Need Therapists/Psychologists: Dissociative episodes

You might find Martha Stout's The Myth of Sanity informative about the range of dissociative states. I don't know if that's helpful or not, but it's an interesting book.

Rachel Udin said:

it's more of a coping mechanism for the stress of being polarized between two countries.

I've looked up types of therapy. What kind of therapy would be good for her? Cognitive, etc kinds.

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I might need a bit more info to help.

My starting point is that people only seek therapy if something is having a significant and negative effect on their lives. That negative effect doesn't come across from your post.

One of my housemates at uni wasn't english and their manner, tone of voice, body language, in fact pretty much everything changed around their family. It wasn't a disorder of any kind, it was simply that one type of behaviour was expected by his parents and at other times he was much more outgoing and typically the leader of the group.

I can't figure out the trauma from your backstory. I can't see why the culture clash is traumatising or why there's a need for your mc to forget / repress or protect themselves from anything, so I can't see why they'd develop a dissociative state.

You could make it easier on yourself by having them revert to a different way of doing things simply due to peer pressure, expectation and habit, and then drop that aspect of their personality in their "new life" because they've moved on, or are a little embarrassed by their past.

I suspect if you assessed the coping skills of a number of people in the public eye you'd find having different showbiz and private personas was pretty normal.

Craig

Rachel Udin said:

Character is roughly in her 30's and when she was younger she was a child star in another country. She's selectively forgotten that part or simply thinks of that girl as another person. When she goes back to that country she tends to dissociate her other self, and blank that episode out and reinvent what she was doing.

I don't think DID is the right diagnosis since it has to be a bigger trauma if I understand right, but it's more of a coping mechanism for the stress of being polarized between two countries.

I've looked up types of therapy. What kind of therapy would be good for her? Cognitive, etc kinds.

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I'm not quite sure what you're saying is going on with her. You say she selectively forgets - you mean she doesn't want to deal with whatever, not that she literally has 'forgotten memories' of some childhood trauma, yes?

Then the dissociating do you mean she like, prefers to pretend to be someone else or she's actually got 'multiple personalities' as it were and doesn't know what she's doing?

Many psychologists do not believe DID exists; among those who do, some of those don't think it's 'caused' by trauma, etc., etc. This is a really sticky wicket - though I suppose that gives you a lot of wiggle room.

There are certainly those who do believe the 'traditional' kind of DID definition and will diagnose it and 'treat' it but it's not accepted by everyone at all.

The 'forgotten memories' thing - where people claim to have been molested or what have you at an age it's possible to remember but forgotten it all entirely until some later date when they suddenly 'remember' that Uncle Bob molested them a lot - is pretty well accepted as bunk. There are people who will believe and 'treat' that too but it's not the mainstream.

In general, treatment I know of is usually psychotherapy of various types. Depends on who it is.

People who believe in DID and will treat people claiming it

Rachel Udin said:

She's selectively forgotten that part or simply thinks of that girl as another person.

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This is not uncommon, nor is it necessarily pathological.

When she goes back to that country she tends to dissociate her other self, and blank that episode out and reinvent what she was doing.

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The best you've got here is garden variety repression, unless you are saying she is in a fugue state. If she's in a dissociative fugue state, she'll travel to county X for a certain period of time, and then have no memory of it whatsoever (e.g., she "wakes up" in a hotel in Mexico having no idea how she got there or what she did while she was there). Keep in mind, she doesn't just choose not to think about it -- she'll have NO MEMORY of it. At all. Your description doesn't sound like a fugue state, given that you've described her as "selectively forgetting" and as "thinking of that girl as another person", and most importantly, it sounds like she has chosen to visit country X (didn't just wake up there having no clue how that occurred).

I don't think DID is the right diagnosis since it has to be a bigger trauma if I understand right, but it's more of a coping mechanism for the stress of being polarized between two countries.

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You're correct that what you've described doesn't even remotely approach D.I.D. You're also correct in describing this as a coping mechanism. Coping mechanisms are not necessarily pathological.

If you want to give this woman a psychiatric condition, you're going to need to include some ways in which this actively interferes with her day-to-day functioning. Without it, all you've got is a person who actively chooses to repress a piece of her past and behaves differently when she's in different situations/countries.

I've looked up types of therapy. What kind of therapy would be good for her? Cognitive, etc kinds.

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Again, unless this is problematic for this woman, there is no reason for her to be in therapy. What would prompt her to seek treatment in the first place? If you can answer that question more specifically (i.e., for what reason did she seek treatment, what symptoms is she presenting), you'll get a better answer as far as potential diagnoses. Is she waking up far from home, having no memory how she got there or what she did? Is she depressed about her situation to the point that she's missing work, crying uncontrollably, and losing a lot of weight? Is she so anxious that she has begun literally pulling her hair out? What has brought her to the point that she is seeking professional intervention?

Craig has hit the nail on the head here. Unless you've left out a big piece of the clinical picture, what you've described is not pathological. Unless this interferes with your character's day-to-day life in a significant way, she's unlikely to meet the diagnostic criteria for any psychological condition, including dissociative disorders.

~STS~

Rachel Udin said:

Selectively forgets==Dissociation. Are you a psychologist? Doesn't seem like it. I used a lot of jargon...

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Although dissociative disorders include an amnestic component, describing dissociation as "selective forgetting" is simplistic at best.

As far as treatment approaches, you'll get as many answers to that as you have therapists and theoretical orientations. CBT is pretty versatile. Many therapists describe their theoretical orientation and approach to treatment as "eclectic" (drawing from a number of schools of thought and a variety of treatment techniques). Probably not the specific answer you're hoping for, but that's the reality.

~STS~

Generally people do not lose the knowledge they just choose not to retrieve it. If really challenged and forced to retrieve it they will. But if not directly challenge they will substitute a generic 'cover story'.

I would just file that under false memory syndrome. It is not uncommon although this would be an extreme case. The causes of false memory only really came to be well understood in the last 10 years and it is seen more as a phenomenon than a condition.

Rachel Udin said:

Thanks will check it out.


While I appreciate your help, you don't seem to be a therapist/psychologist?

Still doesn't answer the base question, what type of therapy in the psychological field would be best to treat dissociation?

This isn't pass judgment on the character time. Didn't ask for that and didn't present enough for that.


Selectively forgets==Dissociation. Are you a psychologist? Doesn't seem like it. I used a lot of jargon...

The reason for the dissociation I don't think is pertinent to the type of therapy needed. Just like having say, BPD, you don't need the cause of the BPD to know what kind of therapy would be good for them. DBT and some CBT probably would be best.

I said I didn't think it's DID, but most psychologists do believe in dissociation.

I got enough for character background, etc to feed the need for dissociation, just don't have a psychology degree to know how to treat it with therapy types. I.e. I hit a wall and I need to know the answer so I can research it. Pretty straight forward...

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O... k then. believe what you like. It is not in any way straight forward, despite what you believe. Nor do psychologists work like that, but you seem to know what you want to happen and what you think happens, so I don't know why you even asked, honestly.

I would agree, what you are describing is not dissociation as it is commonly understood. And yes, I am a psychologist.

Rachel Udin said:

While I appreciate your help, you don't seem to be a therapist/psychologist?

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I'm a consultant psychiatrist working with children and adolescents, and experienced in the treatment of dissociative disorders and several types of therapy.....but I've got plenty of skyrim left to play if I'm not helping here.

Craig

Your above description sounds like classic Dissociative Fugue to me, as far as a diagnosis. In terms of treatment, that's going to depend on the therapist she sees. Different therapists espouse different theoretical orientations and likewise employ different treatment techniques.

If she's "dirt poor", she probably doesn't have insurance, so even getting treatment (at least in the USA) will be difficult (VERY) and/or pricey. Assuming she's able to somehow secure some treatment (maybe at a community mental health center if there are any in her state), she'll probably receive CBT and a consult for meds (assuming she may get dually diagnosed with a mood disorder).

Good luck with your story,
~STS~

p.s. Out of curiosity, how is she paying for out-of-country trips when she is dirt poor?

p.p.s. Although a DSM-diagnosable condition isn't required for treatment, you're virtually guaranteed one if you plan on insurance reimbursement for visits. Third-party payers don't look kindly on paying for treatment for conditions that aren't severe enough to meet diagnostic criteria for one or more conditions. If she's footing the bill herself, there are therapists who would be happy to see her regardless of whether or not she is DSM-diagnosable.

p.p.p.s. Certain personality disorders can also feature dissociative type episodes. I'm thinking specifically of Borderline Personality Disorder. Could also cover her feeling "numb". And if the "bedbugs are my only friends b/c they are bloodsuckers" comment was designed by the character to elicit sympathy from others and/or test their loyalty to her (e.g., character is thinking . . . if I say this, will the person care enough to do anything about it or ask me what I mean), the BPD route could fit. Just something to consider.

A dissociative fugue is a time limited event. Months at the very longest, more commonly hours. If she has lived for years not "knowing" she was the famous girl that suggests something more long term. A dissociative fugue is also general amnesiac (not knowing who you are or what happened to you in the past) not delusional (thinking you are someone else or had a different past).

The thing to keep in mind is that the dissociation in dissociative disorders is between the person and reality--not the person and themself or their own past. The only exception being multiple personality/DID which arguably does not even exist outside of fiction and fantasists.

veinglory said:

The only exception being multiple personality/DID which arguably does not even exist outside of fiction and fantasists.

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The bulk of the professionals, including those involved in writing the DSM (the "bible" of psychiatric diagnosis), would disagree. As do I.

~STS~

There are two schools of thought, I am in the other one. These things happen in professionals, especially in relation to extraordinarily rare phenomena. The number of recorded reputable cases is a few hundred (most of those on the US engaged in a last bid to get off death row). So it is pretty much a purely theoretical issue for most of us.

cornflake said:

The 'forgotten memories' thing - where people claim to have been molested or what have you at an age it's possible to remember but forgotten it all entirely until some later date when they suddenly 'remember' that Uncle Bob molested them a lot - is pretty well accepted as bunk. There are people who will believe and 'treat' that too but it's not the mainstream.

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I know this is an old thread, but this information is false.

False Memory Syndrome From Child Abuse Wiki
http://childabusewiki.org/index.php?title=False_Memory_Syndrome
The term False Memory Syndrome was created in 1992 by the False Memory Syndrome Foundation (FMSF). It has been called "a pseudoscientific syndrome that was developed to defend against claims of child abuse."

The FMSF was created by parents who claimed to be falsely accused of child sexual abuse. The False Memory Syndrome was described as "a widespread social phenomenon where misguided therapists cause patients to invent memories of sexual abuse." Research has shown that most delayed memories of childhood abuse are true. In general, it has been shown that false allegations of childhood sexual abuse are rare, with some studies showing rates as low as one percent and some studies showing slightly higher rates. It has been found that children tend to
understate rather than overstate the extent of any abuse experienced.

It has been stated that misinformation on the topic of child sexual abuse is widespread and that the media have contributed to this problem by reporting favorably on unproven and controversial claims like the False Memory Syndrome.

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Repressed memories and Dissociative Identity Disorder are real.

A good book about dissociation is The Stranger in the Mirror by Dr. Marlene Steinberg.

You can also read about DID and repressed memories on my blog. I have DID, and it is not a circus-side show as it is so often portrayed, but a creative way for a child to deal with unimaginable trauma.