PhD/PsyD Dissociative Disorders

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
Joined
Jul 15, 2014
Messages
2,404
Reaction score
3,303
Anyone else notice an uptick in dissociative symptoms among today's youth? It's all over reddit and I'm sure that's related somehow. My experience has been it's usually a combo of (1) depression/anxiety, (2) a hx of psychological trauma of some kind, and (3) a fun set of drugs. I usually just bypass it and talk about treating other problems but I'm curious about how folks are handling dissociative complaints in their clinical practice.

Members don't see this ad.
 
There's an entire DID thing on Tik Tok. It's pretty popular. It's "privilege" if you have childhood trauma that causes it.

Also some TikTok trends for Tourette's and Autism Spectrum Disorder. Hilarious faking of stimming, and copralalia. Even one video where some adult woman "learns" that rain is wet.

And the entire thing about how professional diagnosis is privilege, so self diagnosis is just as good. There's even a rap about "diagnosis is a privilege".
 
Members don't see this ad :)
Yep, huge up tick especially on TikTok. I personally think it's because identity politics are so popular right now. White kids (who feel a lot of white guilt), are getting "clout" by having (i.e., collecting) intersectional identities beyond whiteness. One of the easiest ways to communicate that you're a "good" white is to get a disability label or a member of the queer community (because being just LGB is boring). In this case, regular anxiety and depression just aren't clout getters because everyone has that now.
 
Last edited:
Yep, huge up tick especially on TikTok. I personally think it's because identity politics are so popular right now. White kids (who feel a lot of white guilt), are getting "clout" by having (i.e., collecting) intersectional identities beyond whiteness. One of the easiest ways to communicate that you're a "good" white is to get a disability label or a member of the queer community (because being just LGB is boring). In this case, regular anxiety and depression just aren't clout getters because everyone has that now.
I don't know that it has anything to do with IDPOL or white guilt. It's just the modern social media version of the same attention-seeking stuff that happened when Sybil and The Three Faces of Eve came out.
 
Yep, huge up tick especially on TikTok. I personally think it's because identity politics are so popular right now. White kids (who feel a lot of white guilt), are getting "clout" by having (i.e., collecting) intersectional identities beyond whiteness. One of the easiest ways to communicate that you're a "good" white is to get a disability label or a member of the queer community (because being just LGB is boring). In this case, regular anxiety and depression just aren't clout getters because everyone has that now.
I see this with adults in SJ circles. People reinvent themselves and add IDs to shield from accountability re: white supremacy. Typically they hide behind the MH stuff when they’re found out (a la “This is too stressful I can’t have these conversations”). Rinse and repeat. However, I’ve seen it a lot more with people claiming non-white racial identities (and we have enough recent examples of academics doing this and being exposed….)
 
Huh. I appreciate this thread. My clinic just got a client requesting a DID evaluation, and I've seen exactly one other of these requests in the last ten years, After the case is assigned, I'll send some of this info on to the clinician!
 
Maybe this is really a malingering thread. All the same, I don't think I've ever actually seen a true DRD or DPD case in training or in practice. I don't even think I would know what to do with a person who truly had the disorder. It's recent popularity has caused me to be increasingly skeptical of everyone. I've only ever seen it in cases of acute stress disorder, but usually it's all stabilization at that point.
 
Something I'm curious about: have any of you seen DID be framed as adaptive or neurodivergence? Recently, I came across material online about multiplicity/plurality and endogenic versus traumagenic systems that are along the same lines as the TikTok videos mentioned above. On the one hand, I understand that there's a movement to depathologize neurodiversity. On the other hand, I am having a hard time seeing the normalization or even glorification of dissociation as being anything but maladaptive.
 
Maybe this is really a malingering thread. All the same, I don't think I've ever actually seen a true DRD or DPD case in training or in practice. I don't even think I would know what to do with a person who truly had the disorder. It's recent popularity has caused me to be increasingly skeptical of everyone. I've only ever seen it in cases of acute stress disorder, but usually it's all stabilization at that point.
I think in most causes this isn't malingering (faking for material gain) so much as factitious behavior (faking for attention). Interestingly enough, neurological clinics have also seen an uptick in Tourette's-like behaviors with unusual/illegitimate clinical presentations during the pandemic, also apparently fueled by social media. In other words, good old mass psychogenic illness. COVID-19 related increase in childhood tics and tic-like attacks | Archives of Disease in Childhood
 
Maybe this is really a malingering thread. All the same, I don't think I've ever actually seen a true DRD or DPD case in training or in practice. I don't even think I would know what to do with a person who truly had the disorder. It's recent popularity has caused me to be increasingly skeptical of everyone. I've only ever seen it in cases of acute stress disorder, but usually it's all stabilization at that point.
There is an exceptional (in my opinion) accounting of how to conceptualize and treat someone presenting with DID from a science-informed cognitive behavioral perspective in the book Case Studies in Clinical Psychological Science: Bridging the Gap from Science to Practice. I can't recommend the chapter on DID or the book as a whole highly enough. It's actually cheap as hell right now (compared to when I bought it several years ago). Great book.

Amazon product ASIN 019973366X
 
On the other hand, I am having a hard time seeing the normalization or even glorification of dissociation as being anything but maladaptive.

Attention is a hell of a drug (reinforcer).


Saw a friend with some likely mental health stuff going on post a picture/meme thing online saying its okay to dissociate when you need... like it is a coping skill akin to playing the guitar or something. like what.
 
Members don't see this ad :)
Split legit lead to an uptick in the DID garbage, as did other flicks in the past as well. I had multiple sanity eval 2nd opinions from 2018-2019 with defendants claiming they were insane (and sadly certain evaluators bought it hook line and sinker). With regard to actual dissociation, I've only ever seen it happen in real life with a patient a few times. Real real scary.
 
I think that dissociation is definitely a thing, and even to the point where it can become disordered, but I don't really buy into DID itself as much as I used to.

BPD is another diagnosis that seems to be "hot" on social media right now, as well as ADHD and C-PTSD (but we've talked about those a lot). There's also this idea that we can't say anything negative about Cluster B or it's ableism.
 
BPD is another diagnosis that seems to be "hot" on social media right now,

The number of HS/college students who have been crushingly disappointed when I told them I did not think they had borderline personality disorder in the last six months is kind of astounding to me. Most striking is the divorce between the clinicians I know who are still afraid to mention BPD to appropriate clients for fear of their negative reaction and the eagerness of so many clients to be diagnosed with BPD. I actually can't think of any other similar discrepancies.
 
Saw a friend with some likely mental health stuff going on post a picture/meme thing online saying its okay to dissociate when you need... like it is a coping skill akin to playing the guitar or something. like what.
My conceptualization of it is much closer to a shock response. Immediately protective in a moment of acute trauma, but not something that is healthy or sustainable over time.

W/regard to DID in general... I have worked at a large high security forensic inpatient facility for years at this point and have never seen DID, nor has anyone else I've talked to about it. Considering the modal level of acuity here, it sure seems like if DID was a distinct thing, someone would have seen it. I'm open to the idea that the most extreme form of BPD could present itself that way, but I'm very skeptical of the idea that the person suffering the multiple identities is not also playing a role in forming and conceptualizing their various mental states as such. And still... Like, we would have probably seen the Sasquatch by now in this neck of the woods, you know?
 
W/regard to DID in general... I have worked at a large high security forensic inpatient facility for years at this point and have never seen DID, nor has anyone else I've talked to about it. Considering the modal level of acuity here, it sure seems like if DID was a distinct thing, someone would have seen it. I'm open to the idea that the most extreme form of BPD could present itself that way, but I'm very skeptical of the idea that the person suffering the multiple identities is not also playing a role in forming and conceptualizing their various mental states as such. And still... Like, we would have probably seen the Sasquatch by now in this neck of the woods, you know?

I have had one client who self-diagnosed with DID who based their belief that they had alters on the fact that they "act pretty different around different people" based on the environment, vibe, situation. Thought (did not say) "welcome to being human."
 
This thread is giving me flashbacks to a "DID" client I had a while back (who I posted about extensively on here) and I think I'm starting to dissociate.
 
A friend's wife recently posted something like "Did x today, better than sitting around dissociating all day!" IIRC, it was a selfie with red lip stick...
 
A friend's wife recently posted something like "Did x today, better than sitting around dissociating all day!" IIRC, it was a selfie with red lip stick...

simon cowell facepalm GIF
 
While we're at it, can I also complain about the now very-popular phrase of "boosts my serotonin"? Way to promote a reductive medical model of mood, guys. And serotonin doesn't work that way...
Ugh. I find this with ADHD and dopamine and "dopamine traps". The reductive model works so well for getting patients to take their stimulants though.
 
I have had one client who self-diagnosed with DID who based their belief that they had alters on the fact that they "act pretty different around different people" based on the environment, vibe, situation. Thought (did not say) "welcome to being human."
Endorsement of the DID critical item on the PAI is super high in college folks. Upon interview I've never seen or supervised the case of anyone who endorsed it but didn't just mean what you said there.
 
Anyone else notice an uptick in dissociative symptoms among today's youth? It's all over reddit and I'm sure that's related somehow. My experience has been it's usually a combo of (1) depression/anxiety, (2) a hx of psychological trauma of some kind, and (3) a fun set of drugs. I usually just bypass it and talk about treating other problems but I'm curious about how folks are handling dissociative complaints in their clinical practice.
I think allowing these individuals to change there diet to something that is pure , such as an organic plant based diet. There already under a biochemical imbalance . So helping the body with pure good nutrients, instead of food that isn’t doing anything to the body could be a start .
What I don’t get is why a lot of MD and DO do not have a team of naturopathic Doctors in there practice. If our love is to really help people make a change, our first clue could be to look at nutrition and the source of we’re those nutrients are coming from. Being integrative with medicine is allowing the term doctor to really be in effect.
 
I think allowing these individuals to change there diet to something that is pure , such as an organic plant based diet. There already under a biochemical imbalance . So helping the body with pure good nutrients, instead of food that isn’t doing anything to the body could be a start .
What I don’t get is why a lot of MD and DO do not have a team of naturopathic Doctors in there practice. If our love is to really help people make a change, our first clue could be to look at nutrition and the source of we’re those nutrients are coming from. Being integrative with medicine is allowing the term doctor to really be in effect.

I'll assume good intentions here. The research on diet and mental health in general is pretty mixed so I'm deeply doubtful towards your confidence in so-called "biochemical imbalances" as causal factors to dissociative symptoms. Anyone who works with patients on a regular basis or keeps up with the science on this topic knows that people can eat well and STILL struggle with mental health problems. As much as I value a healthy lifestyle, it's not the silver bullet we'd all like it to be.
 
I think allowing these individuals to change there diet to something that is pure , such as an organic plant based diet. There already under a biochemical imbalance . So helping the body with pure good nutrients, instead of food that isn’t doing anything to the body could be a start .
What I don’t get is why a lot of MD and DO do not have a team of naturopathic Doctors in there practice. If our love is to really help people make a change, our first clue could be to look at nutrition and the source of we’re those nutrients are coming from. Being integrative with medicine is allowing the term doctor to really be in effect.

Because these people are not real doctors, and almost every one I've seen peddles snakeoil. I'd be fine with nutritionists in a medical practice, but if my doctor's office employed a naturopathic fake doctor, I'd be finding a new doctor for primary care.
 
I think allowing these individuals to change there diet to something that is pure , such as an organic plant based diet. There already under a biochemical imbalance . So helping the body with pure good nutrients, instead of food that isn’t doing anything to the body could be a start .
What I don’t get is why a lot of MD and DO do not have a team of naturopathic Doctors in there practice. If our love is to really help people make a change, our first clue could be to look at nutrition and the source of we’re those nutrients are coming from. Being integrative with medicine is allowing the term doctor to really be in effect.
There are fads that come around every few years. While the role of the gut biome is an interesting academic area of study, my take on the literature has not been very convincing. And, more importantly, (I think) none of it is associated with dissociative disorders. Additionally, this thread is about the over-reporting of dissociation and dissociative disorders (another fad that has a long track record of ebbing and flowing).

While I am in support of the research about the gut biome for mental health, it is far away from showing us any worthwhile (we can argue what this means) effective interventions for diagnosis-able mental health disorders (though, I may be a little behind on the research). I am also a bit skeptical on the validity of these etiological mechanism since poor gut biomes are likely highly correlated with other lifestyle problems (e.g., lack of physical activity, poor sleep), which have already been shown to have worthwhile effects on depression when amended.

Finally, I will echo what others have said; naturopathy is considered a pseudoscience and has no place in science-based healthcare. I know it sounds great and appeals to our sense of natural (whatever that means) interventions. Especially in the time of COVID and vaccine hesitancy/resistance, pseudoscience fields like naturopathy are much more harmful than helpful. Exhibit A:
 
Possibly unrelated, but dissociation, especially DID, is a trending topic on TikTok and other social media used by adolescents and young adults. It's the mental health problem du jour.
It really seems like we are just always going through cycles and history repeats itself. Except instead of movies and TV shows it is social media now. I do the best I can to address this stuff at the undergrad level. Not sure what more I can do about it. I imagine it will come to its own end as it did seemingly every other decade.

In the future, I will be much more vigilant when movies like Split and TV shows like the The United States of Tara are released. This form of entertainment seems much more exploitative and harmful (though, I was a fan of Split) than I previously thought (oh man, I am getting old).
 
I think allowing these individuals to change there diet to something that is pure , such as an organic plant based diet. There already under a biochemical imbalance . So helping the body with pure good nutrients, instead of food that isn’t doing anything to the body could be a start .
What I don’t get is why a lot of MD and DO do not have a team of naturopathic Doctors in there practice. If our love is to really help people make a change, our first clue could be to look at nutrition and the source of we’re those nutrients are coming from. Being integrative with medicine is allowing the term doctor to really be in effect.
Is this a troll?
 
To add to what OP said: I have had quite a few teens lately say things like they “can’t remember days at a time” or feel “like [they] are outside [their] body” and it makes me wonder how many of them are reading about dissociation and/or depersonalization before coming in for an intake, and spouting lines from what sounds like Wikipedia, when their other reported symptoms are consistent with major depressive disorder.
 
To add to what OP said: I have had quite a few teens lately say things like they “can’t remember days at a time” or feel “like [they] are outside [their] body” and it makes me wonder how many of them are reading about dissociation and/or depersonalization before coming in for an intake, and spouting lines from what sounds like Wikipedia, when their other reported symptoms are consistent with major depressive disorder.
Flip side: I once heard an intern say that the fact that that a patient didn’t have a specific memory of walking into the counseling center (not that they were disoriented and suddenly ended up there; that the person just did not have the specific details of the walk in memory) was evidence of a pervasive amnesia disorder. Just saying patients don’t have the monopoly on bad interpretation of symptoms.
 
Flip side: I once heard an intern say that the fact that that a patient didn’t have a specific memory of walking into the counseling center (not that they were disoriented and suddenly ended up there; that the person just did not have the specific details of the walk in memory) was evidence of a pervasive amnesia disorder. Just saying patients don’t have the monopoly on bad interpretation of symptoms.
This sounds like the psychology version of "When you hear hoof beats, think horses, not zebras."
Exhibit A:
That's terrifying.
 
Flip side: I once heard an intern say that the fact that that a patient didn’t have a specific memory of walking into the counseling center (not that they were disoriented and suddenly ended up there; that the person just did not have the specific details of the walk in memory) was evidence of a pervasive amnesia disorder. Just saying patients don’t have the monopoly on bad interpretation of symptoms.
Yes, I've seen similar instances with trainees in the past (e.g., patient describes frustration that lots of other people seem to look out only for themselves that's labeled as paranoia). Usually seems to come from a place of limited to no experience with the symptom/condition under discussion. It can definitely be helpful, just like with patients, to explore and reframe the interpretation. And ensure the trainee appreciates the significance (and importance) of their impressions.
 
Yes, I've seen similar instances with trainees in the past (e.g., patient describes frustration that lots of other people seem to look out only for themselves that's labeled as paranoia). Usually seems to come from a place of limited to no experience with the symptom/condition under discussion. It can definitely be helpful, just like with patients, to explore and reframe the interpretation. And ensure the trainee appreciates the significance (and importance) of their impressions.

Seen this with trainees seeing irritability in a child or teen and automatically thinking Bipolar Disorder without ascertaining if the irritability is a departure from the individual’s baseline and episodic in nature, etc.
 
Unfortunately, a lot of young and inexperienced trainees don't know how to properly assess for dissociation. For example the whole, "I don't have a specific memory of driving to work this one time." By and large, this is simply an attentional issue. Almost everyone can say this at some point, particularly for things that you do that are mostly on autopilot. We're not dissociating, we're simply not paying as much or any attention to certain cues in our environment, and a little bit just in our own heads. By and large, if it's a mundane activity, it's probably not dissociation. And, if it's a dementia evaluation, it may be an encoding problem 😉
 
To add to what OP said: I have had quite a few teens lately say things like they “can’t remember days at a time” or feel “like [they] are outside [their] body” and it makes me wonder how many of them are reading about dissociation and/or depersonalization before coming in for an intake, and spouting lines from what sounds like Wikipedia, when their other reported symptoms are consistent with major depressive disorder.
This! I think you can absolutely tell when you are no longer talking to a person, and instead talking to an attached concept/label/diagnosis/story/etc. I feel it sometimes, the conversation changes in tone.
 
This! I think you can absolutely tell when you are no longer talking to a person, and instead talking to an attached concept/label/diagnosis/story/etc. I feel it sometimes, the conversation changes in tone.

"My generalized anxiety is through the roof."

"Okay, I'm sorry to hear that. You know, I find that different people often mean very different things when they say 'anxiety', so I'm curious - what is anxiety for you? What does that feel like?"

"...generalized anxiety."

"sure, I meant more - what are you aware of feeling when you are anxious? How can you tell when you are anxious versus times when you are not?"

"Because I feel anxious. Like I have anxiety."

"Okay. When did it start getting as bad as it is right now? What was going on at the time?"

"I've had anxiety my whole life."

"Alright, when was the last time you remember not being anxious?"

"I'm always anxious."

"So you said that your anxiety was especially bad right now. What is different about this moment? In what way is it especially bad right now?"

"Because I'm having anxiety."

ad infinitum
 
"My generalized anxiety is through the roof."

"Okay, I'm sorry to hear that. You know, I find that different people often mean very different things when they say 'anxiety', so I'm curious - what is anxiety for you? What does that feel like?"

"...generalized anxiety."

"sure, I meant more - what are you aware of feeling when you are anxious? How can you tell when you are anxious versus times when you are not?"

"Because I feel anxious. Like I have anxiety."

"Okay. When did it start getting as bad as it is right now? What was going on at the time?"

"I've had anxiety my whole life."

"Alright, when was the last time you remember not being anxious?"

"I'm always anxious."

"So you said that your anxiety was especially bad right now. What is different about this moment? In what way is it especially bad right now?"

"Because I'm having anxiety."

ad infinitum

On the spectrum, huh? In my day we thru them in the Army and had them play the bugle!"
 
"My generalized anxiety is through the roof."

"Okay, I'm sorry to hear that. You know, I find that different people often mean very different things when they say 'anxiety', so I'm curious - what is anxiety for you? What does that feel like?"

"...generalized anxiety."

"sure, I meant more - what are you aware of feeling when you are anxious? How can you tell when you are anxious versus times when you are not?"

"Because I feel anxious. Like I have anxiety."

"Okay. When did it start getting as bad as it is right now? What was going on at the time?"

"I've had anxiety my whole life."

"Alright, when was the last time you remember not being anxious?"

"I'm always anxious."

"So you said that your anxiety was especially bad right now. What is different about this moment? In what way is it especially bad right now?"

"Because I'm having anxiety."

ad infinitum

Yeah, these people are not great candidates for CBT. These are always the exhausting cases to supervise.
 
"My generalized anxiety is through the roof."

"Okay, I'm sorry to hear that. You know, I find that different people often mean very different things when they say 'anxiety', so I'm curious - what is anxiety for you? What does that feel like?"

"...generalized anxiety."

"sure, I meant more - what are you aware of feeling when you are anxious? How can you tell when you are anxious versus times when you are not?"

"Because I feel anxious. Like I have anxiety."

"Okay. When did it start getting as bad as it is right now? What was going on at the time?"

"I've had anxiety my whole life."

"Alright, when was the last time you remember not being anxious?"

"I'm always anxious."

"So you said that your anxiety was especially bad right now. What is different about this moment? In what way is it especially bad right now?"

"Because I'm having anxiety."

ad infinitum
Or “it’s my rejection sensitive dysphoria because I have adhd and so the internet told me that I have rejection sensitive dysphoria.” (Tagging @cara susanna because I know you share my pain here).
 
Yes, I've seen similar instances with trainees in the past (e.g., patient describes frustration that lots of other people seem to look out only for themselves that's labeled as paranoia). Usually seems to come from a place of limited to no experience with the symptom/condition under discussion. It can definitely be helpful, just like with patients, to explore and reframe the interpretation. And ensure the trainee appreciates the significance (and importance) of their impressions.
This can also happen when folks from marginalized groups talk about systemic or interpersonal oppression.
 
The number of HS/college students who have been crushingly disappointed when I told them I did not think they had borderline personality disorder in the last six months is kind of astounding to me. Most striking is the divorce between the clinicians I know who are still afraid to mention BPD to appropriate clients for fear of their negative reaction and the eagerness of so many clients to be diagnosed with BPD. I actually can't think of any other similar discrepancies.
I think a lot of these people may either be thinking of BPD as a dramatic “aesthetic” disorder and/or a “get out of expectations and consequences for bad behavior free” card. I imagine that they would find DBT quite “ableist.”
 
I love how they gloss over the money part (paypal/venmo link in bio)!
Yes, because secondary gain must make you rich or it doesn't count.

I can't decide my favorite part of that article. Maybe the alter who takes over in the shower or the other person who developed an alter in response to criticism of their DID.

I made the mistake of clicking on one of the hyperlinks to tiktok. One of them made a tiktok saying they can't watch the new Pixar movie Luca again or they'll develop a new fictive alter of it.
 
Yes, because secondary gain must make you rich or it doesn't count.

I can't decide my favorite part of that article. Maybe the alter who takes over in the shower or the other person who developed an alter in response to criticism of their DID.

I made the mistake of clicking on one of the hyperlinks to tiktok. One of them made a tiktok saying they can't watch the new Pixar movie Luca again or they'll develop a new fictive alter of it.
I also like that part where the dude is like "I was just hospitalized and went inpatient... but having DID is no biggie."
 
Top