An In-Depth Conversation with Elizabeth Vermilyea

   If you've worked in the field of trauma and dissociation for any amount of time, the name Elizabeth Vermilyea will likely be very familiar to you. For survivors new to their healing, you may not know her by name, but you've most certainly been using her tools and symptom management skills! In part due to her own humility and unassuming disposition, it's quite possible to be unaware of the impact of Elizabeth's work, despite having benefitted from it for years and years. If learning the detailed process of containment, modulation, healing pool/healing light imagery, or the more welcoming takes on internal communication, sounds familiar to you -- you have her to thank for that!

   Elizabeth's workbook, "Growing Beyond Survival: A Self-Help Toolkit for Managing Traumatic Stress" truly revolutionized the way that trauma survivors could not only learn about their conditions, but explore a variety of tools to alleviate their suffering at the same time. An unintimidating and easy to understand look at complex trauma, it allowed survivors to really work at their own pace. Clinicians were also given a new language with which to explain coping skills to their clients, and most importantly, a chance to work on them together.  Elizabeth's message of educating with compassion and warmth, and always including survivors in the process, has remained steadfast throughout the years and is a lasting legacy on the community. Through her continued work in the field, she keeps the momentum of trauma education and care headed in the right direction -- always focused but empathic.

    It is our absolute honor and privilege to bring to you an in-depth interview with someone we admire and value so deeply. You'll get a chance to learn more about Elizabeth's personal journey, her experience weeding through the at-times tepid and contentious world of trauma, and also explore the past, present and future of trauma care! We sincerely hope you enjoy!

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Let’s start with some background for those who are being introduced to you for the first time.

・Where are you from/currently residing? Where did you attend school and what did you earn your degree in?
How long have you been practicing and in what capacity do you currently work with trauma survivors?

     I was born in Raleigh, NC, and I currently live in Napa, CA. I don’t like to focus on schools and degrees because I don’t think they tell us anything about who someone is. Suffice it to say, I’ve spent a great deal of time on my education, but I really learned the most from the people I’ve worked with over the years both as clients and colleagues. Currently I do not treat survivors, but I do train and consult with professionals and survivors alike. My consultation with survivors focuses on managing traumatic stress symptoms.

・What made you interested in pursuing trauma disorders? Did you always know you wanted to focus here, or was it something that found you?

     I like to say that I tripped and fell into this work, and then fell in love with it. I had intended to become an experimental psychologist. My first job out of college was at the Masters & Johnson Sexual Trauma program at River Oaks in Louisiana, and I got that job after sending out resumes everywhere I could. They were the ones who called back! It didn’t take long for me to realize that I wanted to make a career in the trauma field.

・When did you come to understand the full impact of complex childhood trauma vs. trauma as an adult? What was your introduction to dissociative disorders like?

     My work at River Oaks was my introduction to all of this. I remember going home one night in tears after having heard some horrific stories of abuse at the hands of a man’s parents. I found my mom and said, “Thank you for not abusing your power over me.” I realized how much that relationship means, how it can be twisted, how it can torment a child. Most of the clients in that program were diagnosed with a dissociative disorder, so I learned a great deal there. The program took a relational approach to the work, and I appreciated that. It wasn’t so hierarchical or tied to the strict medical model.

You began your work in this field over 25 years ago — a time where dissociative disorders were even more heavily stigmatized, disbelieved and could even be used to question the integrity of the very clinicians who supported their existence.

・What would you say the climate was like when you were first starting out? Did you face any particular challenges — clinically, interpersonally or even within yourself? 

     I started this work at the beginnings of what would become known as the recovered memory debate era, but I didn’t encounter much of that controversy until I moved to Baltimore and began working at Sheppard Pratt in their Trauma Disorders Program. Across town was Johns Hopkins and Paul McHugh who staunchly denied that recovered memories could be valid and that dissociation was real. The climate among those of us at Sheppard Pratt was one of dedication to the cause and to believing people. When I was starting out, the challenges I faced were related to understanding that horrible things are done to people, but that doesn’t mean the world is horrible. Holding those truths together is an important part of the work for all of us. More challenges came later when I began to chafe against the medical model and hierarchy in the treatment arena, and especially the “once a patient always a patient” mentality.

・When did you decide you wanted to write a book? And not just an informational or educational book but specifically a workbook for survivors?

     For several years I ran a PTSD Symptom Management group at Sheppard Pratt. I used to create worksheets because there weren’t any around that met the needs of the clients and my needs as a helper. Over time, I had a rather large portfolio of these worksheets. My colleagues and the clients started telling me I should write a book. So I began.

・Were there any unique obstacles to getting it published? Did you ever have any reluctance or hesitation, particularly given the atmosphere back then?

     Getting the book published was an incredibly serendipitous series of events. I was meeting with Esther Giller, the President and CEO of Sidran Institute, a publication company specializing in traumatic stress education and advocacy. Let me see if I can remember it the right way. She was looking for someone to come on board as a trainer for a Federal Grant project she was involved in. At the same time, she was looking for someone to produce a self-help symptom management book for a project being underwritten by the States of Maine and New York who were embarking on a massive training effort in their public mental health systems. This is a long story, but a good one.
     Survivors in the State of Maine had sued the state saying not only was the mental health treatment they received not helpful, but worse, it was hurtful. So the State handed down a consent decree that all state mental health personnel be trained in what is now called Trauma-Informed Care. This was the beginning! Esther had located professionals to create the material for training personnel (the good folks at TSI CAAP – Karen Saakvitne, Laurie Ann Pearlman, Beth Tabor-Lev, and Sarah Gamble – who wrote the Risking Connection Curriculum), and they also wanted material for the clients. That’s where I came in. I left Sheppard Pratt to take the training job at Sidran, and Sidran published the book, which was then distributed to survivors in the Maine and New York public health systems for free. I’m really proud of that.

Your workbook, whether you know it or not, truly revolutionized trauma care on the patient level. Worksheets were printed out on trauma units, weekly inpatient groups were held to teach your skills, your techniques and scripts became the go-to standard for coping with specific symptoms, and survivors in countries across the globe use your tools by name (sometimes not even knowing where they came from or having read your book)!

・Did you ever anticipate that your work would have such a profound impact or global reach, let alone become the foundational launchpad for which survivors worldwide would begin their trauma healing? 

     I am humbled beyond words by what you’re saying. I can tell you when I did the second edition I felt really good that there was still an interest in the book and that it was still useful thirteen years after the original publication. It’s mind boggling to think it has the impact you describe. I guess I have to take your word for it! I really felt I had arrived on the day a friend told me her book had been stolen! I replaced it for her, but for someone to steal it… it must be valuable!

・What has it meant to you seeing your work, and not just your book but your advocacy and education in all forms, fill such a massive void in the trauma community?

How does it feel knowing most has stood the test of time?

     Like most people dedicated to this work, I feel good about being able to educate, support, help, advocate, and hopefully change for the better the process of healing for trauma survivors. I know that every professional I am able to help will spread that exponentially outward, and that’s why I do it. I think it has stood the test of time because the material I focus on is universal and not subject to treatment trends. I want to offer something that can help everyone every time.

・What would you say is the biggest change you’ve noticed in the field of trauma since beginning your studies (ex. education, the approach to care, general attitudes toward trauma/dissociative disorders, etc)?

     The biggest change I’ve seen is the mainstreaming of trauma-informed care. There used to be a handful of treatment centers providing good treatment, and now, thanks to the Adverse Childhood Experiences (A.C.E.) study, there’s a deeper understanding of trauma as a public health issue. Even Oprah has got on board recently! I’ll be working with the Oregon Commission for the Blind next month because they want to better serve traumatized persons in their vocational rehabilitation programs. That’s huge! If you Google “Trauma Certificate Programs” you can find them all over the country. That’s amazing!

・What areas do you feel still need significant improvement? Is there anything you feel is almost missing entirely? What changes would you like to see be made in those areas?

     We need to improve the awareness, understanding, and addressing of the intersections of trauma with addiction and the criminal justice system. These intersections are at the heart of recidivism in both arenas. We have to keep showing agencies and organizations what’s in it for them and how trauma-informed practice can support and enhance their existing work. Essentially, we have to sell it.

・Do you have any colleagues or mentors that you really look up to or admire?

     Oh gosh, too many to name. I can tell you one person who had tremendous influence on me professionally. Her name was Andrea Karfgin, and she was a psychologist. She died several years ago, but she lives on in me. She taught me how to think about this work, how to understand really important dynamics in the work, and she guided me through tough lessons as a professional. I hesitate to mention other names for fear I’d forget someone. I worked with a number of survivors who were brave and trusting enough to let me into their inner worlds and allow me to walk with them into the wider world with more confidence, faith in themselves, and stronger boundaries toward life beyond survival. I’ve had many colleagues who were instrumental in shaping my professional development. I’ve had the privilege to work with some of the most respected people in the field and to have worked with the amazingly skillful lesser-known warriors for survivors. What I love is that I keep meeting people in the field who continue to inspire me and who keep me on track. I am so grateful that I get to do this work.

・What keeps you going after sitting face-to-face with some of the darkest, heaviest tragedies this world has had to know? What keeps you focused, rejuvenated or inspired?

     In the beginning I wrote a lot of songs to process what I was seeing, feeling, and understanding. I would play music for the clients in the evenings, sometimes songs about them and their struggles and strengths. That helped a lot. I keep a guitar in my office in case any of my staff need to sing the blues. Laughter is important and has always been a way for me to rejuvenate. We have to be able to laugh in the midst of awareness of such pain. I’m fortunate that people put up with my goofy humor. What helps most though is that with every workshop I do, I encounter people who believe, who want to help, and who are eager to learn how to be more effective in the work. It gives me such hope!

・·Do you have any advice to new, or even veteran, clinicians who are seeking to work with trauma patients?

     Do your own work. Get a good clinical supervisor. Make friends with countertransference. It will help you through so many confusing moments, and being able to notice it, understand it and use it to strengthen the relationship will be helpful and a huge protection when facing ethical dilemmas. Cultivate a good support system. Pay attention to and address signs of vicarious trauma, compassion fatigue and secondary traumatic stress. TAKE VACATIONS!

・What is the biggest thing you’ve learned from your patients, or other survivors, over the years? What have they taught you that books could not?

     I’ve learned that I can never give up on a person, never write them off, because people are more resilient that we imagine, and we never know when the moment of hope will come - the moment of immersive transformation that gives someone a reason and the will to continue. I’ve learned to trust people’s judgment about themselves. I’ve learned to be kinder. 

・If there was one thing you wish the world could understand about trauma survivors, or the clinicians that help them, what would it be?

   There is no “them.” There is only us.

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     Thank you, Elizabeth for your sincerity, your thoughtfulness, and your humble dedication to survivors everywhere.

    You can find more information about Elizabeth here on her website. You can also order the "Growing Beyond Survival" workbook here (or here). [Note: While the blue cover edition is still available on Amazon, the Second Edition (green cover) is the most up-to-date and has the most current perspective on trauma, so we of course recommend that one. The first is also no longer in print, but Amazon has held onto some copies.]  We cannot recommend this workbook highly enough. It has been the first recommendation on our Resource page, since the day it was made, for a reason!
 

 

MORE POSTS YOU MAY FIND HELPFUL:

  ✧  Grounding 101: 101 Grounding Techniques
  ✧  Flashbacks 101: 4 Tools to Cope with Flashbacks
  ✧  Nighttime 101 and Nighttime 201: Sleep Strategies for Complex PTSD
  ✧  Imagery 101: Healing Pool and Healing Light
  ✧  DID Myths: Dispelling Common Misconceptions about Dissociative Identity Disorder
  ✧  Did You Know?: 8 Things We Should All Know about C-PTSD and DID
  ✧  Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller

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4 Tools to Cope with Flashbacks

    There is no delicate way to put it: flashbacks are just awful. Whether you've just started experiencing these upsetting and intrusive symptoms, or you've been fighting them for years, we know how challenging and exhaustive they can be! Thankfully, a wide variety of tools and skills exist to help you break free—each one highly customizable to your specific needs. That said, some of the very best options out there can take some time, and a lot of practice, before you've shaped them into that go-to symptom management tool you can pull on any time. Skills like imagery, containment, split-screen, and a few modulation tools are all incredibly valuable, but they can be quite advanced, and sometimes even turn survivors away from them altogether if introduced too soon. For those new in their healing, options that are very straightforward and uncomplicated can be their greatest lifeline. For those with a full workshop of tools, we know how possible it is for giant waves of new or stubborn trauma material to put even your best skills out of reach. So, items that are extremely easy to recall in a time of panic or crisis, as well as very rudimentary to enact, may be the only efficient tools at your disposal. We hope to be able to offer survivors in all stages of recovery that perfect flashback kit.

    Before we get too far, let's first define what a flashback is! Whether you're a trauma survivor yourself, or a loved one/supporter of one who’s trying to learn more, you may be surprised to learn there are different types of flashbacks:

Intro to Flashbacks

Emotional Flashbacks

Body Memories

 

    So, what can you do?

     We recognize that half the battle when you're struggling is being able to just remember that these tools even exist and are available to you. When you're terrified, feeling very young, or you aren't oriented to the present, it can be really hard to even recognize that you're symptomatic. Try to be compassionate with yourself (or your friend, family member, or client) about this. Years upon years, sometimes decades, were spent responding to distress/trauma in the same exact way; it is very hard to retrain the brain to respond differently when you're only presented an opportunity to try every so often. Also, flashbacks stem from a completely different section of our daily-functioning brain. It takes hard work to override that circuitry, and none of us think very logically or critically when we’re flooded with fear and adrenaline. But, with practice, and utilizing these skills as early in your symptoms as you can, you'll find they become more habitual and automatic - taking less conscious effort and acting more like muscle memory.

     Let's get to it!

Grounding

     Your absolute number one, first line of defense for any posttraumatic symptom is to get grounded—or at least substantially more grounded than you are in that moment. None of your other skills will be as effective if you aren't oriented to the present day, body, and sense of self first. (You can learn more about what it means to be grounded, as well as have an entire list of 101 Grounding Techniques at your fingertips, right here on our website!) We do know it can sometimes feel impossible to practice grounding before you've put a memory away, especially if that memory is what's fueling your dissociation and making you ungrounded. But, if you're heavily dissociated, and stuck in the past, you're only putting the memory away in the past - not in the here and now. It will continue to find you in this timeline. As you start the grounding process, you'll find that some of the intensity of the trauma material backs down, freeing you up to use other skills you may have (i.e. containment or modulation). This takes things down another notch, allowing you to get even more grounded, and so on. A positive loop.

    What are some of the best, most-easily accessible grounding tools?:

• Open your eyes. Uncover your ears. Make as many senses available as you can!

• Look around. Try to label 5 things you can see, 5 things of a single color, 5 things of one shape.

• Listen. What do you hear? Is it close or far? Loud or soft? Pleasant or grating?

• Open up, feet on the floor. If you're curled into a ball, or have your feet tucked up on the chair, try to put them on the floor and press your feet firmly into the ground. Become rooted to the space you’re in (no longer lifted or untethered from everything, just like your currently dissociative mind). And, especially free yourself of those more childlike, fear-based positions that continue to alert to your brain that you’re in danger. We know they feel self-soothing, but they’re cuing the exact opposite message to your mind in the middle of this symptom. You may be able to return to it later after you’ve gotten confidently in control of these memories.

• De-trance. If you are rocking, tapping, swaying a limb, clicking, or engaging in any other rhythmic, trancing motion, try to start slowing it to a pause or make sure it’s at least no longer a pattern. Some of these actions may be part of something sensorily grounding for you, or a positive stim; if that's the case, just try to diversify its monotonous, predictable traits that can lull us deeper into those trancey spaces.

• Sit upright. If you are slouching deep in your seat or laying down on your bed, try to slowly sit up - vertebrae by vertebrae. Lying prone can be very disorienting and triggering for many.

• Orient. Remind yourself of the date, your age, where you are, and that you're safe now.

• Movement. If you feel frozen and unable to move, start by just trying to wiggle your toes or finger tips. Slowly work up the body, little by little, until you regain function and control of your body. This may take awhile if you’re particularly locked in. That’s okay, just go at your body’s safe pace. In your time, control, and say so.

• Smell. Inhale strong fragrances (they don't have to be pleasant!). Coffee, candles, lemon, lotions, the kitty litter, it doesn’t matter! Just awaken yourself to what’s before you.

• Taste. Chew gum, eat mints, or suck on sours. Eat a meal or snack. Drink a very cold or warm beverage.

• Touch. Run your fingers over unique textures within reach. Your clothes, the furniture, a zipper, a pet, a grounding stone, or fidget item.

   There are many, many other grounding tools, as well as a more detailed explanation as to why and how they are helpful, in our aforementioned article, so we'll move on to our next step to not be redundant! It has the best hacks anyway ;) Our seasoned pros will have heard all these surface-level ones a million times! 

Self-Talk

     Our inner monologue is far more important and powerful than we tend to give it credit. Self-talk during a flashback can be part of your grounding or be used to keep you calm and steady while you employ other techniques.  It can be hard to access your grounding skills (or other tools) if you’re in a panic and can't remember what's even happening to you or who you are. Self-talk can be a vital skill that allows everything else to fall into line.

   You can say things to yourself like:

• "This is a flashback. It is just a flashback; it is not real. This is not happening right now."

• "I am safe now. No one is presently harming me. There is no external threat to my safety in this moment."

• "I am an adult now. My name is ______. I am ____ years old. It is 20__."

• "This will not last forever. I have the power to make this symptom go away."

• "I am competent. I am able. I have done this before."

• "It's important that I get grounded. Dissociating can feel safer, but I've learned it puts me and others at risk. I can do this."

• "I can ask for help. I am worthy, even if that's hard to believe right now."

• "This is temporary. I can feel it getting easier already. I will be okay."

• “I am in control. I get to decide when and how this leaves. I have the power now.”

   Find a mantra or phrase that feels right to you, something you know you'll remember when it's time. Talk yourself through the process. It is healthy, helps keep you planted in reality, and reminds you of the power you have now that you didn’t before.

Separating Past from Present

     Separating past from present can work on many levels as a combination of self-talk, grounding and reality-testing. It's also a tool outsiders or loved ones can help you with, too! No longer all up to you! During a flashback, it's very easy to be disoriented from the current time or place. You could feel like you're all the way back in the 80's, believe you're a small child, or just in a completely different environment than you truly are. Taking the time to label all the things that are different now from the past you're reliving can help your mind tease apart the complete lack of safety you feel from the true security of your present environment. You can do so in your mind, out loud, in writing, or some other creative way that feels right to you.

   Some examples:

• "It is 20__, not [date/timeframe of the flashback]"

• *look at body* "These are adult hands and feet. I am taller now." Observe other physical changes like tattoos, body modifications, health changes, wrinkles or grey hairs.

• "There were no smartphones back then. TVs didn't look like this. I didn't have a laptop or desktop computer like this." Notice other anachronisms and things that couldn’t have existed at the time of the memory.

• "I live on my own now. This is MY house/apartment. I can drive now. I have children/a spouse/a partner now. These are my car keys. This is my drivers’ license/ID." Notice all the traits of living a very adult life - one that has control, power, and say-so that young you didn’t.

• “I am currently outside. That happened inside. (Or vice versa.) It was nighttime then, but it’s noon now.” Name several other environmental differences, or alterations in the room, time, day, furniture, clothes, etc.

• "I have a voice. Before I would have been too scared to even make a sound right now." [Then use your voice in any form to prove to yourself that it's safe to do so.]

• "I am a strong, competent adult now; I am no longer a helpless child. I have options to ensure my own safety, as well as the safety of others. I employ those options."

• Label any changes about your abuser(s): their age, location, relationship to you, if they has passed, etc.

• Label any other major life changes: geographic locations, professions, people you know now that you didn't back then, folks who may have passed on (particularly abusers if they’re no longer with us), other appearance changes, physical limitations or since-acquired illness/disability (or recovery from!), pets you now have, etc.

• List (or listen to) popular music, movies, entertainment you enjoy now. Remind yourself these things did not exist back then.

• Acknowledge the positive supports you have in your life now: new friends, a therapist, a partner, pets, family members, kids, etc.

Internal Communication

     Internal communication is a bit more specific to those with DID/OSDD, but can still be applicable to those with C-PTSD or PTSD in different ways. It is also not quite an "easy, basic skill", as was the case in the other tools offered. This is definitely more of an advanced skill, however, it is very important to include because failing to check inside has the potential to render alllll your other grounding/symptom management tools ineffective. It may come as a surprise to some, but alters in a DID/OSDD system, or even just parts of a less compartmentalized C-PTSD individual, are capable of sending flashbacks your way on purpose. It is not always with nefarious or hurtful intent. It's often with the counterintuitive desire to protect or is being used as a means of communication. This may look like handing you pieces of memory they feel are important for you to know, feel, or be reminded of; or showing you what they’ve been struggling with alone for weeks, ‘asking for help’ in the only way they know how.  When this is the case, using symptom management to make the flashback go away may just exhaust you.

     If you already have some well-established communication inside of your mind, you can certainly ask them these questions more directly. But, if you aren't there yet, or if you don't have differentiated alters at all, you can still send these thoughts back into your mind and see what bubbles up. For those who are just starting to establish communication with their system, sometimes opening that line during a flashback can be the first successful connection to come through.

   Some questions you can ask alters/your mind: (Then, open yourself up to allow the answers)

• "Is there a reason I'm being shown this flashback right now? Is someone sending this to me?"

• "What are you trying to communicate by making me relive these images/feelings/physical pain?"

• "Is someone else in a flashback but came too close to the front of the mind? Can we do a role call and see that everyone is grounded and present?"

• "Are you trying to make me feel as unsafe as YOU feel right now about something else in our life?"

• "Do you want to scare me back into silence?" "Is this your way of reminding me we aren't supposed to talk or tell anyone?"

• "Are you trying to incapacitate me? ...make it so that I can't go to work/go out with a friend/accomplish x task/leave the house/see x person/etc?" "Why are you afraid of me doing that?"

• "Did something trigger you that I don't know about? Did you see/hear/feel something really familiar that I didn't notice?"

• "Are you feeling ignored? ..like I don't care? ..like I'm not listening to you or taking your feelings into consideration? Are there other ways you could get my attention that don't include re-traumatizing me?"

• "Are you oriented to the present? I know that it's 20__, but do you? How can we work on getting grounded together? Do you need to look through my eyes or feel in the body that we are safe and not in danger right now?"

• "Did someone else inside order you to share this memory with me? If so, you can say so without revealing yourself to me. I want to talk to them, not you; you're not in trouble."

• "Am I being punished for something? Can it be shared with me what I did ‘wrong’ or which rules I broke without this flashback? I can't have a conversation with you about it or make amends if I can't think straight."

   There are many ways to appeal to parts inside to get to the root of why a flashback may have been sent your way. It is also possible to send these thoughts throughout the mind even if you do not have parts or a system. Many aspects of the mind may still be operating under similar pretenses and using these symptoms as a protective defensive mechanism -- maladaptive as that may be. Appealing internally may strike a chord and enlighten you to what the real issue is. The answer may just "click" the moment you ask, even if you can't hear a direct/"audible" reply. Once that has been discovered, you will be better able to tackle things appropriately, to meet that need or fear, instead of just exhausting yourself on symptom management skills that won't work until that primary issue is resolved.

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     We sincerely hope these four basic, foundational tools will be able to help you find relief and distance during a flashback -- no matter what stage you're at in your healing. Once armed with more stability and a framework from which to work, you can then explore more detailed and elaborate skills with confidence! We will absolutely be covering more of those, namely imagery, containment, modulation, and the various journaling tools that are extremely helpful in the fight against flashbacks. (We've already introduced a couple!) So, stay tuned. 

     Please don't hesitate to share some of your go-to strategies for flashbacks below and consider bookmarking this page for quicker, more direct access should you need it while you're struggling!

MORE POSTS YOU MAY FIND HELPFUL:

  ✧  Grounding 101: 101 Grounding Techniques
  ✧  Distraction 101: 101 Distraction Tools
  ✧  Self-Care 101: 101 Self-Care Techniques
  ✧  Nighttime 101 and Nighttime 201: Sleep Strategies for Complex PTSD
✧ Color Breathing 101: How to Calm Overwhelming Emotions and Physical Pain
  ✧  Imagery 101: Healing Pool and Healing Light
  ✧  DID Myths: Dispelling Common Misconceptions about Dissociative Identity Disorder
  ✧  Did You Know?: 8 Things We Should All Know about C-PTSD and DID
  ✧  Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller
 
  ❖  Article Index  ❖

DID Myths and Misconceptions

DID MYTHS AND MISCONCEPTIONS

    Dissociative Identity Disorder is by far one of the least understood mental illnesses out there.  It is enshrouded in misinformation, outdated coursework (for students and practicing clinicians alike), and a seemingly unending barrage of defamation attempts.  The latter sounds ridiculous, but probably shouldn't come as too much of a surprise once you consider that DID is caused by longterm, recurrent trauma in childhood - most often abuse.  There is ample motivation for entire organizations to want to squash its credibility or deny its existence, particularly when some of the founders of such organizations were accused of child sexual misconduct themselves.  But, that is NO excuse.  In fact, it's a massive reason why we exist at all and why we are so passionate about getting solid, credible information out there to everyone.

    There will be no shortage of information here on what DID is not, coupled with clarifications on what it is, but let's at least provide a brief summary for those of you unfamiliar so that you can better follow along.  DID is a dissociative trauma disorder in which a survivor has undergone longterm, repeated trauma in early childhood. This trauma, combined with other factors, results in a rather dramatic interruption of psychological development -- particularly as it pertains to identity. Through a process known as dissociation, this thwarted development results in "differentiated self-states" (also known as alters/parts) who may each think, act, and feel considerably different from one another.  These parts of the mind - who may have their own name, age and personality - are able to take executive control of the body, leaving the survivor without any awareness for the time they were gone. These amnesic gaps in memory can be for just a few moments, a few days, or even entire chunks of one's childhood.  The alters in a DID mind exist to help the survivor cope with deeply painful and unconscionable trauma, holding it outside their awareness to the best of their ability.  However, often once the survivor begins to find safety and/or enter adulthood, this once supremely creative and protective mechanism can turn into a maladaptive trait causing real life consequences.  Additionally, all of these experiences can be, and often are, happening alongside the symptoms of PTSD (eg. flashbacks, nightmares, hypervigilance, insomnia, etc), as well as symptoms of other co-occurring disorders commonly seen in trauma survivors.

    So, now that you know a bit more about the basics of DID, LETS GO DEBUNK SOME MYTHS! Since this is a lengthy one, we divided them into three parts: myths the general public tends to believe, misconceptions that even those familiar with the condition still hold onto, annnnnd then some of the truly bonkers ;)  Let's do this!

Part One: The General Public

✘ Myth:  DID is very rare.

Not even close. Its yearly prevalence rate (~1.5%) is actually more common than young women with bulimia and even on par with well-known conditions like OCD.  While it is very hard to gather statistics on a community of trauma survivors built on secrecy; who can be afraid to receive such a stigmatizing diagnosis, have or have had therapists untrained to recognize their condition, are riddled with amnesia (leading many to be unaware anything is even "wrong”), and whose self-preservation often includes intense denial of trauma — it's still inarguable that DID is anything but rare. It is a major mental health issue.

[Update: More studies on the prevalence of DID: x, x, x, x, x, x ]

✘ Myth:  People with DID are dangerous, villainous killers or have alters who do extreme harm.

Contrary to popular belief, survivors with DID are no more dangerous than those with any other mental health condition or the general public. The crime rate, violent use of weapons, domestic disturbances, etc. are no greater than (and often less than) the general population. In fact, due to survivors' prolonged exposure to trauma and violence, it is far more common for those with DID to be re-victimized, on the receiving end of violence and/or abuse, than to perpetrate it.  Many even take very staunch stances on pacifism after a lifetime of aggression and pain.

✘ Myth:  DID isn’t real. It’s a condition created by therapists / exaggerated BPD / attention-seeking / actually HPD and compulsive lying / etc.

Research begs to differ.  DID has distinct markers that separate it from all other disorders already in the DSM and it’s conclusive that DID results from longterm childhood trauma - nothing else. It’s the only condition that has such pronounced amnesic gaps ("missing time"), differentiated personality states, as well as exposure to extensive trauma; it did not just materialize from thin air or without solid precedent. Iatrogenic cases (“therapist created”) do not present the same as authentic DID and can be distinguished, just as malingerers and factitious presentations can be separated. (For more information on those: here.) More very valuable research here on DID validity: ✓, ✓, ✓, ✓, ✓.

As for the idea of it being “just attention-seeking”: It should be observed that ALL disorders, even physical illnesses, have groups of individuals who will pretend to have them. DID, however, has no higher rates of this than other conditions, and there is even a specific set of criteria that clinicians can use to confidently determine if someone is feigning the condition. But, primarily, there are far easier, more believable, more profitable, and more "rewarding" conditions to fake for attention (or to garner sympathy) than DID.  DID is a condition riddled with stigma, vitriol, and people from all corners of the world eager to call you a liar, say it's not real, or (even if they do believe you) hurl a bunch of insults at you just for the complex trauma you've been through. This is not what most are looking for when it comes to cultivating sympathy or attention. While some do try, many tire very quickly once they realize how many small quirks and minor details about their alters they must be able to recall and maintain seamlessly, and most are not trained actors to manage this. Furthermore, there are even greater hurdles to clear for anyone trying to seek treatment or therapy for DID (as opposed to just claiming it in their personal lives or online) - so most do not. 

We do not disbelieve the outright existence of eating disorders, cancer, or OCD merely because some people fake having them, do we? (...even though the rates of malingering or factitious disorders for those conditions are higher.) Why should DID be any different?

✘ Myth: If you have DID, you can’t know you have it. You don’t know about your alters or what happened to you.

While it is a common trait for host parts of a DID system to initially have no awareness of their trauma, or the inside chatterings of their mind, self-awareness is possible at any age. Once starting therapy, receiving a diagnosis, or becoming familiar with the condition, the entire path to healing relies on gaining access to all of that information, as well as establishing communication with parts inside. But, even without therapy, some can be aware of a few traumatic experiences, be able to recognize the signs of switching, or learn about themselves through old journal entries, photos, their wardrobe, reading old letters they don’t recall writing, and more.

✘ Myth:  Switches in DID will be dramatic, obvious, detectable, or involving parts who want to wear different clothes/makeup, etc. / “If you really had DID, everyone would know it.”

*buzzer noise*  False. Only a very, very small percentage of the DID population has an overt presentation of their alters or switches (5-6%). While some hints of detection can be seen amongst friends and therapists, most changes are passable as completely normal human behavior. DID is a disorder structured around concealment. Dramatic switches or changes in one's behavior or physical appearance would attract far too much attention, which could be dangerous for the survivor. Alters learn how to blend in, and many who do have considerably different personality traits, mannerisms, accents, etc., often try their VERY best to mirror the host's presentation.

For some, in the presence of loved ones or others “in the know”, some of these acts of concealment can fall away and their alters may feel more free to express themselves individually - but it still won’t be anything like what you’ve seen on TV. Child alters, however, are sometimes the most distinct when fronting in survivors who are very "adult". They've even been know to win over some the most stern of DID-doubters. But! This is one of the primary reasons that DID systems tend to keep these parts away from the front at all costs, especially in public settings. As for the act of switching itself, it can often look like an inconspicuous fluttering of the eyelids, a little muscle twitch or facial tic, or some other small movement of the body that looks like anyone repositioning themselves (or, y’know, just breathing). Switches can be detected if paying very close attention and while being aware of the condition, but it’s very, very rare for strangers or acquaintances to recognize one themselves. They’d sooner assume something else entirely.

✘ Myth:  DID is a disorder of “multiple personalities”, and that is what's "wrong" with the person afflicted or is what makes it an illness.

Having separate identities is merely the byproduct of something greater, not the sole disorder. The real dysfunction lies in the complex trauma and the countless effects it had on the child’s mind and their neurology -- including flashbacks, nightmares, hypervigilance, dissociative amnesia ('losing time'), depersonalization/derealization, emotion dysregulation, somatic symptoms, and heightened vulnerability to a long list of other medical and mental health disorders. Most of the healing from DID revolves around the processing of traumatic memories and sifting through the layers and layers of pain, sadness, anger, betrayal, grief and trauma that each alter holds. Yes, therapy does also address the very unique, distinct challenges of having alters -- from how to get along with one another and work cohesively, to keeping the body safe when individual parts are struggling with self-harm, to how to keep child parts from popping forward whenever you pass the toy section at a store -- but DID is ultimately a trauma disorder, NOT a disorder of personality.

✘ Myth:  DID happens because the mind is so traumatized that it splits into tons of alters.  The mind just shatters into pieces under all the pressure of trauma.

This was a long-believed model for DID, and one still held by many therapists today who have not updated themselves with the current understanding of dissociation and identity development. The Theory of Structural Dissociation states that DID results from a failure to integrate into one identity, NOT a whole that breaks, shatters or splits. We have a more detailed (but also very “layman-friendly”) explanation here: You Did Not Shatter.

✘ Myth:  DID can develop at any age.

DID only develops in early childhood, no later. Current research suggests before the ages of 6-9 (while other papers list even as early as age 4). Prolonged, repeated trauma later in life (particularly that which is at the sole control of another person, or breaks down a person’s psyche and self-perception) may result in Complex PTSD - which does have overlapping symptoms - but they will not develop DID.

It should be noted there are also other dissociative disorders, some that even mirror DID very closely (most notably OSDD and its subtypes), and age may be a very slight influencing factor in the lessened alter differentiation and/or amnesia experienced there. However, most with those presentations were quite young for their trauma as well. There are also many reasons that one may present more as an OSDD-type system instead of a DID system, but they’re a conversation for another day! Understanding DID is tough enough for most! Still, many of these myths will also apply to many of the symptoms, systems and experiences of OSDD survivors, too.

✘ Myth:  Survivors with DID can just switch on demand if needed for a task or if someone simply asks for them.

Plainly put, this is just not possible. Sure, for some there are absolutely moments where they can call upon specific alters for certain tasks, but there are no guarantees or absolutes (and, for any number of reasons). When it comes to outsiders trying to call upon parts, this could range anywhere from "sometimes possible" (particularly in therapy or in extremely safe relationships where that boundary has been established beforehand), to "hit-or-miss" (dependent on the person, their intent, the state of things inside, being triggered forward but not actually wanting to be there, and so forth), to "never" (it’s either completely inappropriate and uncalled for, it's unsafe, they have a highly protective reason for staying inside, they can’t even hear you, they don't know how to come forward on their own, or some other very important reason). Survivors with DID are not a magic trick.

NOTE: DO NOT TRY TO CALL PARTS FORWARD UNLESS YOU ARE A TRAINED PROFESSIONAL OR HAVE THE SYSTEM’S IMPLICIT PERMISSION TO DO SO IN NECESSARY SITUATIONS.
To not obey this is a serious violation of psychological and emotional boundaries.

✘ Myth:  Communication with alters happens by seeing them outside of you and talking with them just like regular people -- a hallucination.  (We can thank The United States of Tara for this one.)

Nope, not so much. While there are exceptions, this is a very rare, inefficient, and an extremely conspicuous means of communication. It also relies on a visual hallucination, which is typically a psychotic symptom that most with DID do not have.  However, it IS a possibility, and some do experience this; but it's mainly the result of extreme dissociation combined with mental visualization that feels incredibly real on the outside (as opposed to a true external hallucination of an alter). 

For most survivors with DID, "seeing" and speaking to their alters happens internally - inside the mind - often including a landscape called an "internal world". Communication may happen through passively-influenced thoughts, face-to-face (in each other's respective bodies, via the internal world), or through “voice” communication heard in the mind. This is why DID diagnoses can get so commonly mixed up with schizophrenia; these discussions and differently 'voiced' thoughts can seem like “hearing voices”, particularly if you don't know what an auditory hallucination would sound like or have better language to describe your experience. But, in DID, these voices and conversations are not actual auditory hallucinations (again, barring very rare exception). They are more like very “loud” versions of one’s own thoughts (versus, say, hearing the radio or a tea cup talking, or voices of those whom you know do NOT belong to you or share your life story). Alter communication is very much a part of you and stems from somewhere in your conscious mind - even if the thoughts, ideas, and tones are considerably different from your own inner monologue.

Other frequent means of communication are things like: journaling, art, post-it notes, non-dominant hand writing, pictures; and, now more commonly, things like online blogging, social media, voice recordings, videos, and more.

✘ Myth:  Parts in a DID system are all just variations of the host at different traumatized ages of their life.

Nope.  Parts can be any age, gender, or personality type. They can have entirely different outlooks on the world, faiths, sexual orientations, political views, etc. Many are even associated with no specific trauma at all but still have a very important and necessary role inside the mind. Alters are NOT merely “frozen” or “stunted” aspects of the host, marked by when a trauma took place. (Not to mention that trauma 'took place' every single day, for a lot of years, for a lot of people). This can be the case for some - and their parts’ names may even all be similar or variations of the survivor’s name - but even they typically show great variation from what the survivor was actually like at those ages.

Personality differentiation is a hallmark of the condition. Without it, it's not DID.

✘ Myth:  Because 'x' person lied about having DID, they’re probably all lying.

Generalizations have never gotten us anywhere in life. Do some people lie about having DID?  Yep.  Do some ignorantly use it as a crutch to try and excuse bad behavior? Sure do. Does that mean the millions who are struggling every day just to go on after an entire childhood of trauma -- who are fighting an uphill battle of perseverance to overcome sky-high suicide rates, while warring against heartless stigma and lack of access to basic care -- they're just all lying? No, no annnd no. Does it instead make the people who lied the ones we should be shaming?  ..the terrible jerks who appropriated someone else’s suffering for their own gain? Definitely.

✘ Myth:  People with DID will inevitably cheat on you/be unfaithful because their parts will just go be with someone else.

I know it’s hard for many to believe, but everyone is different. What one person does, their system does, or television leads you to believe is inevitable will not apply to everyone. Many exist in highly exclusive, monogamous relationships and are instead the ones living in fear of being cheated on, becoming inadequate, burdensome, or dissatisfactory to their partners; and, too often, they are the ones who are left. DID survivors tend to be more concerned with simply finding a healthy, non-abusive, communicative relationship than to "go wild" with the "promiscuous alters" (but more on them later). Flippantly suggesting otherwise is degrading.

✘ Myth:  You can treat DID with medication.

There are zero medications to treat DID. There are, however, medications that can be helpful in managing some of the symptoms of PTSD or other comorbid conditions. Medications to calm extreme anxiety, alleviate depression, lessen nightmares, stabilize mood, help with compulsions, quell severe insomnia, etc. can all be helpful at various points in a survivor’s treatment. But nothing exists to help the symptoms associated with DID, and many can even make them much worse. Be extremely wary of anyone suggesting they can help with your dissociative symptoms or switching through a medication or infusion regimen. They are most likely misinformed, but may also be lying to you or seeking to cause you harm.

✘ Myth:  Integration is a “must”, or is everyone’s goal in therapy.

Callback to our theme: everyone is different. Complete integration into a single, individualized identity - also known as final fusion - is the goal for some. But it is not, and does not have to be, for everyone. It is possible to achieve full healing by processing memories, establishing communication across the whole mind, lowering dissociative barriers, and increasing aptitude by everyone working toward a common goal - all without experiencing the fusion of any parts at all. Some may choose to integrate a few alters or aspects of self with one another or themselves - or "downsize" - but still leave a small system to go about their lives. Others may begin the process, discover it’s truly not for them, and separate again - either spontaneously or with intention. There are many, many reasons why someone may choose any of the above. But becoming singular is NOT a must, and anyone insisting that it is or refuses to accept your decision to remain distinct identities, does not have your best interests in mind and heart.

✘ Myth:  Folks with DID are incapable of being successful or living normal lives. They’re dependent on the system and just cycle in and out of hospitals unable to do things for themselves.

Absolutely false. While success is defined differently by everyone, there are survivors with DID doing extraordinary things - all at varying levels of function, system size, memory integration, and therapeutic care as they’re doing them, We have folks who are CEOs of million dollar companies, professional athletes, high-ranking members of government, leaders of prestigious non-profits, as well as trauma surgeons, lawyers, military servicemen, professional actors, entrepreneurs, college professors, and even therapists — all with dissociative identity disorder. We know many with PhDs, masters degrees, small businesses, and brilliant technology patents. For some, their DID helped them succeed, with different system members able to take on separate tasks, memorize notes, rotate sleep schedules, or offer new creative solutions;. Others found it an obstacle, but more because of how they were treated or inhibited by those around them. While some found success after reaching a place of more complete stability, others were still in therapy twice a week, wrestling with difficult flashbacks and alter switches, but still excelled nonetheless and were content with their choice to do so at that time.

But, more importantly, success isn’t required, nor necessary for anyone with DID. And there is nothing wrong nor shameful about requiring assistance or needing hospitalization. For many, after a life of such severe, chronic, and painful trauma; followed by a litany of symptoms, stigma, treatment, disbelief, and endless barriers to accessing the same life everyone else was awarded — a boring life is the goal. That is the success. No adventure, no high-stakes, no demands, no chaos. Just peace. Just average. A mundane, quiet, unremarkable life, in harmony with their communities and mind, can be the richest reward for so many. But, what each individual person wants for their life, or has fought tirelessly hard for, says nothing about what the broader collective of DID survivors are, or should be, capable of. Having DID is not what will influence a survivor’s success, lack of safety, support and resources is.

Part Two:  Supporters, Therapists/Clinicians and Survivors Themselves

✘ Myth:  The term alter stands for "alter ego".

Alter [most likely] stands for "alternate states of consciousness" or "alternate personality", though there has been confusion about the original phrasing, including the rare-but-existing use of "altered state of consciousness". In the professionals we’ve worked with, the first term was used in their literature, education and in patient charts of their trauma disorders units. The second is seen most often in journals, sources online and by the majority of second wave dissociative researchers. The third attempts to compare it with trauma-related dissociation, but not label the actual trauma-related dissociation itself. The absolute origin of the term alter is hard to pinpoint, particularly when some publications are no longer in print (which may explain why the former made its way into psychiatric trauma hospitals and research papers of many pioneers without having an identifiable date to timeline it). But, the most currently accepted term we see cited is 'alternate personality'. However, "states of consciousness" is a term used interchangeably for alter/personality in various therapeutic circles. So, the first two are none too dissimilar.

"Alter ego", however, has zero relevance in DID whatsoever. That one can stay with Beyonce and Fight Club.

✘ Myth:  People with DID only have a few alters.

Some can only have a couple or a few, but it's more common to be around the teens. It's also extremely common to only be aware of a few for some time, and then discover many many more as therapy progresses and it is safe for them to be known by the others. Systems in the 30s and 40s are not uncommon either. For those with backgrounds of human trafficking, organized violence, ritual abuse, or mind control, it's well-observed for systems to be well into the hundreds, or even impossible to count. System size does not validate or invalidate a survivor. There is also no direct correlation to system size and severity of trauma.

✘ Myth:  All systems have specific types of alters  (i.e. “The Rebel Teen”, “The Promiscuous Alter”, “The Loving Mother”, “The Adorable Child”, “The Evil Introject”, etc.)

Sure, some do have these alters, and it’s often for good reason and due to themes that exist in abuse, not necessarily themes within the disorder. Many will have none of these alters, others have completely reversed takes on them, and so forth. While it makes for easy book and film-writing - and some survivors absolutely do find themes within their system and another's - there is no universal recipe for a DID system. Additionally, getting too specific or trying to categorize alters into specific role subtypes can be quite damaging and lead to a whole host of new issues (none too dissimilar to the complications that arise from trying to fit regular humans into boxes or “types”).

✘ Myth:  All alters will be (or should be) the same gender/race/sexuality as the survivor.

As mentioned before, different genders, sexualities, and even races may exist within one system. Sometimes this happens at complete random, others develop from positive childhood influences, and then other times these changes were bred out of traumatic necessity. (Unfortunately, this also means some alters become who they are because of stigmatizing belief systems fed to the child about folks that are different from them. In these instances, these potentially toxic or discriminatory identities can be worked on in therapy and eventually transformed into healthier, more authentic self-concepts - free of harmful stereotypes, caricatures, or even bigoted projections.)

✘ Myth:  Inhuman alters are impossible (robots, wolves, ghosts, cats, etc).

Not impossible at all and instead very common. For many children, being a human is scary. It gets them hurt. Being invisible or incapable of feeling, becoming a terrifying entity, a loving creature, or even a shapeshifter can feel infinitely safer and more protective of the whole than fragile humanity. Note: Alters do not come about by conscious choice or planning. They happen within a child’s mind, through their understanding of the universe at the time, unconsciously, and by way of a heavily dissociated surreality. Anything that seems even moderately safer than their current state is fair game inside their survival escapism. Just as human alters can be deaf, blind or have no voice to speak, even within an able-bodied system, inhuman alters who are unable to do similar tasks are just as real, valid and important as the humans. They are protective and significant, not weird or unbelievable.

✘ Myth:  All “littles” are broken and damaged.  Or, Inversely, all littles are happy, bubbly kids that hold the survivor's “innocence”.

*re-accessing our theme here* All humans, systems, and alters are different. Some child parts are deeply traumatized and hardly able to function. While, others' kid parts are the most innocent, endearing, and happy little angels. But there is also every shade in between, and some systems have TONS of kids - up to hundreds even - each vastly different from the other. Happy, sad, energetic, daring, lonely, scared, adventurous, genius, precocious, disabled, shy, athletic, mean, messy, giggly, pristine, posturing, infantile, newborn, brave, hidden, exuberant…the possibilities are endless in child parts, including their capacity to grow, change and transform.

✘ Myth:  “Introjects” are inherently evil and are just like the abuser(s) in that person’s life. 

The word introject refers to any alter who is modeled off an outside individual - mirroring their personality, behavior and sometimes even taking on the same name and visual presentation. These individuals may be positive or negative influences in the survivor's life; some are even fictional characters. (Remember: Alter development is not a conscious process and takes place within a young, traumatized child's mind. Pulling from fiction makes complete sense to little minds.) Most notably, though, are abuser introjects -- alters who are so prevalent in DID systems that the term introject itself has nearly become synonymous with “the bad guys”. That said, it is extremely important to remember that these introjects serve a very important, valuable purpose, and(!) they are NOT the actual abuser. They are a victim, a single part within a large beautiful mind, bred from the survivor's essence. They are just copying behaviors shown to them by bad people, not harboring the intent, sadism or immorality of the actual perpetrators. Most are even trying to protect the system at large. Antithetical as it sounds, these introjects can truly believe that hurting the body or internal system members, can still be ultimately protective, misguided as that is.

Let's learn why.

Introjects are only able to model outside individuals so well because they’ve spent copious amounts of time with them. So, in the case of abuser introjects, it typically means that those alters were the most abused by them. By “becoming them”, they not only get to deliver themselves from that powerless dejection, they get to decide what is allowed and what is not. They write the rules. Their intimidation, bullying and posturing as the voice you fear most in this world can make you far less likely to talk in therapy, to tell a family member or friend, seek justice, file a report, go back to school/work, and more.  …anything your real abuser threatened great harm against you for even considering. Introjects' verbal insults may leave you timid and embarrassed, afraid to “put yourself out there”. They may feel this is the only way to protect you from the 'inevitable' pain, rejection, betrayal or loss that comes from making connections. Even healing from your trauma can feel too threatening or unsafe. By being a relentless, menacing part who terrorizes your mind and body, you stay sick, which keeps you safe from whatever those "threats" are. ...but, unfortunately, only by adding new threats to your safety.  Helping them see this paradox can be the first step in getting them to take pause, and eventually become an alter you can work with instead of fearing implicitly.  Some of these introjects are even extremely young child parts who just posture as these ‘big bad adults’ for some semblance of control and power. It's helpful to keep all of this in mind when you're under siege.

It is especially important to remember that they are not evil. They’re usually extremely traumatized and were given a highly manipulated understanding of safety and love. But also, YOU as a whole are not evil just because these parts live inside of you. They are not the actual abuser and they are just reenacting behaviors/thought patterns that were taught to them by bad people for years and years. It's all they know. But, the difference is that deep down they believe they are keeping you safe from something they believe to be absolutely unbearable. You just need to figure out what that is.

✘ Myth:  Alters who persecute (via bodily self-harm or harm to other parts inside) are bad and should be tamed/gotten rid of/ignored/killed/etc.

In a similar vein, most of these parts are doing these things for a reason - a reason they feel is extremely important or keeps everyone safer (even if that just means safe from having to feel any PAIN if they're profoundly suicidal).It’s important to keep in mind that just because these things may not make sense to YOU (since you can clearly see all the destruction and harm it's causing elsewhere in life), they aren’t working with the same information, life experiences, or emotional connections to the world as you.  If you were locked in a dissociative barrier for years, only able to pull from a select number of life experiences (most that were utterly horrifying), you might not be the most empathic or understanding person either. Moreover, many system members adopted their concepts of “safety” when the body was a child. ..a traumatized child. What they consider safe isn't always going to make sense.

Ignoring them, trying to shut them up or restrain them, punishing them, or any of the various attempts at “getting rid of them” will not only never work (their needs will only become greater and louder), they’ll become more and more traumatized as you confirm to them their every belief about the world. You can’t actually “get rid of them” anyway, so it’s far better to try and understand them. 

✘ Myth:  You can kill alters.

Even if mock deaths or temporary experiences of alters “dying” from old age (or other means) have been acted out in some systems, they aren’t actually dying. You cannot kill off a collective part of the conscious mind like you can a person. Their thoughts, memories, emotions will all still be there, so they must be as well. The part may have gone into extreme hiding, been momentarily immobilized, or merged with another part of the mind, but they most assuredly did not and can not disappear entirely or “be killed”.

Above all: THIS IS EXTREMELY DANGEROUS AND TRAUMATIC TO EVEN ATTEMPT.  Do not do it.

✘ Myth:  Alters can’t have their own mental health issues if the main survivor doesn’t have them.

They actually can, and many do. It’s extremely common for individual alters to battle depression, anxiety, OCD, bipolar, eating disorders, self harm, etc., while other members of the system experience no such thing. Some extremely differentiated systems may even need that system member to come forward and take medications that the rest of the system does not need and will not get.  ..and their brain’s neurology responds accordingly.

One note about some disorders, however. Non-verbal, poor eye contact, savant-like, or sensory-processing-disorder alters can be extremely common traits in DID systems. However, it’s important not to just jump to calling these parts “autistic” if the system as a whole is not autistic. It’s possible for alters to behave in ways that mimic their understanding of SYMPTOMS in other disorders they know about, while not actually possessing the neurology for them. This is a complicated subject we could try to elaborate more on at some point, but it’s just an encouragement to pause and not automatically label some parts as having certain conditions just because they show a few traits of them. It can cause a great deal of conflation and misrepresentation of those illnesses. It may also be purely based on discriminatory or uneducated stereotypes of those conditions that were adopted into a young child’s mind. So, it’s just helpful to check for that possibility first!

But, make no mistake, most expressions of mental illness amongst alters are incredibly real and valid and should be treated as such.

✘ Myth:  It’s impossible for alters to have different vision, health conditions, talents, and so on. "Those are physical. Even if the mind is different, the body stays the same."

Not impossible at all, and instead, extremely normal. We must remember that the mind and body are not only extremely connected, but that DID also isn’t just “in the mind”. There are all kinds of changes that take place neurologically to encourage these harsh separations. Some alters can operate on entirely different neural pathways of the brain, and that determines a lot of what the rest of the body will experience, feel and tells the other organs to do. This may mean allergies to different foods, different glasses/contacts prescriptions, over- or under-production of various hormones, and so forth. The brain is incredibly powerful; it not only tells the rest of the body how and when to operate, but it can completely change how the body interprets and responds to cues, sensations and feedback based on which areas of the brain are most active at the time. Much of this is still being studied because it's so fascinating, but there's no shortage of anecdotal examples and several others already within published research.

✘ Myth:  Anyone can treat a DID patient.  All trauma-informed therapists are capable of seeing a DID client through to healing.

DID is extreeeeemely complex. Even specialists can struggle with the sheer volume of curveballs and knowing they must remain vigilant to any and all unforeseen complications. Most psychology curriculums that lead to a degree in clinical practice only spend about a week or two on DID and other dissociative disorders. To add insult to injury, the majority of the information is out-of-date. Trauma-informed classes rare enough and are something most passionate MH professionals must go out of their way to find. Then, they invest extra time, coursework and continued education just to be able to competently and confidently treat a trauma survivor. Depending on the program, many of these folks are still unfamiliar with the nuances of dissociation, personality differentiation, system dynamics, common pitfalls of therapy, memory-processing, and alter fusion (if that’s what a patient desires). While a clinician who's missing these skills may still be able to bring a PTSD patient through to wellness, these are an absolute must when it comes to rehabilitating a patient with DID.

When patient safety is often in jeopardy (either due to self-harm, eating disorders, drug/alcohol use, or ongoing abuse), and suicide attempts occur as frequently as they do in this population, there is limited room for error. And, just sitting with that knowledge can be extremely (and justifiably) upsetting for many therapists. This may leave them feeling anxious, desperate, or even becoming quite protective over their client - which only increases the opportunity for unintended mistakes.  Specific training in DID, or at the very least a sincere dedication to learning it (and quickly) while working with a patient, is highly advised. Not just anyone can treat this condition, and trying to do so ill-equipped can be catastrophic.

Part Three:  The Bizarre and the Out-There

✘ Myth:  People use DID as an excuse to get away with crimes -or- people with DID can commit all the crimes they want and just blame it on an alter.

Very rarely is this ever used as a criminal defense, and when it is, it’s almost always publicized because it’s preposterous. Despite what Primal Fear may have taught you, no, people don’t really lie about DID just to get away with crimes (if for no other reason than it’s very easy to prove they don’t truly have the condition, nor do they demonstrate any of the behavior consistently). But, wait! There's an even bigger reason: this is not a viable defense in a court of law. DID is NOT insanity.  Regardless of what any alter does outside of one’s awareness, the whole person is still responsible for their crimes and will be prosecuted accordingly. If someone uses that as their defense, it will fail them.

✘ Myth:  People with DID are possessed by demons.

This sounds like something to laugh at, but one short gander in DID communities online and you will find all KINDS of people who firmly believe this and will offer unsolicited advice and/or demands for survivors to be exorcised. Regardless of your faith, this is NOT what is happening in DID, and research has provided a complete explanation of what is happening inside the mind and why. Demonic possession, even if you believe, would not present in such a highly organized, specific, and intelligent way, while also happening to meet all the criteria for a well-documented mental health condition. And attempts at exorcisms, “praying it away”, or even the mere suggestion of something more sinister existing within them can be extraordinarily damaging and traumatic to the already-suffering survivor. This was a somewhat understandable explanation in like, the 1600 or 1700s — but in 2017, this projection onto survivors who simply switched? Is absolutely inexcusable.

✘ Myth:  This is just something the Americans made up. 

Patently false. It’s been found worldwide, and some of the leading research in the field has come from countries that are not the United States.

✘ Myth:  DID and schizophrenia are the same thing.

Not even a little bit. There aren’t really even any universally overlapping symptoms from person to person. Schizophrenia is a biologic, neurocognitive, and in some cases, neurodegenerative, disorder (frequently labeled a psychotic disorder - which carries its own unfair stigma to overcome). Dissociative Identity Disorder is a trauma disorder. Without trauma, it could not organically develop. It is PREVENTABLE. No medication can “treat it” in isolation. This mix-up causes harm to both communities.

✘ Myth:  Films like Split, Sybil, Three Faces of Eve, and Frankie and Alice taught me everything I need to know about DID! The United States of Tara is amazing representation!

Hardly shocking that media can be extremely inaccurate, but when it comes to Split, Sybil, Three Faces of Eve, Frankie and Alice, etc, you'd think that most would intuitively know they're pretty awful. ...but, just one look around and you'll find that disproven rather swiftly. These films are not only abysmal in terms of representation, they severely damage and inhibit the public's understanding of DID. And, sadly, it’s not just the general public who seem unsure of their accuracy. I recently heard a mental health professional, who treats both C-PTSD and DID, refer to some of these as “good” and “informative” — a reference point for those who are new to the condition. Disappointingly, knowing just how harmful they are is not a given, even in the MH community.

When it comes to The United States of Tara, while it is absolutely better than the others, it is not “good representation” by any stretch. Yes, it did touch on some important topics, but most of those are moot when it also displayed the most commonly stigmatizing and damaging tropes in excess, and got so dark by the end that many with trauma histories couldn’t even finish it. A simple scroll back through these myths and you’ll find MOST of them in the show. (She was violent to strangers, abusive to her family, cheated on her husband, and was deemed unsafe to even be around children. Her switches were SUPER dramatic, alter differentiation was the most extreme, and they used very predictable tropes for her alter characterization. She introjected a therapist without any trauma or major life event to necessitate the addition, sought extremely toxic "therapy" without the show ever defining it as such, and safety was dealt with so irresponsibly that it was disturbing. There is much more to add.)

We could write an entire article on this alone (and we may even do so one day), but for now, let’s just squash the myth that USoT is “positive representation”.  I know that as survivors we tend to think of anything that isn’t actively hurting or abusing us as being GREAT! But, just because something isn’t a total disaster or has some redeeming qualities does not mean that it’s positive. At all. And we shouldn’t accept it as such. USoT is great for some laughs and entertainment, but it is not good DID representation. We save our choice words more for films like Split, but hey, we even managed to exercise some restraint there while discussing it in this article here! :)
 

    No doubt there are far more myths than this. We encourage you to add some of the most wild things you've heard in the comments. What are some misconceptions you held onto or believed when you first heard of the condition? What are some things you still hear from those around you or online? ...possibly even from clinicians?  While none of these are a laughing matter, and we hope that we've educated significantly, it's still okay to get a laugh from things now and then, especially when they're so absurd. If we didn't, we'd all go a little bonkers

     We sincerely hope this was very useful to you, and we hope to see you sharing it with anyone who needs some clarity!

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MORE POSTS YOU MAY FIND HELPFUL:

  ✧  Grounding 101: 101 Grounding Techniques
  ✧  Distraction 101: 101 Distraction Tools
  ✧  Self-Care 101: 101 Techniques for Self-Care
  ✧  Flashbacks 101: 4 Tools to Cope with Flashbacks
  ✧  Nighttime 101 and Nighttime 201: Sleep Strategies for Complex PTSD
✧ Color Breathing 101: How to Calm Overwhelming Emotions and Physical Pain
  ✧  Imagery 101: Healing Pool and Healing Light
  ✧  Did You Know?: 8 Things We Should All Know about C-PTSD and DID
  ✧  Trauma and Attachment: 3-Part Series on Attachment Theory with Jade Miller
 
  ❖  Article Index  ❖

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*WE ARE SO SAD TO SHARE WE’VE HAD TO TURN THE COMMENTS OFF THIS POST*

Unforunately, someone had been nefariously using the comment section - within which were hundreds of beautifully helpful comments, research-sharing, and personal support - to seek out vulnerable trauma survivors. Because of this, it is unlikely they will return, but we may make a different choice in the future!

While this is deeply disappointing (and we’ve been handling these types of incidents with law enforcement), it does supply a great reminder of the unique risks of any public, mental health forum. Exercising strong boundaries when disclosing to the public your life experiences and/or medical information is a great skill to sharpen. We’d love to talk more about this with anyone for whom this is a new consideration! Please reach out if you need any support, have questions, or, of course, to let us know if you experienced any targeting by this individual.

Did You Know?: C-PTSD and DID Edition

    No matter the topic, misinformation and lack of understanding is everywhere.  When errors are made or false ideas get perpetuated, they tend to go unchecked and unchallenged usually because most of us just plainly don't know enough to even realize it needed to be corrected or looked into.  And, this is completely understandable, right?  We can't be expected to be informed on nearly every subject and struggle of humanity.  We can try our best, but there will always be things we are still woefully ignorant on.  Access to education, reliable resources, and just knowing where to even look for more information on any given topic is so hard.  We're left to take our cues from those claiming to be knowledgable, go along with the basic understanding held by the general public and our loved ones, and/or just let it be and invest our attention elsewhere.  When it comes to mental health, no doubt, all of these issues collide head on - multiple times over.  We unconsciously acquire so much misinformation about psychological disorders by the time we're only kids - and just by casually picking things up in conversations, media, and comedy, we also tend to adopt some heftily stigmatizing ideas as well.  And, if this is true even for those expressing no real interest in mental health, imagine the damage when people who do try to learn from the professionals are met with uninformed practitioners or those grossly misleading the public, their colleagues, and even their patients.  This is how Complex PTSD, and most especially Dissociative Identity Disorder, have been treated for decades.  We would like to start changing that.

   Little by little, bit by bit, we want to undo some of that damage and raise more accurate awareness for both C-PTSD and DID.  You can read more about the conditions themselves here (individual DID page coming soon!), but we also think it important to touch on what survivors with these disorders are currently going through just to obtain treatment.  After all, they wouldn't be struggling to get care so badly if those in the field had more of a vested interest in them - becoming at the very least trauma-informed, or better-equipped themselves to treat a client with complex trauma.  This will be an ongoing series no doubt - with many myths to debunk and important notes to impress!  So, to start chipping away at that iceberg, here are 8 things we should all know about Complex PTSD and Dissociative Disorders, and the survivors who have them.  

  With as vast as the United States is, this is supremely disappointing.  You can find the current list of those facilities here on our website.  Even within those 9, many keep relocating or downsizing, some have a very small number of beds or are restricted to only certain age groups, others have had all their additional programs (like PHP/IOP) cut entirely or are so underfunded they don't run smoothly.  Overall, the standard of care for trauma patients nationwide is very low.
   Finding a trauma-informed unit at all is pretty scarce, but the greater drawback is that many who claim to be able to take Complex PTSD or DID patients offer them no therapeutic tools or classes designed to address their unique needs and have them intermingled with the rest of the mental health population. This might not sound like an issue, but due to the nature of a trauma patient in crisis and their high susceptibility for flashbacks, panic attacks, switching, and self-harm, being surrounded by unpredictable and sometimes volatile patients is unreasonable and unsafe.  Staff also need to be heavily trained in what is an acceptable and safe way to engage with a severely traumatized patient - particularly if they are in flashback, a dissociated self-state, or critically unsafe.  Units remain safest (from perpetrators and potential flight-risks) when they are locked, but an understanding that this can be also be extremely distressing for other patients is something staff need to be able to empathize with and negotiate.  In short, the nuance of care required for complex trauma patients is unlike that of any other mental health condition.  And yet we have less than 10 places we can safely send individuals, and many of those 10 even have their shortcomings.  A couple even continue to produce more negative reviews than positive, and some of the leading facilities have proven time and again they are fantastic with some patients but are not equipped to handle ritual abuse patients.  Greater education, as well as funding to produce more units in existing psychiatric hospitals is a MUST.

  As a side note, there are a handful of residential facilities cropping up in various places throughout the U.S.  Residential treatment centers, while valuable and a potentially great resource (especially when there's nowhere else to turn), are typically not equipped to handle clients who need stabilization or are struggling with safety.  They are also more unregulated, therapy modalities can be harder to discern, units are not locked, insurance rarely participates, and they tend to be extremely small in bed-availability.  While they are often very beautiful and relaxed, and nothing like an inpatient setting - they can be extremely expensive, with limited staffing, and tough to guarantee quality of treatment.  And again, while they may be able to facilitate a chronically traumatized patient through a rough patch in their healing, they are often not trained or equipped to aid in crisis stabilization, and are usually far from a hospital should the need arise.

   As it turns out, averages can be tough.  Research in this field is still limited, and even where it exists, trauma patients aren't typically the most eager to participate in a study.  However, despite research on treatment length being slightly dated, and the fact we are getting more practitioners better-able to facilitate a patient through their recovery, as well as those who can at least make an informed diagnosis more quickly -- we are still grossly behind.  So, while some may want to argue this estimate is too high based only on what they see in their well-trained offices, others who have patients working well into their 15-20th year of therapy would argue it's still much too low. Regardless of the exact specificity, this is a very reasonable estimate at the moment, and is witnessed to be valid by many, many clinicians, patients, and communities of survivors fighting this battle. Now, this does not always mean 10 years of consecutive therapy - though it absolutely can and does for many.  It's quite common for patients to have to stop and re-start therapy multiple times - for myriad reasons.  Finances, inadequate treatment, personal unreadiness, a geographic move, unavailability of clinicians, and/or feeling stable at one point but needing to return as more things surface later - these are all very common factors for a more drawn out therapeutic journey.

   Ultimately, treatment of complex trauma takes a very, very long time in even the best of circumstances.  It can be extremely daunting and feel outrageously unfair to the survivor.  The average of several misdiagnoses before arriving at a proper one alone, then coupled with misguided therapy, not only adds more years to the recovery but also risks turning clients away from therapy altogether.  It's even been a traumatic experience for far too many.  We need compassion and understanding for these survivors.  To support them through this long process, no matter how many years it may take or how many times they need to stop and try again. Recovery from trauma is scary.  They need our love and support, not added obstacles.

   As mentioned earlier, inpatient care for complex trauma is extremely scarce.  It requires a specialized unit and, for many, that will be out-of-state.  Insurances rarely cover beyond their state's borders and non-participating provider agreements can be very tough to come by - let alone something we should ever expect a survivor to have to fight for themselves while in a terrible, terrible place.  Because of this, many of them have to pay tens- to even hundreds-of-thousands of dollars out of pocket for care.  Many facilities will not let you pay once you get in and settled and can think clearly.  They often require a sizable sum up-front, before you even enter the unit.  And, again, coming up with thousands and thousands of dollars that most don't have to begin with, particularly while in crisis, is a feat many just cannot accomplish.  Needless to say, most go without.

    How many people in the world do you know with red hair?  There are at least that many people with DID in the world - though, more than likely a lot more than that.  Due to fear, stigma, high rates of suicide, misdiagnoses, lack of public education, and countless other reasons, most who have DID aren't even accounted for yet.  But, the bottom line is that this is NOT a rare disorder.  It's only rarely talked about.  And, when it is, it's very rarely talked about in a positive, empathic light.  Most refuse to confront the reality of its prevalence rate, because to do that would mean having to confront causality.  And, what causes DID?  It's most always man's inhumanity to one another and the cruel callousness of the world.  No one wants to acknowledge that or accept how rampant it is, so they sweep the survivors of such under the rug (while others go so far as to actively paint them as dangerous or truly insane, especially in media).  DID is not rare.  It's not a one-in-a-million case you'll never see.  It is everywhere.  And those suffering with it just want someone to help them after years and years of abuse, pain and neglect.

   This is another fact that is just so very sad.  Complex trauma and dissociative disorders are hard enough on their own, but so are depression, anxiety, OCD, addiction, eating disorders, self-harm.  To have a collection of many of these at once just seems grossly unfair - yet that's the insidious nature of trauma.  The ever sadder part is how many of these aching, traumatized souls find themselves in eating disorder facilities or drug/alcohol rehabs (or even jail) for the more overt or destructive symptoms, but never receive trauma-informed care of any kind. Care that is specific to complex trauma or the uniqueness that DID can play in some of these more addictive or self-sabotaging behaviors is even more rare in places like these.  Additionally, when you try to "fix" an addiction or eating disorder through traditional means, without addressing the way its delicately woven and spun around the trauma, you can make them dramatically worse.  This, like all bad treatment, can turn them away from therapy (or help in general) forever - or more devastatingly, push them to lose their battle before they ever had a real fighting chance.

   It may be a broken record, but there is no place that the abundance of misinformation, redirection of resources, or ignorance of childhood trauma doesn't touch.  PTSD in any form is brutal and terrible and all-consuming.  But it's sad that in 2017, the first group of people that comes to mind for most whenever you mention trauma or PTSD, is still veterans.  If our "war flashbacks" and "triggered" memes online are any indication, people really do not understand the severity of the condition at all, nor do they even attribute it to the population struggling with it the most.  There is absolutely a way to keep the very real and VERY valid suffering of war veterans and those who've served in the military very present in our minds, hearts, and resource initiatives, while ALSO lifting up childhood trauma survivors and victims of sex crimes considerably higher than they currently are.  They need our attention and visibility.  And fast. 

    I bet if you call to mind any trauma survivor you know, they've also got at least one chronic (or "mystery") illness - maybe even several.  In fact, it's probably several if they've survived prolonged trauma.  Migraines, fibromyalgia, asthma, autoimmune disorders, rheumatoid arthritis, severe allergies, eczema, dysautonomia, POTS, EDS, neurologic disorders, chronic fatigue, or possibly even the highly insulting [and inaccurate] label of "conversion disorder".  These are all seen to coexist alongside trauma in abundance.  This list is by no means exhaustive, and - just like diagnoses for C-PTSD and dissociative disorders - many are still trying to just figure OUT what is wrong. They know they have a chronic illness, they just don't know which one, and every avenue they explore seems to point toward a dead end.
    We may have a helpful answer to you.  In reality, trauma affects absolutely every part of the body - especially the autonomic nervous system (which then affects everything else).  This can cause all sorts of havoc and in ways we are only just beginning to more fully understand.  It's been well-observed for awhile that trauma and physical illness go hand-in-hand, but it's only more recent that we've been able to see how, why, and where more specifically.  Because of this, and the fact it's a very lengthy topic, we cannot recommend the book The Body Keeps the Score by Bessel van der Kolk enough.  Or, at the very least, if you aren't interested in reading, maybe peruse some of his work online.  It'll be something you definitely won't regret, and supplies a well-studied introduction to all the ails, aches and pains, and mysterious illnesses you or a loved one have been suffering with for what seems like forever.

    Finally, in the same vein as so many of these facts but on a slightly different wavelength - traumatized children are seeing some of the most ludicrous misdiagnoses we've seen in quite some time.  The lack of understanding of what children who are being actively hurt (or just recently were) are "supposed to look like" in terms of their symptoms, is staggering.  Instead of traditional PTSD symptoms that we observe in adults, most kids are demonstrating all of the behavior one might expect from a child presently terrified, scared, shut down to numb, avoidant or afraid to attach, feeling under threat, trying to seek control and a voice, and who doesn't know what to do with all that adrenaline and nervous energy coursing through their tiny, terrorized little bodies. Sure, traumatized children can present in a variety of extremes, and that can be tough to distinguish at face value - but it's not too difficult to learn. And it's not acceptable to take the response of "No, no one's hurt me." as gospel in a child who's still in danger and never pursue it further - especially when all their symptoms are telling you otherwise.
   Jumping to the opposition-defiant, mood-dysregulated, ADHD, autistic, etc labels/misdiagnoses can be so harmful and even lead to more abuse at home.  Not to mention, they can follow them around forever, reshaping who they think they are or believe to be "wrong" with them.  It can make them feel broken or defective - particularly when the treatment for these suggested conditions can make them so much worse.  In reality, they are just traumatized children who did nothing wrong, but are being wronged by all the caregiving adults in their lives.  They're trying to communicate their suffering to you in any way they know how, but most of those "listening" are all too eager to villainize, label, or neglect them instead.  That is not helping them.  We need to do better.

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  There are so many, many more things we all need to know and recognize about Complex PTSD, dissociative disorders, and the survivors who have them.  We will absolutely be continuing this list and adding more to the conversation.  What are some of YOUR greatest misconceptions about trauma disorders, or details you really wish people knew about the process of healing from them?  Please share them below!

MORE RESOURCE POSTS YOU MAY FIND HELPFUL:

  -  Grounding 101: 101 Grounding Techniques
  -  Nighttime 101 and Nighttime 201: Sleep Strategies for Complex PTSD
  -  Imagery 101: Healing Pool and Healing Light
  -  Coping with Toxic/Abusive Families During the Holidays

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