De-escalating angry or protective alters – use of code words or magic phrases in DID

I was in an airport with my husband and was triggered – triggered by the sense of being trapped and not in control. Much later, we talked about things he could have done to bring me back. What word, what gesture, that would not make me worse.

This is critical when protective or out-of-control alters come out. This article deals with methods friends and family can use to de-escalate the situation.

Dealing with dissociation in children – it’s not so different

Dissociation as severe as DID usually begins with childhood trauma. While most of us are adults by the time we are diagnosed, we can still learn from recommendations made for children with DID. Waters presents an informative article with specific issues of children with DID. While I have not written previously on this, I found some very useful recommendations that I can use today when my rageful alter comes out.

Waters lists the following items and expands on each in her article:

1. Use only non-physical forms of discipline.

2. Use a calm, low voice when the child is out of control.

3. When discussing with the dissociative child consequences, ask the child to have “all your parts (alters, fragments, ego states) watch and listen” so everyone is aware of the undesirable behavior and consequences.

4. No matter who was out or internally influenced the child at the time of the inappropriate behavior (alter, fragmented personality, ego state), the child still has to be held responsible for his or her behavior.

5. When the child denies a witnessed, problematic behavior, the parent gives the firm message that the child needs to sort out with the alters what occurred as the parent provides an understanding atmosphere.

6. The therapist, child, and parent confer and identify internal helpers who are requested to assume control if the child or an alter attempts to engage in destructive or abusive behavior.

7. The therapist, parent, and child confer and agree on modified treatment techniques to be employed at home for safe discharge of feelings. The child is rewarded with an agreed-upon privilege.

8. Therapist, parent, and child agree on code words or symbols to signify the presence of intense, and uncontrollable feelings, thoughts, and behaviors. It is advisable for the therapist, parent, and dissociative child to select code words or symbols which can be verbalized by the child, parent, therapist, teacher, and other appropriate adults to signify that the child is in need of quick stabilization.

Relating these recommendations to adults with DID

A key to managing children is flexibility, which may be harder for friends and family to accept in adults. After all, adults should be in control of themselves; mature. However, an adult with DID has a fragmented sense of self, may have one or more child alters, and may not be aware of the actions of some alters. Alters have a range of emotions as well, though some may be trapped in rage and anger, and others may be generally happy and sociable.

Waters recommends non-physical forms of discipline. This is one reason why individuals still in an abusive relationship have much lower prognosis for recovery. Physical touch can be a powerful trigger.

Individuals with DID may have been screamed at and had their sense of self-worth destroyed. A calm voice and time-outs are useful to de-escalate the behavior, with the child acknowledging the behavior afterwards. [Waters] Advice on dealing with angry alters is to treat them with love – they usually carry the rage of abuse, and the individual with DID may be unaware or afraid of these parts. [FaithAllen]

Interestingly, my parents used both – I was smacked and spanked, but often got the “to go your room and think about it” and was required to stay until I could come out and apologize calmly. My father always counseled, “To thine own self be true.” I was never sure which self he meant, because I could never feel the core of myself – I felt a fake, but I could generally recognize what words were required of me to utter in order to have my parents forgive me. It was more important to me that they were not mad at me, than understanding what had caused my behavior in the first place. I realize now that sometimes I wasn’t even aware of what I had done wrong to be punished for anyway.

I learned how to protect myself. It solidified a part of me who could deal with the outside world.

One recommendation I see both for children and adults with DID is that the caregiver or therapist ask that all parts be present and listening so that all are aware of the bad behavior. And to identify a helpful alter who can come out and take control. Okay, that makes sense to me if all alters are actually AWARE of one another. My rageful alter is only peripherally aware of the rest of me. And this is why my husband and I struggle to identify ways he can get through to the more rational parts of me when this occurs. Perhaps this is something he can try – asking for a particular self.

Both the child and the adult need to accept responsibility for the behavior of all alters. This may be harder for a child to grasp, but as an adult, this one is fully engrained in me. I fully accept this and have apologized for past behaviors I remember and have no memory of, and also for future problems I know will still occur. My husband understands that this will happen, and that it is not me. But it still does not stop him from being hurt by it, and that is what hurts ME as well.

But even though I accept responsibility, I still blame that angry part of me who I cannot reach or communicate with. “Some have anger management issues exhibited when the patient becomes scared or angry. These personalities take over to deal with the patient’s emotions. When this happens, any outcome or blame is placed on the alter personality.” [Chan]

Expressing anger – Waters lists several activities to dissipate the anger, with associated rewards for completing the activity. Punching a pillow (right, I say sarcastically), drawing their feelings and then ripping up the paper. Running around the block or using an exercise machine. Journaling. Verbalizing the anger and allowing the parent to help him/her process it.

Each of these the child knows will be followed up by a reward – a movie, seeing a friend, watching TV, etc. I have seen these coping mechanisms online and from my therapist, but they were never followed by a reward. Why not? Who says that the children in us are less deserving of a small reward for addressing the angry self?

The main reason I decided to write this post is the next item – finding a keyword or symbol that a caregiver can provide that conveys that a bad behavior is in progress. This keyword must be agreed to beforehand, with the idea that quick stabilization is needed.

The caregiver may not know what is happening – the child may be experiencing intense anger, is in the middle of a flashback, or may be struggling over control with an alter who may want to hurt the child or another. But the keyword is a way to convey that others are observing the behavior. [Waters] This also allows the child to gain better control over his shifts and to help manage the behaviors. These can trigger the child to focus. [International]

There is no reason why the same cannot be applied to adults, and this is something my husband and I are trying. We have two ideas. Since I know I feel intense rejection and disconnection with this occurs, he is to ask me gently with no anger in his voice if he can touch my arm, or my leg. A very small thing to make a connection with him. The other thing we are trying is that I carry a small notebook with pictures and sayings to help me. We wrote a page that may help me deescalate or switch. However, that rageful alter is not aware of the note book, so I told him he may have to go to my purse and open it to the right page and then hand it to me. While we have not had the opportunity to try these yet, we will.

Dealing with rageful alters

In an interview in dealing within the multiple system, Pratt advises that the most difficult problem is when the host cannot reach or communicate the angry alter, although internal communication is key. The therapist can help in this case, attempting to gain the trust of that alter. She recommends trying to understand that alter’s goal, and try to reach some agreement on how to reach it that is different from the self destructive behaviors. Is this issue safety? No being heard? In some cases, alters have different loyalties. Perhaps use a journal to communicate with other alters, or get some agreement that not doing X, you will do Y for them. [Pratt]

One method therapists can use is to identify an Inner Self Helper (ISH) within the system. This self can be thought of as the observing ego, with awareness of the entire system. ISHs may be explicitly brought into therapy as an advisor who is able to comment about the client’s strengths or weaknesses, but who also may be protective of the alters. Other therapists do not deal with the ISH, thinking of them as merely “serene, rational, and objective commentators and advisors.” ISHs can provide valuable information for a therapist to consider. [Dissociative]

While these techniques may be better suited to the therapist, it is not inappropriate for a patient’s confidants to recognized that there may be an inner self who can comment dispassionately about the system and provide information on dealing with these angry alters. It doesn’t quite matter how it happens, only that the individual with DID be able to respond to a code word, picture or request, and be able to switch or gain control of the situation.

Easier said that done, but knowledge and planning is the first step.

References

Chan S. (2002). Dissociative Identity Disorder: How Many Personalities Do You Have?, accessed from http://serendip.brynmawr.edu/bb/neuro/neuro02/web1/schan.html

Dissociative Identity Disorder: Ethically unsplitting the split personality, accessed from http://mentalhealthedce.com/courses/contentDID/trkDID10.html The entire course is located at http://mentalhealthedce.com/courses/contentDID/contentsDID.html

FaithAllen. (???).How to Integrate Angry Dissociative Identity Disorder (DID) Alter Parts, accessed from http://www.ehow.com/how_2178141_identity-disorder-did-alter-parts.html

International Society for the Study of Dissociation . (2004). Guidelines for the Evaluation and Treatment of Dissociative Symptoms in Children and Adolescents, Journal of Trauma & Dissociation, Vol. 5(3) 2004, http://www.haworthpress.com/web/JTD, Digital Object Identifier: 10.1300/J229v05n03_09

Pratt A. (???). DID/MPD: Working within the multiple system. Online conference transcript accessed from http://www.healthyplace.com/Communities/personality_disorders/Site/transcripts/multiple_system.htm

Waters FS. (1996). Parents As Partners in the Treatment of Dissociative Children, The Dissociative Child: Diagnosis, Treatment, and Management by Joyanna L. Silberg, Ph.D. Copyright 1996 by The Sidran Press and accessed from http://www.theawarenesscenter.org/DID.html or http://www.sidran.org/sub.cfm?contentID=65&sectionid=4

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2 Comments»

  Tigerweave wrote @

The comments you made about the way your parents handled your anger when you were little really struck a chord with me. I too learnt to behave in the “right” ways, but that left the actual causes of the anger unresolved.

I have read a lot on anger management and so much only focuses on the actual anger-state and not addressing why it is there. Let alone realising the anger is there for a reason, and that reason needs to be addressed.

When growing up, the problem was always seen to be my angry behaviour. Once I calmed down from the immediate anger-reaction, the reason for it was never gone into. There was no “problem” any more as I wasn’t acting out.

After this played out over and over in my childhood, with the (very sensible) reasons for my anger never being fixed, when really bad things happened I had no voice left to be able to tell what was happening to me. I was angry for what was happening. There was no way I could communicate it without being angry.

So I couldn’t communicate it.

Over time the anger turned into vindictiveness (I will hurt them so badly they *can’t* come back and hurt me again/I will get in first/I will show them how it hurts by hurting them, maybe that will make them stop hurting me now.)

But resolving those original reasons for the anger is what dissipated that backlog of anger, and showed me the roots of that vindictiveness.

But nowadays, I am a more formidable person to be around, because if I am angry, I presume it is for a good reason and look to fix said reason, rather than looking at myself and my lack of “anger management” or “self control” as the problem.

Some people think I am an angry person!

But not really.

  emilylonelygirl wrote @

Tigerweave
You did an even better job than I did describing the inability to find the source of the problem – I struck a chord in you, and then you struck a chord in me!

The end of your comment has me thinking. I had a terrible session with my therapist last night, where she went terribly on the defensive, said I picked a fight with her, said I questioned her qualifications, was professionally and personally offensive to her. That I was trying to show I was smarter than she is. Even tho she said it was good I had done the research. Now I wish I hadn’t taken my findings in there because she seemed?!? She would not back down, and said since it happened there, she said it happens in all my relationships. I walked out going, WTF?

I understand your comment that if you hurt them first they can’t hurt you. When people hurt me, I will protect myself and in the past more, did lash back. But she took it one step further, saying – “Picking fights by finding fault with others and how they act toward you is an attempt to anger them. Then you can say, they are angry at me. It is your anger that is the issue.” I may be stubborn and withdrawn when I am upset, but I purposely pick fights?

Hunh. I didn’t even go in angry – I was trying so hard to be calm and show I was trying to understand why I had this trust issue. I talked about the the research I did and the emailed list of questions I presented in a previous post. She felt my asking them was offensive and would not let go of it the entire session. What the hell did I trigger in her?

She was demanding that I be accountable for what I was doing, and I didn’t see it at all. I continued to try and explain that the research made me feel “normal” within the diagnosis, but she turned it around on me. It shocked me what she said, and THEN I went on the defensive and got mad but kept it under control. It was awful.


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