Medication and D.I.D.

Medication can be both helpful and unhelpful when it comes to the treatment of D.I.D. There is no such thing as a magic cure and there currently is no form of psychiatric medication that stops switching completely. Medication is normally used in conjunction with therapy (whether that be EMDR, MBT, CBT, DBT, CAT etc). While medication cannot really help stop switching it can be used to treat co-occurring mental health problems that go alongside DID. It is rare for someone with DID to not have another disorder alongside it. Some disorders that can occur can include - but not limited to - borderline personality disorder, psychotic disorder, depression, bipolar, eating disorders and PTSD. 

I asked some people that have DID to tell me what medication they take and whether it helps. Many of them felt the medication helpful in treating symptoms that were caused by another disorder, such as depression or psychosis. However, a few people thought that medication could do more harm than good. It is hard for someone with DID to be put on medication when their switching has become out of control and frequent as many alters may have differing views on medication which could mean some alters stash medication, fail to take them completely or alter the dosage they are supposed to have.

Here is a very short list of the medication a dozen people I asked are on. These are just a few examples of the kind of medication someone with DID can take (and the reason why) if they have symptoms that are affecting their day to day life (not including the rapid switching of alters);

Psychosis - Amisulpride, Olanzapine, Quetiapine, Clopixol, Risperidone, Geodon

Depression - Mirtazapine, Sertraline, Venlafaxine, Florouxetine, Wellbutrin, Effexor

Mania - Lamictal

Anxiety - Diazepam, Lorazepam, Promethazine, Ativan, Visteril

Taking medication is assessed on an individual basis. What works for one person may not work for another and you may have to try many if you are thinking of going down that road. Some people are quite content about being on no medication and that opinion is also perfectly valid. I, personally, have gone through over a dozen different combinations of tablets before settling on the medication I am on now that seems to be working. I'm one person with DID that needs medication to function day to day.

Always consult a psychiatrist before taking any psychiatric medication, altering your dose, or weaning off any of your medication.

Managing Triggers

(C) GOT PARTS? BY ATW

Triggers are something that remind you of, or bring you back to, an emotional or psychic place of remembering something about the traumatic event(s) in your past.

Triggers vary greatly from person to person, and from alter to alter. A person (or part) may or may not be aware of what their triggers are, or why they are triggers. Triggers are specific to that person's/alter's experience. Something which is very triggering to one person or alter may not be a trigger to anyone else, perhaps not even to anyone else in one's own system. Triggers usually involve one or more of the five senses: sight, sound, taste, touch or smell.

One basic way to begin learning to manage triggers is to have each part make a list of what their triggers are, understanding this list may grow longer as the therapeutic process progresses. This is not because you're 'getting worse', but is because your bank of self-knowledge and self-awareness is growing. This is a good thing, because the more you know, the less chance you have of being blindsided by something on the future.

Each alter can share their list with others inside, and as co-consciousness and the level of trust between parts increases, you all can find ways of helping each other when one or more parts get triggered.

It will be important to share your lists of triggers with your therapist, who will have additional ideas on how to work to get them to a manageable level. However, please remember there is no magic answer, no quick fix to any of this. It comes down to doing hard and challenging work, seeing what works for others, and sometimes, plain old trial and error.

We are not isolated in the effects our triggers have. People around us, and those we are in some type of relationship with are also affected when we are triggered, or when we learn to deal with our triggers.

One system had this to say about triggers...

"People have different triggers. It would be helpful to discuss these things. Allow yourself some room to avoid certain triggers while working on becoming comfortable with a physical environment that has been involved in previous hurts. It's very possible to overcome these triggers with work and support. Believe in yourself!"

While some triggers may never totally go away, over time you can figure out what works, and so to get to a place where the effects of triggers don't have to be as devastating or disabling.

Sectioned in Hospital - 5 months 17 days

Written by Fox.

DAY 171 - 25th January, Saturday

Keri woke up quite late again. She didn't go to bed until early this morning. The staff tried repeatedly to get her up but gave up after a while. They knew Keri would get up when she felt she was able to.

I've spent most of the day trying to search for Natalie (one of our oldest alters) and Keri has spent most of the day with her little brother. Jamie cut Keri's hair so that she no longer looked like she had a mop on her head. They chilled out and watched TV, did some shopping in the supermarket, escorted by staff. As far as I'm aware Keri enjoyed his company, although of course I can't say that for certain as I was a bit busy myself. She normally does like him visiting though so I don't see why today would be any different.

Tonight Keri was getting extremely depressed again. She went out to smoke to find Ade and Gemma sat smoking on the bench. In the end they invited her to have a game of Scrabble in the foyer. The game went on for over an hour! Keri lost but she didn't mind. She had her medication an hour late and sat outside with Ade after the game to smoke. He said that Keri seemed a little more alert than yesterday and Keri said it was because of the time she'd spent with staff rather than all her concentration being on Sally and her criticism.

Unfortunately Keri is back in her room again but I'm hoping she'll spend some more time with Ade and Gemma tonight, whether sitting in the office or playing a game with them. The less conversation with Sally the better off we are. Keri's CPA is in 6 days. There's still a 100% probability that Sally will have disappeared by then, at least once, or cut Keri to the point she needs stitches (which isn't helping her iron levels which are already low). 

I'm hoping to find Natalie tomorrow. I'm giving it another shot for Keri's sake. 

TRIGGER WARNING - scars, stitched wound and dressed wounds in the photo.

P.S. Keri's new hair. She's pretty happy with it. One of the bonuses of having a little brother who does hairdressing!

Experiences of Being Detained by Police

Being sectioned by the police is never a pleasant experience for anyone, especially those who have a trauma based disorder or have DID. Restraint that is usually used against burglars, rapists and criminals can also be used for mental health patients that the police need to detain for the person's safety or for other people's safety. It can be a harsh and unpleasant experience.

It can be hard for someone with DID to be restrained, especially if the officers have no idea what the disorder is. In my experience the officers have been quite reassuring if I've been 'me'. However, if my aggressive and homicidal alter is out, the police have no choice but to restrain her, often having to use several officers. The mental health professionals seem to be of the opinion that "someone has to do the dirty work". 

A section 136 of the Mental Health Act allows a police officer to detain someone who is an immediate danger to themselves and take them to a place of safety, such as a police cell or a psychiatric hospital - the latter being the preferred option. This can be for up to 72 hours. The police are responsible for the person until their care is turned over to the mental health professionals. The problem with police is they were originally designed to help against crime and aren't fully trained in mental health, especially DID. They don't know how to deal with it. Unfortunately I've been arrested many times for trespassing (railway lines), endangering others (e.g. if I jumped in front of a train and it had to stop suddenly) and on my most recent 136, I was also arrested for breach of the peace. Luckily, none of these ever went to court or had charges placed on me because at the time I was on a 136 and viewed as not having full mental capacity.

Below are some of the experiences from people that have had to be detained by the police.

My Latest Experience

Please note: some of my 136's haven't been too full on, depending on circumstances, and officers have been sympathetic. But there is a nasty side to things which I do think needs to be addressed. This post isn't to "slag off police officers" or say they're terrible at their jobs, so please don't take it that way. 

My most recent 136 experience was 13th July 2013. On 8th July, I knew I was going to dissociate into Clarissa (a promiscuous binge-eater). She gets very excited when she's going to come out so I had warning. This was in the evening. That was the last thing I remember. According to my carers I then switched again to Fox (Clarissa's mute twin brother). He remained out for 5 days. Then yesterday I switched again to Sally (my aggressive, violent alter). Sally took me to the Clifton Suspension Bridge to jump off of it but the security guards had been warned and the police were already on their way. I've been told that they tried calling her Keri which made her go absolutely apeshit. She refused to go with the officers when they arrived so they had to forcibly put her in the back of the van as one lane of traffic had had to be blocked off so they couldn't talk for long. Of course, she wasn't having any of that and jumped from the back seat across to the front seat and opened the police van door from the front. 

This is where I have 10 seconds of full memory when I switched to me for a very short time. Obviously, the police didn't know I was Keri and Sally had already got half way out the door, almost knocking over 2 cyclists. I was grabbed by one of the officers who proceeded to put his arm around my neck and carry me to the cage in the van. By this point both lanes of traffic were now blocked off. The first thing I remember the officer saying was "Right, no more fucking around. You had the easy way or the hard way so now we're doing this the hard way". Obviously, I had no memory of the last 6 days and to suddenly find myself being manhandled by police scared me shitless, so instinctively I tried my hardest to get out of his grip. The problem was, the more I tried scratching and kicking, the harder he held onto me. Having someone carry me with an arm around my neck and literally bundling me in the cage through a series of headlocks and two males using a lot of force is not something a trauma survivor should have to deal with. I switched back into Sally as soon as the sound of the cage door was slammed shut. Apparently she was violent, aggressive, uncooperative and very angry. At first the officers took her to the police station to be secured and searched while phone calls were made so they could transfer Sally to the 136 Suite at the nearest adult psychiatric hospital, the same hospital I've been admitted to as a patient twice.

I was me again after a period of time in the 136 Suite. I had no idea how I'd gotten there and knew it must've been Sally because of the flashback of being manhandled into the cage of a police van. The first thing I did was phone my carer, which is when I found out I'd been dissociated for 5 days. Luckily the assessment was arranged quite quickly and one of the people on the assessment panel was someone who I'd had a lot of contact with and was good at trying to understand Dissociative Identity Disorder. Without her there, I'm not sure I would've been discharged. The day after I was full of aches and pains from the force and amount of restraint used, especially when they get your arms behind your back and start bending your wrist to make you compliant (pointless to do to Sally as she's unaffected by pain). The ten seconds I remember have almost retraumatised me. I have NEVER been restrained in that way. This was all because of officers that had no concept of what DID was. Most other times officers are fully clued up and all information about my disorder is shared to all the officers involved. Unfortunately for me, these two officers didn't get that message and treated Sally like a violent and aggressive criminal instead of a mental health patient that needed help, not over-the-top and painful restraint.

Felt Like an Attention Seeker - Caroline H

I hated being detained. I couldn't deal with it so I disappeared and self injured. I was found by someone walking by who called an ambulance. I just wanted to be dead. My alters were being so mean. I refused to get in the ambulance and ended up hysterical. They called the police and they restrained me until I calmed down. They took me to a medical hospital under a 136 and they couldn't get an assessment for 10 hours. An officer had to sit there with me all that time. I felt like all eyes were on me and couldn't help but feel like the officer felt like he was babysitting me and wasting his time. I dissociated while in my cubicle into Samantha. She made advances on the police officer and I found myself restrained, not knowing why. The staff didn't seem to understand that I had no control of my switching and the officer almost pressed charges for sexual harassment. I got help though. I was sectioned and got a really good therapist who deals with DID all the time. I'm a lot better now and that is partly because of getting 136ed. 

Very Helpful - Suzanna H

I've heard a lot about people who have bad experiences and I'm sorry to those that do. For me, they've only been beneficial. I think it really does depend on the police officers. Some are open minded about mental illness whereas others don't have a clue. But isn't that what it's like in normal society? Yes, I was restrained, but it was done in a non-harmful way and looking back at the incident I know it had to be done. I'd like to add that there are a lot of people who have good experiences of being on a 136. Some have even managed to get extra help because of police involvement. I realise police can be a little over the top at times but sometimes it has to be done. Some people with mental illness can be very unpredictable, especially someone with uncontrolled DID. Police officers not only have to keep the person they've detained safe but also have to keep themselves safe too. 

I found that being 136ed actually got me extra help. Yes, I've had bad experiences, who hasn't? But mostly the officers that have to deal with me are understanding and sympathetic. Those that don't understand mental illness and go full on with restraint and control I think need to do some training! If anything I do pity them a little as they're dealing with a situation they aren't familiar with.

Totally Ignored - Anon.

I got 136ed after I suffered a psychotic episode. The police knew I had DID. They were called when I sat in a library. It was closing time and I was refusing to leave. I switched to a toddler alter and just cried. The staff working in the library tried to comfort my alter but it didn't work. He went with the police very peacefully when they got there but all of a sudden I switched again and an angry alter came out. He started attacking the officers and I was taken to a police station and dragged into a cell. I was left there for hours before an assessment could be arranged. I wasn't even allowed a blanket as they thought I'd try and suffocate myself with it. I was cold, hungry and scared. I was ignored until the point when two detention officers came to take me to a room where the assessment panel was. None of them knew about DID and just thought I'd been attention seeking. I was discharged and kept getting 136ed every other day for a week or so before my mental health team finally got back from their holidays. It was a horrible experience and it won't be one that'll be forgotten.

Twitter Comments

"I understand restraint if it is needed but I think it's used more often than it should be. What happened to just trying to talk to someone?" - Mel Y.

"I think the police do a good job in my area if you get put on a 136. I think they deal more with mental illness than they do actual crime!" - Sandy L.

"Screw the police. I hate them and think they suck. They've never helped me. They just don't give a shit!" - Anon.

"There's too much of a burden on police. I think mental health professionals leave the bad bit for the police to do. It's not fair on them." - Anon.

"Traumatising, distressing, degrading!" - Kirsty O.

"I think the police go in to heavy handed on s136 patients they are not criminals they are ill !!" - Lady T

Reply from Insp Michael B: "That's a big generalisation about 25,000 interventions a year ... I hear many stories that say otherwise?"

And also a quick thank you for those who retweeted and replied (at the time of this post being published): Julie W, Kirsty O, Wokstation, Insp Michael B and NYPOLFED.

So that's that, such a variation. Sometimes it's helpful, other times it can be traumatising. That's why we need to raise awareness so that people like us aren't viewed as attention-seeking or some other kind of negative label. 

People with DID (or any other mental illness for that matter) need help, not stigma or being treated like a criminal. If you're a police officer or mental health professional and you're reading this, try to understand. We don't mean to cause 'trouble' and we aren't attention seeking. In times of crisis all we need is someone to listen, help and understand.

Four Commitments

There are four commitments you should make if you have DID to do whatever it takes to get better. No, they're not simple and it's very difficult. But perseverance, determination and patience do pay off. Some of these extracts were used from the book I have called 'Got Parts? An Insider's Guide to Managing Life Successfully with Dissociative Identity Disorder'. There is a link at the bottom of this post  for those of you who wish to order a copy.

First off it's not just you who has to make these commitments, it's also your alters that have to as well. This can be difficult if you have parts that are saboteurs, misguided protectors, or just plain uncooperative ones. If you can get them onboard through therapy (and sometimes medication alongside this) then you have a better chance. That doesn't mean that you have no chance if these parts choose not to cooperate, it'll just be a little harder.

There are 4 main commitments, but these aren't the total picture. This is the minimum you should try to do, if you can. Remember that if you set your mind to something, things can change.

1) Be honest - even when it's bloody hard!!

There's no time for game-playing. Energy is better invested in focusing on moving you all forward in the helping process, whether that means co-consciousness or re-integration (whatever your choice of an overall goal is). Be honest not only with yourself, but also with the other parts in your system, with your therapist, with any other caregivers and also friends or loved ones who are helping you through the process.

2) Do the work!

This may seem stupidly obvious, but if you don't do any 'homework' your therapist asks you to do, and don't work hard at the issues that come up along the way, successful, healthy, effective and long-lasting change is much less likely.

3) All parts internally need to be cooperative.

When you're part of a group, including a group of alter personalities, you may not always get your own way. Having a strong and successful system involves a lot of give and take. Always remind yourself of the larger goals of reintegration and healthy functioning in the internal and external world. It's important to learn to communicate honestly, work to set ego aside and consider and seek what is going to be in the best interests of the system overall.

4) Stand down and step aside.

There is no place for control freaks, loose cannons, saboteurs, queen bees or lone rangers within a system. Stepping aside is a very extreme challenge to any controlling, bullying, bossy, know-it-all, fearful or head-strong parts - or to ANY part whose speech, behaviours, attitudes etc are not in the overall best interests of the system-as-a-whole.

This is really just the MINIMUM. No one said it will be easy, but it's definitely not impossible. Stay strong my friends. :)

As promised, a link to the book I used as a partial reference: http://www.amazon.com/Insiders-Managing-Successfully-Dissociative-Identity/dp/1932690034/ref=sr_1_1?ie=UTF8&qid=1373097482&sr=8-1&keywords=Got+parts%3F

Alter Photos

Clarissa was desperate for me to put up photos of her and the other alters. I've decided to do this though I haven't added all of these due to the fact some of them aren't ready to be so open yet. If you'd like to see these then visit this page and go to the 'My Alters' album :)

www.facebook.com/DIDCampaign

Alters and Facebook

Should alters have their own Facebook pages? I both agree and disagree with this.

I'll start with the reason I disagree. Many people with DID live their lives in secrecy, which is half the reason why it can take so long to diagnose the disorder. When alters start making their own Facebook pages things can start getting very complicated. For instance, alters see themselves as how they 'really  look'. They don't see themselves as a variation of the physical body, they see themselves as different people. Some alters can get very confused by this if they don't understand yet that they are all part of the same body. Photos can be confusing. Some of my alters have made their own profiles and one in particular was quite upset that people didn't see her the way she sees herself. This meant she ended up searching online for a photo that she thought was close to resembling her 'true face'. Not only is this confusing for the alters, but also for the people they end up communicating with online! It's not too bad if people you know know about your DID but what if they're strangers that they've decided to make friends with? What about the private messages you don't know they're having? What about any meetings they're planning to arrange that, again, you don't know about? This goes back to the complexity of being a multiple!

In other ways though, there are some pros to the whole idea. It allows alters to communicate with each other and also to communicate with other people. They have the option of being themselves and they have the option to be more open with one another and help other alters who don't yet understand the concept of being a multiple. In my experience alone, having alters on Facebook has been helpful as I've also met other people with DID and the alters all friend request each other and can talk openly without being scared of being judged. Also, since my first alter made a Facebook, we've also found out that an unknown alter has now felt comfortable revealing herself. I guess the Internet is easier to use rather than face to face contact. I can say that I much prefer writing things down rather than speaking to people!

Overall, depending on your situation, alters on Facebook can be a good thing. To me it is, mostly, because I'm actively trying to raise awareness of the disorder. If people want to be friends with my alters then that's perfectly fine with me. What surprised me was that a shy alter who didn't want to be known has found it easier to be on Facebook and work from there. Unfortunately for her she has no idea she's a multiple but I know she is having conversations with Clarissa (another alter) who is trying to explain, to no avail as yet.

Have you got alters that have their on social networking profiles? Have they worked for you or have they just caused chaos? Opinions are welcome either on the DID Campaign page or on this blog.

Be Positive

This is a photo that one of my alters decided to share on Facebook and I thought it would be nice to share it in a blog post :)

Daily Meeting Example

I wrote about the concept of daily meetings earlier but didn't have my dissociation journal to hand so I couldn't get a picture. I have one now! During the time of these two meetings I was getting through a litre of vodka per day, I wasn't eating anything and I was refusing to take any of my medication (mainly because Sally didn't want me to take it). I thought I would put a picture in to show what kind of thing I'm talking about. Each alter chooses a feeling or emotion and this is written down; either by myself or by the alter in question (you can tell who did their own because of the handwriting). In addition to the alters writing down one emotion, additional notes were added highlighting any points that felt important and any concerns that needed to be addressed. During these two meetings many alters were not actively present and making conversation. The alters that were around at the time all chose to take part - even if it was just a load of cuss words saying how shit the whole idea was (Sally). I hope this example helps. This is just one day of meetings.

I'm sorry if the image isn't too clear but you can see the layout I've used her to try and keep it simple and to the point so it's not a long drawn out process, especially for the little ones who have short attention spans!

Daily Meetings

First off, for those that don't know, a daily meeting is a session where you can sit down and talk to your alters, almost like group therapy. I tell you, I definitely felt like a group therapist the first time I did a daily meeting! I felt like I was trying to control a group of pre-school children! Daily meetings allow different alters to express how they're feeling, talk about any concerns they have and even gives the chance for 'the littles' to tell a joke they've heard that day (if they want to say it, be sure to laugh!). 

It's recommended that daily meetings should be done twice per day, morning and evening - more frequently depending on the circumstances. To begin with it may not be easy. If you have uncooperative, aggressive, violent or sabotaging alters then, from my experience, you're just going to get a mouthful of abuse. Yes, this is upsetting for everyone but in some ways it also allows these alters to express their rage.

Some alters may not even want to participate but may well join in later on after a few sessions once they know what's going on. Others will be confused over the whole idea if they don't quite understand the concept that they are in fact a multiple and not a completely separate person in a different body.

I currently have 6 alters who are wanting to participate in the daily meetings out of the current total of 16 alters, 17 including me (although I have not been able to do a daily meeting due to certain circumstances). One of these alters, Sally, just shouts abuse and cuss words. We allow her to do that. Every alter who wishes to speak should be given the chance and notes should be written during each meeting. If there are any concerns then these should be brought up with your therapist, psychiatrist, carers, loved ones... Anyone who's involved in your care and can support you with your DID.

The whole point of these meetings is to try to keep things working as well as possible. There are times when the internal system is in absolute chaos, at these times daily meetings may not be possible and the first thing that needs to be sorted is maintaining the safety of yourself, your alters and people around you. Don't be scared to talk about your alters with people you trust. It's a lot easier to do with a good support network.

I found daily meetings helpful. Unfortunately I've been very tired and unmotivated lately as I'm having issues with my medication but as soon as I'm sorted again I will be back to doing the daily meetings. 

Anything I suggest on this blog isn't going to work for everybody. Some things will work for some people, whereas other techniques will work for others. Everyone is unique, especially people with DID as there are so many variations. No two people with DID are the same, so no one technique will work with everyone.

If any of you try the daily meetings I would love to hear your feedback, positive or negative. Feel free to post your thoughts on our Facebook page or a private message if you feel more comfortable.

Don't feel you have to rush into anything. Pace yourself, take your time and try to take care of yourself and your internal family.