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The Dissociative Identity Disorder Sourcebook
By Deborah Bray Haddock. New York: McGraw-Hill Companies, Inc., 2001, 285 pages, $16.95
Deborah Bray Haddock writes a comprehensive book covering a wide array of issues concerning dissociative identity disorder. This book is thorough and well written. Braddock provides a look inside the life of people with dissociative identity disorder, also know as DID, through case vignettes that illustrate the struggles of some of the author’s clients. While still known to many people as Multiple Personality Disorder, the author attempts to bring some understanding and explanation to the disorder and help clarify myths that are often associated with this mysterious and puzzling disorder.
The first chapter begins with an overview of the disorder itself including the DSM-IV diagnostic criteria and the criteria of several trauma-related disorders. The chapter also focuses on an explanation of terminology typically used with dissociative identity disorder, various reasons why people dissociate, and how the process of dissociation works. The author reports that an estimated one of every one hundred people have DID or a subtype. Finally, this chapter explores the physical aspects of DID, such as how the brain reacts to the severe trauma that causes DID.
The second chapter addresses some of the current stigma attached to those with mental illnesses and discusses how mental illnesses represent functional adaptations. The author also touches on the topics of memory, how emotions can become tied to memories, and at a very young age that we experience memories as a part of who we are. Ms. Braddock explains the developmental stages of children according to the theories of Piaget, Erikson, Bowlby, and Ainsworth, and how these theories can help explain deficits in development experienced by those with DID. An example of homework is provided that addresses clients’ their particular and personal experiences with DID.
The author reviews specific indicators of dissociation to include having a chaotic lifestyle, out-of-control feelings, anxiety or depression, abrupt mood changes, and forgetfulness. The author also discusses appropriate interventions with a client who may dissociate. For example, it is very appropriate for a psychotherapist to ask a client about his/her past, specifically life growing up. It is not appropriate for the therapist to try to convince the client that he/she has been abused, or to use sodium amatol or hypnosis for the specific purpose of trying to evoke old memories.
Ms. Braddock also writes about the differences and similarities in DID and schizophrenia and Borderline Personality Disorder. Similarities to schizophrenia, such as hearing voices, believing that their thoughts can be controlled by others, that others can hear their thoughts, and that thoughts are being taken out of their head can make differentiating DID challenging. DID is also similar to Borderline Personality Disorder (BPD) in that clients can experience unstable relationships with those around them, impulsivity in the form of sexual behavior or drug abuse, suicide attempts or self-mutilation, and angry outbursts. She concludes the chapter with reporting benchmarks of the typical individual with DID and scales, questionnaires and models that can be useful in part of diagnosing a person with DID.
The fourth chapter discusses the issue of insurance reimbursement for treatment, which is very important to most people and rarely discussed outside of psychotherapy itself. The author weighs the advantages and disadvantages of paying out of pocket for services versus allowing insurance to cover the majority of the cost. While paying out of pocket results in a significant expense that some may not be able to afford, there is no intrusion by insurance companies that may dictate the number of sessions of treatment authorized. Although many individuals rely on insurance to cover medical expenses, doing so may result in intrusions into one’s privacy and having to give up some control over one’s own treatment.
Also included is a lengthy list of basic questions that an individual with DID symptoms may want to ask prospective psychotherapists before making an appointment. Some of these include information about their treatment philosophy, licensure, fee and insurance information, available emergency contact, and more. These questions, if asked, can truly help an individual make an informed decision about their treatment. Finally, the author spends the majority and remainder of the chapter focusing on the theoretical perspectives of treating DID. Discussions address cognitive, psychodynamic, and Adlerian theories, but the author also briefly discusses Family Systems Theory, Ego-States Therapy, Feminist Therapy, and Object Relations Theory. While the list of possible types of psychotherapy is not all-inclusive, the extensive list provided enables clients to have a broad range of theory with which to identify and consider.Chapter five discusses the four stages of treatment for DID and what a client might expect during each of them. This informative chapter makes clear the process of therapy and what may be expected as one participates in the process. During the first stage of stabilization, the client and the psychotherapist work on any crisis the client may have that might impede further treatment, especially with the internal system of the individual, which the individual uses to create safety for him or herself. The stabilization stage provides the foundation for all other stages. Before moving on to the next stages, the author discusses several issues that may surface for the individual when they are diagnosed with DID. These include internal stress, trust factors in the psychotherapy relationship, safety for themselves, normalizing the disorder, negative beliefs or framework that the client is operating from, and awareness of how the individual’s internal system works.
The second stage involves working with the trauma that the individual has experienced. It allows clients to tell their story, highlights the different ego states of the client, and how they may be impacting on them. A part of this is processing memories, increasing the integration of the individual, and understanding his or her anger. The third stage is dedicated to integration of the client, which can be a very complex and difficult process. It is in this stage that the client must decide which of the three integration types would be best for them: planned fusion and integration, spontaneous fusion and integration, or co-consciousness. The final stage of post-integration deals with solidifying the coping strategies that the individual has learned and how they should deal with a crisis or emergency.
The sixth chapter is divided into three sections that provide explanations of why a client may feel “stuck” during the therapy process, reactions to trauma, and possible adjunctive therapies for the client and psychotherapist to consider. This chapter may effectively be assigned for the client to read when it appears that the client is feeling dissatisfied with the treatment process or is not making anticipated progress.
In addition to trauma symptoms an individual may be experiencing, the chapter discusses possible adjunctive therapies when a client or psychotherapist feels as though more needs to be done. Some of these include art therapy, hypnosis, group psychotherapy, meditation, and more. Guidance for making appropriate referrals or for providing needed adjunctive treatment is provided.
The seventh chapter approaches the topic of medication for the DID client. Explanations are briefly provided of how medications work, the possible side effects clients may experience, what each medication specifically it helps with, and any special considerations with each medication. The medications discussed are for the symptoms of depression and anxiety frequently seen with DID. In addition to prescription medications, alternative medications are discussed with the same care and thoroughness.
Chapter eight is entirely devoted to group psychotherapy and may be good for a client to read before beginning a group psychotherapy process that the clinician may recommend. It may also be helpful for friends and family members to read this chapter to assist them to better understand the treatment process the client is going through. The chapter talks about the differing opinions of mental health professionals on this topic and the relative merits of different types of treatment. Braddock also mentions Yalom and his curative factors for the group process including, group cohesiveness, instilling of hope, universality, socialization, and giving to others in the midst of their own pain, among others.
The ninth chapter states in the caption that it this chapter is specifically for those with DID, but can also be read by friends or family to help understand more about what the individual is experiencing. This chapter discusses what DID clients may be experiencing when they are dissociating, and gives a list of symptoms they may experience. It also gives ideas for clients when creating a safety plan for themselves either alone or in collaboration with their psychotherapist. It is very helpful because it provides lists of actions for clients to take when an emergency arises, samples of cards to carry for use if they dissociate and become disoriented, and a sample contract for survival for clients to sign about specific actions they promise to take if they become suicidal or find themselves in an emergency or crisis.
The final chapter is written for friends and family of the person with DID and for the psychotherapist as well. It highlights the importance of communication and provides diagrams of assertive versus passive communication styles, as well as ways of handling conflicts with may occur within the relationship. It also emphasizes the importance of self-care for the person with DID and gives diagrams for the client’s weekly schedule, lists of needs, ways of meeting those needs, and a list of important care issues for the individual. The self-care plan provides space for the client to plan how to meet their needs mentally, emotionally, spiritually, and physically. Lastly, it also provides suggestions for managing the relationship between the client with DID and family and friends.
There are two appendices to this book that provide extensive lists of nationwide treatment programs and various resources such as newsletters, organizations, books, and internet sites for anyone who suffers from, knows, or cares about anyone with DID. These extra sections can be of tremendous help to those who many want more information on the topic and who need a further source of support or assistance.
This book is a very comprehensive, plainly written, and useful resource for information concerning this very challenging and troubling disorder. While it surely can provide many answers for those who read it, it also includes lists of additional resources for any areas or questions that it may not have addressed fully. This book would be a wonderful resource for individuals with DID as well as those who may suspect this diagnosis for themselves, friends and family members. It is also very useful for practicing psychotherapists, family members, and friends who may want more information on the topic. It could serve as a most worthwhile supplement to psychotherapy. The psychotherapist can assign chapters to clients, keeping in mind where they are in the treatment process and what the psychotherapist believes they would find most beneficial. While most individuals who realize that they may be suffering from DID are adults, for those children who are identified as dissociating, this book may not be appropriate. To benefit from use of this book in bibliotherapy one should have at least a high school reading level. However, overall, this book may serve as a useful adjunct to ongoing psychotherapy for those who suffer from DID.