Dissociation is the ability to cut off from what is happening around you or to you. In its simplest form it is daydreaming. It is a skill all children have and which children with autism tend to overdevelop in managing a world they find overwhelming for a whole range of reasons. Dissociation, Derealisation (the feeling nothing is ‘real’ or that everything feels like a dream), and Depersonalisation (cutting off from emotions, detaching, inability to take experiences personally), are experiences most of us have had. Dissociative disorders are where these create problems with functioning and coping in every day life. Some people will have greater TENDENCY toward developing dissociative disorders and if they then experience significant trauma may be more at risk of Post Traumatic Stress Disorder (PTSD). If they are continually entrapped with such experiences from infancy or very early childhood they may be at risk of more severe dissociative disorders such as Dissociative Disorder Not Otherwise Specified (DDNos) or Dissociative Identity Disorder (DID).
In 2010 I was diagnosed with the dissociative disorder, DID. I have since connected with a number of adults both on and off the autism spectrum who are also diagnosed with DID and used my skills as an autism consultant to begin to navigate the complexities of dissociative disorders. I did some consulting work associated with DID, primarily working with therapists as they came to grips with the DID systems of their clients.
Dissociative identity disorder’ (DID) is a dissociative disorder within a spectrum of dissociative disorders. This spectrum includes conditions such as general dissociation, Derealization and Depersonalization (DP)Dissociative Amnesia, Dissociative Fugue, PTSD, Complex PSTD (C-PTSD)DDNOSs, DID and Polyfragmented DID. The change from MPD to DID distinguished DID as part of a spectrum of dissociative disorders.
This spectrum included general dissociation common to any and all human beings, standard in children before the age of 5 and possibly higher tendencies in some children on the autism spectrum.
PERSONALITY TRAITS AND PREDISPOSITION
Certain personality traits were also found to commonly overlap with DID and contrary to the general stereotype, BPD overlaps less with DID than several other personality disorders.
*AvPD (Avoidant Personality Disorder) had a 76% crossover .
* Self Defeating Personality Disorder had a 68% crossover .
* Schizotypal Personality Disorder had a 58% crossover with dissociative tendencies.
* BPD (Borderline) had by contrast only a 53% crossover .
* Passive Aggressive Personality Disorder had a 45% crossover .
DISSOCIATION AND AUTISM
The higher rate of Schizotypal and Avoidant Personality Disorders among the autistic population who are already known to commonly over-employ dissociation. With anxiety disorders in autistic children thought to run as high as up to 85% co-morbidity, it may be worth exploring the spectrum of dissociative disorders an autistic context.
Recent advances in awareness of DID now allows diagnosing psychiatrists to more easily distinguish DID as a dissociative disorder from BPD, Schizophrenia, Bipolar, (and when it occurs with any of these as co-morbids). With altered criteria for the diagnosis of DID, it can also now be more easily distinguished from hysteria, factitious disorder, or malingering which probably once underpinned the over-diagnosis and criticism of what was once MPD. Nevertheless, controversy surrounding MPD as a valid medical diagnosis continues to haunt DID.
This redefining of DID as a dissociative disorder differentiated it from MPD which had been seen as a stand alone personality disorder. There are proposals to include DID in the DSMV as part of the spectrum of dissociative disorders under the section on stress and trauma. Within the DSMIV the following are listed as Dissociative Disorders:
1. dissociative amnesia
2. dissociative fugue
3. derealization – depersonalization (DP)
4. dissociative disorder not otherwise specified (DDNOS)
5. dissociative identity disorder (DID)
and within the ICD 10 the following are listed as Dissociative Disorders:
F44 Dissociative [conversion] disorders
F44.0 Dissociative amnesia
F44.1 Dissociative fugue
F44.2 Dissociative stupor
F44.3 Trance disorders
F44.4 Dissociative motor disorders
F44.5 Dissociative convulsions
F44.6 Dissociative anaesthesia and sensory loss
F44.7 Mixed dissociative [conversion] disorders
F44.8 Other dissociative [conversion] disorders
.80 Ganser’s syndrome
.81 Multiple personality disorder (DID)
.82 Transient dissociative [conversion] disorders occurring in childhood and adolescence
.88 Other specified dissociative [conversion] disorders
F44.9 Dissociative [conversion] disorder, unspecified
Carmel Anne Jones
Hm, was easier to relate to when they called it MPD (multiple personalities; becomes too confusing otherwise)
Well, MPD presumed it was a PERSONALITY disorder, and it’s actually not because a PD is where a personality TRAIT has become so extreme that trait is at disorder proportions… like Antisocial, Sadistic, Narcissistic etc personality disorders…. Also, we all have personalities made up of different collections of personality traits, as do alters… do there’s nothing disordered about THAT…. and different people and environments naturally bring out our different personality traits, just like in DID, except that in DID each alter has its OWN set of perceptions, history etc… so again, MPD was misleading… and MPD said nothing of dissociation, which was the main ingredient in SPLITTING, which is purely DISSOCIATIVE… so MPD failed to capture the reality. Sure, it had the word ‘Multiple’ in it, and those with DID experience themselves as Multiple, but the PD part was misleading… sure you could read it as Multiple Personality…. er disorder…. (ie a dissociative disorder involving the experience of multiple personalities/identities) or as Multiple… Personality Disorder (a collection of personality disorders in the one person so each alter is considered relatively personality disordered). And people were taking it the second way. Also MPD was made out to be something bizarre, something so stand alone that nobody without it could possibly imagine it… but as a dissociative disorder, anyone who has experienced dissociation (all humans) could then roughly relate at least to its most primary foundation (of splitting).