Managing flashbacks in Dissociative Identity Disorder

One aspect of DID is the PTSD suffered by some of the alters. PTSD is similar to Panic Attacks in that once turned on, the anxiety is fed into a vicious cycle. Http://

One aspect of DID is the PTSD suffered by some of the alters. PTSD is similar to Panic Attacks in that once turned on, the anxiety is fed into a vicious cycle – psychiatrist David Yeung

Dissociative Identity Disorder (formerly known as Multiple Personality Disorder) is caused by overwhelming early life trauma, so knowing how to manage dealing with the flashbacks present in Post-traumatic stress disorder is important.

Psychiatrist Dr David Yeung offers useful ideas on managing flashbacks using  physical movement or sensations in his blog.

Read his article Grounding exercises and working with flashbacks.

Related links

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Positive effects of Post-traumatic Stress Disorder. Seriously?

Post-traumatic Stress Disorder is a ‘challenging’ (difficult) diagnosis to live with, and hard work to heal from. The symptoms seem ‘irrational’ and you may feel like you are ‘going crazy’ at first. One thing which is known to help reduce PTSD symptoms is finding positives which resulted from the PTSD. Many people speak openly about finding meaning after trauma, or experiencing Post-traumatic Growth.

Certain types of traumatic experience may make finding meaning from trauma seem almost impossible, for instance if the trauma included the deaths of others. Witnessing such an experience leaves many people with survivor guilt: the belief that others should have survived instead of them.

An alternative approach to seeking positives is to consider if some of your current, disruptive symptoms may have a few unexpected benefits. Here are some of mine:

Hypervigilance – alert to changes in environment which may indicate possible danger. If the temperature in a room isn’t quite what it normally is, the lighting looks different or there is a slight draft many people just don’t notice. It’s useful to notice the early signs of a problem with the air conditioning or heating, a light bulb which needs replacing, a window that isn’t closed properly, etc.
Dissociative trauma survivor Carolyn Spring says she has never had a mobile phone stolen but her husband has had two, because he doesn’t expect the people around him to do bad things.

Easily startled – Both times I’ve been pick-pocketed in a crowded area I noticed right away, and without thinking yelled and started moving. Both times the thieves dropped what they stole, although one quick was enough to remove most of the money first. I would not have known who the other thief was if he had not started running after hearing me yell incoherently.

Emotional numbing – The ability to remain calm and thinking logically in a crisis:
Internationally known terrorism expert Dr Jessica Stern credits this for her capacity to remain calm while interview dangerous terrorists overseas. Dr Stern’s PTSD dates from a childhood rape. Emotional numbing may also allow someone to give a good description of an attacker without the distress and confusion caused by overwhelming emotion.

Denial A memoir of terror

Denial A memoir of terror

Physical numbing – Occasional physical numbing allows you to cope with physical pain more easily. Combine this with emotional numbing and you get the ability to do basically medical care quickly, even if other people are panicking or fainting at the sight of the injury.
Soldiers find themselves fleeing from danger without even knowing whether they have injured until afterward.

Avoidance – PTSD itself acts to protect you during trauma: combat veterans like Jake Wood says the hypervigilance of the ‘danger mindset’ helped soldiers sense potential danger and react instinctively to avoid it. So avoidance helps survival.

Coping mechanisms for Amnesia – Growing up with Dissociative Identity Disorder meant growing up with amnesia, and been frequently criticized or punished for forgetting to do things at the right time. This led to adopting a series of ways to track time and organize myself including writing everything down, and checking the list repeatedly (more hypervigilance). I’m amazed when I hear comments about how ‘well organized’ I am. (The downside includes being hours late or missing things if an alter decides not to go of course!)

Amnesia for some of the trauma – This gives you the benefit of time to adjust to PTSD symptoms, and process some parts of the trauma, instead of having to cope with the knowledge of the entire trauma at once.

Depression & Anxiety – not symptoms of PTSD but common results of PTSD. Both have given me greater empathy for other people’s struggles, and talking to people with depression or anxiety has given me different insights into thinking patterns and coping techniques, which have helped ease my own symptoms.

Can you relate to any of the examples above?

Which positives can you find in your own symptoms?
If you can see Post-traumatic Growth, or see how your trauma responses symptoms helped you cope during trauma, then leave a comment.

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Mindfulness protects adults from physical, mental health consequences of childhood abuse, neglect

ACE study – Mindfulness helps protects adults from the consequences of childhood abuse & neglect
Find your Adverse Childhood Experiences Score at

About the Adverse Childhood Experiences Study

Adverse Childhood Experiences Pyramid

ACE pyramid

This blog is based on the following research

Whitaker, R. C., Dearth-Wesley, T., Gooze, R. A., Becker, B. D., Gallagher, K. C., & McEwen, B. S. (2014). Adverse childhood experiences, dispositional mindfulness, and adult health. Preventive Medicine, 67, 147–153. doi:10.1016/j.ypmed.2014.07.029

Full paper

ACEs Too High

Aeye2Fact #1: People who were abused and neglected when they were kids have poorer physical and mental health. The more types of ACEs (adverse childhood experiences) – physical abuse, an alcoholic father, an abused mother, etc. – the higher the risk of heart disease, depression, diabetes, obesity, being violent or experiencing violence. Got an ACE score of 4 or more? Your risk of heart disease increases 200%. Your risk of suicide increases 1200%.

Fact #2: Mindfulness practices improve people’s physical and mental health.

Now, says Dr. Robert Whitaker, a pediatrician and professor of pediatrics and public health at Temple University, there’s one more important fact: People who are mindful are physically and mentally healthier, no matter what their ACE scores are.

This study, to be published in the October issue of Preventive Medicine, is the first to look at the relationship between ACEs, mindfulness and health. And it…

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The Layers of Halloween Weekend

A minority of people with Dissociative Identity Disorder or a similar form of complex dissociative disorder were abused in ritual ways (ritual abuse). Halloween can be a particularly difficult time for survivors because it is a trauma anniversary for many who were raised in abusive cults.

Read Kathy’s post about The Layers of Halloween Weekend.

Powerlessness is the very essence of trauma. But we are powerless no longer.

Recovery is My Best Revenge

Using visualization for stabilization and safety in Dissociative Identity Disorder and OSDD

Phase 1 of Treatment

Phase 1 of treating both Complex Dissociative Disorders and Complex Posttraumatic Stress Disorder is establishing safety, stabilization and symptom reduction.

Guided Imagery

If you have ever looked at a holiday brochure and imagined yourself lying on the beach, in the sunshine or perhaps swimming in the warm water, or you have looked at a car and imagined what it might feel like to drive, then you have used guided imagery, often called visualization.

Containment of Trauma Memories

Dr Onno van der Hart, a psychologist and researcher specializes in the field of Trauma and Dissociative Disorders, and has written an interesting paper on the use of guided imagery for reducing PTSD symptoms and improving daily life functioning, most of which applies to Complex PTSD as well as Dissociative Identity Disorder and Other Specified Dissociative Disorder (formerly DDNOS).

This approach is also referred to in the Guidelines for Treating Dissociative Identity Disorder in Adults (p156-158) as an auto-hypnotic technique which has been well-proven in Phase 1 of treatment. It does not involve trance-like states or investigating amnesia/gaps in memory, but instead serves as a method of self-soothing, calming and containing distress. Because this is an auto-hypnotic technique it can be used outside therapy sessions, and whilst maintaining awareness of the present and current surroundings. Anxiety can also respond well to the use of guided imagery to aid relaxation.
Van der Hart suggests the following examples of guided imagery:

  • Imaginary protective gear (especially useful for emotionally younger ones)
  • Inner safe places
  • Containment of traumatic memories
  • The imaginary meeting place (for dissociative parts/alters within DID)
  • Inner community building (for dissociative parts/alters within DID)
  • The inner source of wisdom

I would highly recommend reading the full article, this section starts at around the third page, under the heading ‘Guided imagery during phase 1 treatment. The book Coping with Trauma-Related Dissociation also includes helpful exercises including creating an inner safe place.

van der Hart, O. (2012). The use of imagery in phase 1 treatment of clients with complex dissociative disorders. European journal of psychotraumatology, 3. (full article)

Related links

Guidelines for Treating Dissociative Identity Disorder in Adults Journal of Trauma & Dissociation, 12:115-187, 2011 (Institute of Trauma and Dissociation – large file)

Dissociative Identity Disorder (

Treatment of Dissociative Disorders Study Results (July 2014,

Forging a Deeper Understanding of Flashbacks Part I  (Paul F. Dell,

Structural dissociation: Division of the personality (

Phase I: Overcoming the phobia of dissociative parts (

Flashback Worksheets for Trauma Survivors (

Attachment-based therapy (