Dissociative Identity Disorder and Comorbidity

As my wife and I have walked together the last 6 years to see her healed of dissociative identity disorder, I have become familiar with the term comorbidity. Wikipedia defines it the following way:

In medicine, comorbidity is the presence of one or more additional disorders (or diseases) co-occurring with a primary disease or disorder; or the effect of such additional disorders or diseases. The additional disorder may also be a behavioral or mental disorder.

In medicine, the term “comorbid” can be either medical condition(s) existing simultaneously but independently with another condition; or it can indicate a related medical condition or conditions. In psychiatric diagnoses it has been argued in part that this “‘use of imprecise language may lead to correspondingly imprecise thinking’, [and] this usage of the term ‘comorbidity’ should probably be avoided.”

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

During our journey it was suggested to me by a health professional that my wife had a comorbid eating disorder because she is in the bottom of the weight charts and has a very bad body image. And from time to time the little girls have suggested to me, after taking various online tests, that they have some tactile disorder and are borderline autistic among other things. The first year Tina joined us she nearly made us house-bound because she was terrified of all crowds; and certainly our dysfunctional sex life deserved a well-placed disorder to proclaim my wife’s sex issues.

But I’ve always been of the opinion that attaching all these additional labels ‘comorbidly’ with their d.i.d. would be unhelpful. First, if I allowed them to “own” these other disorders then it gives them permission to act dysfunctionally because, “hey, I’ve got this (or that) disorder” if you understand what I mean. I think we all tend to live up or down to the expectations of others to a certain extent. But secondly I always minimize the attempts of the girls or others to label them with additional disorders because of how systemic d.i.d. is and how it works. Instead I’ll tell the girls, “Hey, let’s get the dissociation resolved and you girls all together and then we’ll see if these other things are still an issue.”

See, from each girl’s point of reference when she “takes executive control of the body” she feels as if she completely in charge and in full control of all personality and abilities systems. No matter how many times I talk with them and explain to them that “Honey, you need the other girls. They control things that you don’t” they simply don’t get it because from their frame of reference they have never known anything except their dysfunctional abilities: all 7 of them, no exceptions.

What that means is when Tina first came out, her terror of public places and crowds would easily have gotten my wife labeled “agoraphobic.” But Tina only controls a part of my wife’s abilities and traits even when she’s in executive control. So it’s unhelpful to label “my wife” (the whole) as agoraphobic when only one girl in the group is. I had the attitude, “Let’s get Tina healed and feeling safe and connected to the other girls who are NOT agoraphobic because their strengths will overcome her weakness” and that’s how it worked. Once I got Tina and Sophia connected and they became sisters, most of Tina’s agoraphobia melted away. I’m not saying Tina loves to be in public with crowds. She’d still rather be home alone in my arms watching tv, but my point is her agoraphobia was only a manifestation of how d.i.d. truncates each of the girl’s abilities.

I still need to get Sophia and Tina connected to Amy to finish dealing with the residual agoraphobia because Amy is my “brave girl.” In fact I call her “Amy the brave” because I believe she literally controls my wife’s entire ability to be brave and daring. Amy is the one who wants to go on a roller coaster. Amy is the one who wants adventures. Amy is the feisty girl ready to punch someone with “the old 1, 2” as she used to quip! Not even Alley the defender is truly brave, nor Karen. Amy alone is my brave girl and so when the others cower in fear, I send Amy to wrap them up in her arms or put them on her lap, even Karen. Amy finds it tiring to always be the brave one for the entire group (except KA who is miss sunshine and rarely concerns herself with the fears of the others, lol), but I tell Amy she was made to do it. I also remind her, “Honey, when you get tired you can always come to me, and I will happily hold you. You don’t have to be brave on your own: I will help you!”

Another dysfunctional manifestation that we are currently dealing with is Alley’s extreme introvertedness. She is so private that she’s nearly “100%” when she takes those introvert questionnaires online (there ought to be a law against all these inane personality profile tests online!!! ). But again, I see this as a function of how d.i.d. works, and so I always discount her introvertedness and say, “Honey, once we get you connected to KA and Shelly, they’ll be able to help you.” I know that KA and Shelly each control parts of the personality that Alley can’t currently access. These two girls will be instrumental in helping Alley overcome her extreme introvertedness. Since Alley’s always been this way, she doesn’t understand when I try to explain to her how the other girls can help her. So I just have to slowly lead her to the solution in a way that doesn’t feel like I’m coercing or shaming her to do what needs done. And that process has been going on all summer and is still continuing even today…but we are getting there slowly (painfully slowly!).

I guess I could continue with other examples that some might attach a comorbid disorder label to my wife, but I always minimize these when talking with the 7 girls. As the girls connect to each other, one’s girl’s extreme weakness because of her truncated personality and abilities is balanced out by another girl’s strength. And as the healing process continues the comorbid and obsessive habits that so often characterize d.i.d. patients have simply melted away in my wife without directly addressing the disorder or obsession (that doesn’t mean I don’t address the girl’s concern about a particular issue as I have noted in other posts).

I can’t speak for other d.i.d. patients, but that’s how it’s worked for us.

Blessings to you all!

Sam, I Am

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8 Comments (+add yours?)

  1. Hope
    Aug 23, 2014 @ 17:01:10

    I read somewhere that DID patients, on average, get seven other diagnoses before the DID diagnosis, and that certainly squares with my experience. I think most mental health treatment (and physical health treatment, too, really) doesn’t know how to see the whole of someone’s experience. In many cases, they don’t even try–I can’t count the number of psychiatrists who told me all they wanted to hear was whether I was suicidal and how much I was sleeping because they didn’t deal with other problems. They want to section off this behavior or that symptom from the whole person and treat only that, so it becomes a form of confirmation bias: all they see is agoraphobia or ADHD or bipolar or paranoia because that’s all they’re looking for.

    You’d think it would become obvious to them fairly quickly that that’s not an effective way of treating a person, but in another logical fallacy, they assume that improvement in the narrow scope of their view means the whole person is better.

    For me, when I got the DID diagnosis, all the previous diagnoses finally made sense. I’d always felt like each of the previous diagnoses resonated with me somewhat, but all of them also felt lacking in a way I couldn’t define. Once I got over my initial denial reaction to the DID diagnosis, it all made sense: none of the previous diagnoses quite fit because they were all really just symptoms of a greater dissociative dysfunction.

    Reply

    • Sam Ruck
      Aug 25, 2014 @ 17:22:20

      Hi Hope,

      I read about so many bad experiences with therapists that’s it’s kind of disheartening. My wife loves her counselor but she only kind of gets some of the things that I’m doing with the various girls. I wish more therapists would listen to their patients of those of us in supporting roles instead of dismissing our input.

      I’m glad your final diagnosis validated your experiences so that you can start moving forward.

      Thanks for stopping by..

      Sam

      Reply

  2. Bourbon
    Aug 24, 2014 @ 17:28:00

    I agree, Sam. If I literally listed every disorder that I have ever been diagnosed with (I mean ‘I’ loosely, as in other parts too) it would be ridiculously long and totally pointless. Our diagnostician just said – you have DID – other trauma-caused disorders are pretty much a given, there is no need to separate them out. Best wishes xx

    Reply

    • Sam Ruck
      Aug 25, 2014 @ 17:18:17

      Hi Bourbon,

      thanks for stopping by…I’m glad this post resonated with you. I’m glad your diagnostician ‘gets it.’ I wish more of them did…

      Well wishes to each of you,

      Sam

      Reply

  3. ccchanel41
    Aug 29, 2014 @ 01:49:37

    Hi Sam,
    I nominated you for the Very Inspiring Blogger Award.
    You do not have to accept this, and if you do, you do not have to follow the rules exactly. Either way please know that you and your blog have been an inspiration to me and I can see many others.
    Here is the link to the my blog where I nominated you
    http://ccchanel41.wordpress.com/2014/08/29/what-inspires-me/

    Reply

  4. Those Interrupted
    Aug 29, 2014 @ 18:43:13

    It’s always so interesting to me to see how disorders play out among systems. For example, some but not all of us have eating disorders or Depression, and I’m not sure how much of those aren’t disorders on their own but things that will disappear if/when we heal from the PTSD. On the other hand, we’re Autistic beyond a shadow of doubt, yet some of the alters are more affected than others, and some of the traits of Autism seem to be split among alters, only affect some of us, or affect all but a few of us. In that case, it might even be that integration would increase the affects of the disorder as we could no longer section off some of the symptoms!
    -Rage

    Reply

    • Sam Ruck
      Sep 02, 2014 @ 18:34:48

      Hi Rage,

      thanks for stopping by and for sharing your experience! Until I get all my girls connected, I largely just take a “wait and see” approach about the various dysfunctional things I see in their lives. I help them address areas that inhibit the larger, current goal of learning to connect and work together or if they would be self-destructive, but I try not to worry, as much as possible, about specific things.

      Sam

      Reply

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