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Handbook for the Assessment of Dissociation: A Clinical Guide

Marlene Steinberg

Top 10 Best Quotes

“Interviewer: Have you ever felt as if there was a struggle going on inside of you as to who you really are? Patient: Yes, for years, and I still can't find out who the fuck am I, man. Excuse my language, doctor. I don't know who the fuck l am. Interviewer: What do you mean by that? Patient: Who is [A.B.]? Who the fuck am I? I don't know. I don't know who I am. I really don't know who I am. I look at the rest of my family and I say, "I ain't part of this family, man, this can't be. They're all different than me. They also look alike, but they look different to me." (SCID-D interview, unpublished transcript) As the preceding example indicates, the theme of puzzlement is characteristic of patients at all levels of educational achievement and verbal ability. The clinician should be alert to the presence of this theme in the self-descriptions of all patients endorsing dissociative symptoms, not just in those of patients who completed a college degree or who are accustomed to introspection and self-analysis.”

“The patient mentioned that she compensates for her memory gaps by pretending that she recognizes people who claim to know her. In the follow-up section, later in the interview, she remarked, "I don't really have memories. I can basically tell you what people have told me, and then I have a memory of that, but it's not the actual memory." These amnestic episodes have occurred without the use of drugs or alcohol and in the absence of acute medical illness, because the patient reports abstention from drugs or alcohol.”

“People with DID often experience conflicting advice or opinions emanating from their alter personalities. Individual alter personalities may have coherent, consistent identities, but, taken as a group, the incompatible internal personalities generate an atmosphere of conflict as well as incoherence. As one patient described it, "Do you know how hard it is to get a hundred and four minds to come together to a single decision?”

“Levels of identity alteration can run from absent to severe (see Figure 11-1 and Table 11-1). What differentiates the various degrees of severity are the distinctness and complexity of the personality states involved and the ability of these states to control a person's outward behavior. Mild identity alteration is widespread in the general population. Many, perhaps most, people are aware of occasions in their lives in which they have assumed different roles or demeanors but remained conscious of their role-switching or alteration, and perceived themselves having been in control of the transition.”

“In some instances the patient will have a visual image of a contrasexual alter. For example, one female patient endorsed the presence of two male alters with the same name, one a boy of about age 10 wearing a baseball cap and the other a slightly older but still aggressive adolescent. Because a patient's use of visual images provides rich evidence for the degree of identity alteration, each of the SCID-D's follow-up sections incorporates questions about visual images to allow the patient to elaborate on this symptom.”

“Identity Confusion in Patients With DID We can locate the identity confusion characteristic of DID in the middle-to-upper range of severity. Identity confusion is a significant factor in DID, when an environment created and sustained by one personality conflicts with the expectations of another personality who is not prepared to function in this alternate environment.”

“Derealization—A feeling that one's surroundings are strange or unreal. Often involves previously familiar people.”

“Depersonalization—Detachment from one's self, e.g., a sense of looking at one's self as if one is an outsider.”

“By contrast, moderate identity alteration differs from its milder countepart in that the alterations are not always under the person's control. In addition, moderate identity alteration does not always manifest the presence of distinct alter personalities. Someone who experiences moderate identity alteration may present with mood changes and behaviors that they perceive as uncontrollable. Patients with nondissociative psychiatric disorders (e.g., manic depressive illness) may report moderate alterations in behavior/demeanor that they cannot control; for example, one patient diagnosed as manic depressive mentioned being bothered by his inability to "keep his mind from racing" (SCID-D interview, unpublished transcript). However, these alterations do not coalesce around distinct personalities. Similarly, individuals who have borderline personality disorder tend to fluctuate rapidly between radically different behaviors and moods; however, these changes do not involve different names, memories, preferences, distinct ages, or amnesia for past events.”

“Another patient with DID described the visual images she had of the personalities inside her in the following way; Interviewer: What does she [the personality] look like? Patient: She wears jeans, she never wears a dress ... Interviewer: Does she look like Josie? Patient: Yes, they look identical except that their manners and their clothing and their hair.. .. Josie's hair is curly with ribbons and Julie has braids and could care less what she looks like. She's tomboy looking. Interviewer: Do they look like you? Patient: I think they look like me. Wthout the glasses. They don't wear glasses... Interviewer: Do you have an image of Diane? Patient: Blonde hair, she looks older. (SCID-D interview, unpublished transcript)”

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Book Keywords:

derealization, inability-to-recall, dissociative-disorder, identity-confusion, identity-alteration, visual-image, dissociative-identity-disorder, different-roles, inner-struggle, dissociative-states, identity, puzzlement, amnesia, borderline-personality-disorder, self-states, dissociative-disorders, dissociation, internal-struggle, depersonalization, alter-personalities, identity-crisis, internal-conflict, personality, memory-problems, introspection, dissociative-symptoms, eho-states, multiple-personalities, bipolar, role-switchibg, dissociative-amnesia, identity-quotes, dissociative-parts, depersonalization-disorder

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