Dissociative Disorder Not Otherwise Specified
Dissociation and DDNOS
It's not Sybil, and it's not The Color of the Night, but it is real. It pains me when personality fragmentation becomes a political issues, or when when people say it can't exist. I think the controversy stems from extreme images on the media. I'm not at liberty to share some of the things that I have witnessed because they involve other people. I want to begin this, though, by saying I have some personal experience. I'm writing this page to make the issue seem more comprehensible and less like a movie. My focus here is on a milder form of identity disorder that is sometimes termed DDNOS, though the line between DID and DDNOS -- like the line between personality states -- sometimes blurs.
Often identity disorders are the result of severe trauma, but some people are more sensitive or susceptible. They don't need as much trauma to lose their footing. It can be a normal process gone awry. Everyone plays different roles in different situations -- and has slightly different editions of himself -- but for some people the process of creating selves goes out of control. Dissociative disorders can begin when a child feels, very strongly, that they need to be one person in one context and another person in another context. They may develop the strategy of flipping rapidly from one projected self to another, perhaps when a particular person enters the room. I've heard the process compared to flipping channels on a TV.
Personality states become more compartmentalized -- more self-contained -- than those that the typical person experiences. This can be an adaptive strategy. It can help a person keep parts that are broken at bay and allow them to function seemingly normally at school and work. But sometimes things break down. The person flips channels at the wrong moments. In times of stress, they may act in uncharacteristic ways or ways that just aren't appropriate to the situation they're in. They may appear different ages at different moments. For a few minutes at a time, they may talk in a completely different voice, perhaps the voice of a small child.
There will likely be memory lapses. They may remember their actions from day to day or minute to minute, but not know why they do the things they do. Or they may 'lose time' and have no recollection whatsoever of things they've said or done. (It isn't necessarily deep, dark things, I'll add -- certainly not crimes.) But the person doesn't have control over the situation.What started out as a strategy has become something else. Early trauma is associated with neurological change: actual alterations in pathways in the brain.
Even if it doesn't happen real often, it's frightening to a person. They may express that they're afraid of being the wrong person at the wrong time. At least they may express it if they trust you. But for years, they may express nothing, and may take one medication after another, unsuccessfully, for things they don't quite have. Dissociation is something that a lot of people hide. I have no doubt that there are some people who have faked multiplicity, or that psychiatrists have sometimes put ideas in the heads of susceptible people. But my understanding is that most people with fragmented personalities are doing their best to hide. I am more familiar with situations where bipolar disorder was diagnosed too freely. How much good does it do to keep putting a person on different medications when something else entirely is going on inside them?
Dissociative Disorder Not Otherwise Specified
There are a lot of "NOS" classifications in mental health. Dissociative Disorder Not Otherwise Specified (DDNOS) is a term for someone who has a dissociative disorder, but doesn't quite fit into a classification. It's not always about personality fragmentation. They may instead have a disorder that's related to derealization or amnesia.
But I understand that the term is most commonly used for people who don't quite meet the diagnostic criteria for dissociative identity disorder. They may not have quite enough distinction between personalities or they may not have enough walls separating their memories. The distinction between DID and DDNOS isn't necessarily made on the basis of how a person acts from day to day, but rather on how they act in more extreme moments. If a person talks in a child's voice in front of a psychiatrist, the psychiatrist has to assess things, like whether or not the person knows who they are. If the person can't identify key personal information when in that state, a diagnosis of DID would be likely.
DDNOS: A Personal Site
This is an excellent personal site that has been maintained for several years. It offers an inside view of DDNOS, and a perspective on various issues, from the labeling issue to self management. This is written by a person who has so much self-knowledge that she can provide scientifically accurate information in a way that makes sense to the lay person.
The Color of the Night
I think the media does people a disservice by 1) overdramatizing personality fragmentation and 2) portraying frequent violence. People who dissociative are usually gentle types. Self-violence is common; violence to others isn't -- though you wouldn't necessarily know this from popular media, where the goal is thrilling and unexpected plot twists.
I've never seen the movie The Color of the Night and I have no interest in seeing it as I believe that it promotes false images of dissociative disorder. Yet I love the song.
Long before I had any idea of what it was about -- long before I knew that this song was supposed to have anything to do with dissociative disorder -- it captured for me the mood of being swept up in a not quite comprehensible situation. Oddly, this is a song I associated with a person/ situation described in the opening of this page... and ultimately with dissociation.
Dissociation and Gender
Dissociative Disorders are diagnosed more often in females. My experience suggest that females are more frequently screened -- even when it doesn't fit -- and that males can easily be missed. Like so many things, it depends on the doctor. I have been screened for dissociative disorder -- I mean, in the sense at least of being asked a question or two before the doctor decides the label doesn't fit. Not so with male friends.
Additional Resources: Dissociation
- Sidran institute
Resources on various trauma disorders.
- Dissociation Talk
A rather intellectual question and answer site about dissociation -- for those digging deep.
- Psych Central
Forums on dissociation and other mental health issues.
- Tumblr: More Personal Experience
A discussion of having personality states that are severed from each other and can't access each other well
- Medscape: Sexual Abuse and Dissociation
This is more than just an overview of the connection -- if you read beyond the first page, you'll get a bit of the pathophysiology.
- Treatment Study
In this study, people received a diagnosis of dissociative disorder after they had been in treatment, on average, two years.
Dissociation and Medication
In a sense, there is no medication for dissociation. However, medication can help, as things like anxiety and panic tend to precipitate episodes. It's during high stress times that people are more likely to lose control of the situation.