DID, dissociation and safety. How to decompensate your DID patient with Trauma-focused Therapy.

Dr. Loewenstein will review data that dissociative disorder diagnosis, especially Dissociative Identity Disorder (DID), is a risk factor for self-destructive and suicidal behavior. DID is a severe, life-long, childhood-onset posttraumatic developmental disorder where a young child experiences unpredictable, malevolent threat and maltreatment by caregivers. The child fails to achieve the normal development of a unified sense of self across states and contexts. Rather, the child develops multiple, relatively discrete senses of self: dissociative “self-states”, which organize into systems, become subjectively personified, and are often in conflict. While severe, studies demonstrate that dissociation in DID also is a resilience factor preserving important psychological strengths consistent with good response to triphasic trauma treatment. The stabilization stage is critically important to stabilize safety, co-morbidities, and symptoms, and to ensure more consistent availability of strengths. Premature use of unmodified adjunctive techniques (non-stabilizing hypnosis; EMDR; mindfulness-meditation; “body-focused” therapies, etc.) create a high-risk for decompensation and self-destructive and suicidal crises. As co-editor of upcoming ISSTD Guidelines for DID Treatment, Dr. Loewenstein will review specific aspects of these interventions that, combined with the hypnotizability of DID patients, the extremity of attachment-based maltreatment, and the adaptation to these by the DID individual, almost inevitably lead to adverse outcomes.