The SCIENCE of PTSD and DISSOCIATION | Debunking DID: Ep 12

Hello everybody, welcome back to another video by DissociaDID. We are a channel that's devoted to providing education and destigmatizing dissociative identity disorder. This video is a debunking DID video which means that all the links to studies, medical journals, everything you need to know about the research that's included in this video will all be found in the description box below. So don't forget to go and check out the research at the end of this video. Okay, so How does dissociative identity disorder relate to PTSD? What is PTSD and why do you need to know about it? If you have dissociative identity disorder, let's find out. (Music) So let's start with the real basics. Why does PTSD have anything to do with DID, Dissociative Identity Disorder? DID is essentially a very severe form of complex PTSD. If you wanted to consider it on a scale, like everything is really on a spectrum, the least severe in terms of long-term effect on brain function would be PTSD then CPTSD then OSDD and then DID, dissociative identity disorder. (Train passing in the background) Alright. Fine. Cool. Train, sorry. (Humming starts) Nina let me do this, please. I'll be quick. I'll be quick. Okay, everyone with *DID or OSDD will suffer from PTSD. That doesn't mean that all alters in a system, which means every personality in one body will suffer from PTSD but every system will suffer from PTSD and because of that, it's very important to understand how PTSD works and how it affects the brain. Especially because PTSD is what causes triggers and flashbacks. Now I'm sure a lot of you have heard of those phrases Especially when it comes to like memes of like triggered and stuff like that. But what does it really mean? Let's start off by discussing PTSD. So what is PTSD? At the most basic level, PTSD is a memory filing error which is caused by a traumatic event. When you do experience a traumatic event your brain will switch into survival mode. This means that although normally as you're experiencing life, your mind will be processing what's happening and creating memories, of the experience that you're having. But if you're experiencing a trauma, the brain will suspend some of its normal functions. This will generally shut down normal operations. That would be going on, in day-to-day life such as the creation of memories and memory processing. The brain thinks, considering what's happening now, this could be a life or death situation. Either way, it's something intensely traumatic and difficult and could be a threat to my life. What's important right now, is getting my heart rate up, getting ready to run, getting ready to escape this danger or get out of this situation. Alive. And as unimpacted by it as possible. So more important things right now might be sending adrenaline to your muscles. For example, so memory processing can take a backseat until we're out of this situation. We need to be safe first and foremost because of this until the danger passes. The mind doesn't process the memory of that event in a normal way because it suspended its memory processing functions. This means that when the brain goes back to that little file of the Experience to present it to the person to be processed as a memory. It can be very very distressing. Why, why is it distressing you might think, the person has already been through this, they've already done it. Why is it so distressing for it to come up again? The issue is the brain doesn't recognize this experience as a memory because it hasn't been filed as one. So when the brain presents it to the person, to get ready to process it as a memory the brain thinks that this is an event that's happening, right now. The facts of what happened during the trauma will be relived as if it was happening in that very moment. Which includes sensations: feelings of physical touch, sights, Smells, sounds, taste, vision movement, smell. All of it exactly how it was and the brain isn't able to Distinguish that this isn't happening right now because it hasn't been filed as a memory yet. This experience is presented to the mind in the form of a flashback. Where you re-experience everything that happened during a trauma, as if it was happening in that very moment. Before I go any further, it's very important to remember to distinguish PTSD and DID. PTSD can form at any time in life after a traumatic event occurs. However, DID can only form in childhood for the ages of 7 to 9. Which is when the personality fully integrates into one personality. Repeated trauma in childhood disrupts the development of this singular personality and so they end up with multiple. This is what dissociative identity disorder is. After the age of 79, the personality is fully integrated into one. So it is impossible for the dissociative identity disorder to form after those ages. However, if you are experiencing traumatic events, it is completely possible for PTSD to form. So, some people may have the DID and PTSD, others may only have PTSD. You can only get the DID from repeated childhood trauma and some other factors that are involved in the creation of Dissociative identity disorder. Okay. So now we know basically what PTSD is and essentially what a flashback is. So what's a trigger? When you experience something like a sound or a smell? The first thing your mind does is go off to try and find a memory that matches the information that it's being given. For example, if you smell Sun cream your brain may associate a memory of a good holiday that you had and when you're smelling that Sun cream you may be reminded of this lovely holiday that you had. So when you experience something that may have been related to the event of the trauma and your mind goes off to try and find something associated with what it's experiencing. The first thing it will come across is this unfiled, unprocessed experience of the trauma and thinks oh, I need to process this as a memory. This hasn't been filed yet. Let me bring it up so that we can process it and this is then presented to the person in the form of a flashback where they re-experienced everything as I explained earlier. Again, this isn't something you can just snap out of because the brain can't distinguish that this isn't just a memory. It needs to be re-experience in order to be filed as one. Because of this sufferers, of PTSD can have lots of triggers and they may not necessarily make sense. There is no such thing as a silly trigger. It is whatever your mind has associated with something that happened around the time of or during a trauma. Triggers can be anything, a sound, a smell, an object, a taste. Being touched in a particular place, in a way on your body, tone of voice. Volume of voice, specific sounds. Anything can be a trigger. Even emotions can be triggers and they can bring back flashbacks of a traumatic experience. So in order to combat and reduce your flashbacks, if you have PTSD is really really important to come to terms with and understand the triggers. There can be external and internal triggers. So external triggers are things that you may be faced with on the outside. These can be things such as sounds, sights, smells are associated with trauma. People, locations or objects, "things" that could record the trauma. Significant dates or times like anniversaries of an event. Especially if it was a, especially if it was a reoccurring event, so some sufferers of the DID experienced organized abuse that may have happened on specific birthdays or Specific dates and this can be a trigger, that date can be an anniversary of trauma which can be triggering. Anything in nature even like weather conditions, temperature. Conversations or media coverage about trauma or whether that's specific to your trauma or not can be distressing. Which is why it's very important to be careful or even just not ask about someone's trauma. We made a whole video on this if you would like to see it. You can find it up here! Situations that make you feel claustrophobic or confined So for example, if you're sat in a doctor's office or something like that, this can also include buildings. So like certain buildings, like hospitals may be triggering to some people or schools. These are just the most common it can really be anything and like I said, there's no such thing as a silly trigger. Internal triggers are things that are more like Emotions or feelings, any physical discomfort like fatigue, hunger, thirst sickness, sexual frustration. Any bodily sensations that might be reminiscent of trauma. Such as pain, touching the site of an old wound or injury, very strong emotions, especially feeling helpless or out of control or like you have no say in the situation. Can be very triggering. Mixed feelings towards people so you may love someone very much but also feel a lot of resentment and anger and pain those Feelings and that confusion can also be triggering because you think why do I feel this way, bam! memory. (Chuckle) Yeah, not fun, so again, let's bring this a little bit more back to dissociative identity disorder. What are the dissociative subtypes of PTSD? Dissociation is a normal experience. Everybody dissociates, what you may know is zoning out, is dissociating. This is normal and nothing to worry about. You may be reading a book and realize you've come to the end of the page But don't remember what you were reading or maybe you drive and you don't remember the journey at all. You just kind of went on autopilot and all of a sudden. Oh god. I'm on the motorway. Thank goodness. (Chuckles) Yeah Because I wasn't paying attention, your brain is just dissociated. Which kinds of means, one of my therapist said once, it's like your conscious mind putting its feet up and letting your Unconscious mind sort of drive the body so you can have a rest. This is normal. Abnormal dissociation is much more intense than that and it can involve losing memories and amnesia, things like that. We do have a video on the difference between normal and abnormal dissociation and also derealization and depersonalisation if you'd like to watch that you can find it up. Here! So dissociating, is a really common response to trauma and it's almost always found alongside PTSD It's an instinctive way of blocking out memories of trauma or feelings that came with trauma. It's thought to be an automatic defense mechanism when you're faced with something like an overwhelming Emotion or physical trauma. It occurs in around 50% of adults but as a psychiatric condition it shows up in about 3% of people and when you think about it 3% of the, what 7 billion and something, people in the world. That's a lot of people, you have a dissociative disorder, chronic, abnormal and problematic dissociation. Is much more likely to occur if you have experienced repeated trauma is even more likely that you'll develop a dissociative disorder if this occurred in childhood so really dissociation is an umbrella term. It can include people suffering from, well normal dissociation. It can also include people who have depersonalisation and derealisation and Dissociative Identity Disorder. It can range from mild to severe and it can last a few moments or years. So if you have general dissociation, you might experience things like feeling yourself or the world around isn't real. Minor memory loss, like I said If you were driving your car and you don't remember how you got somewhere just a few minutes, feeling that you might have multiple identities. Sensitivity to light and sound, tunnel vision feeling like you are bigger or smaller than you actually are or the world around you is growing or shrinking. Not really being aware of the passage of time or seeing objects that appear to move when they're actually stationary. These are all symptoms of general dissociation if you have Depersonalisation then you'll feel very disconnected from yourself. The experience is kind of a change in your self-awareness of who you are as a person. You may feel like you're observing yourself. Maybe from a bird's eye perspective Or just observing yourself, watching yourself do things as though it's not really you doing it. People often describe it, as like "watching yourself from the outside". Feeling like this isn't happening to me or as though you're watching a film of yourself. I always described it as seeing myself as like a character in a game like a PlayStation And somebody else was controlling this character, that was me. Detachment from your emotions or the intensity of your emotion. Out-of-body experiences being unable to recognize yourself in a mirror or feeling, just feeling very disconnected from yourself and the body that you reside in. So whereas with the personalisation you experience detachment to yourself. Derealisation is a detachment or feeling of, unreality to the world around you. You may feel like you constantly live in a dream or the world around you is dreamlike or just not quite real. A quote I found about derealisation is that it's been described as; "Peering at the world through a fog with a world unreachable and meaningless." I've always described it as similar to that, like you're looking through a fog or looking through someone else's eyes, a world that doesn't really exist. It's just not real, like even if you could touch something. You might feel like your hand will go right through it or constantly feeling as though you're in a dream, things may look bigger or smaller than they really are. You'll feel very detached from the world, even familiar things may seem Unfamiliar, even though you know, they're familiar. Very strange feeling, feeling that people, you know aren't real and the sense of what's happening isn't real. So what about dissociative identity disorder, DID which used to be known as multiple personality disorder, was renamed in the 1990's. So it's the same disorder, it's just now called Dissociative Identity Disorder. Its the most extreme of these three types of dissociation. They will experience all the symptoms that have come with the other three types of Dissociation as well as some others. If you have DID you may feel uncertain about who you are And feel like you have other people living inside your body or separate identities that you have no real memory of what happened when they were fronting, when they were out. You might experience seeing different handwriting that's vastly different or just slightly different from yours. DID is often very very covert as it's the defense mechanism, which is meant to keep you safe. So a lot of these differences may be very minor, feeling like a stranger to yourself. Feeling like there are other people living in your body, behaving out of character, hearing voices referring to yourself as we. Being very very confused about your sexuality or agenda. I remember that, that was a fun time. (Laughs) So what's the relationship between PTSD and dissociation around 15 to 30% of sufferers of PTSD also report the derealization and depersonalisation. And other research which has assessed a relationship with PTSD to dissociation has suggested that there might be a dissociative subtype of PTSD, but this does need a little bit more research. The studies that we do have regarding it have shown that those with a dissociative subtype of PTSD will have experienced repeated trauma before the onset of the PTSD. So around now you may be thinking, okay Chloe I get it. Now I know what PTSD is, DID is dissociation depersonalisation and derealisation. All are, as well as triggers and flashbacks, but what's the science behind it? If you're studying PTSD It's very important to remember that PTSD is considered to be a psychological injury, rather than a mental illness. Lot's of neuroanatomical studies have identified changes in major brain structures for people who have PTSD such as the Amygdala and the Hyppocampus. Which shows there are significant changes in the brain for sufferers of PTSD. Which, in turn, means that the brain can be directly influenced, changed, and affected by trauma. So let me give you some examples of how these changes to brain structure can effect the symptom. PTSD sufferer may find it very difficult to express how they're thinking or feeling, to find the right words to describe their experience. This is actually due to the Pre-frontal Lobe which is responsible for language, being adversely affected by the trauma. Which affects and impairs linguistic function. Basically, it means that it impairs your ability to express yourself well with words. (laughs) For a non-sciency way of talking about it, people with PTSD may also find it difficult to control emotions. Which is due to the amygdala, brain scans of people with PTSD have shown that the Amygdala has increased in size and therefore is in overdrive and the Amygdala is responsible for emotions and emotional regulation which obviously explains why people with PTSD may struggle to control their emotions. The Amygdala is a lot larger than in someone who doesn't have PTSD. Short-term memory loss and amnesia which affects people with PTSD is due to the Hyppocampus and opposite to the Amygdala. Which grows bigger, the Hyppocampus actually shrinks down. The Hyppocampus is responsible for memory assimilation and basically turning your experience into a memory. If you have DID this amnesia can be short term and long term. You may forget or will have no memory of whole sections of your life this can be years, months, decades. Yes, it's distressing. These sections of your life and especially childhood will be separated into memory held by specific alters who will have experienced that or have the memory of the experience of that time which is why you have no memory of it. Each alters memory is separate, which means that amnesia is near constant for most people. PTSD has been described as someone being constantly on alert. Ready for danger and therefore can make you feel frightened no matter what you're doing whether you're safe or not. And this is due to the Pre-frontal Cortex. Specifically, the medial Pre-frontal Cortex which regulates emotion and fear responses as it just doesn't work properly after experiences of trauma. It struggles to regulate itself and function as it would in a "normal" brain that hasn't experience trauma. Let's talk specifics. What about the effect of PTSD? specifically on the Hyppocampus, let's go into some more detail with that. Under normal conditions when a memory is built or retrieved the Hyppocampus will simulate all this information into one experience, one memory. It will blend together all the different parts of that experience which includes information from all of the senses into one complete memory that's assimilated. The Hyppocampus is responsible for short-term memory. So short-term memory is held in the Hyppocampus essentially, which is your conscious memory. So you'll be aware of it and then when a memory is no longer needed to be a conscious memory in short-term. The Hyppocampus is the part of the brain that processes these memories to essentially move it into your long-term memory, which is in other areas of the brain. As I said before the Hyppocampus tends to shrink or reduce in volume in people who have PTSD and have suffered trauma or repeated trauma and this means that, if you're trying to retrieve old memories or process new memories these experiences and memory can be distorted. The Hyppocampus is also the area of the brain that is responsible for distinguishing between reality. Things that are happening now and memory of the experience. So it's the Hyppocampus fault that you have flashbacks because it can't distinguish between the fact that this is a memory, that you're experiencing and not an event that's happening right now. So what about the Ventromedial Pre-frontal Cortex? Try saying that ten times fast (Giggles) Ventromedial Pre-frontal Cortex. Ventromedial Pre-frontal Cortex. Ventromedial Pre-frontal Cortex. Ventromedial Pre-frontal Cortex. Ventromedial Pre-Frontal Cortex. Ventralmedial Pre-funkel :) I bet you'll do better than me, comment below if you made it this far into the video and managed to say that ten times fast. Not slow, fast. Anyway, Ventromedial Pre-frontal cortex. This area of the brain regulates negative emotions like fear because this area of the brain shrinks in people who have PTSD. The ability to deal with and process these emotions is diminished because of this people with PTSD may experience extreme fear, distress, anxiety. Even in regards to things that seem to be completely unrelated to their trauma or only very mildly connected as it's very difficult for this area of the brain to regulate itself. Now that it has shrunken size. You may have seen brain scans where it's painfully visible that certain areas of the brain are much more active and light up a lot more than in people who don't have PTSD. This is the Amygdala, trauma has been shown to increase activity in the Amygdala region of the brain. This area of the brain is also linked to processing fear responses and other emotional responses. It communicates with the Hyppocampus to decide whether things are safe. So, okay. This is an experience that's happening. How do I feel about this? Is this situation safe? And if the response is no, then boom! Fear is released or panic or anxiety. It's responsible for questioning. Okay. Do I need to start up, stress release hormones? Do I need to get the body ready to run? Is this situation dangerous? So as this area of the brain has become hyperactive and is communicating with the already slightly damaged Hyppocampus. The communication between them is going to be warped and will often result in the "wrong" or slightly distorted version of events. Which will mean that often the reaction is ah yes, This is a dangerous situation release all the fear, all the hormones, all these emotions. Especially as both these areas of the brain are responsible for processing emotions. It just gets a little bit hectic. So this affects your emotional regulation and also can cause distorted views of a situation. So what about your Cortisol Levels, biologic alterations that come from PTSD don't uniformly resemble the kind of alterations that come from people who are just experiencing severe stress. In some studies of patients with PTSD, Cortisol Levels are shown to be much lower than normal. However, the Corticotropin-releasing factor in the cerebral spinal fluid is shown to be increased. The psychological and biological data show that the development of PTSD is partially due to the body being unable to contain stress response. So overall, trauma really does change the way the brain works, the way the body receives sensations and the way a person will experience the world. Trauma and PTSD can make the world seem like a perpetually frightening and dangerous place and this isn't just because somebody is "overreacting". The brain is making them think that and there are specific biological reasons as to why a person will be reacting this way. It's not something you can just snap out of. Which is why it's very important to take your time, be understanding and try to encourage and support Somebody with PTSD as much as you can. We're going to be making a video on how to support people, how to help people, with PTSD and if you want to see the video that we did about why not to ask people about trauma. Then please feel free to check that out. Most of the videos in our debunking DID series are specifically about DID. And if you would like to have a look at those, please do have a look. We are very dedicated to eradicating as much stigma surrounding this disorder as possible and not all of our videos are this scientific based. So if you'd like to watch something more fun or something more advice based. Then we have lots of videos like that on our Channel and I really hope that you'll stay and learn some more. Thank You so much for coming to visit DissociaDID! today. (Giggles) I'm sorry, thank you so much for watching this video. I really really appreciate it and hope you enjoyed it. If you did, please like and subscribe, and we will see all of you in the next video. Lots of love everybody. Bye (Music)