Navigating Healthcare With DID

How to Improve Your Physical Health While Still Struggling With “Somatic Tolerance”

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What is “somatic tolerance”? It is a therapy term that is used when you find it either unpleasant or just plain difficult to be present in your body. You could be unable to answer a question like “When you are scared, where do you feel it in your body?” or you could not know that you are dehydrated until you almost pass out. When you try to use a relaxation strategy such as progressive relaxation technique, you want to vomit because of how being connected to your physical body makes you feel. You don’t care about your body, don’t want to be more “in it” if you can help it, and certainly don’t enjoy it.

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Your doctors and dentists won’t fully appreciate this combo of emotions about your body and your active ignoring or your passive inability to know what your body is communicating. Your trauma therapist might not either. This is one of those things that providers think is hard-wired. They often think that everyone that hasn’t had a stroke or head trauma should be able to sense their body’s signals. Everyone that is over 5 should be motivated to optimize their physical health. Everyone wants a better mind-body connection.

NOPE. Not “everybody”.

Not for people who endured ongoing horrific abuse.

The body was the scene of many crimes, much pain, and lots of stress. It is hard to imagine that anyone with DID is good at somatic tolerance. This includes dancers and other kinds of physical performers. You could be able to control the body but not be connected emotionally to it. You could manage it like a separate being; feeding and caring for it, but not realize that “it”is exhausted or hungry, or full. And that your body is the only one all of you have to bring into a therapy session and into life.

So how can you get better at caring for your body when your somatic tolerance is low?

By understanding why that makes complete sense, having no shame about it, and taking small steps that do not scare you or your system.

This is tough stuff. But it really does make sense that people with DID have low somatic tolerance until they do a lot of healing. We don’t know everything about how DID alters interoception as well as continuous identity and consciousness (although the ads I get for courses make it seem like I could learn it all in a 4-hour online course!!). We DO know that DID allows people who experience early severe and prolonged abuse to survive. It comes at a cost, and this is one of those costs.
You didn’t cause the abuse you experienced or perpetuate it. The responsibility for THAT falls on your abusers and those that did not see and report the abuse.
While you didn’t initially create low somatic tolerance through self-harm, substance abuse, or through any other action you took or are presently taking, those actions may be making it harder to build your somatic tolerance. They are desperate survival strategies that have cost you dearly.
You can begin to care for the body by taking small steps. Your system may have ideas, so ask inside. If you are drawn to a type of toothpaste or a healthy food, try it out. If you need to drink more water, see if a particular type of water or a water bottle appeals to you. Make it easy by automating healthy actions. Pair taking a walk with something you already do. Ask a trusted person to go with you. Draw or paint or craft something connected with healthy actions. Make-your-own-pottery places could be fun for child parts, and you might make something related to dental care, healthy meals, exercise, or sleep. All good for the body, your body.
If any parts get scared, review the goal, reassure that there is no reason to go any faster than needed, and that everyone gets a vote. Even flossing one tooth is a move in the right direction. Promising tiny actions instead of huge plans works for so many people. It can reduce the fear. If you think that flossing that one tooth in your therapy session is a good idea, ask your therapist to support you. It could be the best session you have this month!

I invite you to comment and share your healthy ideas on building somatic tolerance here !!

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Are Parts of Your Dissociative System Too Active at Night?

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Many people with DID wake up to find that their parts have been active while they thought the were sleeping. They weren’t sleeping; they were switching. This means that their body (there is only one) wasn’t getting the benefits of sleep. Poor sleep can make daytime harder. You are on edge, you dissociate more and take longer to recover from being triggered, etc.

It isn’t great that your parts aren’t interrupting your job or your dinner out with friends. Their nighttime actions are costing you mentally and physically. This isn’t good for any of you.

So why do they do it? They may not have a chance to be a part of what goes on during the day. If you have little internal communication and you aren’t making space or time for them, it makes sense.

Child parts certainly don’t belong in the office or at a bar. Really. So this is not suggesting that at all. But they ma need a sense of welcome and space from you. And then, like lots of kids and teens, they need boundaries.

Some people with DID have the diagnosis but remain unsure that it fits them, or horrified that their therapist thinks that they have DID. It signifies damage and deficit rather than being the logical outcome of a very painful childhood.

There may be such fear of parts and of having DID that parts are consciously or unconsciously pushed away. Like Einstein’s ideas about matter, parts don’t go away because you want them to not be there. They are in there, with all of their energy. They take advantage of the nighttime to express what they want or need.

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What can be done about parts that get active at night?

Sleep is essential for health, and without a healthy body it is very hard to heal from trauma. Being unkind to parts isn’t the answer. But ignoring this isn’t smart.

First: Make it clear to your system that being active at night is a price too high to pay. Make your home, and your bedroom, appealing to parts. Don’t have any sense of what that would look like? Go shopping and let your system speak to you. The blanket that catches your eye, the stuffed animal you come back to 3 times in the store. Parts may be telling you something. Buy second-hand stuff if you want to experiment on the cheap. Your system will give you feedback.

Make it harder for parts to act. Lock up things you don’t want them to have access to. Block things on your phone or computer while leaving out things like a note from you and your therapist about going back to sleep.

Use their actions as clues to what is missing for them during the day. If they cooked something you never eat, they might want a different menu. If they watched shows you don’t watch, take note of the theme and try out a short show then see how they react.

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Are Your Antidepressant Meds Making You Feel Stupid and Keeping You Awake?

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Trauma survivors often heard people say really awful things about their abilities in childhood. “You are so dumb” is one of them. The truth usually is that they are being gaslit or groomed for later abuse. There is nothing wrong with their intelligence. But when an adult trauma survivor finds that they can’t remember simple information like someone’s name or where they left their keys, they could begin to wonder if those long-ago statements were right.

The sad truth is that (well-known) side effects from a medication class intended to help them with their emotions could be at play.

Most antidepressants, but not all, reduce the type of sleep known as REM (rapid eye movement) sleep. These drugs both reduce the total amount of REM sleep and increase the time it takes the brain to shift into this pattern of sleep.

Taken too late in the evening, they can make you wake up with brain fog that lasts a while. When you don’t sleep well for a few days (or weeks) you will lose some of your mental sharpness. Some antidepressants are well-known known to cause late sleep cycle insomnia.

There is no secret here; the drug makers know this, doctors know this, it is easily available information online. The effects of less REM sleep are well understood too: decreased concentration and increased forgetfulness during the day, along with daytime sleepiness. Did I mention that it can increase Bruxism (tooth grinding)?

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Oops.

There are four things that can be done to address this:

Discuss the idea of changing your meds to an antidepressant that doesn’t have strong anti-REM properties with your prescriber.
Discuss whether you can take your medication earlier in the day, so the effects are less by the time you go to sleep. Do not alter your dosage schedule without speaking to your prescriber. That is a recipe for too many problems, and if you are taking antidepressant, you don’t need more problems!
Ask your prescriber if you can decrease the dosage of your medication. Too often this is never considered, because both prescribers and patients are terrified of a relapse. But if you are suffering from insomnia and/or the mental effects above, you should be considering all of your options. This is because feeling badly about yourself during the day…was the reason to take the drug in the first place!
If you aren’t in psychotherapy, you might want to give it a try. It doesn’t involve any drugs, and has been proven to be just as effective as medications for people with mild depression. Even for people with severe depression, psychotherapy combined with medication is the gold standard for care.

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Why Your Doctor Doesn’t Know You Feel So Exposed in an Exam

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This one is fairly simple: They have a different perspective than you do, one that is often is more on their mind than how comfortable you feel.

Providers have been at this examination business for a long time, and most of us have been looking at all types of bodies every day. All types. Nothing is that unusual, very little makes US uncomfortable, and we are looking with focused intent. When we are examined in our own appointments, we have a totally different attitude most of the time. That might not work to your advantage. Yes, we aren’t likely to find any of your body parts embarrassing or disgusting to view or touch, but it can dim the lights on awareness. It can mean that your doctor isn’t thinking about how you feel when your gown doesn’t cover you up very much, or when they remove part of it and don’t replace it.

As an occupational therapist, I have a slightly different perspective. I still need to visualize and touch to treat. But because my training is as a therapist, I put more effort into my relationship with my clients of all ages. I am not simply there to assess and treat. I am teaching as well. And “students” who are uncomfortable aren’t great learners who will continue to work with me on recovery and healing. I spend time and attention to develop my client’s level of comfort. I have that luxury in the longer therapy sessions I am given.

I need my clients to feel OK about my viewing and touching them in each session. And I do not do emergency treatments, where life is on the line. Doctors do. Their residencies train them to hyperfocus, and one of the things that gets lost in translation is how uncomfortable their patients with trauma histories can become in an exam.

What can you do when you feel over-exposed in an exam?

You can either ask for more modest draping, or you can BYOG. Yup. You can bring a more modest exam gown or leave on clothing that doesn’t compromise the exam.

Asking for a sheet or an extra paper gown is probably the easiest thing to do. You don’t have to buy or bring anything. Your provider will tell you if it is in their way; no provider would negate part of the exam because you insist on modest draping. They may remove it briefly, but you can ask if it can be replaced as they move their treatment to another area of your body.

Where can you buy a more modest exam gown for regular appointments? Gownies This site has gowns for all types of bodies (people of all genders could want more coverage!). If you pick a design or color that your system likes, you have shown them the consideration that they missed growing up. These gowns and jackets still allow your provider to treat you. This includes access for monitor lines and pumps.

The most important thing is to know that you have options and that your provider can alter their actions to increase your ability to “stay in the room”!

Why Does Tech Torpedo Sleep?

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Everyone loves their devices.

Everyone.

Except your brain and body.

Your brain gets glitchy with doom scrolling, and how much it loves the simple rewards of clicking through things rather than diving deep into stuff. It goes right into a high Beta brainwave state, where it is hyper focused but vulnerable to anxiety and anger.

Your body doesn’t do any better on tech. Between craning and twisting your neck vertebrae to see your phone, to wrecking your thumb ligaments, to adrenaline rushes with bursts of short news pieces, to alarms that a thunderstorm or an escaped criminal is in your area….you get it. Brains and bodies don’t love tech the way we do.

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Tech has a particularly disastrous effect on sleep. Let’s forget the way it feels to have revenge sleep procrastination Revenge Bedtime Procrastination: How it is Different for People With DID? . The blue LED light emitted from tech makes it harder for you to fall and stay asleep. I just did sleep coaching for a friend who is a trauma survivor. She said she was so happy I could help her reduce, but not eliminate, TV. “TV is a friend to me” was her exact quote.

I understood. I have a similar, but not identical feeling. But that screen, like all of the others in my home and hers, emits blue LED light. The part of the light spectrum that is alerting to our brains. Oops. One of the many ways in which staring at a screen is rewarding. You feel more “up”. Even when doom scrolling, you feel more alert even as you read bad, bad news. And when off, those little buttons and that clock also emit some blue light. Just when you would like to sleep.

Uh-oh.

It is really hard to remove all tech, or let it sit there but stop using it. It can be scary too. It can feel like what the “bad people” of your past would do to you: punish you. The good news? Any small change right now will make your sleep better. And every improvement brings you closer to being able to make another change.

Moderation and caring thoughtful change is not only mature, it is healing. You and your system experience what the kind and thoughtful stewardship of tech feels like. This is what healthy relationships are like. We care for others and support them to be their best selves while accepting that they aren’t perfect. And best of all, you can improve things today without feeling like your lifeline to friends and information and entertainment is gone.

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What can you do to minimize the blue light from tech without going “Cold Turkey”?

Change your device settings. Go into “systems” and look for “displays”. Select “night shift” for a Mac device, and “night light” for a PC.
Move the device further away from your eyes. A TV screen is better than a tablet, for example. A tablet on a stand is better than a phone.
Cover the screen, and just listen. You know you walk away to do stuff and just listen to it a lot anyway, right?
Cover the bright little buttons with stickers that dull the lights. Find FLANCCI stickers on Amazon.
Use lightbulbs that remove blue light. Not inexpensive, but getting cheaper all the time, and they last a very long time.
Avoid reaching for screens in the middle of the night. Be prepared, and amass other diversions around you to reach for if you get up and you can’t sleep.

Should Trauma Survivors Avoid Taking Naps?

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A lovely long nap seems like a gift. And for trauma survivors who fear sleeping at night, a nap might be their most peaceful sleeping time.

It can also be the major contributor to their sleep terrors and nighttime insomnia.

The reasons for this are not a mystery to sleep scientists. They don’t have to know anything about trauma, dissociation, or DID to explain it. I will try to use as few scientific terms as I can to tell you what they are saying about daytime naps and the sleep problems common to trauma survivors.

Everyone’s brain produces a chemical that builds up during the day and produces a feeling of sleepiness at night. Adenosine accumulates whether or not you have things to get done. Naps “suck up” some of this chemical, and can make it harder to feel sleepy. Could you still be exhausted at night? Sure. Fatigue and sleepiness aren’t the same thing. Ask any first-time parent during COVID. But being sleepy is what you need to fall asleep and stay asleep in a healthy way. Being exhausted is one of the risk factors for sleep terrors and insomnia.
Melatonin is another brain chemical that is important for sleep. Our brains inhibit it when we are up and moving in bright light. The more we stay in that light during the day, the more our brains block the release of Melatonin. When we close the lights/shades and close our eyes, this triggers the release of this hormone, and we feel the pressure to sleep. Melatonin doesn’t help us stay asleep, but it helps us initially fall asleep. Napping disrupts this natural cycle, delaying nighttime sleep onset.
Poor quality sleep, insomnia, being exhausted, and poor quality REM sleep in particular (predominant in the later phases of sleep) will all predispose people to night terrors and insomnia. As if trauma survivors needed help for those!

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What can I do when I want so badly to take a nap?

Try to be more active, not less. Open the shades, go outside in the later afternoon without sunglasses since cloudy days still give you more lux (measure of light) than interior lights. Turn on your fave tunes and maybe dance around the office or the house if you can, or do something else that is active. Not willing to show your coworkers your dance moves? You can do something calming but active, like Progressive Muscle Relaxation. But if it is safe and available to you, it is best if you are more physically active outdoors. You may be surprised how effective this will be when compared to taking a snooze.

If you nap to avoid feelings or current stressors, those have to be dealt with anyway. Don’t pay with your physical and mental health today for something that happened last week or 25 years ago. You are then paying twice! Talk to your therapist or a trusted friend. Make a plan to tackle things in a small way. A way that makes you feel powerful and safe.

If you are napping because you fear sleeping at night, you need to work on making your sleep environment feel safer and building your orientation to the current, safer time. “This” is not “then”, and “these people” are not “those people”. The more you and/or your system knows this is true, the easier it will be to sleep.

Are there any naps that are OK?

Sure. A super-short one that happens early in the afternoon. By “short”, I mean 10-20 minutes, with an alarm to wake you. You get extra points if it occurs at the same time every single day. Your body will get used to it, and it might not affect nighttime sleep in a negative way. If it seems to be doing that, then you know what to do…

What if I am sick?

That is a different story. An acute illness like COVID or the flu will make you want to sleep. That’s OK. Your body knows the healing power of sleep. With a chronic illness, you still need to rest, but if you don’t need more nighttime sleep (7-9 hours is your goal), then targeted rest is better for you than a nap. You can totally destroy your circadian rhythm so that you sleep more in the day and are awake at night. Try hard to avoid this, because it is associated with damage to your physical health. It will take time to move things back to a better schedule, and you may need professional help to do it. But if you have a chronic illness, you should know how damaging this pattern can be to your health.

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Why Your Nightcap Could Torpedo Your Expensive Trauma Therapy

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It is pretty common for trauma survivors to look to alcohol to take the edge off at the end of a rough day. Most days are challenging when you have DID. Some days it feels like 5 pm by noon. Or earlier.

A small glass of wine or a single bottle of brew seems quite minor when you consider the other ways to unwind, such as sleep meds (mostly highly addictive), non-prescribed drugs, or self-harm. It can seem that as long as you don’t go overboard, a little alcohol couldn’t possibly be that bad for you.

It might not be the worst thing you could do, but it could erode much of the benefit from of your last therapy session.

How does that happen?

Phase I of trauma therapy is all about stabilization: building emotional regulation, learning new coping strategies, and developing smooth system communication. Phase II is processing trauma memories, and phase III is crafting a satisfying life that isn’t oriented around the past and the symptoms of DID.

Trauma therapy has a strong learning component in every phase, but particularly in phase I, which is actually present throughout all 3 treatment phases. It is only a separate stage in theory. Every therapist uses and helps clients refine their phase I strategies during trauma treatment.

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That nightcap (a small glass of wine, a shot, or a beer) will be metabolized by your liver overnight. The process will produce ketones, and those need to be metabolized. The degradation of that nightcap while you sleep will rob you of some of your REM sleep a few hours after it leaves your stomach. REM (rapid eye movement) sleep is predominant in the 2nd half of your night of sleep. The disruptive effects of ketone metabolism on REM sleep is why you are more likely to awaken in the early hours of the morning after drinking alcohol. Reducing REM sleep is also a trigger for night terrors; these are the times that you awake screaming and shaking while still asleep but don’t remember anything. It wasn’t a nightmare; it was a night terror. All the terror of your past, but without all the story line. If you thought that a part was not giving you access to your dream, you might not be correctly looking at what was happening unless you understand sleep terrors.

REM sleep is when the brain focuses more on processing the emotional content of the past day, but also when it endeavors to connect information about your emotional learning for the past few days. There are some trauma therapists that think that dissociation creates difficulty with pathways in the brain that use REM sleep for this purpose. We do know that almost 90% of trauma survivors with any diagnosis have some degree of sleep problems.

Poor sleep during this stage of sleep makes it harder to knit together newly learned information into emotional growth, and poor sleep due to alcohol will make it even harder to process emotional content. Content you may have paid for with your HSA dollars or actual greenbacks. Great therapists are more frequently cash-only.

Oops.

Eroding learning is never anyone’s intent. Not at those prices.

So if you are wondering why you aren’t making as much progress as you had hoped, take a look at what else you are doing day AND night that could be unintentionally torpedoing your best efforts and your therapist’s efforts. If you aren’t getting enough sleep or enough quality sleep, that might be one contributor to your sense of being stuck in treatment.

For more information on sleep and DID, read Could Getting Better Sleep Decrease Your Response to Trauma Triggers? and Three Common Sleep Issues for Trauma Survivors (and an effective treatment for nightmares!) .

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How Trauma Survivors With DID Can Accept Help While in the Hospital for Medical Issues

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Being hospitalized for a physical illness or injury can be extremely stressful. No one gets any sleep, the food is often a bit scary, and communicating with your outside providers might be tough to manage.

But too often, you just want some help to get to the bathroom… in time.

If you have DID, asking for help OR accepting the help that is offered can be almost as hard to do as getting through the medical treatments.

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Many people with DID find that asking for help while being temporarily in need of assistance is as difficult as the pain or other symptoms that brought them into the hospital.

This struggle to ask for help, accept help, and manage the help you receive isn’t so hard to understand. That doesn’t mean that it is recognized by staff. This is true even if you have disclosed your DID diagnosis, and it is your chart. Do not expect that psychiatric consult to make a difference in this situation. Translating a diagnosis into practical strategies outside of crisis is not a psychiatrist’s specialty.

The source of the challenges can be missed or minimized by inexperienced psychotherapists. This isn’t part of the DSM diagnostic criteria, and it is absent in almost every book on DID treatment.

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Finding it hard to ask for help, requiring help for simple and intimate acts, and having difficulty getting prompt and effective assistance create frustration. Wanting to be cared for when in pain or immobilized is also universal. This is what comes to the mind of someone who doesn’t understand DID.

But not everyone hospitalized has a history of being abused and neglected to the degree that adults with DID have experienced in their past.

Here are some of the reasons asking for help in the hospital is so very hard:

When care was absent or dangerous, being independent is a survival strategy. Loss of independence creates vulnerability. Vulnerability triggers a primal fear.
When trust in strangers is absent, trusting in a provider can be very difficult but necessary, due to incapacity while hospitalized.
Needing care can trigger parts whose survival strategy is intense attachment to a stranger. Intense attachments to anyone you really do not know are a recipe for disappointment and abandonment.
Changing shifts mean that the person who provided good care is never seen again, creating another opportunity to trigger abandonment issues from long ago. Or not so long ago.
Slow care delivery, or inconsistent/inadequate care delivery reinforces a belief of distrust, unworthiness, or suspicion of malicious intent toward a caregiver. Sometimes this is valid. Often it is hard to know.

How can you ask for help?

If you think that other people would deserve assistance in this situation, then you deserve care too. Parts that say otherwise need to know that “now” is not then, and “these people” are not “those people”. Healthy trust is earned, and can be fractional. Asking for some small act or object, and observing the quality of the response, is a good way to start. Your support person can give their input, helping you to identify good candidates for your trust.

How Can Your System Support You?

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You want to be the one requesting and receiving the care unless you are in too much pain, too disoriented, or too dissociated. This builds your system’s confidence in YOU! You can also ask your adult parts with good communication skills to support you. A part that is active at work, at church or shul, or a part that runs meetings would be a good choice. They have a skill set that could be helpful to you. Immediate and “blanket” trust or distrust should be questioned. It is likely to be the influence of parts that operate under old survival methods rather than healthy boundaries and attachments.

Some care really isn’t good care. It isn’t you; it is them.

What can you do then?

You can think of what you would do if your friend, your child, or your partner were in this situation. Find your wise adult part, and let them be the advocate that you would certainly be for important others in your life.
Ask the most kind and supportive person around you to give you some assistance. This may not be the person with the most letters after their name, like a doctor. The care aide, or the food service staff person, could be your best advocate in the moment to get what you need.
Act sooner rather than later. A good plan now is better than a terrific plan later. Letting your pain go up or your frustration fester risks more dissociation and bad outcomes.

Need more information like this?

I wrote a book for you!

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“Staying in the Room” has changed the lives and the quality of care for many people with DID! Armed with strategies from the book that are easy to use and don’t require you to bring your therapist to your dentist or doctor’s appointments, it could be the survival manual you need!

Learn how to ask for adaptations that transform the OB/GYN visit. Understand what questions to ask a new doctor to get results. Find out why what you do in between appointments could be more essential to your health than you could imagine.

Find it today on Amazon!

How to Manage Your Response to Physical Pain When You Have DID

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No one wants to be in physical pain.

No one.

Parts who think you deserve pain often believe the terrible things they were told in childhood about you, or hope that by feeling bad now you will avoid even worse things later. Sometimes they simply feel that being in physical pain is familiar to them, and “familiar” is easier to handle than something new and different.

If these reasons sound illogical, immature, or even ridiculous to you, then the current self-state in control of your thoughts is mature and logical. Parts are born from trauma, and do not have the skills to handle physical pain in the way an adult can. They might resort to desperate measures because they see every event as a dangerous crisis, even now. They are not acting or reacting as if they knew about the inherent power of being a competent and compassionate adult.

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Managing pain from illness or injury can be difficult for trauma survivors who se brains associate any current pain anywhere in the body with past abuse or neglect. This doesn’t have to be a conscious thought to happen to a survivor. And it can happen remarkably fast.

One of the “stickiest” problems with trauma disorders is the speed with which these responses occur. This makes sense; children must quickly sense danger and act. Their habitual reactions will sometimes prevent more abuse or allow them to switch before it begins. If this is successful, that pattern will be used the next time something bad happens. And with people who have DID, there were a lot of “next times”. The nervous system will refine fear or defense responses until the neurological pathway is almost reflexive. A bad experience in childhood is now an adult neurological response without conscious control.

This makes over-reactions to physical pain and the search for substances or dangerous actions in adulthood very “sticky”. Stopping it is like stopping a freight train on the tracks.

One solution is quite similar to dealing with that freight train on the tracks: Create warning signals and mechanisms to re-route.

To continue with the analogy, this makes YOU the part of the system that is driving this train. The train is not driving you. Nobody drives a freight train independently from the first day on the job. There is a learning period, and you take easier routes at first. You work up to the trickiest towns and cities during rush hours.

With pain management, the same thing applies. Everyone gets a bump or a bruise, a headache, a cold, or a hangnail. Use these minor episodes of pain for practicing more effective responses. When you have a bunch of effective and familiar ways of thinking, and actual physical tools to deal with pain, you will be a better driver when the route gets hard to navigate (see how I wove this site’s name into this post)?

This isn’t some woo-woo suggestion that the agony of a major injury or dental procedure can be eliminated with your positive outlook. Far from it. You will need actual medical or dental intervention. Dealing effectively with pain requires calm thought so that you can get good care, advocate for what you need, and avoid excessive fear and anger. Those emotions are well-understood to…you guessed it…increase pain!

What does this look like?

Gather your pain intervention tools at home or at the office for quick access. Store them for easy access, know how to use them, and practice using them so that you know when and how ice, heat, pain gel, NSAID meds, pain pads, etc. are each optimal for you.
Experiment with different safe choices. This means that you can learn about what things could harm you and avoid those. If you are not sure what is safe and what could harm you, find a healthcare provider to help you. Ask before you use something that can harm you. Your system will not trust you if you prove to be untrustworthy. Make it easy for them to trust you.
Show them to your system so that they know what you know: we have stuff that works.
Use imagery or visualizations that you have refined for its calming but also energizing effects. This isn’t time to sit back, because you probably have to be able to get care or take care of the body.
Make a list of your resources and have it available on paper, on screens, or with your therapist. In DID, stuff can get lost or forgotten. Parts can erase what they fear. Be aware of this and act accordingly. You may have to make the list decorative for parts that are calmed down or convinced by how nice things look. If they need your therapist’s stamp of approval, get it. In writing if necessary.
If your therapist is trained in DBT and CBT principles, learn a few useful skills that can help you think clearly when you are in pain.
If thinking clearly is the problem when you are in pain, you need better stabilization techniques first. Nobody remembers to think of red and blue things in an appointment once they have switched. Ask to be taught a wide variety of techniques and practice them in low-stress situations to get skilled at using them when you are in pain.

Need more information on dealing with pain, appointments, doctors, and dentists?

I wrote a book for you!

“Staying in the Room” is available as a paperback on Amazon . Get a copy today and start learning how to make life easier when you have DID!

Starting to Dissociate in an Appointment? You Have Some Choices

Everyone with DID has been there.

You are in the middle of a medical or dental appointment, and you either hear another part’s words coming out of your mouth, or you feel yourself floating to the ceiling, or you can’t open your mouth to answer a simple question.

You are dissociating or switching.

Think fast. Dissociation isn’t a slow process. How could it be? When an abuser was present, your nervous system had to be lightening-quick.
Choose the stabilization technique you can use right away, in the moment. Even if it isn’t a good one, speed is more important than efficacy if you can feel yourself sliding away.
Communicate inside. Your parts need to hear from you and see that these people are not “those people” and this place is not “that place”, and that this day is not “back then”. If you don’t understand that parts can have a different understanding of time, then you need to learn more about DID.
Ask for a break. Even a few moments could give you the time to use a stabilization strategy. Dissociation slows thinking, so your graduate degree or your professional license isn’t an indicator of how successful you will be at parsing the situation. We know a lot about how autonomic activation will torpedo logical thought, so don’t beat yourself up for being unable to think.

joy

Once the appointment is over, you have to consider that this could happen again, and make a plan to circumvent dissociation the next time.

It is possible. I wrote a book on how to do it!

Accept that you were almost certainly somewhat dissociated before the appointment. Some people with DID live in a partial trance state. They don’t always know it. But if you noticed changes as soon as you made the appointment or when you got up the day of the appointment, you know that you were vulnerable well before you left the waiting room.
Make a better plan. Use stabilization strategies earlier, perhaps days earlier. The best techniques for you are the ones that work for you, and you don’t know that unless you have learned and practiced them in other situations. My book has an entire chapter on how important practicing them can be for successful appointments. Practice right, and you are like the pit stop crew at the Indy 500. On it!
Consider your parts. Perhaps they didn’t tell you how they felt about the appointment. Perhaps you did not ask. Parts can react exactly how you were raised: with fear, anger, deceit even! Care for them in the ways you were never cared for; with consideration, forethought, and compassion. This is a key to all treatment with DID: learning to give yourself the care you never received.

Looking for more ideas on managing appointments?

I wrote a book for you!

Staying in the Room: Managing Medical and Dental Care When You Have DID

There was simply nothing out there that was practical and helpful to adults with DID. So I wrote a book.

DID isn’t a “bad” case of PTSD. DID is different, and it can be hard to find information that is clear and compassionate, AND useful.

Learn why trauma-informed care principles do not always help people with DID. They can make things worse.
Understand why expecting healthcare providers to know much about DID isn’t the best use of your time and energy. Really.
Learn how to widen your view of stabilization strategies to deepen your “toolbox”.
Build the ability to care for yourself at home. Not needing an appointment is the best strategy of all!
Tough appointments like pelvic exams and dental treatments are covered, not ignored.
If you need the ER, be ready with your DID emergency plan. I show you how.
Treatments can be adapted so that they are not as painful or as traumatic. You can ask for an adaptation without offending your provider or reducing their ability to help you. Because I am a provider, I can give you the specifics and tell you when an adaptation is most effective.

Buy a copy of “Staying in the Room” on Amazon today!

Make your next appointment better without needing to bring your therapist with you, or needing a day off from work to recover!

You can do it!

breathing trauma