Tuesday, May 07, 2013

Dissociation - Broader Than I Thought

I have a dual diagnosis of PTSD and autism, and because of this, I have an ongoing thing of trying to figure out what's autism and what's PTSD. And I just realized that a couple things I thought were autism are actually PTSD. Or specifically, dissociation.

I've known for quite awhile that I dissociate on rare occasions, under extreme stress. I have no memory for most of the sexual abuse that occurred, even though I remember that I used to remember it. The one memory I have is so dramatically different from most of my memories (colorless and from the ceiling, with absolutely no emotion unless I try to imagine being that little girl down below) that I strongly suspect I laid down that memory while severely dissociated. And a couple of times since then, during my worst flashbacks, I've ended up freezing and my vision blurring, and my thoughts feel like they're echoing in an empty room. I know that stuff is dissociation.

But apparently some other stuff is as well, and I never realized.

On a forum, someone pointed out a study about anomalous self-experience. The study in question focused on schizophrenia, but another study suggests that a lot of those experiences are shared with dissociative disorders.

"2.4 Diminished Presence 
A decreased ability to become affected, incited, moved, motivated, drawn, influenced, touched, attracted or stimulated by objects, people, events and states of affairs. This decrease should not be understood as active and deliberate withdrawal, but more as something that afflicts the patient and hinders his life. The patient does not feel fully participating or entirely present in the world; he may 
feel a distance to the world, which may be accompanied by changes of world perception. This item includes both physical and social hypohedonic states as well as apathy (lack of feelings).

Subtype 2 
Nonspecified: a pervasive nonspecified (quasi-perceptual) feeling of distance to the world, or a sense of a 
barrier between one-self and the world (a feeling of being 
enclosed in a ‘glass case’ or being behind a glass). Yet this 
sense of distance cannot be specified by the patient in 
further details, e.g. in terms of specific perceptual/experiential changes (e.g. if the ‘glass case’ patient seems to 
experience looking through a glass, then it is subtype 3).

2.15 Diminished Transparency of Consciousness 
A pervasive or recurrent sense of not being fully alert, fully awake, fully conscious, as if there was some lack of clarity, inner hindrance, or feelings of internal pressure, blocking, opacity. The acts of consciousness or the very way of being conscious appear as somehow peculiarly faded, diminished or inefficient. 
If the patient complains about a sort of globally unpleasant, but not further describable pervasive mental state, or a global feeling of pressure, oppression, blocking, and the like, locating these sensations to his head, mind or brain, then diminished transparency should be rated as present, that is if the complaints are not caused by a concomitant thought pressure (1.3). Experiences of diminished transparency should not be rated if they appear to be secondary, e.g. linked to thought pressure, hallucinatory states, mental exhaustion, clinical depression, seasonal affective disorder, and organic brain disorder (e.g. epilepsy) or drug intake.
Typical vignette 2: A patient says that he is frequently affected by ‘dizziness’, which means that he is ‘only incompletely in contact with the world, only 60–70%. It is, as if there was no hole (no opening) to the world. There is a lack of transparency between me and the world’. He emphasizes: ‘It has nothing to do with perception, perceptual impressions or the senses.’ 
NB: In this case, there should be scored diminished presence, subtype 2, ‘glass case’ (2.4.2), but also diminished transparency, because the patient’s experience appears to involve diminished transparence of consciousness as a medium of experience (e.g. his insistence on the 
fact that the problem is not located in the sensory processes/perception)."

This sounds like the floaty feeling. Like the patient in vignette 2, I seem to have both 2.4.2 and 2.15 at the same time. In my case, it's episodic and triggered by certain styles of writing. It never lasts more than a couple hours, but I find it extremely unpleasant while it lasts.

"2.7 I-Split (‘Ich-Spaltung’) 
The patient experiences his I, self, or person as being divided or otherwise compartmentalized, disintegrated into semi-independent parts, or not existing as one unified whole. The patient’s complaints must have an experiential quality that may form a continuum from a vague sense of split, ‘as if’ division, to a split that is elaborated in a delusional way. It does not suffice to score this item 
in cases where the patient is aware of having, e.g., a ‘multifaceted personality’.
Subtype 2 
The rating of I-split is based on reports of ‘as if’ experiences.
To subtype 2 
• Approximately, once a week, she had a feeling ‘as if she was two’, ‘as if she was able to see herself from the outside’. ‘She splits up into two parts and fl ies away, composed of those two parts’.
NB: Score also dissociative depersonalization (2.8). 
• She says that her thoughts ‘divide themselves’, and she feels a split in herself. It is a question of negative and positive thoughts. She feels it as if there were two different parts of her which 
‘carry out a war with each other’. 
• He describes that he often has no contact to his left side; it feels as if he ‘was half’ only. This feeling can propagate itself into the depth of his body. 
NB: Here, score also somatic depersonalization (3.3)"

The middle quote sounds a lot like me. I feel like there's a rational part of me and an emotional part, and they don't talk to each other very well. The rational part is usually in control, with the emotional part mostly dormant, but during a meltdown the emotional part takes over and the rational part is a helpless observer. Sometimes the rational part can influence what I do, but only within certain limited options (eg do I scream at my parents some more, or do I start punching myself?).

"1.10 Inability to Discriminate Modalities of Intentionality 
Brief occasions or longer periods with difficulties in the immediate awareness of the experiential modality one is currently living or experiencing. The patient may be uncertain whether his experience is a perception or a fantasy, a memory of an event or a memory of a fantasy. This phenomenon applies to affectivity as well: the patient may be unable to discriminate between different affects, feelings or moods. He may experience (usually negative) mental states that he is unable to designate or describe (has an experience that he does not know – has no words for it). He may be unsure whether he had spoken loudly or had just thought."

I have this sometimes. Typically in the form of thinking I've said something that I only thought about saying, or thinking I did something I only thought about doing. Or sometimes the reverse - thinking I only thought about saying or doing something when in fact I actually did it. It only happens retrospectively, not as I'm thinking/saying/doing the thing, so I'm not sure if it might just be a memory problem. I seem to have poor 'source memory'.

"3.2 Mirror-Related Phenomena (C.2.3.6) 
This is a group of phenomena, which have in common an unusually frequent, and intense looking in the mirror or avoiding one’s specular image or looking only occasionally but perceiving a facial change. 

The patients either perceive changes of their own face 
or they look for such changes, and therefore examine 
themselves in the mirror often and/or intensely. They 
may become surprised or frightened by what they see, and 
even tend to avoid mirrors because of what they see. 
Sometimes they look in the mirror to assure themselves 
of their very existence. They might also look at photos of 
themselves to find out about their own identity.

Subtype 2
The patient perceives his own face as somehow changed 
or deformed.


To subtype 2 
• She had an experience that her face looked witch-like, and therefore she did not like to see herself in the mirror. 
• She saw that her neck muscles were strangely protruding. 
• When she looked at herself in the mirror, she focused on the eye, 
which she suddenly saw as a ball in her head. It was ‘surrealistic’, and she felt that her face was changed."

This one I'm uncertain about. I like staring at my eyes in the mirror, and when I focus closely on my eyes, they start to look strange to me. Not that anything about the way they look is objectively different, but it seems different. However, I enjoy this feeling, instead of finding it distressing. (I especially liked when, to test my retina, the eye doctor put medication in my eyes to make my pupils expand. Several times while waiting to be seen I would run into the bathroom, stare at myself in the mirror, and then start giggling madly.)

I also keep feeling like my face doesn't look the way I expect it to look. It's like I forget what my face looks like when I'm not actually seeing it. But this is also not unpleasant, just a bit startling. I figured this was due to poor interoception (there's a test for it which I describe here, and I score well below average). I guess poor interoception could be linked to dissociation, though it seems to fit well among sensory processing issues as well.

It's weird. I knew I had dissociative episodes before. But now, I feel almost like I've discovered a new diagnosis for myself. I don't know why I never considered that this stuff could be part of dissociation. It's incredible.


Blogger DJay32 said...

I know the feeling very much. I've been trying to distinguish what behaviours and experiences of mine are due to Asperger's Syndrome or due to C-PTSD. The dissociation definitely fits into the latter.

I have trouble looking at mirrors. I have to be wearing specific clothes or else I'll just look like.. well, the best word I have for it is "a victim." If I'm in casual clothes, I feel like a victim. And I hate seeing myself like that. I can't stand it.

I often feel like my emotions are different parts of me entirely. When I'm sad, I feel like I have entirely different memories than when I'm happy, like a different part of me 'woke up' and all elements of the other part of me became just words in my head.

Flashbacks make me lose sense of time and reality and identity.

..I lost track of where I was going with that. But here's a comment. I love this blog.

12:16 PM  

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