Complex PTSD Comorbid with Dissociative Identity Disorder
Like so many others with dissociative identity disorder (DID), I have comorbid posttraumatic stress disorder. But it isn’t the temporary response to short-lived trauma that most people think of as PTSD. It’s a deeper, more pervasive, and chronic response to life in general. This form of PTSD is called complex PTSD. And it occurs so often in conjunction with dissociative identity disorder, that I sometimes wonder if there's anyone with DID who doesn’t live with this monster.
Complex PTSD Is PTSD from Repeated Trauma
Assuming I didn’t already have it, if I survived a serious, terrifying car accident I might very well develop PTSD. Let’s say I was just driving to work on a normal, inconspicuous day when suddenly a car swerved into my lane and sent me careening into oncoming traffic. In a matter of seconds, I traveled from every-day-okay to death’s door. If I began having flashbacks of the accident, and experiencing extreme anxiety and panic whenever I was in a car, I might be diagnosed with posttraumatic stress disorder.
But let’s imagine instead for a moment that I survived a car accident exactly like that once a week, on average, for the first 10 years of my life. Changes things significantly, yes? That is akin to what childhood trauma feels like for many people with dissociative identity disorder and it represents the essential difference between PTSD and Complex PTSD.
Living with Complex PTSD
When an event like a serious car accident teaches you that the world is unsafe, you may become fearful not just of cars and driving, but all kinds of things. A man who barely lived through a car accident might find himself afraid of fires too, afraid of drowning, afraid of being attacked on the street. He has learned not just that cars are unsafe, but that life is unsafe (Why PTSD Symptoms Flare Up in Unlikely Places). The difference between PTSD and the Complex PTSD that so many of us with dissociative identity disorder have is that we may never have experienced the world in any other way. We learned early on that:
- Horrible things happen all the time.
- There's no way to prevent those horrible things from happening.
- At any moment, we may be annihilated by one of those horrible things.
- If we survive, it will only be to wait for the next horrible thing which will inevitably occur.
I don't walk around consciously thinking those particular things. But those beliefs color my perceptions of the world, other people, myself, everything.
DID Helps Me Live with Complex PTSD
Complex PTSD is traumatic in and of itself. You can never escape the traumas that ended long ago because this disorder is always there to make sure they come to life again and again in everyday, benign circumstances. As I see it, I developed dissociative identity disorder to cope with overwhelming stress as a child. And as an adult, I have DID to cope with Complex PTSD.
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Gray, H. (2011, April 4). Complex PTSD Comorbid with Dissociative Identity Disorder, HealthyPlace. Retrieved on 2019, June 17 from https://www.healthyplace.com/blogs/dissociativeliving/2011/04/complex-ptsd-and-dissociative-identity-disorder
Author: Holly Gray
PTSD is also a dissociatieve disorder !! DID is a Dissociative Identity Disorder !!
Jenna says:she has not seen me switching yet. I’m not sure how I feel about it. Maybe a little angry, scared and I have no idea what else.
Reads as if you'd like a DID, believe me, you would rather not have it. Accept the diagnosis PTSD that is already heavy enough
I have been diagnosed with ptsd, but do dissacociate and I am SOOOO uncertain regarding whether I have multiples or just 'regress' a lot. I can't find much about regression, but I spontaneously feel like a very young child (sometimes just during my extreme fear moments, sometimes when I have a slight hurt either physical or emotional, and sometimes for no reason I can find). When I say I feel young, sometimes it is so extreme I use pillows to feel like I am in a crib to feel better. I also notice what some mention about feeling this childlike 'thing' inside even when I don't actually have that young regressed feeling. I can't say I feel like I have multiple people inside me though. I do feel like I 'talk to myself' but who doesnt. I do yell at that whiney kid in there though and tell it to snap out of it. . I don't know what is normal for people, what might be regression moments, or how to tell if this is did (mpd) and I am just realizing it.
Any insight would be sooo helpful because it is so unclear to me right now.
Can anyone tell me more about this EYE TEST?
The link isn't working for me.
I like the posts. Can anyone give me some tips about finding a psychologist. I had gone to oone for about 5 years and she's nice, intelligent and I would recomend her, but she doesn't have specific training in PTSD which I've delt with for 15 years. I look on line and nobody's little speal about themselves does not impress me with the idea that they are particularly skilled in the matter. Now after 15 years of self reflection of pre-during and post event and the on going struggles I suspect complex PTSD. Here's another question. I know that during the last event I was dissosociated for 3 months, I remember what that feels like and some of the times when I did it as a child. The episode flet different. Recently with little events occuring it makes me wonder if I'm either flirting with it or mildly involved. What's it feel like to different people? Any response would be greatly appreciated.
i believe i needed help that i couldnt get. my memory is extremely spotty. i know i went through innumerable abuse and bullying, resulting in the need to make myself more like the step siblings in attempt to avoid further abuse but at the same time dealing immense harm to myself and my mind. i am certain that i was horribly close to death on one occasion in which i had participated in gasoline huffing with the oldest step sibling. recollection of darkness in the room and neon explosions in front of my eyes in that darkness. i am horrified nothing was done to intervene for my sake after he was caught that night getting high. this is the same night the sexual abuse occurred, although i'm uncertain of that it feels like one timeline.
it's not like i'm walking around in response to everything "doesn't matter... one of these days something will kill me, take away everything" but that's how i feel, become the slave to an impending death. i feel awakened from a nightmare that i just want to forget but instead if just inhabits me. like none of it is real as it is gone and over, but so great impact on me that i have no identity.
i don't know how to feel a different way than that. the way i do anything of value is to commit things down in places that will continue to exist even if temporarily once my body shuts down and my self dissolves.
I've known about the DID for 12 yrs, but have had no help or treatment of it. I've found one Dr, retired, who was first in differentiating between the 2, DID and MPD, Ralph Allison, Psychiatrist whose information has given me a great deal of understanding even more. http://www.dissociation.com/
He has been retired for some time, but I'm also reading one of his books, 'Minds in Many Pieces''.. I think he was a trail blazer for us..
I have been trying to find help, but I have not yet found anyone who really understands this. At times it feels like a volcano inside
"There are plenty of people who ‘only’ get raped once and have PTSD for the rest of their lives."
Absolutely. My apologies. My intention was merely to explain what we mean when we say Complex PTSD as opposed to PTSD, not to compare traumas or suggest that PTSD is somehow better or easier to live with than Complex PTSD. I regret that my words came off dismissive to you.
Thanks for letting me know.
Shadow, this is me too: "From all I have read to start healing from CPTSD you have to be in a safe place. For me there is no safe place. There is no safe place".
If there is no safe place, how am I supposed to start healing? I don't trust anyone. I can't even really connect to anyone. I pretend that i do, so they don't feel bad, and I don't look like a total freak. I can be quite good at pretending.
Today I stumbled on the site and I am happy to have found it. I was diagnosed with DID, severe depression, and some other stuff they won't let me rember. I had a major trama 5 years ago which brought all my stuff to the front. I had 10 alters inside. I was doing well for a year and then it started all over again. We self injure, although it is not as prevelent as it used to be. We used to tattoo the body and it is quite colorful. Some are better at it than others. The thing is it never goes away I guess like scars. I just got a new therapist who seems like he will ask the questions even if we don't want to hear them. I had a recent popping out of some of my old alters and that is ok. They know their jobs but there is one alter that I dread. He is like a pillar of flame all twisted up. I am afriad of him. I thought I knew and dealt with the bad stuff but apparently there is something more. Are these regressions normal. I stopped therapy for a year because my therapist wasn't getting at the poblems and the sessions ended up being a B.S. session. I apologize if I put this in the wrong place. If you want me to stay away I will.
I apologize for responding so late. Thank you for reading and sharing. You are certainly welcome here. Glad to have you. :)
When you ask if "these regressions" are normal do you mean the "I thought I dealt with this stuff and now here we go again!" thing? If so, yes, that's absolutely normal ... and not just with Dissociative Identity Disorder. It's just my opinion, but I think of that as a life thing. Just when I think I have some problem figured out, a new side of the equation pops up.
I think with therapy it's also just necessary ... your brain needs a break sometimes, you know?
To start this story I will say I'm 69 years old and only found out i was did and ptsd. To have, such as I have a alter that creates problems and also become fearful of that alter. There is not communication between him or I. We, I will never be even near norn if he does not join in our conversation. It has been only 3 years since I learned of these two( did ptsd 0 so you see I am very early in therapy and old in age. I suggest to you, enter any chat room and learn all you can, sounds like you are doing you're best. Good luck.
Do you think that being able to construct and tell one's trauma story is an essential part of recovery from PTSD and DDNOS? I noticed Deahn says, " I think the PTSD is in compartments like the abuse was in compartments only it does not heal with releasing it." I don't think simply telling my therapist my trauma story is the cure, but I also believe I will need to listen to the part of my system that keeps demanding my attention, trying to tell me about past abuse. It appears to be a "hidden" part that holds the abuse experiences but does not feel safe enough yet to reveal much. I can't do this type of trauma right now. I do, however, think I will need to know and accept what this part has to say.
The result is that I am a hyper alert, hyper vigilant person, who's brain and nervous system functions as if I'm still in a war zone, ready for the next invasion of my person by another, ready for the next bad thing that is just around the corner. My whole psyche is arranged around the notion of PERMANENT SELF DEFENSE. There were quite a few times growing up I didn't know if I'd see the next day, and I do remind myself of an army veteran who has come home still seeing potential danger around every corner. Then you add to this, persistent and ongoing body memories, and I wonder if these things are more intractable than the DID itself. I have only recently, really come to accept that I have been experiencing post traumatic stress issues since my teens and this is an incredibly important issue I need to address in therapy. Thanks for the great post Holly, I think this is a very relevant and important issue to discuss.
Yes, I'm well aware of Judith Hermann's book (Trauma and Recovery) and the fact that Complex PTSD is a differentiation originated and proposed initially by her. You may notice I linked to a very brief summation of Complex PTSD in the first paragraph of this article. And I never said Complex PTSD = long-term PTSD, I said it generally occurs in response to long-term trauma.
Does it help to add more labels?
Well I guess if you see it as merely a "label" then no, it isn't likely to be helpful at all. As for me, until I read Hermann's suggestion that there is a difference between PTSD and Complex PTSD, explanations of what the differences are, and how it might develop, I was intensely confused by my PTSD diagnosis. So I guess your question is a rather individual one. In this case, for me, yes, it's helpful. It helped me understand myself a little better.
" ... if you look at the numbers ...."
Continuing education is very important to me and so I'd sure love to see these numbers you're referring to. I know you mentioned in another comment that you're a scientist so I've no doubt you can point me in the direction of your sources. I'm very interested to learn more.
As of now, I stand by my statements. And I'll cite my sources here:
"The American Psychiatric Association has published Practice Guidelines for the Treatment of Patients with Acute Stress Disorder (ASD) and Posttraumatic Stress Disorder (PTSD) (American Psychiatric Association, 2004). Since DID patients almost universally suffer from co-morbid PTSD, the reader may wish to consult those documents in addition to these Guidelines in developing treatment plans for dissociative disorder patients." [International Society for the Study of Dissociation. (2005). [Chu, J.A., Loewenstein, R., Dell, P.F., Barach, P.M., Somer, E., Kluft, R.P., Gelinas, D.J., Van der Hart, O., Dalenberg, C.J., Nijenhuis, E.R.S., Bowman, E.S., Boon, S., Goodwin, J., Jacobson, M., Ross, C.A., Sar, V, Fine, C.G., Frankel, A.S., Coons, P.M., Courtois, C.A., Gold, S.N., & Howell, E.]. Guidelines for treating Dissociative Identity Disorder in adults. Journal of Trauma & Dissociation, 6(4) pp. 69-149. Journal of Trauma & Dissociation, Vol. 6(4) 2005 Available online at www.informaworld.com doi:10.1300/J229v06n04_05]
& under the same citation:
"Because most DID patients also have Posttraumatic Stress Disorder (PTSD), the diagnostic process should assess whether symptoms of PTSD are present. Assessment for PTSD may provide another avenue into the patient’s trauma history." *read more: http://www.isst-d.org/education/treatmentguidelines-index.htm
"Patients with dissociative disorders averagely suffered from 5 comorbid disorders. The most prevalent comorbidity in DDNOS and DID was PTSD." - Axis-I comorbidity in female patients with dissociative identity disorder and dissociative identity disorder not otherwise specified. Rodewald F, Wilhelm-Göling C, Emrich HM, Reddemann L, Gast U. *read more: http://www.ncbi.nlm.nih.gov/pubmed/21278542
"All patients with dissociative identity disorder in this study also had a diagnosis of PTSD according to the DSM-IV-TR criteria and the Clinician-Administered PTSD Scale cutoff score. To our knowledge, this is the first study to confirm PTSD diagnoses in dissociative identity disorder patients by using the Clinician-Administered PTSD Scale, generally considered to be the gold-standard psychometric instrument for PTSD diagnosis. These results are consistent with the conceptualization of dissociative identity disorder as an extreme form of early-abuse-related PTSD." - Hippocampal and Amygdalar Volumes in Dissociative Identity Disorder
Eric Vermetten, M.D., Ph.D., Christian Schmahl, M.D., Sanneke Lindner, M.Sc., Richard J. Loewenstein, M.D., and J. Douglas Bremner, M.D. *read more: http://ajp.psychiatryonline.org/cgi/content/full/163/4/630
"Clinical studies have found comorbid PTSD or a lifetime history of PTSD in 80%–100% of dissociative identity disorder patients." - Armstrong JG, Loewenstein RJ: Characteristics of patients with multiple personality and dissociative disorders on psychological testing. J Nerv Ment Dis 1990; 178:448–454
I'll stop there.
That's a powerful message. And I suspect one many readers can relate to. Sometimes I'm in a "mode" where I can't imagine why I'd feel unsafe. But there's always some other aspect of self in there wondering what safe even feels like.
My current therapist diagnosed me with PTSD almost nine years ago, (before my DID diagnosis). She has been treating me for it ever since. I hadn't accepted the suggestion of me having DID at the time, so PTSD was all she could really focus on until I began seeing and accepting the signs of DID for myself, and ultimately agreeing to pursue the DID diagnosis.
Now I am starting to wonder if PTSD is going to be a life-long condition. I say this because after nine years I've only slightly improved with my symptoms.
I was researching Complex PTSD because I identify with it, but I'm not sure if I can be officially diagnosed with it as it is not in the DSM yet. But that doesn't mean I can't be treated for it, right? I'm not sure if the treatment would be much different than the treatment for PTSD.
All I really know is that this is very difficult to live with.
"I don’t walk around consciously thinking those particular things. But those beliefs color my perceptions of the world, other people, myself, everything."
Yes. I totally relate to that.
What is fascinating me now is how you said that just as DID helped you cope in the past with your childhood stresses, DID is helping you cope as an adult with Complex PTSD. That makes so much sense. It really does!
Now if only I could get my therapist to understand how I experience my DID so that she can stop thinking that I'm still denying my diagnosis and purposely being difficult ....but that's a whole different subject. My last session was just so frustrating for me, and for her. I really wanted to quit therapy, but I'm going to force myself to stick with it for now. I obviously have so much more to learn and work on. I just want it to be easier!!
"Now I am starting to wonder if PTSD is going to be a life-long condition. I say this because after nine years I’ve only slightly improved with my symptoms."
I wonder the same thing. I feel I've made significant progress with what I call the emotional startle response, but overall I'm still very much in the grips of PTSD. I feel it may always be that way. Which is a bummer.
"I was researching Complex PTSD because I identify with it, but I’m not sure if I can be officially diagnosed with it as it is not in the DSM yet. But that doesn’t mean I can’t be treated for it, right?"
Oh yes, you absolutely can be treated for it. And it sounds like you are being treated for it. I'd wager most researchers and clinicians specializing in the field of trauma and dissociation recognize that PTSD is different in people who've been subjected to long-term trauma than in people subjected to short-time or single incident trauma. Respected authorities in this field advocate the addition of Complex PTSD to the DSM. It doesn't mean it will happen, but quite frankly, I'm more inclined to listen to leading authorities who've spent entire careers researching and treating trauma and dissociation than I am the APA board responsible for deciding what is and isn't in the DSM. The former specialize in this, the latter do not.
" ... I would be severely triggered by a certain situation, and other days the same action by the same person would have no ill affect. In the months that followed, it became obvious that something else was going on and I came to realize (with the help of my therapist) that I had DID. Different aspects of Complex PTSD are held by different parts of my system."
Yes, I so relate to this. And the most socially adept aspects of my system are also the least traumatized, the least likely to suffer posttraumatic distress. That confuses other people, I've no doubt; and it used to confuse the heck out of me. I understand it better now that I figured out the same thing you described.
"On the other hand, I think it complicates the healing process."
I couldn't agree with you more. It's a frustrating catch-22.
Thanks for your comment. :)