# USEFULL ADVICE



## Guest (Nov 30, 2005)

Guys,

These documents are quite long, but their descriptions of DP/Dr are so good i wanted you all to see them. Sometimes, if your anything like me then, a little reassurance decreases my anxieties and DP. Hope these can help someone understand more.

"It is important to remember that the frightening experience of being lost inside one's own mind is purely a feeling state and (once any neurological or systemic dysfunction has been ruled out) there is no reason to believe any permanent change has occurred within the brain itself. While in the midst of the illness, it seems impossible to believe that the ?normal' self is still intact. But these are feelings as if reality does not exist ? or as if the self/identity has perished. We know better ? we just cannot feel what we know. Reality has not actually been lost ? it is only the ability to experience it that is temporarily beyond reach. The same cognitive clarity that allows us to realize that the world itself has not actually changed is the same cognitive strength that will allow for complete recovery."

*Understanding dissociative disorders What is dissociation?*
Your sense of identity, reality and continuity depend on your feelings, thoughts, sensations, perceptions and memories. If these become ?disconnected? from each other, or don?t register in your conscious mind, it changes your sense of who you are, your memories, and the way you see things around you. This is what happens during dissociation.
Everyone has periods when disconnections occur naturally and usually unconsciously. We often drive a familiar route, and arrive with no memory of the journey or of what we were thinking about. Some people even train themselves to use dissociation to calm themselves, or for cultural or spiritual reasons.
Dissociation is a defence mechanism helping people to survive traumatic experiences. The bomb survivor, quoted opposite, is describing a normal dissociative response, which allowed her to focus on the things she needed to do to survive, including remembering where the nearest exit was. Dissociation can also occur as a side effect of some drugs, medication and alcohol.

Are there different forms of this response?
There are five types of dissociation, which are listed below. Occasional, mild episodes are part of ordinary, everyday life. Sometimes ? at the time of a one-off trauma or the prolonged identity confusion of adolescence, for instance ? more severe episodes are quite natural.

Depersonalisation
A feeling that your body is unreal, changing or dissolving. It also includes out-of-body experiences, such as seeing yourself as if watching a movie.

Derealisation
The world around you seems unreal. You may see objects changing in shape, size or colour, or you may feel that other people are robots.

Identity confusion
Feeling uncertain about who you are. You may feel as if there is a struggle within to define yourself.
Identity alteration
This is when there is a shift in your role or identity that changes your behaviour in ways that others could notice. For instance, you may be very different at work from when you are at home.

What are the dissociative disorders?
Dissociative disorders occur when people have persistent and repeated episodes of dissociation. These usually cause distressing internal chaos and may interfere with work, school, social, or home life. Five different forms of these disorders are defined in DSM-IV, the American diagnostic manual commonly used. They can be arranged, in order of complexity, along the ?dissociation continuum?, which also includes everyday dissociation and post-traumatic stress disorder. A person?s position on the continuum will depend on the severity and mix of the types of dissociation they experience.

The dissociation continuum
?	everyday dissociation 
?	depersonalisation disorder 
?	dissociative amnesia 
?	dissociative fugue 
?	post-traumatic stress disorder (PTSD) 
?	dissociative disorder not otherwise specified (DDNOS) 
?	dissociative identity disorder (DID)

Depersonalisation disorder
This features strong feelings that you are detached from your body, or that your body is unreal. A person may also experience mild to moderate derealisation and 
Dissociative disorder not otherwise specified (DDNOS)
In DDNOS, each of the five types of dissociation may occur, but the pattern of mix and severity does not fit any of the other dissociative disorders.

Dissociative identity disorder (DID)
This is the most complex dissociative disorder. It?s also known as multiple personality disorder (MPD) according to the ICD10, the British diagnostic manual. This has given rise to the idea that this is a personality disorder, although it is not. Its defining feature is severe identity alteration. Someone with DID experiences these shifts of identity as separate personalities. Each identity may assume control of behaviour and thoughts at different times. Each has a distinctive pattern of thinking and relating to the world. Severe amnesia means that one identity may have no awareness of what happens when another identity is in control. The amnesia can be one-way or two-way. Identity confusion is usually moderate to severe. It also includes severe depersonalisation and derealisation.

Additional problems
People may have other problems, too, such as depression, mood swings, anxiety and panic attacks, suicidal tendencies, self-harm, headaches, hearing voices, sleep disorders, phobias, alcohol and drug abuse, eating disorders and obsessive-compulsive behaviour. These may be directly connected with the dissociative problem, or could mean the person also has a non-dissociative disorder. In the case of DID, these problems may only emerge when a particular identity has control of the person?s behaviour, thoughts and feelings. Many mental health problems, such as schizophrenia, manic depression and borderline personality disorder, have dissociative features.

What are the effects of dissociative disorders?
Dissociation can affect perception, thinking, feeling, behaviour, body and memory. So, the person with a dissociative disorder has to cope with many challenges in life. The impact of dissociation varies from person to person and may change over time. How well a person appears to be coping is not a good way of telling how severely affected they are. People can be doing responsible jobs or raising families. By using dissociation, and compensating for it with other exhausting strategies, people put up a good front.
Almost everyone coping with these difficulties strives to keep them hidden from others. Few people with a dissociative disorder will switch rapidly and openly between identities, in the way that is often portrayed on TV and film. Nor is the classic ?Dr Jekyll and Mr Hyde? shift of identity common.

The effects of dissociative disorder may include:
?	gaps in memory 
?	finding yourself in a strange place without knowing how you 
got there 
?	out-of-body experiences 
?	loss of feeling in parts of your body 
?	distorted views of your body 
?	forgetting important personal information 
?	inability to recognise your image in a mirror 
?	a sense of detachment from your emotions 
?	the impression of watching a movie of yourself 
?	feelings of being unreal 
?	internal voices and dialogue 
?	feeling detached from the world 
?	forgetting appointments 
?	feeling that a customary environment is unfamiliar 
?	a sense that what is happening is unreal 
?	forgetting a learned talent or skill 
?	a sense that people you know are strangers 
?	a perception of objects changing shape, colour or size 
?	feeling you don?t know who you are 
?	acting like different people, including child-like behaviour 
?	being unsure of the boundaries between yourself and others 
?	feeling like a stranger to yourself 
?	being confused about your sexuality or gender 
?	feeling like there are different people inside you 
?	referring to yourself as ?we? 
?	being told by others that you have behaved out of character 
?	finding items in your possession that you don?t remember 
buying or receiving 
?	writing in different handwriting 
?	having knowledge of a subject you don?t recall studying.

How are dissociative disorders diagnosed?
There are questionnaires that can be used as tools to screen for and diagnose dissociative disorders. Two of the most common are the Dissociative Experiences Scale (DES) and the Structured Clinical Interview for DSM-IV Dissociative Disorders (SCID-D). These can provide a more accurate diagnosis than is possible for most psychiatric illnesses. But only when administered by a professional who has been trained in their use, and who is prepared to consider dissociative disorders. Some people, who have been in contact with mental health services for years, have made astounding progress once dissociative distress was recognised and treated.

If I think I may have a dissociative disorder, what should I do?
Be cautious about diagnosing yourself without the advice of a suitably experienced professional"


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