Complex PTSD Comorbid with Dissociative Identity Disorder

April 4, 2011 Holly Gray

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.

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APA Reference
Gray, H. (2011, April 4). Complex PTSD Comorbid with Dissociative Identity Disorder, HealthyPlace. Retrieved on 2024, July 24 from

Author: Holly Gray

October, 9 2017 at 8:30 am

I was wondering how does DID affect PTSD? Does it limit the ones memory of ptsd or does it cut out important details? Any reply would help

In reply to by Anonymous (not verified)

October, 9 2017 at 1:21 pm

I’m not entirely sure what you are asking. DID doesn’t necessarily affect PTSD, although different parts can also experience PTSD symptoms, while some parts may not. A person can also experience PTSD symptoms without really understanding the trigger (although that can happen without DID as well).

July, 30 2017 at 11:35 am

I have Cptsd and just been diagnosed with Dissociative issues from childhood traumas. Ive only recognized 6 alters..Im ok with them except for the one that holds the emotions...dont want anything to do with her...How do you work through that? I know I need to ....but everything in me doesnt want anything to do with the emotional parts.

March, 19 2017 at 2:05 am

I'm so happy I came across this blog, it has been very helpful to read. No one (therapists) could explain why I have DID because I didn't meet all the criteria to make it possible, like I was too old when the trauma happened to qualify for DID to be possible. But when my trauma therapist figured out that I am on the autism spectrum everything made much more sense to her. I have been traumatized since I was very young because of lack of connection (attachment issues) from the autism and sensory processing disorder which constantly tells me I'm not safe in the world and this of course was from an early age. Also interesting is that I was on a sensory processing support group page reading and noted how many of those people also have the diagnosis of DID. It made me wonder if there is a correlation between SPD and DID. Living with sensory issues makes a person feel as if they are never safe and is always an assault on the body in a very physical way. I really appreciate this post and everyone who shared. Thanks.

Patrick Poor
February, 9 2017 at 12:21 pm

I am convinced PTSD is a Dissociative Disorder. Every time I have treated it as such over the last 22 years, the client has gotten better. This argument has been going on since 1889. The reason PTSD has had such poor treatment outcomes is due to therapists not recognizing and treating it as a Dissociative Disorder. Dissociative disorders are 100% curable. When treated as a Dissociative Disorder, PTSD can be cured.

September, 23 2016 at 4:27 am

Hi all, my therapist just gave me a diagnosis of PTSD and a dissociative disorder. She said my other therapist gave me a diagnosis of DID... 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.

In reply to by Anonymous (not verified)

Carla nichilas
July, 9 2017 at 12:39 pm

I went through all that. Trust your feelings. Everyone's system is different. My therapist says you can't go by the text books. What u went through was unique to your life. My switching isn't obvious I had a diagnosis with a Dr who took his time. I have DID AND PTSD.Many therapists don't believe in it that is the world. So you must have a therapist you trust. Don't take crap from many in mental health. Believe u can get well. You are worth it

In reply to by Anonymous (not verified)

February, 4 2018 at 8:52 am

Jenna says:my therapist just gave me a diagnosis of PTSD and a dissociative disorder.
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

December, 1 2015 at 1:02 pm

The only way I was finally able to understand what I was feeling was to be seen by a counselor that diagnosed me. It does sound like you dissociate since you feel younger at times. But, a therapist would be able to know for sure. There is help out there.....and a light at the end of the tunnel. Oh, you may want to read the last blog on here written by Crystal. I found it very helpful since I have symptoms unlike others I have read about.

November, 24 2015 at 7:06 pm

I have searched all over the Internet and this blog is the closest I can find to an answer, but still no answers.
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.

December, 8 2014 at 10:22 am

I have having great success treating my PTSD by integrating the alters and healing each one of their traumas. Amazingly once their traumas are healed, that part of you starts to feel safe. Many of them have no idea that they are actually a grown adult who can defend themselves and make themselves safe. They think they are still children waiting in terror for the next round of abuse.

August, 26 2014 at 9:39 am

Hi Dana, I'm reading this. I don't know the specifics of your experiences or life circumstances, but I do know I've called the following hotline -- they will help you if you're emotionally distressed, regardless of whether or not you feel suicidal, and I had a good experience with them: 1-800-273-8255, National Suicide Prevention Lifeline (I called them last week). Also I would recommend calling 2-1-1 for your area (if you're in the United States) and asking for resources, including shelter if you need it and low or no-cost trauma counselling resources...some cities that aren't even very big, like mine, have places like that. You could also call RAINN,if you haven't called them or don't have a 2-1-1 in your area. Their number is 1.800.656.4673 and they are staffed 24/7, as is the first number I gave you. I was badly sexually abused in my very early teens and didn't know how to get help. I finally started therapy in my late 20s. Don't wait so long to get help. PTSD symptoms are terrible, what happened to you is horrible and I don't pretend to have had an equivalent experience or a bunch of answers, but you deserve to live and get better. Everyone deserves to live and get better and receive care. There's a light in you that the past eight years haven't been able to put out. Hang in there and don't believe the report your emotions give you on the worst days. I care about people like you, and people like me. Please post back to us here and let people know how you're doing.

August, 10 2014 at 8:56 pm

Can anyone tell me more about this EYE TEST?
The link isn't working for me.

July, 13 2014 at 5:45 pm

So I am 19 years old. Since age 11 I have been sexually abused, raped multiple times, in child slavery for 4 years. I was shipped to florida in a trailer and shipped to germany in a cargo plane. I don’t know if anyone is reading this. If anyone gives a shit. I don’t know. I have just returned to the states in August and I thought I could just come back and get my life together. Turns out it doesn’t work like that. At first everything was going really good I was the happiest because I was finally free. But then eventually it HIT me. All at once. I can’t sleep without the lights on. I feel like someone is gonna get me. I am so tired every day. I can’t get anything done. I cannot hold a conversation, I can’t look anyone in the eyes. I don’t know why the fuck I am even writing this at the moment. I just hope somebody does. cause I need help. And I don’t know how much more I can last.

In reply to by Anonymous (not verified)

November, 30 2019 at 5:38 pm

Dana I care u
You poor thing , I don't know how I can help I mean first u how do u take care of your sekffreeor areu still working against your will it don't matter ...can someone please help this poor young lady there hast to be hope oehelp I'm so damaged at 44 no hope to help me but this victim is crying out in plane English but not one ..
August, 25 2013 at 1:52 am

Thank you for putting into words a world I experience myself.

February, 20 2013 at 8:42 am

So I came across this blog looking for info, hope, help and connection.
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.

December, 26 2012 at 5:20 pm

thank you for this concise description of the c PTSD "core belief" i really have difficulty trying to communicate who i am after surviving a childhood of helplessness after the death of parent.
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.

larry robinson
October, 9 2012 at 12:44 pm

I have SUFFERED with this all my life,Im 55 and cannot get help. So im just giving up,tonight im going to end all this pain and pointless agony.Goodbye.

December, 24 2011 at 3:49 pm

Rain you are right. I have had CPTSD for years it only gets worse. There is no safe place for me to start healing. Jumping off calls to me constantly too. I'm still here. I try to explaim why I act the way I do sometimes. No one understands. They just stay away from me. I don't trust them anyway. No one cares. But it's ok. I'm used to being an outsider. Good luck to you!

November, 1 2011 at 3:57 pm

Severe cptsd is for life, never seek ways for improvement, waste of time that doesn't exist. It never gets better, it can become more symptomatic under stress. Never ever gets better severe cptsd. Don't let them lie to you with their fairy tales. Its a life sentence of a physical imprisonment, with a surreal out of body experience, numb, intimacy is damn near impossible, jumping off Golden Gate bridge calls to me constantly. The positive Polly's , therapists, lie about possible improvements with severe cptsd. There isn't a possibility. It's permanent.

October, 10 2011 at 6:07 pm

I write this all the time that DID is sorta like PTSD on steroids.. that's just the part I'm conscious of. I feel this constantly and have also been diagnosed with anxiety/panic disorder and depression.
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.
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

September, 15 2011 at 5:10 pm

I'm not trying to distract from the post, but calling PTSD 'temporary' if it's from one traumatic event is simply not true. There are plenty of people who 'only' get raped once and have PTSD for the rest of their lives. It just really bothered me that you described it that way, because for many people, PTSD is not temporary even if they don't have DID alongside it, and it seemed dismissive.

In reply to by Anonymous (not verified)

Holly Gray
September, 19 2011 at 3:18 pm

Hi Jessica,
"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.

June, 20 2011 at 11:36 am

Thanks Holly for the post, and thank you everyone for your comments.
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.

June, 3 2011 at 4:20 am

My worst DID was when I was above myself looking down on my self talking to a person. As I watched my below self talk I remember my above self thinking "at least what I'm saying is making sense." Yes DID goes with CPTSD. 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.

Karen S.
June, 2 2011 at 2:00 pm

I am reading this information, I would like to share, in conjunction with my first attempt to reach out for help for all of my illness, which has included Complex PTSD, I now see, and which currently includes dissociative stuff. I am really having a hard time right now, but reaching out is a good sign, I suppose. I would be happy to receive any support, etc. from anyone else who might understand what I am going through.

Tim Slutter
May, 29 2011 at 2:19 am

Hi Holly and all,
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.

In reply to by Anonymous (not verified)

Holly Gray
June, 8 2011 at 2:38 pm

Hi Tim,
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?

In reply to by Anonymous (not verified)

Bill J
December, 28 2018 at 2:47 pm

Hello Tim
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.

Darla M
April, 30 2011 at 5:35 am

Hello again Holly,
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.

Darla M
April, 30 2011 at 5:17 am

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.

April, 13 2011 at 4:07 pm

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

April, 13 2011 at 4:50 am

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.

April, 11 2011 at 8:01 am

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!

April, 9 2011 at 7:11 pm

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.

April, 9 2011 at 5:26 pm

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?

In reply to by Anonymous (not verified)

Holly Gray
April, 9 2011 at 5:52 pm

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.

April, 5 2011 at 8:51 am

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

In reply to by Anonymous (not verified)

Holly Gray
April, 5 2011 at 11:59 am

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 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:
"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:
"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:
"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.

April, 4 2011 at 10:05 pm

This week in therapy my therapist asked if I felt safe in her office. I asked her what safe was.

In reply to by Anonymous (not verified)

Holly Gray
April, 5 2011 at 12:13 pm

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.

April, 4 2011 at 5:00 pm

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!!

In reply to by Anonymous (not verified)

Holly Gray
April, 5 2011 at 12:30 pm

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.

Blue Collage
April, 4 2011 at 3:28 pm

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.

In reply to by Anonymous (not verified)

Holly Gray
April, 5 2011 at 12:40 pm

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. :)

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