse and even now, I would say that the greatest part of our society is in denial about the magnitude of this problem.
David: We have a lot of questions regarding treatment for DID and integration:
lovey: Is it important to integrate your alters, in your opinion?
Dr. Noblitt: Not all individuals with DID/MPD are motivated to achieve complete integration. I believe the patient has the right to make this decision without coercion on the part of the therapist. If the patient asks me, "is it healthy to integrate?" I would say yes.
More important than integration is improving the level of functioning and the quality of life.
David: Why would you say "it's healthy to integrate?"
Dr. Noblitt: I view integration as a process with many levels and steps to it. Before the alternates "go away," the individual with DID learns to integrate experience and behavior, reducing inner conflict and becoming more functional.
colbe:> Do you still think the number 1 treatment for MPD is hypnosis?
Dr. Noblitt: Let me qualify my response by saying that I think it is important to work in trance states and hypnotherapy may be a good way to accomplish this. Hypnotherapy in the traditional sense may not always work with this diagnosis.
maranatha: I just found out in January that I have DID. My alters fight and tease each other all the time. There is much confusion and mistrust among them. My doctor wants me to try to get them to talk to each other, but I can't even get them in the same "room," so to speak, or to sit with everyone. Any suggestions on how to start building that trust and communication between them? I can't hold a job down cause of so much confusion in them. Is it still possible to integrate them?
Dr. Noblitt: There are a variety of ways to increase communication: journaling, music therapy, art therapy, hypnotherapy. Why not ask your therapist what he or she recommends since he or she knows you? Integration is definitely possible and is a realistic goal. Not all individuals with DID achieve this goal.
David: Also Maranatha, we had an excellent conference on getting your alters to work together. I hope you'll take a look at the transcript.
Maera: Can you touch on how to break the self-destructiveness or alters inside who will not cooperate and only sabotage?
Dr. Noblitt: Increase inner communication and learn why the self-destructive motives are there. Usually, these self-destructive motives are related to traumatic experiences that need resolution through therapy.
7claire7: Why do you like to use trance and hypnosis?
Dr. Noblitt: Dissociative Identity Disorder is a trance disorder. Unlike the other various diagnoses, DID involves trance states. I have observed that patients who do not work in trance states in therapy are often more unaware of the functioning of their entire dissociative system. Developing this awareness is healthy and increases the patient's control over the disorder.
David: There are two things I wanted to address tonight and both deal with memory. Because DID is the result of trauma or abuse, many with DID suffer from flashbacks on a fairly frequent basis. How does one cope with them and then reduce the number and frequency?
Dr. Noblitt: This is a complex question. Ultimately, flashbacks reduce over time after the trauma associated with the flashback has been worked through in therapy or independently. However, before that time, many individuals want to reduce these flashbacks and are able to do so by learning to "shut down" the system.
I encourage my own patients to "open up" when they are in therapy and "shut down" when they are not in therapy. Also, some medications can help with the frequency and intensity of flashbacks. Anti-psychotics tend to reduce some particularly disturbing flashbacks and some anti-anxiety medications will reduce the anxiety that accompanies them. This varies from person to person. As I mentioned before, people with DID sometimes have unusual reactions to medications.
David: When you say "shut down" the system, what do you mean by that and how is that accomplished?
Dr. Noblitt: Individuals with DID sometimes experience trance states that may be spontaneous or triggered by particular stimuli. When this happens, there is likely to be more dissociative "switching" and "losing time." Shutting down is like the reverse of being in such a trance state. This can be accomplished in different ways by different individuals with DID. Sometimes it takes trial and error to find what works with a particular individual. Some individuals respond to "self-talk" and particular cues that may cause them to shut down. For some individuals, particular pieces of music may serve this function.
David: The other memory question I had was how to deal with "losing time" caused by switching alters or dissociating. This can be very frustrating and confusing for those with DID. Do you have any suggestions for helping with that?
Dr. Noblitt: Improving inner communication and increasing the degree of integration tends to reduce loss of time. Further, when the various alternates are working well together, they can contract to prevent or reduce loss of time.
David: By the way, Dr. Noblitt, where can one purchase your book?
Dr. Noblitt: Inititially, my assistant, Pam and I put this together for the benefit of my patients who were experiencing problems obtaining appropriate services. I would be happy to make a copy available over the internet if individuals are interested and can receive attachments.
David: We will post more info on that in the transcript when it goes up on Friday evening. A few site notes, then we'll go right to the audience questions:
Here's the link to the HealthyPlace.com Personality Disorders Community. You can sign up for the mail list and receive our newsletter, so you can keep up with events like this.
Here's the next audience question:
asilencedangel: When you have a protector who is extremely angry and has been recently betrayed by a spouse, how would you suggest she learn to trust again?
Dr. Noblitt: It may be necessary to resolve the betrayal of trust in a joint therapy session with the spouse and that particular alternate present.
Hannah Cohen: Dr Noblitt, what do you do when the spinning starts and the motion carries the time wild and you cannot stop to see one thing to grab on to and stop yourself? You stand still the best you can and say strong and loud for the circle of spinning to stop so you can walk away from the noise! Dr Noblitt, I'm having difficulty getting away from the noise. Any suggestions would be appreciated. Thanks.
Dr. Noblitt: When spinning occurs, the individual may be in great distress and often is motivated to learn how to stop the spinning. This may be accomplished several ways. The most permanent solution is to work through the trauma associated with the spinning. A more temporary solution is to learn how to trigger a "shut down" response. Some individuals are able to reduce the effects of these experiences with medication. Many individuals spin as a consequence of "telling the secrets." However, telling the secrets eventually wears down the spinning response.
AngelaPalmer27: How much luck have you had dealing with alters that self-injure other alters?
Dr. Noblitt: This varies from individual to individual. Self injury is more common early in therapy and less common later in therapy when the individual has worked through the various issues around experiences of trauma.
Some individuals can learn through imagery to stop or block self-injurious behaviors. In response to your question, I have had some patients who can learn to stop this experience and others who do not learn to until they have worked through the trauma.
Bucs: I was recently diagnosed with MPD. My alters don't talk to me or talk out loud, as other peoples alters do. I have noticed that my handwriting styles change day to day, and I still have what I refer to as "mood swings." Will they ever talk to me? And should I even worry about it if they don't?
Dr. Noblitt: This is a common experience, particularly in the early stages of therapy. As you work on opening up your system in therapy and increase inner communication, this will become less of a problem for you.
sryope77: My question is this (and I will try to be appropriate and not offend)... I lead a BDSM alternative lifestyle and I was wondering how to keep the babies and kids and others who don't want/need to be involved out of it. Please don't judge me, this is a common lifestyle among many DID survivors and a lot of us led this life LONG before the net, but we are having trouble keeping it "healthy" for all of us.
Dr. Noblitt: I know that this is a common experience among individuals with DID and I do not judge anyone's sexual lifestyle. But, I recommend that individuals who have been abused not participate in any activities that may be interpreted as retraumatization by the alternates. This is not because this particular lifestyle is "bad," but for many, it resembles too much the original trauma.
sryope77: I hope I can get some help with this. My former therapist "dropped" me because she says she is a Christian and we are not to discuss that, but how can we heal or get better if we are "censored" in therapy?????
David: Sryope, I want to add here that if you are not finding your therapist helpful, then it's time to get another therapist. Here's a good article on "Rating Your Pyschoterapist."
Dr. Noblitt: David is right. You need to find a therapist who is willing to work with you and your needs, not have you conform to hers.
sryope77: That's what my former therapist says, but we use our lifestyle sometimes to work THROUGH the past traumas and it is about the only way we ever get any "GOOD" touches like hugging and holding.
Dr. Noblitt: This is exactly how a traumatized child feels.
David: Here's the next question:
Snowmane: Have you heard of using energy work along with containment exercises to control and clear memories?
Dr. Noblitt: Yes, I have heard of it, but I don't know of anyone who is having success with this approach. Some have claimed that this can be effective, but whenever I have investigated this further, I have not found it to be helpful.
Containment exercises are very helpful but one can never "clear" past experiences. The best one can do is desensitize them and reduce inner conflict and keep self-sabotage to a minimum. As a word of clarification, I should state that I am not from the "energy" school and may be biased against it.
lovey: How long is the treatment of Multiple Personality Disorder, Dissociative Identity Disorder?
Dr. Noblitt: Unfortunately, DID/MPD requires lengthy treatment. The briefest case I had took six months. Most individuals, however, are in therapy for years. It should be pointed out, however, that many individuals will develop some skills in managing dissociation within the first few months of treatment. Others may have the symptoms of depression and PTSD (Post-Traumatic Stress Disorder) reduce sometime later in therapy.
Treatment for DID seems to progress in steps and stages. Individuals with more severe symptoms usually take longer than individuals with milder symptoms.
wlaura: In your treatment of DID patients, what is their life like after integration? Are there residual problems related to the abuse?
Dr. Noblitt: Some individuals are disabled prior to treatment and periodically hospitalized to address their disabling condition. Many of these individuals are able to obtain employment and experience significant improvements in their functioning such that they no longer require hospitalization. However, in my experience, patients who have successfully completed treatment still have some residual problems. Treatment for DID does not completely wipe clean the effects of trauma.
luckysurvivor:I suffer from DID and bipolar disorder and work and manage to survive, although I am suicidal a lot. My biggest emotional pain is an alter that is destroying relationships I have with people. Now I have no friends. I don't know how to reason with her anymore. Any suggestions?
Dr. Noblitt: It would be helpful to understand the alter's motivation. Some alters destroy relationships because they fear closeness with others, sometimes because they were betrayed in a close relationship. That particular alter will need to work in therapy to resolve her fear of vulnerability and to develop better interpersonal skills.
jjjamms: I am highly functional when it comes to working - it's the interpersonal relationships that are hard. How does one reach out with DID? It's very isolating.
Dr. Noblitt: There is no easy answer to this dilemma. It takes much effort and work to overcome. I would encourage you to bring this up with your therapist. Together, you may be able to formulate a specific plan for expanding your social life.
Different approaches seem to work for different people. Some individuals develop a sense of closeness with others in a support group (although this does not work for everyone). Some people can make social contacts through a church or synagogue. Sometimes it is possible to develop social relationships at work.
This is a very important goal and I wish you luck in achieving it. Most individuals with DID who expand their social network soon notice improvements in their mood and quality of life. It is difficult to change one's lifestyle when one has been living like a recluse for years, but I have known people who have succeeded through their perseverance.
eveinaustralia:I live in Australia and I have been refused talk therapy because I stopped taking the Psychiatrist's drugs (my significant other and I thought they were making me worse). Do you believe that MPD people have to take drugs and that it's okay to refuse therapy without them? Also, why are the drugs so important to MPD people?
Dr. Noblitt:I believe in the patient's right to choose aspects of therapy that are helpful and reject those that they feel are not helpful. I do not think that therapists should require that their patients take medications unless such medications treat a life threatening condition (such as HIV).
I believe no patient, DID or otherwise, should be forced to take psychoactive medications without their consent.
David: If you haven't been on the main HealthyPlace.com site yet, I invite you to take a look. There are over 9000 pages of content. http://www.healthyplace.com
HealthyPlace.com is broken down into different communities. And so some of the questions about depression, for instance, can be answered by the reading through the sites and "conf. transcripts" in the Depression Community.
We also have a very large self injury community.
Between the sites and the "conf. transcripts," you will find a lot of information on almost every mental health topic.
We have a few more questions, then we'll call it a night.
katerinathepoet: Hello Dr. Noblitt, I have had Multiple Personality Disorder most of my life. I was wondering how I can get my husband to understand MPD. He is not comfortable with me and doesn't understand it all. We do not have enough money for therapy, so any suggestions on how to get him to understand my MPD?
Dr. Noblitt: You might consider contacting the Sidran Foundation for literature that can explain your condition to him. You might also want to explore possibilities of obtaining Medicaid, Medicare, or some other form of subsidized funding for treatment. You can also consider pastoral counseling with a therapist skilled in DID issues.
sherry09: What do you do when the children are screaming in your head because they are still in the past?
Dr. Noblitt: This problem falls within the realm of developing self-soothing and grounding skills. Sometimes self-talk can be helpful, reminding them that they are not in any danger at the present time, letting them observe their present environment. Other soothing and calming strategies can be helpful as well.
David:Here's the flip side to katherinathepoet's question about getting her SO to understand her DID:
Temper: I am an SO (significant other), and on one of my support lists we have been talking about the role of an SO. What role do you see an SO having in therapy and outside. What can a significant other do to help their DID partner (specifically, they were talking about messing with internal politics, rescuing alters, and instigating system changes)?
Dr. Noblitt: The role of the significant other is probably the primary social support for the individual with DID. The most important thing about this role is maintaining a healthy relationship where the individual with DID can learn to trust and to give and accept unconditional love.
The significant other can help the individual with DID by being supportive and responsive. He or she should never take advantage of the relationship or use the DID's vulnerability to jockey for a power position. There should be boundaries established in the relationship to distinguish between a healthy partnership and a therapeutic relationship.
Maera: What do you think about EMDR treatment for DID?
Dr. Noblitt:I believe that EMDR methods effectively access dissociated mental states, for some individuals, not all. I think we should learn more about how and why EMDR causes these particular effects. Hopefully, all of us are interested in the effectiveness of the method, not the particular theory behind it.
MomofPhive: Why don't all individuals with DID achieve the goal of integration? Is it that some aren't able to or choose to and why not?
Dr. Noblitt: I don't think that anyone really knows the answer to this question. Many therapists assume that the individual has not been able to heal the effects of trauma or that the individual does not want to say goodbye to their alternates.
SoulWind: Is it possible to recover and function in a normal way without dealing with ALL of the repressed memories and the accompanying flashbacks?
Dr. Noblitt: Again, I don't think anyone knows for sure. However, I assume that patients need to deal with the flashbacks but do not necessarily have to deal with every memory that may be hidden from their conscious awareness. Individuals with DID need to have enough insight into these memories, however, to understand the gist of what happened to them, why they have alternates, and why their alternates behave and feel as they do.
David: Thank you, Dr. Noblitt, for being our guest tonight and for sharing this information with us. We especially appreciate that you stayed late to answer many of the audience questions. And to those in the audience, thank you for coming and participating. I hope you found it helpful. Also, if you found our site beneficial, I hope you'll pass our URL around to your friends, mail list buddies, and others. http://www.healthyplace.com
Thanks again, Dr. Noblitt.
Dr. Noblitt:My pleasure, David.
David: Good night everyone.
Disclaimer: We are not recommending or endorsing any of the suggestions of our guest. In fact, we strongly encourage you to talk over any therapies, remedies or suggestions with your doctor BEFORE you implement them or make any changes in your treatment.