DID: The ACE Study

A new and profoundly important paradigm for understanding overwhelming emotional pain has emerged over the last few years, with the potential to change the way we conceptualize human suffering across the whole spectrum of mental health difficulties. It is an evidence-based synthesis of findings from trauma studies, attachment theory and neuroscience, which offers new hope for recovery. It also presents a powerful challenge to the biomedical model of psychiatry in that it is based on scientific evidence that substantiates and attests to what many individuals with first-hand experience of mental health problems have always known — that the bad things that happen to you can drive you mad.

A New Paradigm for Understanding Severe Mental Distress

The CDC-Kaiser Permanente Adverse Childhood Experiences (ACE) Study revolutionizes the way we think about the body and mind.

The ACE Study settles the question of whether we are shaped by genetics or the environment: we are shaped by both.  Nature Versus Nurture: Where We Are in 2017

The ACE study proves that child abuse causes enduring neurological damage that can affect a person’s health and quality of life throughout the lifespan.

The body of a frightened child floods with hormones and prepares to fight, run, or die.

In less than an instant, the amygdala sends an alarm to the hippocampus, which tells the adrenal glands to release adrenaline.

Adrenaline increases heart rate and breathing, oxygen goes to the muscles and brain, which increases hearing and sharpens eyesight.

Adrenaline wears off and cortisol takes over; cortisol is a longer acting stress hormone designed keep the body alert.

Illustration from Harvard Medical School
Understanding The Stress Response, Harvard Medical School

If a child fears for his life, he may freeze and go numb.

For a prey animal in the wild, numbing is a blessing.

For abuse survivors, it means gaps in memory

During the fight, flight or freeze response the brain inhibits the prefrontal cortex.

The prefrontal cortex is responsible for retrieving memories. 

The memory is there but the brain can’t retrieve it.

A chronically abused child lives in fear which damages the structure and
functioning of a the brain. Harvard University

The toll of chronic fear on physical health includes:

  • Immune system dysfunction
  • Endocrine system dysfunction
  • Autonomic nervous system alterations
  • Sleep/wake cycle disruption
  • Eating disorders

The toll of chronic fear on emotional health includes

The Pyramid of effects of abuse on the lifecycle
Abuse Affects the Life-cycle

It takes nine months for the fetus to become a baby that can survive beyond
the womb.

Between birth and the age of two, we have no words; for the first ten years of our  lives, we are helplessly dependent on our parents and communities for our physical and psychological well being.

Child abuse is a betrayal of unconditional trust.

You don’t just ‘get over it’.

People with dissociative disorders report the highest occurrence of abuse and childhood neglect among all psychiatric disorders. This suggests dissociation is the ultimate reaction to significant trauma. Links between Trauma, PTSD, and Dissociative Disorders

A 2018 review found changes in the structure of the brain in people with DID. These changes are complex and  include decreased limbic activity, increased frontal lobe activity, and changes in communication between these two regions.

An illustration depicting a little boy glaring at his drunken mother, passed out on the floor
Child Abuse Lasts a Lifetime

DID is something done to you, like the rapes and daily beatings.

One must accept what happened and make peace with it.

Acceptance means seeing what might have been and grieving the loss.

Acceptance means letting go of the idea that I brought it on myself, that I am shameful and not good enough, and it means not letting the dismissive arrogance I sometimes encounter gnaw at my soul.

Acceptance means holding abusers accountable for the messes they make.

Acceptance means believing the abuse will end.

I am not completely there.

How do I accept the evil of child abuse when the abuse never ends?

For now, broken but better is the best I can do.

DID: When Everything is a Trigger

Get Your ACE Score

(C)Rob Goldstein 2019

‘Child Abuse Lasts Forever” (C) Rob Goldstein 2019

All other graphics were found online and are used here for educational purposes.

Dissociative Identity Disorder: The Positives and Negatives

People have described me as flaky, high maintenance, difficult, hysterical, confusing, compulsive, and dishonest.

That last one, dishonest, is a common reaction to people with DID.

If I wanted to fake an illness I’d choose something people would believe

People tend to go with what makes the most sense based on what they know.

Most people know nothing about the mind, much less states of minds.

The other wordson that list are alternate descriptions of the symptoms of DID.

Gaps in memory look flaky, but they’re more than forgetting. These gaps
are the same as not knowing.

High maintenance means I require more medical supports and more patience from friends and family.

Panic attacks look like hysteria.

Personality switches are confusing because my alternates have different interests.

However, the words people use aren’t all negative.

People also describe me as, loving, intelligent, empathetic, compassionate, loyal, strong, and honest.

That last, honest, means I say what I think is true based on what I know or think I know.

The goals of treatment for dissociative identity disorder

My ultimate goal in life is to be a good person; it’s an ongoing project and a choice I have to make every day.

What are the words people use to describe you?

Rob Goldstein 2019

This is a companion to a previous post; ‘A Lifetime’

#BraveWrite: A Lifetime

I’ve spent a decade in therapy to recover from an emotionally needy, gaslighting  narcissist, who raised her Jewish Son among abusive, anti-Semitic, fag-bashing racists, some of them pedophiles, who considered themselves good Christians.

Ironic, isn’t it?

I’m the one with the diagnoses.

What have I learned?

I am a human being,

I have a right to be alive.

When the trauma is drawn out over a number of years, dissociation becomes a way of life. Once learned, it is a fixed part of the personality that asserts itself long beyond the original dangers that prompted it.

This is an illustration of the principle that C-PTSD is essentially a learning process gone awry as a consequence of the child developing in a dangerous environment.  Dissociation and C-PTSD


The effects of long-term child abuse last a lifetime.

This post inspired by the #BraveWrite hashtag on Twitter.

Rob Goldstein 2019

“Los Portales’ (c) Rob Goldstein 2016

#MeToo

I am not that little boy
who lay awake at night
dreading the touch
of a pedophile’s
hands

– I am not that little boy –

But I will never forget
his pain or dishonor
his torment by
pretending it
never happened.

(c) Rob Goldstein 2017