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

pexels-kindel-media-7298899

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.

pexels-andrea-piacquadio-3791136

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.

train 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!

31+xCqAe5nL._SX331_BO1,204,203,200_

“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!

  1. 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.  
  2. 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!
  3. 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!

31+xCqAe5nL._SX331_BO1,204,203,200_

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

 

Should You Tell Your Dentist You Have DID?

browntoothbrushes

Short answer:  It depends.

Long answer:  It depends on your goal.

Revealing a diagnosis because you think it will result in an immediate action by the dentist, which will make sitting in that chair easier, is usually based on magical thinking arising from stress and anxiety.  It makes sense:  “please give me one thing I can do to make these awful feelings go away.”

I wish life with DID worked that way.

Parts might want to reveal your diagnosis because they think they can scare the dentist, and that would defend them against being abused or mistreated.  Again, this is faulty thinking from a part that believes things are as desperate and dangerous as they were in the past.  It is understandable.  They were formed in terror.  They react as if the terror is still going on.  But they are wrong.  You are an adult, with some agency and power now.

jugglerff

There is one situation in which telling your dentist about your DID diagnosis is absolutely necessary, and not saying anything will almost certainly make your treatment much more difficult for both of you.

If you are almost certain you will switch during your appointment, because you have done so in the past, and the part that appeared was either aggressive, combative, or tried to leave during a procedure, you cannot remain silent.  Saying nothing when this has happened repeatedly in other appointments is a mistake.  Once it occurs in an exam or treatment without you having given warning, your credibility with that provider has been cratered.

Another massively disruptive action would be to freeze in dissociation and be immobilized during treatment.  Not being able to speak or move would be alarming to a provider, and this needs to be addressed honestly.  You will have to share your best strategies for them to take if it happens.  They could be more scared at that moment than you are.

pexels-nohk-1749057

Anyone who has parts that take over, whether you are co-conscious with them or you have complete amnesia for the time they are “out”, needs to work hard on internal communication.  They need to learn effective stabilization skills, because switching often is the result of being triggered.  It can be done.  It will make your life better, and your medical and dental appointments better.  Your system will be able to take a breath.

Question:  What about if I am just severely anxious and afraid, but don’t think I will switch?

Answer:  You still have to think of your ultimate goal(s) before you reveal your diagnosis.

Assuming that saying you have DID will result in your dentist knowing how to alter their treatment to help you be less triggered is not a fair assumption.  Not now, not in our current state of healthcare.  There is no way to know if they know what DID really is.  They may not be any more informed than your next door neighbor.  They could have watched the series “United States of Tara” and that is ALL they know about DID.  Remember, this is someone who works on teeth.

Sadly, providers are still people, with the same biases and the same issues as the rest of us.  Some are beyond compassionate and curious.  They want to learn.  Others are judgmental and closed-minded.  You don’t get wings with that license! They are definitely not trauma therapists, so even the most caring provider has very limited knowledge and skills about how to deal with dissociation.

Can I say anything at all?

Of course.  There is a lot you can say and do that will help you.

Every dentist is familiar with people who find sitting in their chair anxiety-provoking.  Saying that you are very anxious should alert them to bring their “A-game” of anti-anxiety tools to bear.  Saying that you have had some traumatic experiences in the past, and dental work makes it harder to deal with them might also result in getting more compassion from the dentist, and it is a warning that you may be edgier or more emotional during treatment.

pexels-olya-kobruseva-5428833

If you need support, you can bring someone with you, bring a toy or other item that helps you channel your support team, or bring concrete ideas about how the session should be managed.  In my book, “Staying In The Room”, I describe many ways that examinations can be done to reduce stress and reduce the chance of increasing dissociation.  Patients can make requests for dentists to alter their treatment in ways that can reduce dissociative symptoms but don’t significantly affect the ability of a dentist or doctor to do their job.  Dental patients with DID who are informed and  know their system well can be proactive and empowered.

Your appointment could go well if you reveal your diagnosis.  It just might not get you what you want:  excellent care with less fear and pain.

Want more information on how to make appointments better without needing to be sedated or taking your therapist with you for a cleaning?

I wrote a book for you!

Staying in the Room:  Managing Medical and Dental Care When You Have DID is available as an e-book or a paperback on Amazon .

31+xCqAe5nL._SX331_BO1,204,203,200_

Revenge Bedtime Procrastination: How it is Different for People With DID?

clocks
Question:   Why would anyone take revenge on themselves as trauma survivors?
Answer:     They (incorrectly) think they are getting a reward.

Revenge Bedtime procrastination is something that people without trauma histories do all the time.  Adults with DID aren’t alone with this one.

It is when you have had a full day, with lots of “to-do” items, most of them boring, stressful, or downright miserable.  You come home, and the theme continues even though the location changed.  Life in the 21st century can be like that.

Bedtime arrives.  It just so happens that that is when your fave show is on, or when you can sit down and play a video game on your phone, or read your novel.  It is when you can go online and look at social media for a while.  “I deserve a bit of fun” you think, and 10 minutes turns into 60.  You toss the phone and put your head down on the pillow.

You are still awake 30 minutes later.

You blame your job, your partner, your dog, or the tight back muscles you can feel cramping up.

You have just engaged in revenge bedtime procrastination.

proneipad

Why is this such a risk to your health?

We don’t know everything about how sleep affects physical and mental health.  But we know enough.  We know that short sleep (sleeping less that 6 hours/night consistently) is really bad for your body and mind.  Name a body part or a mental skill.  Short sleep makes it worse.  It is the all-purpose hammer to everything good about life and living.  Revenge bedtime procrastination makes it harder for you to fall asleep and then get a good night’s sleep, because you did not wind down the brain and body to prepare it to sleep.  You are cutting into the preparation time and  stealing quality sleep opportunity time, all in one step.

But I crash in less than 5 minutes!  I am good.  Honestly.  You don’t know me.

Sorry.

Normal brains don’t crash.  They glide into sleep.

pexels-andrea-piacquadio-3791136

People who crash are almost certainly sleep-deprived.  Or brain-damaged, or have a brain-based sleep dysfunction.  And you are probably not the latter; you are more likely the former: sleep-deprived.

If the following internal conversation is running through your head while you read, don’t stop: read all the way down:

What can I do?  I deserve, actually, I need a break.  I gave everything I had to everyone else, all day long.  What about “me” time?  I am starting to be thinking that revenge was a good word.  I am getting more resentful by the moment.

Answer:  Yes, you definitely deserve “me” time.  You deserve fun.  You deserve it all.  All of your system deserves it.

If you have bedtime sleep procrastination, you are taking it at the wrong time of day and not refining it for optimal effect.

  1. You may need to take another look at your schedule and your priorities.  And the other people in your life may have to share more of your work/home burden, or do their share of their own jobs.
  2.  The best way to deal with revenge bedtime procrastination is to front-load your “me” time.  Delegate or simplify, but think carefully about what you are sacrificing.  You are sacrificing ….you.  Get your “me” time in early.  Get it, and remember that you made yourself a priority.  You have DID, so you must think about your system too.  Let all of your parts have something that is their “me” time as well.  They can take it in groups rather than individual time.  Groups work great.  You have probably been in some and learned a lot!
  3.  You won’t need to devote a lot of time to this, particularly if what you do has meaning to you AND them.  A meaningful action, though small, means more than taking a personal day for some systems.  Your system can be taught to savor the fun and to accept that there is a limit.  You won’t be quitting your job so you can go to every amusement park in the country, or empty your 401K so they can have a Tesla.  As long as they know they will get time, and it won’t be grabbed away or discounted.  Doing that bait-and-switch feels as bad as it sounds.
  4. This could mean planning for it.  You can do it, because the reward is sweeter.  You might be looking forward to sleeping, because the sooner you sleep, the sooner it will be tomorrow and your “me” time is early, not late.

sunflower

Three Common Sleep Issues for Trauma Survivors (and an effective treatment for nightmares!)

pexels-asad-photo-maldives-457881

Trauma survivors with and without DID often have sleep-related problems.  They are so common, in fact, that it leaves many providers wondering if disordered sleep should be a component of the next DSM diagnostic criteria.

I will leave that to the psychiatrists.  Today’s post is about sleep behaviors that scare adults with DID, and why they are really guideposts to a solution for better mental and physical health.

That’s right.

Scary sleep behaviors could be your brain’s way of getting your attention and pointing out how you can heal from trauma.

litsparkler

  1.  Hypnic Jerks.  These are the sudden large-muscle movements that happen just before you fall asleep.  Good news:  they aren’t a sign of anything bad.  They are usually an indication that your brain is struggling to wind down.  Lower your caffeine, alcohol, nicotine, late-night exercise marathons, and work on getting more sleep.  To repeat:  they aren’t dangerous.
  2. Sleep Inertia:  This is the grogginess you can feel on awakening.  You might find it hard to move, speak, think, or pay attention.  It can last for a few minutes or over an hour.  This is also….normal!  In fact, the degree of sleep inertia you experience is mostly based on genetics.  It isn’t an indication of trauma or even sleep deprivation.  People with DID are so used to thinking of themselves as abnormal, and used to other people thinking that too, that it might come as a shock that this is 100% normal.  Recalculate how you see yourself.
  3. Sleep Paralysis:  OK, this one can be really scary for people with DID.  This can happen when falling asleep OR when waking, even in the middle of the night.  You can’t move, can’t talk, you may have what seem to be hallucinations, and you may experience a lot of fear from any of those things.  Good news!  This isn’t an indication of anything that you aren’t already aware of!  It is more common with people with trauma histories, people with insomnia, anxiety, panic attacks, and narcolepsy.  Building better sleep routines should decrease these episodes, even if you aren’t in therapy.

pexels-yunus-tuğ-7877810

What can you do?

Work on improving your sleep hygiene in ways that also support your system and make your waking life better.  Healing from DID means that you must communicate internally and be engaged with your system as much as you are capable of doing at this moment.  Don’t have any way to build connections inside but still want to sleep better?  You can still work on sleep skills, but you might hit a lot of resistance and make very slow progress compared to the effort you are putting in.

When you sleep better, you are more capable of dealing with everyday stress and with working in therapy.  You will be a better friend, partner, parent, and worker.  Life gets better, even if therapy isn’t going great or if you are still trying to find a good therapist.  Don’t take my word for it.  There is a bunch of research on the many types of mental issues that get better when sleep problems decrease.  Really.  The good kinds of studies:  peer-reviewed, double-blind; all that stuff.  Not on DID.  Sadly, DID ends up being exclusion criteria for a lot of studies.  But these have been done across a large number of diagnostic categories of mental illnesses, and for people who are really struggling in everyday life.

Do you have an issue with nightmares?

This is a very common problem for people with all forms of trauma, and there is a treatment for it!

No, not a drug.  There is no drug that will sedate you enough to get rid of nightmares.  None.

Imagery Rehearsal could work for you.  It is something you can learn and use.  If your nightmare is of being abused, you may have to try lucid dreaming techniques too.  The reason that many therapists have been told to avoid using Imagery Rehearsal with trauma survivors that dream about their abuse is (you already knew the answer)  they don’t know how to deal with dissociative responses.  And they don’t know how to teach stabilization techniques to people with DID so that they actually can use them at home.

tunnel

If you have brushed off practicing these techniques because you wanted to get into talking about the past or talking about your boss, you may want to rethink that decision.  When your sleep improves, you will have the energy to deal with jerks at work and the brain reserve to work on painful things too.  There is at least one research study that suggests that working on nightmares BEFORE you work on other sleep issues could give you the biggest boost in sleep quality.  But you have to be able to talk about and visualize your nightmares without severely dissociating and being unable to recover during your practice.

Your therapist can help you figure out if you are stable enough to work with Imagery Rehearsal techniques.  If not, there is good news (I know, you weren’t expecting that)!  Better sleep hygiene strategies improve the quality of your sleep.  Your brain will thank you by being calmer during sleep, reducing the nightmare frequency and intensity.  If you combine great sleep hygiene strategies with internal communication and daily stabilization techniques…you will get even better results from your sleep AND in therapy.  This is a win-win-win!!!

I will be getting certified as a sleep coach this spring.  My hope is that I can support the DID community to build this essential physical and mental health skill!

Need more information on managing life with DID?

I wrote a book on how to handle healthcare appointments and improve your ability to care for yourself!

31+xCqAe5nL._SX331_BO1,204,203,200_

“Staying In The Room:  Managing Medical and Dental Care When You Have DID” is filled with practical strategies to get good care…and not need so much of it!  It is available as an affordable e-book or as a paperback on Amazon  .

How to Avoid Needing Medical and Dental Care When You Have DID

jony-ariadi-QZub8Ni3x_c-unsplash

Most people really don’t enjoy being ill or injured.  For the people that do find being sick a good thing, this isn’t the blog site for you.  Google “Munchausen” and good luck to you.

For everyone else, being hurt or feeling sick is miserable, and one of your strongest wishes is to stay out of the ER, the hospital, and even Urgent Care.

Too many people with DID avoid getting the treatments they need because of their fears, their concern that they will dissociate further during treatment, and because they have to focus on the body to receive care.  Then eventually something bad happens, and they end up needing emergency treatment or a series of treatments.

hospgownphone

Avoiding those appointments isn’t always possible, but it is always desirable.  This post is about how to take good enough care of yourself to avoid much MORE care.

It can be done.  Really.  You can minimize bad things happening to you.

This is the first thing to understand: childhood abuse is often accompanied by its mean cousin, childhood neglect.  It doesn’t always look the same as in the movies.  You could live in a wealthy home, surrounded by wonderful things, and yet be neglected as a child.  Trust me on this one.  The neglect might be that your health wasn’t a priority, or that you were never shown how to care for your body so that health was maintained.  Lots of bad things happen in fancy homes.  Not all of it is as dramatic as the movie-of the-week stuff.  But it makes living a healthy life as an adult much harder.

Children who have been abused or neglected become adults who might carry around a variety of attitudes and opinions that torpedo their health:

  1. “I am young; I will go to a doctor when I am old.”
  2. “All drugs are dangerous.  I only put natural things into my body.”
  3. “If they find out I have DID, they will admit me to a psych ward, or not listen to anything I say.”
  4. “When I refuse to tell them something, or refuse a treatment, they will hate me and retaliate.”
  5. “If they tell me bad news, I will fall apart big time.”
  6. “They are going to criticize me and blame me.  I can’t take that.”
  7. “The pain from their treatment won’t be tolerable.  I will be in agony.”

There are more.  This is not the complete list.  It is just enough to communicate how childhood neglect sets adults with DID up for failure before they even enter a healthcare provider’s office.

We can turn this around.

It can start today.

pexels-goda-morgan-9896886

One of the first places to go is to the basics.  Basic health information.  The basics of maintaining your health are found online and in books.  With DID, parts have their own reactions to information and events.  You could have a graduate degree in nursing, but you have other parts that freak out when you have a headache.  It happens.

Adults with DID often have younger parts.  Some of those parts might like to read books on health that are written for kids.  These books tend to focus on the positive, and limit the scary stories.  They are gentle but firm in their teachings about basic everyday healthcare.  That could make your system relax a little.

What About Feeling Sad/Bad About What I Didn’t Learn as a Child?

A part of trauma therapy is grieving the loss of a decent childhood.  There can still be some grieving to do.  Realizing that part of the horror of your childhood was not learning what the other kids absorbed naturally about caring for themselves can be incredibly sad.  You could feel anger as well.  And some other things.  Using all of your coping skills to be prepared for a wave of sadness, anger, and loss is a smart choice.

Some people with DID would prefer not to open that door.  The problem with that strategy is that leaves them vulnerable to greater future pain.  Physical as well as emotional.  This stuff just doesn’t evaporate.  It festers like an infection.  Trauma is exactly that “sticky”.  The best way to prevent greater pain is to find the easiest and most painless way to deal with things today.

pexels-johannes-plenio-1165991

And that path is to do small but healthy things today.  Do two tomorrow.  Do both of them a few seconds longer on the next day.  Rinse and repeat.  When I say small, I mean very small.  There is a good reason not to jump into the deep end of the pool.  That reason is the way structurally dissociated personalities behave.

Start small.  That way your system doesn’t have as big a shock or as much of a chance to react with defensive stuff like thinking that you don’t deserve to be treated well.  Never underestimate the ways your system can act like the bad people in your past.  Be smart, and present things in ways that don’t make it easy for parts to go there.

browntoothbrushes

One of the best things I can think of is to floss your teeth.  Not only is it cheap and quick, we know now that good gum health has major effects on reducing inflammation throughout the body.  Everywhere.  Since nothing is separate, reducing inflammation is a good thing for most parts of your body.  

Did you know that chronic stress is associated with chronic inflammation?  Yeah, this isn’t good news.  But this means that taking action to reduce overall inflammation is a way to fight back against past actions done to you.  So grab some floss and a book for kids on how to care for your teeth, and consider it your first step in turning back the tide of trauma’s effects.

You can do the same with sleep.  I have written a bunch of posts on sleep.  That is because getting slightly better sleep quality and a healthy amount of sleep is also cheap and affects so many aspects of health.  Read  Could Getting Better Sleep Decrease Your Response to Trauma Triggers?  and  Sleep And DID: Could Better Sleep Be As Important As Therapy?  to learn more.

There are other ways to stay out of the doctor’s office.  Drinking enough water (but not too much-it happens!) is also cheap and makes every organ in your body work better.  So there you have it.  Three cheap things that could prevent you from ending up sick or injured.  None of them have to be done in a way that risks more dissociation or retaliation from a part that listened to your abusers.

Want more information?

I wrote a book for you!

31+xCqAe5nL._SX331_BO1,204,203,200_

“Staying In The Room” explains why managing healthcare is so difficult, but it doesn’t depend on trauma-informed care providers to make changes.  It is all about trauma survivors learning how to manage their system, their actions, and their providers to get the care they deserve.

And it focuses on adults with DID and OSDD.  

Want to make your next pelvic exam less of a nightmare?  It is in there!

Want to go to the dentist and not freeze solid in fear?  It is in there!

Want to survive the hospital or Urgent Care without needing time off from work to recover from how you were treated?  It is in there!

“Staying In the Room:  Managing Medical and Dental Care When You Have DID” is available on Amazon  as an affordable e-book that can be read with their free app, or as a paperback.

joy

Why is it so Hard to Use Many Common Stabilization Strategies in Medical and Dental Appointments?

The short answer?

Because the part of your brain that goes partially “off-line” when you dissociate is the SAME PART that is supposed to remember and use the techniques your therapist taught you in session.

Yup.  

I know.

Me too.

pexels-andrea-piacquadio-3791136

The long(er) answer?

Because you aren’t using them early enough, using more than one, or using sensory-based strategies.

I can’t explain why your therapist hasn’t mentioned any of this to you.  All of the emails I get for continuing education tell me that they are going to teach me the latest, the very latest, techniques based on neurological research on trauma.   Since they never mention what I just told you, I will take a pass on their courses.  Because they seem to be missing a real contradiction here.

pexels-katerina-holmes-5905923

What can you do?

  • Start using your stabilization strategies way earlier than you think you need them.  They won’t harm you, they shouldn’t take a lot of your time, and they can help lower your degree of dissociation.  This could mean using them when you are in the waiting room, the parking lot, at breakfast that day, or the day/week before the appointment.
  • Blend and mix strategies.  We know that some strategies target one aspect of dissociation, and some target others.  They use different skills, and different senses.  Mix and match.  Give your brain more chances to succeed.  In my book, “Staying In The Room” I have an entire chapter on how to practice stabilization strategies for maximal effectiveness.  Why therapists think this is “one and done” is beyond me.  Maybe they don’t understand the brain and the effect dissociation has on brain function as well as they think they do.  Maybe it is because a weekend course won’t teach you much about the brain.
  • Consider sensory-based strategies.  I use them because they work, and they don’t require conscious thinking. I just go beyond and below the part of the brain that goes off-line.  They often last longer and have a bigger effect because of how they impact brain function.  They are described in my book, and they they are definitely not squishing a foam ball or touching a silky cloth. That won’t make enough of a difference to a dissociated brain.  Sorry.

31+xCqAe5nL._SX331_BO1,204,203,200_

“Staying In The Room:  Managing Medical and Dental Care When You Have DID” will help you figure out how to improve your experiences today.  You don’t have to find the perfect provider or wait until you get more therapy.  Those ideas don’t work anyway, because life (and illness, and injury) happens to all of us.

You will learn that there are many things you can do to improve your appointments, and these will also make everyday life better as well.  Becoming more informed doesn’t mean you need to go to medical school.  Simple actions can make a huge difference in your health.  Learn to speak “doctor” just a bit better, and you could avoid expensive and painful complications.  Ask for treatments that reduce shame, pain, and dissociation, and you will leave feeling empowered.  Stay out of the ER if you can, but if you can’t, know how to navigate it with skill.

“Staying In The Room” is available as an affordable e-book or a paperback (you know you want to highlight, underline, and write in the margins, right?) online at  Amazon.com .

31+xCqAe5nL._SX331_BO1,204,203,200_

Could You Use Stimulus Control Therapy to Work With Parts?

emma-matthews-digital-content-production-p6g6S_kXkFc-unsplash

Stimulus Control Therapy is a behavioral strategy for insomnia.  Put simply, you create a sleep environment that subconsciously messages you that you are there…to sleep.  You do not remain in bed if you can’t sleep, but you also don’t use your bed for hanging out during the day.  Your actions are calm and purposeful, and take advantage of what we know torpedoes sleep.  Stimulus Control Therapy has been studied fairly intensely, and I think it should be considered part of sleep hygiene for adults with DID, not just treatment for insomnia.

Even if you don’t have insomnia, you will have periods of stress that make falling asleep or staying asleep more difficult.  Having DID routinely makes daily life stressors challenging.  Dealing with triggers that crop up regularly because your trauma happened in regular life situations, supporting your complex system, and learning new and better coping skills, is a lot of work on a good day!  Most adults with DID have sleep issues at some point, so is almost a given that having sleep strategies already in place would help.

What does using Stimulus Control Therapy principles look like in daily living?

Your regular routine is to avoid hanging out in bed during the day.  You get up at the same time 7 days/week.  The lights go on in the morning, with natural light predominating, and they dim as evening approaches.  You consciously and purposefully control your nighttime environment to bias your brain toward sleep.  This includes your nightclothes, what you watch or read, who you speak with, and even what kinds of lightbulbs you have.  Your actions at night signal sleep at a nervous system level.  This isn’t meditation or positive imagery.  Most people are too tired or stressed to dig deeply into that.  This is crockpot therapy; set it up as a routine and an environment, and let it do the work for you!

nick-fewings-GoXNygZlftg-unsplash

But How Does it Improve Communication With Parts?

If you have created an environment that is appealing to more of your system, and you can let them know that you have a plan for dealing with sleep problems when they arise, you are using the wise adult part of yourself to support the emotion-driven parts.

You are telling them with your actions and plans that you have their back, you are not flailing around in distress.  Parts of a DID system are born from trauma.  They are the solution to feeling intractable pain with no source of help or comfort.

Using Stimulus Control Therapy principles gives them hope that someone is helping, and that someone is you.

For more on sleep and DID, read  Could Getting Better Sleep Decrease Your Response to Trauma Triggers?  and Sleep And DID: Could Better Sleep Be As Important As Therapy?  .

annie-spratt-bxt-tWSF-Ko-unsplash

Could Getting Better Sleep Decrease Your Response to Trauma Triggers?

pexels-yunus-tuğ-7877810

Well, we really don’t know for sure.

What we do know is that sleep deprivation is, to put it technically, really bad for your brain.

Bad in so many ways.  It negatively affects so many other organ systems as well.  But we do know that affects the brain in ways that make it easier to go into a dissociative state, a depressive state, and an anxious state.  And stay there.  

Sleep deprivation makes anyone less capable of logical thought, of paying attention to the important things around them, and making solid decisions.  So it is logical, but not formally scientifically proven, that sleep deprivation could make being triggered easier, more frequent, and more severe.  Why?  We do know with research studies that short sleep (sleeping too little) as well as long sleep (particularly spending a lot of time in bed, not sleeping and sleeping) decreases the brain’s ability to access the prefrontal cortex.  

For those of you who are not science geeks like me, that part plays a big role in using all of the strategies to handle triggers and dissociation that your therapist is trying to teach you.  You need it in order to assess where you are at and remember to use those techniques.  Heck, if your prefrontal cortex isn’t activated, you won’t even remember that you know any ways to calm down!  Janina Fisher speaks a lot about using your prefrontal cortex to manage DID.  Does she give you ideas about how to get more sleep so you have an active cortex?  

Nope.

None of that is good news for people with DID or OSDD, or dissociative PTSD.  

Not any of it.

the-creative-exchange-cpIgNaazQ6w-unsplash

People with DID are so vulnerable to sleep problems.  Anything from mild issues to diagnosable sleep disorders Sleep And DID: Could Better Sleep Be As Important As Therapy? .  This isn’t news to anyone working in trauma treatment.

What kind of interventions could help adults with DID get better sleep?  

CBT-i, or cognitive behavioral therapy for insomnia, has some promise.  This type of CBT teaches a ton of simple strategies that have been clinically proven to make a difference.  UC Berkeley’s Golden Bear Sleep and Mood Research Clinic is the home of CBT-i.  

They know a lot about how poor sleep creates a vicious bi-directional cycle.  They know that bad sleep increases depression, anxiety, and trauma responses.  They know that depression and anxiety make getting good sleep harder.  You get the idea.  This has been proven over and over.  And over.  They call it “epiphenomenal”.  I can think of some other words for it, but you shouldn’t say those words in polite company.

pexels-andrea-piacquadio-3791136

But the folks at UC Berkeley don’t seem to know that much about dissociative disorders and sleep.  Not yet.  They are smart cookies, so I suspect they will soon.

 Understanding severe childhood trauma and how to work with someone that has more than one identity state really isn’t their “thing”.  You would still need help managing the impact of living plural.  This suggests that combining work with a highly skilled trauma therapist with the CBT-i approach could really help adults with DID change their sleep for the better.

jony-ariadi-QZub8Ni3x_c-unsplash

 

Here is What You Can Request From Your Doctor To Feel Safer In Your Next Appointment

tailor

I will be speaking at the Healing Together conference next month, and one of my handouts will be a modified version of this list of suggested adaptations.  I thought I would share it here, since it could be the most helpful thing I say to the audience during my presentation.

Why ask for adaptations?

Because your provider may have no idea how to help you tolerate their treatment more effectively.  You may be too dissociative to use a stabilization technique that requires thinking clearly.  If you switch, or a part takes executive control, you are out of luck to take control of the situation as it goes off-track.  A treatment or exam adaptation can be like a crock pot:  you adapt things once, and it keeps on making a difference throughout the time you are in the office.

hospgownphone

I selected these adaptations because they will be applicable for many, but not all, types of appointments.  There are adaptations that are specific to certain treatments or examinations, such as pelvic exams and ER visits, and those are discussed in my book, Staying In The Room: Managing Medical And Dental Care When You Have DID  .  The ones I have chosen here will require some degree of familiarity with DID.  A newly-diagnosed adult may need to use only one or two until they have learned more about their diagnosis and how people function effectively when they have a dissociative disorder.

Helpful adaptations should never reduce the quality of the treatment from your health provider, or frustrate them significantly.  If your provider is unwilling to use any adaptation, you have been given the gift of information about their ability to be a full partner in your care.  Depending on the situation, you may choose not to receive future treatment from this person.  These adaptations should not incite frustration, require more time in an appointment, or make it impossible for them to do their expert job.

examtable

  1. Request the most modest draping and positioning possible.  Draping is the way your body is covered.  If you don’t think you need to be fully exposed, ask how much is needed and request to leave on more of your clothing or be given a sheet to cover you up.  Treatments that allow you to sit up or place your feet on the floor enhance orienting to the present time.  Request these adaptations regardless of how you feel at the beginning of treatment.   Modest draping and positioning is money in the dissociative bank, preventing future stress.
  2. Request the amount of information about your treatment that gives you and your system enough safety to move forward.  You do not need so much information that you become overwhelmed, but you do need some information.  Learn how much and what delivery method (app, pamphlet, verbal, online) helps you most, and this will guide you at your next appointment.
  3. Request that your treatments are done in a way that minimizes pain.  Even if you are a warrior, not all of your parts are.  Pain is almost always a huge trigger for people with a history of chronic child abuse.  Protect them.
  4. Ask for super-brief breaks in a long treatment.  Use this time to use your stabilization strategies that you know can help you most.
  5. If you are familiar with the treatment, request the adaptations that minimize your triggers, switching, or dissociation.
  6. Don’t wait to ask for adaptations.  Most adults with DID enter an appointment in a level of dissociation.  Assume that this will be difficult, and get in front of the problem.  If all goes well, you can celebrate and your provider will also feel good about the appointment.

peacerocks