This study was carried out in Poland in and IPA was selected to build a deeper understanding of how patients who endorsed and identified with dissociative identity disorder made sense of the diagnosis and what it meant for them to be classified as false-positive cases during reassessment.
Interpretative phenomenological analysis uses phenomenological, hermeneutic, and idiographic principles. IPA uses small, homogenous, purposefully selected samples, and data are carefully analyzed case-by-case Smith and Osborn, ; Pietkiewicz and Smith, Potential candidates enrolled themselves or were registered by healthcare providers via an application integrated with the website www. They filled in demographic information and completed online tests, including: Somatoform Dissociation Questionnaire SDQ, Pietkiewicz et al.
In Poland, there are no gold standards for diagnosing dissociative disorders. It included questions such as: What made you participate in this study? What are your main difficulties or symptoms in daily life?
What do you think caused them? The TADS-I differs in several ways from other semi-structured interviews for the assessment of dissociative disorders. Firstly, it includes a significant section on somatoform dissociative symptoms. Finally, the TADS-I also aims to distinguish between symptoms of pathological dissociation indicating a division of the personality and symptoms which are related to a narrowing or a lowering of consciousness, and not to the structural dissociation of the personality.
TADS interviews ranging from 2 to 4 h were usually held in sessions of 90 min. Interview recordings were assessed by three healthcare professionals experienced in the dissociation field, who discussed each case and consensually came up with a diagnosis based on ICD An additional mental state examination was performed by the third author who is a psychiatrist, also experienced in the differential diagnosis of dissociative disorders.
He collected medical data, double-checked the most important symptoms, communicated the results and discussed treatment indications. Interviews with every participant in this study ranged from 3 h 15 min to 7 h 20 min mean: 6 h. Participants of this IPA were six female patients aged between 22 and 42 years who were selected out of 86 people examined in a larger study exploring dissociation and alterations in consciousness in clinical and non-clinical groups. Four of them had higher education, two were secondary school graduates.
All of them registered in the study by themselves hoping to confirm their diagnosis but two Olga and Katia were referred by psychiatrists, and the others by psychotherapists. All of them traveled from far away, which showed their strong motivation to participate in the assessment. Four had previously had psychiatric treatment and five had been in psychotherapy due to problems with emotional regulation and relationships.
In the cases of Victoria and Dominique, psychotherapy involved working with dissociative parts. They all felt emotionally neglected by carriers in childhood and emotionally abused by significant others.
None of them reported symptoms indicating the existence of autonomous dissociative parts. None had symptoms indicating amnesia for daily events, but four declared not remembering single situations associated with conflicting emotions, shame, guilt, or conversations during which they were more focused on internal experiences rather than their interlocutors. None experienced PTSD symptoms e. None had auditory verbal hallucinations but four intensely engaged in daydreaming and experienced imagined conversations as very real.
All of them had been seeking information about DID in literature and the Internet. For more information about them see Table 2. Their names have been changed to protect their confidentiality.
The principal investigator IJP is a psychotherapist, supervisor, and researcher in the field of community health psychology and clinical psychology. The second co-investigator RT is a psychiatrist, psychotherapist, and supervisor. The third co-investigator SB is a clinical psychologist, psychotherapist, supervisor, and a consulting expert in forensic psychology, who also developed the TADS-I. They are all mentors and trainers of the European Society for Trauma and Dissociation, with significant expertise in the assessment of post-traumatic conditions.
She is also a psychotherapist in training. All authors coded and discussed their understanding of data.
Their understanding and interpretations of symptoms reported by participants were influenced by their background knowledge and experience in diagnosing and treating patients with personality disorders and dissociative disorders. Consecutive analytical steps recommended for IPA were employed in the study Pietkiewicz and Smith, For each interview, researchers watched the recording and carefully read the transcript several times.
Next, they categorized their notes into emergent themes by allocating descriptive labels nodes. The team then compared and discussed their coding and interpretations. They analyzed connections between themes in each interview and between cases, and grouped themes according to conceptual similarities into main themes and sub-themes. During each interview, participants were encouraged to give examples illustrating reported symptoms or experiences.
Clarification questions were asked to negotiate the meaning participants wanted to convey. At the end of the interview, they were also asked questions to check that their responses were thorough. The researchers discussed each case thoroughly and also compared their interpretative notes to compare their understanding of the content and its meaning the second hermeneutics.
Participants in this study explained how they concluded they were suffering from DID, developed knowledge about the syndrome and an identity of a DID patient, and how this affected their everyday life and relationships. Five salient themes appeared in all interviews, as listed in Table 3. Each theme is discussed and illustrated with verbatim excerpts from the interviews, in accordance with IPA principles. Table 3. Salient themes identified during the interpretative phenomenological analysis.
All six participants hoped to confirm they had DID. They read books and browsed the Internet seeking information about dissociation, and watched YouTube videos presenting people describing multiple personalities. Dominique, Victoria, Mary, and Karina said that a mental health professional suggested this diagnosis to them. Dominique remembers consulting a psychiatrist when she was 15, because she had problems controlling anger at home or in public places.
She initially found descriptions of borderline personality captured her experiences well enough, but a psychiatrist refuted the idea and recommended further diagnostics toward a dissociative disorder. However, the girl refused to go to hospital for observation. During an argument with my mother I felt as if some incredible force took control and I smashed the glass in the cabinet with my hand. It was like being under control of an alien force.
I started reading about borderline and I thought I had it. I found a webpage about that and told my mother I should see a psychiatrist. I went for a consultation and told her my story. This led Dominique to research the new diagnosis. Karina also said she was encouraged to seek information about DID, when a doctor suggested she might be suffering with it. When I was 11, I had problems at school and home. Other children made fun of me.
My mom took me to a doctor and he said I had borderline, but later I was diagnosed with an anxiety disorder. Victoria and Mary shared similar stories about psychotherapists suggesting the existence of dissociative parts, having readily accepted this new category as a good explanation for aggressive impulses or problems with recalling situations evoking guilt or shame.
Dominique and Victoria stressed, however, that, apart from feeling emotionally abandoned, they could not trace any significant traumas in their early childhoods, although therapists maintained that such events must be present in dissociative patients. I have no idea why I have this [DID]. Katia and Olga had used psychiatric treatment for anxiety and depression for years.
After exploring information about different mental disorders they concluded they had DID. They thought there was a similarity between their personal experiences and those of people publishing testimonials about multiple personalities. I tried to understand this battle inside, leading me to stagnation. Some of these things I have discovered myself and some were new to me. Subsequently, Katia presented to her doctor a review of literature about DID, trying to persuade him that she had this disorder.
Once participants had embraced the idea of having multiple personalities, they seemed to construct inner reality and justify conflicting needs, impulses or behaviors as an expression of dissociative parts. They referred to being uncertain about who they were and having difficulties recognizing personal emotions, needs or interests.
Some of them felt it was connected to a negative cognition about themselves as worthless, unimportant, and not deserving to express what they felt or wanted.
Victoria said she would rather define herself through the eyes of others:. My therapist asked what I wanted or needed. Otherwise, I think they will not like me and reject me, because I have nothing to offer. Since a young age, Dominique tended to immerse herself in a fantasy world, developing elaborated scenarios about people living in a youth center administered by a vicious boss.
Well, there is John who is a teacher and researcher. He teaches mathematics. I have no skills in maths at all.
Tim is a philosopher and would like to train philosophers, enroll doctoral studies. He would like me to study philosophy but the rest of the system wants me to be a worrier. Ralf is a caring nurse and would like to become a paramedic. It is difficult to reconcile all these different expectations. Whoever comes up front, then I have these ideas. Dominique neither had amnesia nor found evidence for leading separate lives and engaging herself in activities associated with her characters.
She maintained her job as a playwright, and merely imagined alternative scenarios of her life, expressed by her inner heroes. They were her own vivid thoughts representing different, conflicting opinions or impulses. Katia said she felt internally fragmented.
There were times when she engaged in certain interests, knowledge and skills, but she later changed her goals. Fifteen years ago she gave up her academic career and went on sickness benefit when she became disabled due to medical problems; she experienced this as a great loss, a failure, which affected her sense of identity and purpose.
In recent years I have a growing sense of identity fragmentation. I have problems with defining my identity because it changes. I used to feel more stable in the past. I had these versions of myself which were more dominating, so I had a stronger sense of identity. For example, 20 years ago there was this scientist.
I was studying and felt like a scientist, attending conferences. Long ago I liked certain music, played the guitar, sang songs. She described changes in her professional and social lives in terms of switches between dissociative parts. Participants also reported thoughts, temptations, impulses or actions which seemed to evoke conflicting feelings.
Dominique thought it was inappropriate to express disappointment or anger, but she accepted the thought that her dissociative parts were doing this. And suddenly Greg switched on and had a row with the cashier. I mean, I did it, but wound up by his anger. Mary said she had parts that expressed anger, sadness, and needs associated with attachment.
She observed them and allowed them to step in, when situations required. There were situations in my life when the teenager must have been active. She protected me. She is ready to fight; I am not like that at all. I hate violence, and that teenager likes using force to protect me. They made me comply, so I agreed to call her if I do not feel well. It has always been like this. During assessment, no participant provided evidence for the existence of autonomous dissociative parts.
It seems that the inner characters described by them personified unintegrated ego-states which used to evoke conflicting feelings. I read First person plural which helped me understand what this is all about.
The drama of the gifted child and The body keeps the score. More and more girls started to appear. There is a 6-month old baby which showed up only 2 months ago, a sad year old teenager, and a year old who thinks I am a loser.
I was a teenager like that. Now she is having problems and becoming withdrawn there are fewer switches, because she knows we need to help the little one first. Olga was also inspired by books. Not only did she find similarities to trauma survivors but she made new discoveries and thought there were other experiences she had been unaware of earlier.
Victoria started using techniques which literature recommended for stabilization in dissociative disorders. She said these books helped her understand intense emotions and improve concentration. This explains everything that happens to me, why I get so angry. I also found anchors helpful. I focus on certain objects, sounds or smells which remind me where I am, instead of drifting away into my thoughts. At first, they merely struggled with emotional liability or detachment, internal conflicts, and concentration problems.
Later, they started reporting intrusions of dissociative parts or using clinical terms e. I think it is a form of dissociation on the emotional level. I read a lot… The minds of Billy Milligan or First person plural. For sure, I do not have an alteration of personality. I have co-consciousness. My theory is, we are like a glove, we all stem from one trunk, but we are like separate fingers. She hopes to bring about social change by educating the public on the science behind childhood abuse and its effects on the growing brain, and by normalizing her stigmatized disorder—Dissociative Identity Disorder.
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Advocacy Crisis Intervention. Instead, having either condition is a risk factor. People diagnosed with ADHD often experience difficulty paying attention, restlessness, and impulsiveness.
Doctors have also recognized emotional issues in some people with ADHD. This is characterized by an inability to control their emotional responses, or hypersensitivity. Since these individuals experience more intense emotions, they may have a heightened response to any sense of rejection.
This neurodevelopmental disorder affects the nervous system and triggers a variety of symptoms. Children or adults with autism may have difficulty communicating and socializing, and sometimes they have difficulty understanding the actions of others. They might also deal with emotional dysregulation and hypersensitivity to physical and emotional stimuli. As a result, any real or perceived feelings of rejection or criticism can cause them to become overwhelmingly upset.
Although symptoms of RSD can mimic other conditions, one distinguishing factor is that symptoms of RSD tend to be brief and triggered by emotional cycles, rather than an actual event. Figuring out if you have RSD can be challenging. Your doctor may inquire about your family history and symptoms.
Since this is associated with autism and ADHD, your doctor may recommend treating any underlying condition first. But medication can help relieve associated symptoms such as hyperactivity and depression. Behavioral intervention can also help reduce hypersensitivity. This can make it easier to manage and cope with rejection and criticism. Therefore, your doctor will likely suggest psychotherapy. One type of effective psychotherapy is cognitive behavioral therapy CBT. This is a type of talk therapy which teaches coping techniques.
Guanfacine is a common medication for RSD. Along with traditional therapies, you can do a few things on your own to help manage your emotional response to rejection and criticism.
For example, keep your emotions in perspective. Understand that what you feel or perceive to be rejection or criticism may not really exist. Understandably, it can be hard to control hurt feelings. But instead of having an outburst when you feel shunned, stay calm and rationally discuss your feelings with the other person. It also helps to reduce your overall stress level , which can help you feel more calm and at ease.
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