A couple of years ago, life piled up, and mental health concerns disabled me. One of the hardest — and most helpful — things for me to come to grips with has been a diagnosis of “Dissociative Disorder Not Otherwise Specified” or “DDNOS.”
The diagnosis was hard for me to accept because I didn’t want to believe that I had the illness. It scared me. And I didn’t want to believe that “something (like that) was wrong with me.” I felt ashamed. Ultimately, I’ve come to accept the diagnosis and I’m writing about it now because of how helpful this diagnosis, and the correct treatment, is proving to be for me.
Many — perhaps most — mental health professionals do not fully understand dissociation and therefore fail to diagnose the dissociative disorders correctly. As a result, people who have a dissociative disorder fail to receive the correct treatment. I have had DDNOS for my entire life and was not diagnosed until I was 48 years old.
Dissociation occurs along a spectrum and, in fact, we are all dissociative sometimes. Examples of normal dissociation include things like: driving to work in the morning and not really taking in much of the scenery; spacing out for a couple of seconds during a conversation and not catching something that was said; or occasionally coming into a room and forgetting your purpose for being there.
However, a dissociative disorder can develop as a result of trauma that has not been fully processed. The following is paraphrased from literature authored by the organization, “PODS” (Positive Outcomes for Dissociative Survivors):
Dissociation is a common response to trauma. Trauma is defined as an extremely distressing experience, involving a threat to life or the physical body, which is accompanied by feelings of helplessness. Dissociation is when a person alters their consciousness to achieve distance or disconnection from the full impact of what is happening. It can happen automatically as the best and usually the only means of mentally surviving the trauma. Dissociation is a normal process which starts out as a defense mechanism to handle traumatic events, but which becomes problematic over time.
The PODS literature goes on to state that, “The purpose of dissociation…is to take the memory or emotion that is directly associated with a trauma and to try to separate it from the conscious self…. Dissociation has been described as ‘an unconscious defense mechanism in which a group of mental activities splits off from the main stream of consciousness and function as a separate unit’ (O’Regan, 1985). ”
For as long as I can remember, I have felt disconnected from other people. I now recognize this as dissociation. More specifically, I now know that I have used disconnecting or dissociation as a means of trying to protect myself from perceived danger from other people. I learned to dissociate to protect myself from abuse when I was very little. Because the trauma I experienced was never fully processed, I continued to dissociate around people, for protection from the trauma that occurred years before but which I hadn’t been able to process. This is not the complete story of my experience of dissociation. But I will write more about it here, and in other blog posts.
In therapy, I’ve learned about “dissociative parts”. Everyone has different parts to their personalities that were formed as they were developing. For example, if someone was told repeatedly as a child that they were not pretty or handsome, then part of them may still believe that and act as if it’s true sometimes. Even though they may have, as they’ve gotten older, decided that in fact, they are pretty or handsome.
I have many different parts to my personality, based on the ages I was when I experienced particular forms of trauma and abuse, and the strategies I used to try to cope with that trauma and abuse.
For example, it seems very likely that when I was quite young, I experienced abuse that caused me to believe I might die. That young part of me gets activated now at anything that reminds her of the abuse from the past — like people. However, for my entire life I’ve also had to function in the world of people. I’ve coped by dissociating from my fear, pretending it didn’t exist and stuffing it down, deep inside. I’ve also coped by trying to adopt an exterior persona of invincibility. In fact, I haven’t done a bad job of that; I’ve been told before in my life that, “Annie, you look like you have it all.” The problem has been, of course, that when my external armour of invincibility has been poked and prodded, it’s revealed a very fragile person underneath. And also, it takes a huge about of energy and effort to stuff your emotions down, to be split off from them, and to keep the armour on.
My younger part has held onto much of the fear from which I’ve been dissociating. Now, working with that younger part in therapy — carefully, slowly — some of my fear can be exhaled. And the younger part that held the fear can be more fully integrated with the rest of me.
I’m including Kathy’s blog post here. In it, she discusses the image and how the way it is drawn relates to different parts of the main character’s personality — parts that include different coping mechanisms that were employed to deal with past trauma and abuse.
I hope this post has been useful to you. I am only beginning to understand my own diagnosis and will clarify or add more as I know more.