PhD/PsyD Dissociative Disorders

[cara susanna]

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That TikTok article was a ride. I keep thinking about a video I saw of a DID patient at a DBT training and how it was conceptualized as the patient functionally being reinforced for saying things as a "different alter." Like, saying things that the patient didn't want to say to the therapist. If you go with that view, these TikTok people are getting INCREDIBLY reinforced for their dissociative behaviors.

 

[romanticscience]

"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

Glad it’s not just me in these situations. When I get in these loops, I immediate start considering identity issues/hysteria/dissociation/etc.

 

[clausewitz2]

Glad it’s not just me in these situations. When I get in these loops, I immediate start considering identity issues/hysteria/dissociation/etc.

See I aways first think 'i bet they've been on Xanax 2 mg TID and have a medical marijuana card.'

 

[borne_before]

Glad it’s not just me in these situations. When I get in these loops, I immediate start considering identity issues/hysteria/dissociation/etc.

Sometimes with autistic kids, I'll ask "pretend I was an alien and I had never experienced anxiety before, what would that feel like?"

 

[futureapppsy2]

That TikTok article was a ride. I keep thinking about a video I saw of a DID patient at a DBT training and how it was conceptualized as the patient functionally being reinforced for saying things as a "different alter." Like, saying things that the patient didn't want to say to the therapist. If you go with that view, these TikTok people are getting INCREDIBLY reinforced for their dissociative behaviors.

The physical illness faking/drama on social media is also a trip. Personal favorites:

-A woman in her 20s who claimed that she had not eaten more than 200 calories a day for six months and not giving her a feeding tube was "sending her home to die" despite a) gaining significant weight to the point of obesity over this six month period and b) having perfectly normal bloodwork

-Someone asking if they might have hEDS (a genetic connective tissue disorder marked by extreme flexibility/hypermobility) despite having no flexibility/hypermobility, no history thereof, and no family history thereof.

-A woman in her 20s claiming to be "internally allergic to water" (girl, you'd be dead)

-A woman in her 20s claiming to have severe gastroparesis and needing a feeding tube while also posting pictures of the truly massive amounts of food she ate by mouth each day (she also claimed extremely poorly faked DID, where all the alters also responded to her name)

 

[PsyDr]

See I aways first think 'i bet they've been on Xanax 2 mg TID and have a medical marijuana card.'

Do you have to prescribe for each personality? Is it diversion if an alter takes the controlled medication?

 

[futureapppsy2]

Do you have to prescribe for each personality? Is it diversion if an alter takes the controlled medication?

There are DID probable-fakers who claim that some "alters" have certain allergies or medical conditions that others don't, so I wouldn't be shocked if some tried that tactic....

 

[PsyDr]

There are DID probable-fakers who claim that some "alters" have certain allergies or medical conditions that other don't, so I wouldn't be shocked if some tried that tactic....

I'm gonna need the alter's insurance information.

 

[cara susanna]

I was looking around the Reddit communities related to this phenomenon and someone said that some "quack" psychologists have gone viral on social media promoting the legitimacy of DID. Has anyone seen this or know who these psychologists are? I thought that I was fairly in tune with social media, but I guess not!

 

[AcronymAllergy]

I was looking around the Reddit communities related to this phenomenon and someone said that some "quack" psychologists have gone viral on social media promoting the legitimacy of DID. Has anyone seen this or know who these psychologists are? I thought that I was fairly in tune with social media, but I guess not!

That's disappointing but not surprising.

But my social media game is very poor. I'm still stuck back wondering where @futureapppsy2 is seeing all the stuff described above. It's like there's a social media dark web that I'm just completely oblivious to.

 

[borne_before]

I was looking around the Reddit communities related to this phenomenon and someone said that some "quack" psychologists have gone viral on social media promoting the legitimacy of DID. Has anyone seen this or know who these psychologists are? I thought that I was fairly in tune with social media, but I guess not!

Grifters are gonna grift

 

[romanticscience]

See I aways first think 'i bet they've been on Xanax 2 mg TID and have a medical marijuana card.'

That too! Maybe more awkward is when there’s reason to believe the person is malingering (fictitious?); damn it, they just strongly believe they need Xanax. Some probably know they should do something else (ambivalence) but they need Xanax from you.

Anybody have some tips on how to use MI in this setting? I tried finding readings for MI and prescribing but they weren’t really helpful.

Is it as simple as agreeing the focus is Xanax and the provider isn’t in agreement (forget which box that is in the Miller text). Same goes for adderall and ADHD; it’s these psychiatric disorders which allow for such ambivalences to hide. People, influenced by extratherapeutic factors come to have a strong belief in a treatment before they even walk in the door. Sometimes I wish I was a pre-internet/Tik-tok doc!

 

[Ludwig2000]

Enjoying this thread. And just a few days ago, was consulted for early 20s female; she described her experience of becoming a few different people the night prior. She suggested- “I think it’s called, dissociative identity disorder? I read a book about it in high school.”

My question for you guys is: in cases of mass psychogenic illness, if the illness is psychiatric, then can it become a case of actual mass illness?

That is, if the behaviors and willful symptoms are being reinforced, might they actually become entrenched, and “real,” ie as real as anything else in the mind.

Interested to hear your thoughts

 

[msc545]

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.

Why are you here and not on a chiropractic forum?

 

[msc545]

Is this a troll?

If it isn't, it should be.

 

[cara susanna]

That too! Maybe more awkward is when there’s reason to believe the person is malingering (fictitious?); damn it, they just strongly believe they need Xanax. Some probably know they should do something else (ambivalence) but they need Xanax from you.

Anybody have some tips on how to use MI in this setting? I tried finding readings for MI and prescribing but they weren’t really helpful.

Is it as simple as agreeing the focus is Xanax and the provider isn’t in agreement (forget which box that is in the Miller text). Same goes for adderall and ADHD; it’s these psychiatric disorders which allow for such ambivalences to hide. People, influenced by extratherapeutic factors come to have a strong belief in a treatment before they even walk in the door. Sometimes I wish I was a pre-internet/Tik-tok doc!

In our clinic (not a prescriber, but I've still had this conversations with patients because you have to stop benzos for PTSD treatment to be effective), we explain that these medications actually make chronic anxiety worse long-term.

 

[borne_before]

In our clinic (not a prescriber, but I've still had this conversations with patients because you have to stop benzos for PTSD treatment to be effective), we explain that these medications actually make chronic anxiety worse long-term.

Benzos give me some nasty rebound anxiety beyond the reinforcing of anxiety. Benzos also make you stupid (from a learning perspective).

I think most psychologists know this. I'm not buying Jordan Peterson's ignorance claims about them.

 

[cara susanna]

Benzos give me some nasty rebound anxiety beyond the reinforcing of anxiety. Benzos also make you stupid (from a learning perspective).

I think most psychologists know this. I'm not buying Jordan Peterson's ignorance claims about them.

Yup, rebound anxiety and reinforcement of anxiety... not to mention fall risk with elderly patients. Back when I was in PCMHI and patients who were on benzos were getting referred for OPMH medication management, I would actually warn them that there was a good chance the psychiatrist would want to taper off the benzo. And explain the above. The psychiatrists in our clinic generally do not prescribe benzos.

National Center for PTSD also has a really great handout on why benzos are contraindicated for PTSD specifically.

 

[futureapppsy2]

National Center for PTSD also has a really great handout on why benzos are contraindicated for PTSD specifically

I always direct my students to Nation Center for PTSD to try to counter-act/prevent them from buying into some of the egregious trauma/PTSD psuedoscience that's out there.

 

[WisNeuro]

I always direct my students to Nation Center for PTSD to try to counter-act/prevent them from buying into some of the egregious trauma/PTSD psuedoscience that's out there.

If only we could direct more physicians there to counteract the pseudoscience in that group...

 

[futureapppsy2]

That's disappointing but not surprising.

But my social media game is very poor. I'm still stuck back wondering where @futureapppsy2 is seeing all the stuff described above. It's like there's a social media dark web that I'm just completely oblivious to.

It was a glorious subreddit on calling people our for bad chronic illness faking/exaggeration on social media that unfortunately got shut down (as someone who knows a lot about ableism, there was some ableism in the comments, but really not that much at all, and comments were generally responsive to feedback about that).

 

[clausewitz2]

In our clinic (not a prescriber, but I've still had this conversations with patients because you have to stop benzos for PTSD treatment to be effective), we explain that these medications actually make chronic anxiety worse long-term.

I mean, that is definitely the right answer and important to be willing to keep at that conversation. I suggest that you might get a scintilla more outward agreement when you engage with people on this because at the end of the day your clients know that you personally are not actually going to be able to fill their Xanax no matter what they say. With some people unfortunately you run into a wall when you try to have this conversation as the one with the legal ability to provide them with benzos.

You can tell them all the reasons and evidence that they end up making anxiety worse until you are blue in the face but some folks will just keep doubling down. "I know my body, It's the only thing that's ever worked for my anxiety, you're a quack" etc. They often genuinely don't believe you. I share @RomanticScience 's frustration when dealing with just that sort of situation. Sometimes I can get through with pointing out how seriously impaired they are by anxiety and ask them in what sense the medications are actually working, but this is obviously not as viable a tactic for more functional but still distressed people.

The ones who are persuaded by the health risks often will agree, taper faster than planned, then show up to their PCP's office acutely distressed and get given a refill at the strength and frequency they were taking months ago. They will be apologetic but say, "you don't understand, I just couldn't stand it." Then we have a talk about why they didn't see fit to mention to their PCP that they were actively seeing a psychiatrist.

 

[cara susanna]

I mean, that is definitely the right answer and important to be willing to keep at that conversation. I suggest that you might get a scintilla more outward agreement when you engage with people on this because at the end of the day your clients know that you personally are not actually going to be able to fill their Xanax no matter what they say. With some people unfortunately you run into a wall when you try to have this conversation as the one with the legal ability to provide them with benzos.

You can tell them all the reasons and evidence that they end up making anxiety worse until you are blue in the face but some folks will just keep doubling down. "I know my body, It's the only thing that's ever worked for my anxiety, you're a quack" etc. They often genuinely don't believe you. I share @RomanticScience 's frustration when dealing with just that sort of situation. Sometimes I can get through with pointing out how seriously impaired they are by anxiety and ask them in what sense the medications are actually working, but this is obviously not as viable a tactic for more functional but still distressed people.

The ones who are persuaded by the health risks often will agree, taper faster than planned, then show up to their PCP's office acutely distressed and get given a refill at the strength and frequency they were taking months ago. They will be apologetic but say, "you don't understand, I just couldn't stand it." Then we have a talk about why they didn't see fit to mention to their PCP that they were actively seeing a psychiatrist.

Oh yeah, I didn't mean to devalue the difficulty you psychiatrists have. People here constantly fire psychiatrists over benzos.

 

[WisNeuro]

Oh yeah, I didn't mean to devalue the difficulty you psychiatrists have. People here constantly fire psychiatrists over benzos.

Can get complicated based on your organizational demands and other issues. Luckily my spouse, who is a PCP, has a pretty good policy that she will not prescribe or refill maintenance benzos as part of ongoing patient/provider relationship. She's willing to help them taper if they will contract for it, but that's about it. So far, no pushback from the beancounters upstairs.

 

[AcronymAllergy]

I definitely got less pushback than did the psychiatrists when I had the benzo talk with patients, largely (as noted above) because I ultimately wasn't going to be the one changing their meds. Same generally went for the stimulant talks. My hopelessly optimistic self thinks this might've resulted in the patients being a bit more open to "sitting with" the thought. At the very least, they were hearing it from someone other than "just" the psychiatrist.

But even mentioning opioids, whoa boy...