• advertisement

Our Mental Health Blogs

Complex PTSD Comorbid with Dissociative Identity Disorder

It seems most people with Dissociative Identity Disorder also have PTSD. But it's a form of PTSD called Complex PTSD. Read more at the Dissociative Living Blog.

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.

cptsd and ptsdBut 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.

Follow me on Twitter!

44 thoughts on “Complex PTSD Comorbid with Dissociative Identity Disorder”

  1. Hi Holly. My previous therapists were reluctant to give me a diagnosis and kept insisting a diagnosis wasn’t important because my treatment would be the same. This caused me a lot of distress for some reason, probably due to a part of my system who felt dismissed and another part who screams, “There’s nothing wrong with you”. Just before I left, the therapist diagnosed DID. My new therapist disagrees and says DDNOS is a better fit. Either way, for me at least, I seem to NEED the diagnosis. It validates my experiences and helps me on the path to awareness.

  2. All these comments have been so helpful. I am experiencing a lot of triggers this month as related to the Christian holiday of Easter. I think I sometimes try to desensitize myself by getting overly involved in these Religious rituals that often send me running from church services. But my solution does not always work that well for me. The comments have explained so much why sometimes it works and other times not. Being dissociative does complicate the healing.Thanks, I will cut myself(ves) some slack. Cocoon

  3. Hi Holly, my Aspergers specialist was trying to help me today with my issue of compulsively checking my car, sometimes up to 20 times whenever I park it. And I was explaining to him that I believe unless I check the car %100 properly the car will roll backwards and kill a child. And I know this stems from a deep routed belief that was born in my childhood, that if I’m not %100 vigilant bad things will happen. Compounded by a belief that I am totally untrustworthy because I have a memory like a sieve and have vagued out and switched during times when I was checking something important. He suggested I challenge this belief by asking a few questions, one of which was, what truly are the odds of this bad thing happening? What statistic of incidence makes this a more dangerous exercise in the potential harm of a child, than say actually driving a car every day. And my response was, that it didn’t make a difference whether the odds were 1 in a million, knowing my luck I’m going to be that 1. He thought this was the OCD fear talking, and to some extent he’s right, but I went home and had a long hard look at this today. And I realized I do believe horrible things happen everyday, and that in some way I’m destined to have horrible things happen because I’m a magnet for bad people and bad things. I know intellectually this is not true, but deep down I don’t feel safe in the world. I don’t trust people and I don’t trust fate to be kind to me. It’s as if I don’t believe I’ll get to the end of my life without more trauma, because that’s what life is like. And peace, restfulness, and true safety are not in my destiny.
    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.

  4. I am a woman who spent 10 years in therapy for super MPD (that’s what they called it then when you had hundreds) then I finished with 3 years in a rape group (very healing) and I was the only one with MPD in the group. I had major integration occur just naturally. Although I do not switch anymore and have to feel the feelings…I have a core child that is very much PTSD and cannot function normally. I think the PTSD is in compartments like the abuse was in compartments only it does not heal with releasing it. Also, I have always suspected something was there before the abuse…I thought this child had Autism in my search years ago but ruled it out because there were symptoms that did not fit…but lately I discovered Asperger’s Syndrome symptoms (sensitive-sensory). This fits her like a glove in many areas. Took the test for it and it came back that its possible with the score. Its just an observation. Does a label help here? Yes, it would. It would explain many…why’s. It would help me be more compassionate and my approach to healing may change. It would explain why this med works or that one doesn’t. It explains loud noises, and the knowings, and the crowds, etc. and the algebra and the art. MPD did not explain it all. Neither does PTSD. Certainly not now. The integration has occurred years ago and I don’t switch for defense now. The PTSD is still here and does not explain it all either so I casually look and listen and feel my way through. I enjoy everything you have all shared. Thanks!

  5. I guess I misunderstood what you were saying then. Trauma that doesn’t resolve and has multi-facets to it (like your non-resolving car crash example) has always had a label for decades called PTSD, chronic type. So, I guess I just don’t understand what the big distinction is between what already exists and what Hermann proposed. I know it’s now pretty accepted now and people use it (even if it’s not in the DSM) and I should just get over it. But regardless of that I still don’t see the need for it. I guess it’s my bias against the overuse of the word complex. Using the word complex in reference to anything about human behavior is sort of redundant. So, I personally think it’s sloppy language. Psychiatrists often use sloppy language.

  6. I’m not trying to nitpick. But Complex PTSD is not long-term PTSD. Long term PTSD is just called chronic PTSD. Complex PTSD is a construct, proposed by Judith Hermann in a book, meant to encompass several commonly seen attributes in trauma responses and includes dissociation. Personally, I think it just makes things more complicated. Does it help to add more labels?

    1. Thanks Paul.

      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.

  7. actually, the more dissociative disorders I come across, the less incidence of ptsd I find. if you look at the numbers, and the symptoms overlap, many many many people with DID do not have dx’able ptsd

    1. Hi kate,

      ” … 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 http://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.

    1. Hi castorgirl,

      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.

  8. Earlier today I was just reading some information on Complex PTSD, and I came here this evening and find that you have written about it. Pretty cool that I get to come here and read about the exact subject that was on my mind today!

    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!!

    1. Hi Mareeya,

      “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.

  9. Thank you Holly for describing the relationship between Complex PTSD and DID. Early on in therapy I was told I had Complex PTSD, but what I didn’t understand at the time, was why some days 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. I have a part that wants to self harm; a part that is triggered by perceived abandonment; a part that is fearful to the point of paranoia; plus parts that are quite functional and logical and able to “get on with it”. DID helps me cope with Complex PTSD by ensuring that I’m not constantly being triggered. On the other hand, I think it complicates the healing process.

    1. Hi Blue Collage,

      ” … 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. 🙂

Leave a Reply

Your email address will not be published. Required fields are marked *

Follow Us

Subscribe to Blog

  • advertisement

in Dissociative Living Comments

Mental Health Newsletter

Sign up for the HealthyPlace mental health newsletter for latest news, articles, events.

Mental Health
Newsletter Subscribe Now!

Mental Health Newsletter

Sign up for the HealthyPlace mental health newsletter for latest news, articles, events.

Log in

Login to your account

Username *
Password *
Remember Me