Just a quick update. I wanted to share something I came across. This is a recent article entitled Inside the Fragmented Minds of People with Dissociative Identity Disorder.
This is a really great read, and features some discussion from Dr. Loewenstein (Medical Director/Founder of the Trauma Disorders Unit at Sheppard Pratt.
Here is a link to my discussion about the article on Reddit.
Trigger Warning: Self-Harm
Therapy continues…we’re still seeing K. once a week and going to group once per month. Yesterday, we couldn’t shake some intense feelings. We did DID symptom management skills like grounding and a couple “past vs. present” ‘s for different parts. But, we just couldn’t control the intensity and dissociation. So, we called K., and she had us come in for an emergency session.
We talked about some things I’ve told her before, and we talked about some things I’ve never told her before.
As a result, I’m having a ton of increase in urges to self-harm. Most of it has been impulses to harm and thoughts/plans, but not actions.
So, let me talk about Alex. Alex is a teen part, who was mostly present during the body’s ages of 15-18. During that time, she often engaged in self-harm. Most she cut the skin but she also sometimes hit/bruised the body.
Why does Alex self harm? Alex had to do a lot of talking in counseling with our then-counselor, Andrea, but she eventually learned why. This was huge not just for her, but for us as a system to better understand Alex and what she went through. At the time the body was ages 15-18, we had no escape from the trauma and re-traumatization of not being believed by family, school teachers, and child protective workers. Feelings of loneliness and and depression were so severe that cutting became one of the few outlets that worked to relieve some of the intensity.
As Alex began to trust Andrea, self-injury took on a new meaning. It became one of the few ways she could communicate to Andrea tha inner turmoils she was constantly surviving. It also became a way of communicating she needed help.
I think this is important to note, because although the behavior of cutting remained the same, the why evolved over time.
Next, we have a child part (unsure of who exactly), but this part will sometimes intentionally bang their head, pick/scratch cuticles until they bleed and bite nails until they bleed.
For this child, we are still learning the why. This seems to have to do with impulsivity and an obsessive need to hurt the body. There is definitely focus for this part on the creation of physical pain. Once the pain has been created (or the bleeding started), she then can hyperfocus on that physical response instead of the (unknown) emotion that triggered the impulsivity.
I’m starting to realize that we (several adult parts) also engage in self harm indirectly. What we mean by this is we do things that aren’t intentionally self harming (like Alex and the unnamed child part). Unfortunately the actions do end up causing harm to the body. For example, Carrie and Beth engage in substance use. Vickie gets into risky sexual situations with men. Nel doesn’t eat enough food or sometimes eats too much of a food that is worth little to no nutrition (e.g. chocolate for breakfast–for 5 days straight).
Lastly, I’m beginning to understand that there is programming associated with some of my tendencies of self harm. This is a very overwhelming and scary thing to realize. I’m not sure what to make of it. Every time I seem to realize this (or remember I have realized this before), I blank out, lose the memory, or lose a couple hours. See, even me trying to put it into words now seems difficult to do.
Until next time…
“Each falling apart eventually brings a coming together.” -Mina (co-fronter part)
It’s almost been 2 weeks since we’ve seen K. (our therapist). Snow storm hit in the beginning of the week, and so I’m a bit behind seeing her. Honestly, I needed a little break. Therapy has been tough.
Going through my regular night routine, and I’m preparing for tomorrow. I wanted to do some writing/internal communication about therapy.
I imagine tomorrow we’re going to follow up on the possibility of recorder/reporting parts. I am terrified for multiple reasons to discuss this. On one hand, I think I’m having some passive influence of Clara’s terror. On the other hand, I’m having super rejection sensitive dysphoria (intense emotional response to the perception of disappointing/failing others–even when no actual rejection has taken place). In other words, someone (maybe Clara again?) is afraid that K. will withdraw her care or abandon us if we continue to talk about this.
All of this is overwhelming, awful, and at times unbearable. We’re not even sure where to start with grounding when we hit this level. It’s a level of yuck feeling that isn’t really addressed on our Crisis Continuum.
I’ve had several requests for more information on Before During After (BDA) Plans. This is a symptom management techniques I learned at Sheppard Pratt last year.
BDA Plans are used to prepare for events that may cause an increase in CPTSD and/or DID symptoms. You might use them to plan for both positive and negative events. This includes things like holidays, appointments, or telephone calls.
The plan has three sections, aptly named Before, During and After (the event). In each section, you identify what symptom management skills you can use at each point.
Some things to note:
- Before starts whenever you need it to start. This could be anywhere from days to hours before the event.
- During is helpful to focus on grounding skills or whatever else you need to do to stay present.
- After is just as important as any part of this plan, to help you in case of any impact after the event is over. Self-soothing and Internal Communication (if needed) are very important here.
- Use your Crisis Continuum as a guide to incorporate things that help into the BDA.
To give you an idea of how a BDA looks when all pulled together, here is one that I developed at Sheppard Pratt:
Event: Taking a Shower
As you can see, Internal Communication is a big part of the entire process. What helps us is the BDAs not only helps us plan for difficult situations, but helps us have a script/talking points for Internal Communication. This plan in particular has been very helpful in building trust between parts during a vulnerable moment and in turn giving us power in our recovery.