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.

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Forging a Deeper Understanding of Flashbacks: Part II

Understanding Flashbacks: Part II – from Paul F. Dell

Understanding Dissociation

Flashbacks have at least four striking features:

1. Flashbacks are experiential, marked by a sense of reliving, accompanied by sensations and affects).

2. Flashbacks are distinctly fragmentary.

3. Flashbacks are autonomous and involuntary.

4. Flashbacks are frequently associated with dissociative amnesia.

In this post, I will focus solely on the first of these — the experiential/reliving quality of flashbacks.

Why Are Flashbacks Experiential Rather Than Cognitive?

Perhaps the best current answer to this question comes from Chris Brewin in England (Brewin, Gregory, Lipton & Burgess, 2010). Brewin is one of the leading cognitive psychologists in the world. He has been studying PTSD and its intrusive symptoms for the last 15 years or so (see also Brewin, Dalgleich & Joseph, 1996). Brewin proposes that humans have two memory systems for episodic and autobiographical memory: (1) a contextual memory system that represents an event via abstract, contextually-bound…

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Chronic Pain – caused by trauma?

Many trauma survivors experience physical symptoms as a direct result of psychological trauma. It can be very difficult to know what symptoms are caused by trauma, or separate to it. Physical symptoms do need treatment – regardless of the cause – but those caused by trauma often respond less to physical treatment.


Trauma and the Body

If this all sounds rather strange then think of the briefer physical effects in our bodies when our minds are under pressure… racing heart and sweating before a job interview, a headache as a result of an intense argument, and the exhaustion of depression. And, of course, flashbacks occurring after a trauma trigger…

These physical effects from trauma are referred to as ‘somatization’ or ‘somatic dissociation’, and are the body’s way of bringing some of the trauma held unconsciously into the conscious mind. It feels an awful experience, but just like flashbacks, our mind is trying to help us heal.

Pierre Janet, another pioneer in the field of dissociation, documented a range physical symptoms in patients with what was later named dissociative identity disorder. These historical accounts formed the basis for the current Somtaform Dissociation Questionnaire (SDQ-20) developed by the top traumatologists Nijenhuis, van der Hart and Vanderlinden. The SDQ-20 has proved an effective tool in aiding differential diagnosis of Dissociative Identity Disorder, particularly when compared with schizophrenic disorders, borderline personality disorder and bipolar disorder.

Carolyn Spring, director of charity Positive Outcomes for Dissociative Survivors talks about her physical symptoms, and how they linked to her trauma.

Related downloads
Somatoform Dissociation Questionnaire (SDQ-20). Nijenhuis, van der Hart and Vanderlinden. (
The Scoring and Interpretation of the SDQ-5 and SDQ-20: Update 2003. Ellert R.S. Nijenhuis. (

Akhtar, Salman (2009). Comprehensive Dictionary of Psychoanalysis. ISBN 1780493037.

Nijenhuis, E.R.S., Spinhoven, P., Van Dyck, R., Van der Hart, O., & Vanderlinden, J. (1996). The development and the psychometric characteristics of the Somatoform Dissociation Questionnaire (SDQ-20). Journal of Nervous and Mental Disease, 184, 688-694.

Nijenhuis, Ellert R.S.. European Society for Trauma and Dissociation: The scoring and interpretation of the SDQ-20 AND SDQ-5:Update.

Nijenhuis, ERS, van der Hart, O, Vanderlinden, J. Somatoform Dissociation Questionnaire (SDQ-20).

International Society for the Study. Guidelines for Treating Dissociative Identity Disorder in Adults, Third Revision. Journal of Trauma & Dissociation, volume 12, issue 2, 28 February 2011, page 115–187. (doi:10.1080/15299732.2011.537247)

Useful books
The Body Remembers: The Psychophysiology of Trauma and Trauma Treatment. Babette Rothschild (2000).ISBN 0393703274.

Flashbacks and Nightmares – PTSD and Dissociative Identity Disorder

Ingrid’s experience of living with PTSD and Dissociative Identity Disorder

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Can Posttraumatic Stress Disorder be positive??


I’ve just been reading an excellent blog by senior trauma therapist Sara Staggs on After Trauma, and the words below in particulare really made me think about the fact that posttraumatic stress disorder can be viewed as a positive way of adapting to traumatic situations.

Trauma isn't the infection, it's like the fever that tries to address the infection - Sara Staggs LICSW MSW MPH

Trauma isn’t the infection, it’s like the fever that tries to address the infection – Sara Staggs LICSW MSW MPH

Triggers, Flashbacks, Avoidance, Hyperarousal… doesn’t sound positive

It’s fairly clear how avoidance can be positive during times of danger, but how can things like triggers, flashbacks and hyperarousal be positive?

Hyperarousal is being on edge and automatically alert, your body and mind are constantly watchful, expecting trauma to happen, you feel anxious, on edge and jumpy. It’s exhausting. But it also means that if a traumatic event occurs you will notice is sooner than those without the same level of awareness, allowing you to respond automatically, which could be a life-saving defense if you are a risk of danger.

The problem with PTSD is that your body and mind don’t automatically know when the trauma is over, so you respond to even minor stimuli (triggers) in the same way as major ones. If your trauma involved a fire, then the smell of smoke could well be a trigger which you respond to. If you have PTSD then your brain would respond in exactly the same whenever you smelled smoke, it would not pause to consider how much smoke there was, or what size of fire it was.

A part of the brain known as the amygdala is key in triggering this automatic reaction to the smoke; interpreting the smoke from burnt toast in the same way as the smoke from a house fire, in effect assuming that the house is on fire again, and generating the fight-or-flight response. If you are living in a war zone where fires are a daily occurrence then PTSD becomes a life-saving defense. That might not seem a particularly common living situation but if your homeland is in the midst of a civil war it could very well be. PTSD is more likely to occur if a person experiences multiple traumata, which is also when the symptoms would be a positive adaption to future trauma. It’s when you are in a safe space that PTSD symptoms becomes maladaptive rather than a positive adaption.

So can PTSD symptoms handled better?

Read more from the original blog