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PTSD on Dissociation Spectrum?


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Hiya,

I read that PTSD is considered by some pdocs/academics/researchers to be a part of the dissociation spectrum. There are times when you're not yourself or in yourself, but in another moment and time. Do you think this makes sense, or do you think PTSD is still in its own thing?

I know this is kinda weird.

loon

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Not weird. Totally sensical!

There's another thread somewhere about this.....

I dissociated when I was in traumatic experiences in my past.....because they were too much to bear......and when I get into flashbacks and such, I dissociate 'back to that time', as if its still happening, now....

..am trying to make my way to current reality, but sometimes it just hurts too much....the dissociation hurts now too, because I miss all the warmth and connection there might be by being friendly with others, but because I'm scared of people still..

(another angle to this is my projection etc....its all for emotional self defence, as it were...)

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  • 8 months later...

This is exactly what I was inpatient (taken to by ambulance) at McLeans in Belmont, MA hospital for.

I had a very big and long traumatic dissociating experience, and unfortunately public, or perhaps fortunately so finally getting the help I needed for god so many years, help for.

They are with Harvard University and they do DBT and many other groups etc. for this.

While inpatient they have seperate floors, one is just for women with this and things close such as DID, and of course now men and men returning from military with such.

They also have a dual dx floor.

I was on the floor with all just women, it was very good for me.

I just am starting out in their day group, I had some delays due to personal issues discussed on my thread, but I am very much looking forward to getting into it full swing tomorrow.

I will post more on it here as I learn more myself.

This is in my AXIS 1, both that you mention, so yes they can go hand in hand, and they both can be very severe, and very life interrupting.

Aly

PS where is other thread?

Perhaps I should post my farther findings there?

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NOT TRUE, by definition this idea is wrong! PTSD is not on a dissociation spectrum or scale.

Dissociation is only one possible symptom of four symptoms of one out of five ways that someone may re-experience the traumatic event.

Five other major symptom areas must be present for diagnosis of PTSD. Thus, dissociating (if present at all) represents only one small portion of the overall PTSD symptoms.

a.m.

DSM-IV diagnostic criteria:

Post Traumatic Stress Disorder (PTSD)

A. The person has been exposed to a traumatic event in which both of the following were present:

(1) the person experienced, witnessed, or was confronted with an event or events that involved actual or threatened death or serious injury, or a threat to the physical integrity of self or others.

(2) the person's response involved intense fear, helplessness, or horror.

Note: In children, this may be expressed instead by disorganized or agitated behavior.

B. The traumatic even is persistently re-experienced in one (or more) of the following ways:

(1) recurrent and intrusive distressing recollections of the event, including images, thoughts, and/or perceptions.

Note: In young children, repetitive play may occur in which these or other aspects of the trauma are expressed.

(2) recurrent distressing dreams of the event.

Note: In young children, there may be frightening dreams without recognizable content.

(3) acting or feeling as if the traumatic event were recurring (includes a sense of reliving the experience, illusions, hallucinations, and/or dissociative flashback episodes, including those that occur on awakening or when intoxicated).

Note: In young children, trauma-specific re-enactment may occur.

(4) intense psychological distress at exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

(5) physiological reactivity on exposure to internal or external cues that symbolize or resemble an aspect of the traumatic event.

C. Persistent avoidance of stimuli associated with the trauma and numbing of general responsiveness (not present before the trauma), as indicated by at least three of the following:

(1) efforts to avoid thoughts, feelings, and/or conversations associated with the trauma

(2) efforts to avoid activities, places, and/or people that arouse recollections of the trauma.

(3) inability to recall an important aspect of the trauma

(4) markedly diminished interest or participation in significant activities

(5) feeling of detachment or estrangement from others

(6) restricted range of affect (e.g., inability to have loving feelings)

(7) sense of a foreshortened future ( e.g., does not expect to have a career, marriage, children, or a normal life span)

D. Persistent symptoms of increased arousal (not present before the trauma), as indicated by at least two of the following:

(1) difficulty falling or staying asleep

(2) irritability or outbursts of anger

(3) difficulty concentrating

(4) hypervigilance

(5) exaggerated startle response

E. Duration of the disturbance (symptoms in Criteria B, C, and D) is more than one (1) month

F. The disturbance causes clinically significant distress and/or impairment in social, occupational, and/or other important areas of functioning.

Acute Duration of symptoms is less than three (3) months

Chronic Duration of symptoms is more than three (3) months

Delayed Onset Onset of symptoms is at least six (6) months after the incident

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A.M. I guess I worded something wrong, I am hardly a pro, I did not claim to be, for goodness sake, i lay here broken, saying only what I experience, and my dx told by my therapist, would you like her number?

she did not say hand in hand i guess, she said for me my ptsd, now let me try to think be exact how she worded it, and remember this is me, but they are axis 1, she told me that just this am, not axis 2 neither, ok, now here i go, my ptsd is very severe, and it does have god what all you listed so that was not so nice to read, but yeah, really bad, child and again later and later and later, but yes mine she said is also with dissociation.

Why does that make you angry?

And read up on all the research done at Harvard and McLeans, and all the work going on there.

It is world wide known, books written.

and there will be so many more places needed with all the people returning home from Iraq and all the other places, already not enough places.

I am not getting into argument with you about my MI.

I really don't need that.

I will have therapist post here, seriously, i have gone too fucking long without an advocator, without a voice, i just won't tolerate it any longer, do you hear me?

I have this downloaded and will take this all to my next session and to McLeans tomoorow, and just see where I am wrong.

I really want to know.

Aly

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It doesn't make me angry. I just don't like sloppy definitions.

Alyson.....Read the Diagnostic Criteria above!!!

PTSD is NOT dissociation. Dissociation is NOT PTSD. Dissociation is only one possible symptom of over a dozen that define PTSD.

a.m.

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AM, I am sorry you find me sloppy, I was just so excited to see this, that december brought it up, and nestlings reply to her.

I really feel very on edge with you, that you jump so all over me when I post up here.

I saw nothing said to the other two, I come along, and hence a pounce.

I am very confused right now as i stated in that first post, and that I am just starting and searching for answers and help.

You would really think in your position here, that would be what I would have gotten, the guidance to the other threads that i asked for, the corrections you felt but in a nice way, not a not true, like liar liar pants on fire, I mean are we really children here?

I know we all act it at times, so guilty here, being MI, but can't we try just try.

my head is fuzzy from reading and criteria, i wanted real people real input from those the same.

i wanted to share while i learn, while i maybe get better?

god I am so tired.

again all i do is cry.

Aly

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i don't think AM was saying anyone here was sloppy. I think AM was saying that he doesn't agree with the clinicians and other people theorizing that ptsd is part of some dissociative spectrum. i think he was questioning the idea of a spectrum, which Loon brought up but it's not her idea. And I don't think anyone can argue with anyone experiencing dissociations as part of post-traumatic stress.

i think that there is some concern (in the mental health field) about dissociation, and i suppose cases where dissociation is the primary symptom -- like, in DID, the primary symptom is a type of dissociation, but whether other kinds of dissociation, whether they are the most prominent feature of illness or not, could exist on a spectrum (which itself is an ideological construct, not a thing that exists 'out there' to be touched or verified) is the question.

often dissociation is a symptom that is part of a whole cluster of symptoms. dissociation can be part of psychosis, or depression, or bipolar, or personality disorders, and of ptsd. but saying this doesn't mean it's untrue that for any one person it is the most distressing or life affecting or primary symptom of any of these disorders.

does that make sense? i am sorry. i didn't read AMs response as anything but exasperation at a medical community that is being sloppy about their definitions.

Discussing this is good. finding ways that those of us who experienced trauma in our past live with and deal with dissociation, and supporting one another, finding commonalities and help and ways of thinking about all of this is important.

And aly i think you have a lot to offer people here with what you'll learn at Macleans. I hope you come back to share some of it with us, like the general ideas and principles you might be learning about, and the ways you feel like the program is helping.

I don't know about the idea of a spectrum. there are other kinds of spectrums out there, and in some way to me, they're mostly pointing to a continuum of severity. so on one end of the bipolar spectrum is BP1, and at the other end is what they might call "soft bipolar" where some thing manifest, others don't, or is describing the way a person responds to antidepressants or has 'shadow symptoms' of bipolar? or the autistic spectrum, at one end LFA and the other aspergers, or shadowings of autism? I'm sorry if any of these descriptions of continuums or spectrums are sloppy.

i think there is a good discussion here, and i think AM was just commenting on the idea, not that anyone here was sloppy or even that he really was angry at anyone except an idea that he doesn't agree with.

pj

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Gee Alyson, I'm sorry you are feeling so poorly today.

My initial post was not replying to any one person, it was a reply to the stated thread topic.

You replied to my initial post, hence our discussion.

You are right that wading through the DSM-IV diagnostic criteria can make your head swim! ;) Sometimes I have to read it over and over, and look up other definitions to understand them.

Hope your week is better!

Cheers, a.m.

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I am OK A.M., I read over my notes from McLeans, on DBT I have and other classes, for my grounding etc.

I understand we are all in this together, and that is what i want.

i do not want to be pampered be impossible to get along with.

i am very lonely from how i built my walls, and how uptight and selective i am, oh just so picky about everything.

i want to forgive, i have such big things to forgive, i can not get so angry at such small things.

i am going to take this to group with me so i understand, and to help me with how i handled this confrontation, or how i took it as one.

i do understand you worrying that people would have thought i meant all people with ptsd.

that was incorrect, if i stated such.

but it is not just possibly, it is factual, so very factual, so very many real people to say and show so for many years back.

I will get that data as soon as i can, or remember, and books all i will write down list for here, ok?

dbt is learning to face exactly this kind of stuff and so very much more, very much bigger.

believe me i have bigger, and i want to do much more.

so if could guide me to other threads, i have been in fog lately, i would appreciate that.

i think this will be great interaction doing this between McLeans, all the Harvard students psych med research and here.

meaning this topic.

Aly

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A.M. I hope that gee sorry i am feeling whatever was sincere, for some reason it made me LMAO!

like they say crazy but not stupid.

really have trouble trusting, here, you would really have to know me, but hell we aren't going to do that, and I would probably have to kill you after :) !

Any whoo to get serious now, i didn't read your or PJ ;) miss you gal posts before posting.

my therapist and up here at McLeans in mighty Boston and Harvard Land, Dissociation is not a personality disorder, but in axis 1. We went over this very thouroughly to make sure I would not screw up my dx, and be real with it, accept it, deal with it, and work on it.

She did go on to say that other disorders such as bpd or still in the axis 2 personality disorders.

She said in all honesty, with all that has been going on with me in such short time, all the turbulance, flashbacks, bipolar, ptsd so severe, dissociation, the big meltdown, she did not even get to my axis 2.

So my Axis 1 reads Bipolar 1, PTSD severe form, Dissociation, and as she just said to me also super severe.

That is me, and she said the dissociation developed from the severe ptsd.

quote unquote from my therapist.

and what McLeans does so much work and study with as I said they are a reseach study hospital/teaching with Harvard.

I believe the DBT and this to be known and first book was written in the 70's so around the Vietnam vet time.

and i know by a Harvard PHD.

i really of course want to be saved from this hell, which only those that live in such a world ran by night terrors that live also in the day of hours at times of flashbacks and lost time, lost so much, could know, then throw bipolar 1 hell on that, I don't even need to explain my days and nights.

of course i want to do whatever it takes to get better.

and of course i want to share any hope i feel i found with others.

and for now McLeans has been my Beacon of Hope.

So please don't rain on that.

Here is link about McLeans and if you go there, well women and on that floor, hanging in the group room over tin foil oh heck what do you call those symbols new age well I made one of the four points the one above the symbol for life, and right below mine is the symbol for same in Jewish that the nicest lady from the cape did and made her point, and two other wonderful women one from Lexington, and one from Newton did the other two.

It is really beautiful, we chose jewel tones, very rich, and the tin foil behind reflects it like a mirror.

Debra in charge of art therapy said it was truly beautiful, and she had family from Summit NJ too, what are the odds?

She asked me if I was from S.Jersey, because of my dialect, maybe the way I acted too?

she did the yoga too.

hey you got jersey there, what more do you want?

http://en.wikipedia.org/wiki/McLean_Hospital

I will get name of book.

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This is just like a little FYI fun tidbit.

but i only read the site i put link to, and i saw that McLeans was what they base the movie girl interruppted on, well OK here is the scoop you know the tunnels and shit the girls in movie went into, well of course with buildings so old, like they did not just disappear or anything, if anything they are cleaned up,lit up, used for when it is cold to transport patients around, i was wheeled in one to go for my EEG, and get this they use them for walks in the winter for patients, and the cool aides let you smoke in the off parts of them, no shit!

You got the inside scoop!

I can't smoke so I only did that once took that walk and found it creepy, but glad did now that saw it was from movie and all.

I liked going to the fitness room it was like any modern circuit club room, could do that or the walk twice a day for 30-40 minutes on average.

yeah much healthier there, all the motivation, then art, yoga, group on group.

coming back home is really hard when so isolated away from T and not able to drive, get a job now like me.

We are moving Metro North to buy this summer when all is over.

I have to have goals, it is near T, people, keep me focused, I will get a part time job.

We have place already in the starting stages, I know jumping the gun, maybe, but you have to have Faith.

Aly

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just because i'm a little confused.

dissociation is a disorder-- dissociative identity disorder-- which is on axis I

dissociation is also a symptom (of many things PJ mentioned, some of the disorders are axis I, some are axis II)

i don't think it's helpful to think of PTSD under the umbrella of dissociative disorders as there are other things that come with PTSD that do not come with DID.

but it's always nice to think about these things, connect the dots.

------------------------

Loon,

if you are having problems dissociating, there are things you can do to ground yourself. some of these skills are part of DBT, but you need not do all of DBT to learn them. if you're seeing a tdoc, ask them. if not, let me know and i'll get out some books, or maybe others can chime in here about how they ground themselves.

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Yes Penny I agree, nothing should just be lumped.

I really was hoping for discussion, and just bringing up my axis dx, so bluntly, to see if any other with such.

So Penny, my therapist did say the PTSD, and as we are saying dissociative would then be under the umbrella of that(PTSD) in my axis 1 dx, not visa versa?

Really trying to not be confusing.

but again would love to openly share, what i am going through with my therapy here.

my best grounding for very quick fix, is to grab ice cubes and clench them tightly in my fists (have zip lock baggies made up ahead)!

Then step out into cold crisp air, which is good now, in warm weather take cool shower,or quick fix cold splash water on face.

Then quickly make phone call to a support person.

Why we are going to move to Metro North area, it will have access to T, and it has nice set up of yuppie type community shops right there, for me to walk around, get out, and a park walking bike trail, river front, yacht club, whole sha bang of inter-action going on, so I don't go to Wonderland, which ends up....

Aly

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well i guess better if i do just ask at McLeans the ?, I asked.

I will post here the answer, in fact will write it down so have answer verbatim, I know there seem to be very much difference in opinion, and it appears therapists here on all of this too.

Maybe a regional, thing?

got me, but i do know i was not getting anywhere in IN where first surfaced( flashbacks, night terrors, manic, the whole kit and caboodle) after death of first brother, or PA with therapists for what I have finally have found truly hope at McLeans.

I was on PH2#'s for phone 2nd floor.

Just stamping and grinding your feet into the floor can work for grounding when sitting in group, or while standing some where, to be quiet just grind in!

Always take care of your breathing, breath deeply down to your diaphram, put your hand just above your navel, breath so your hand gets pushed up and down.

Please do not breath quick and shallow!

Not getting enough oxygen can bring on that terrible panic.

If you have lost a sense of where you end and the rest of the world begins, rub your body all along it feel the edges, your curves, the boundary of you.

wrap yourself in a blanket, feel it around you.

I imagine my babies, when so very newborn and how they loved to be swaddled.

That makes me all warm too.

Flashbacks are so draining, reward, pamper yourself afterwards.

a nice warm bubble bath while soothing music plays and a cup of hot choc. or tea.

Sometimes my only bath times : )

Know I am here you are not alone, whoever else is out there, I care.

I been there, am still there, as we are.

but i believe in my program.

don't give up, ok?

Aly

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So Penny, my therapist did say the PTSD, and as we are saying dissociative would then be under the umbrella of that(PTSD) in my axis 1 dx, not visa versa?

i don't know what your doctor said exactly.

Often people with PTSD dissociate as a symptom of PTSD.

This is different from a diagnosis of DID.

You can dissociate without having DID.

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I worded that terribly what you quoted, i always see it in the quotes after the fact.

i know what my therapist said, i posted it, i would be redundant to do so again.

i was just trying to clear up what i thought i was being so confusing, gawd i am so!

i will write down all while in group, so to have to share more clearly.

yes you very much can dissociate and quite to the tune of it feeling like DID w/o it being DID, but i don't have that, so i don't know, so i found out now, again i better not go on or i will confuse!

ptsd and dissociating i know to be so severe, oh well it is why i spent the day so trying to reach out you know?

i just hope if any other maybe what i learn in my group will not only help me but them.

i do pray so.

Aly

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i haven't been keeping up with my topic here, but great, people are actually talking about it!

my opinion (and i am NO pdoc or researcher), i'm just someone with severe PTSD and other various disorders.

i think that a severe ptsd episode is a form of dissociation. you don't have to have DID to dissociate, i dissociate sometimes, mainly from PTSD. however, i think it is helpful to see it as a form of dissociation. it, to me, doesn't put you in the DID classification, but does put you into the realm of dissociation. i don't know if there is a classification of its own when dealing with dissociation as a symptom and not as a disorder.

i'm sure this has been answered, but i'm easily confused ;) what axis is PTSD anyway?

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The important thing to keep in mind here is that the only people who care what it's called work for he insurance company. This whole system of classification persists so that they know what to charge for what. In reality it's never that cut and dried. Anyone who has been dealing with this crap for over ten years and is still trying to pin down a working diagnosis can tell you that.

The problem is the conflict between the system set up to charge for things and the system to help understand and explain things. Ostentatiously they need to be the same or else there would be charges of fraud. Since money has more clout than science and reason, we kinda get screwed sometimes. Realize that good doctors work with a tacit understanding that everything they put on paper is garbage for bean counters to read.

The fact of the matter is that there is neither PTSD or most dissociative disorders have a great treatment success rate. At least, not as they are defined in the DSM. A smart clinician will reframe the problem and start to look if maybe the way we understand and define these conditions is part of the problem. If a physician can make the case that PTSD is best understood as a dissociative condition, and in so reframing it is able to glean insight into new treatment modalities, fuck the bean counters.

As for where we are right now:

PTSD is classified as an anxiety disorder, falling under axis-1, but that may not mean what you think it does. See http://en.wikipedia.org/wiki/DSM-IV#Multi-axial_system

McLean does have some of the best resources I've seen on this, so if they want to call PTSD Peggy Sue it's fine with me.

The important letter in DID is the I and not the D though. Remember it used to be MPD. There are several other dissociative disorders without the funky ego stuff.

I need a nap.

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Thanks VE, HellS Bells all that talk about what AXIS it was put in, and how far my therapist got on mine, well of course my Axis 1 that is where the treatment is, the insurance is!

On other note I had great day at group @ McLeans today, mind slowing down since all the bad meds out like the prednisone.

We disscussed containment, which I will just try to put simply is to kind of put the lid on all the thoughts, don't go there past or future, know you can do that safely in group or therapist, so hold it till then.

So, just do that one for today, what I am doing now : )

Aly

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