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abuse. See also sexual abuse alien abduction experiences and, 275–86, 290–91, 293
cognitive distortions from, 266-67
depersonalization and, 59, 61, 62, 261
derealization and, 71, 75–77, 78
dissociation in, xi, 16–18, 114, 298
feeling invisible and, 123–24
identity confusion and, 93-95
men and dissociative disorders and, 118–24
mental clouding from, 61
past life experiences and, 286–90, 293
alcohol abuse, 15, 17,18, 62,107,119
alien abduction experiences, xvi, 275–86, 290–91, 293
alteration of identity. See identity alteration
alter personality. See multiple personalities
American Psychiatric Association, 83, 84
amnesia, 37-51
alien abduction experiences and, 276 277, 283, 285–86
common signs of, 44
compensatory techniques for, 44-45
as a core symptom, 31, 34-36, 37–51
definition of, 31
derealization with, 70
dissociative disorders in men and, 122
as a dissociative symptom, xvi distorted sense of time in, 45 examples of, 44
factors influencing propensity toward, 26
identity disturbance dimensions and, 101
integration and, 272
mild, 37, 38–40
moderate, 40–41
multiple personalities and, 46-47
normal versus abnormal dissociation and, 13
myths about, 24-26
past life experiences and, 289
questionnaire for evaluation of, 48–51
amnesia (continued)
self-injury and, 43
severe, 41–42
surface versus hidden symptoms and, 254–55
trauma triggers for, 46
anger, 118–19
antianxiety medication, 28, 274, 295
antidepressants, 28, 274, 295
anxiety, xvi, xviii
depersonalization with, 56–57, 58–59
derealization with, 70
in dissociative disorders, 6, 15, 113
dissociative disorders in men and, 119
drug therapy for, 28, 274
normal versus abnormal dissociation and, 13
parental rejection and, 267-68
attention-deficit hyperactivity disorder
(ADHD), XV, xviii, 119,134, 262, 274
bipolar disorder. See manic-depressive illness
blanking out. See amnesia
body perception, 62, 114
borderline personality disorder, 106
brain, physiological basis for dissociation and, 14–15, 25–26
burning behavior. See self-injury
case histories
Jean W., 207–50
Linda Α., 169–206
Nancy L., 129–68
childhood
abuse in. See
abuse identity formation in, 85–89, 102–3
mild amnesia about, 40
children of alcoholics, 17,135–36
Cicchetti, Domenic, xvii
Claymar, Aphrodite, 286
cognitive distortions, 266–67
cognitive theories
of derealization, 71
of identity formation, 85
comfort (four C’s approach), 258–64, 271
communication (four C’s approach), 264–69, 271
compulsive behavior, 7, 17, 119. See also obsessive-compulsive disorder (OCD)
connection (four C’s approach), 270–73
cooperation (four C’s approach), 269–70
coping (defense) mechanism, dissociation as, xix, 5, 8–18, 56–57
creative visualization, 263-64
cutting behavior. See self-injury
DDNOS. See dissociative disorder not otherwise specified defense mechanisms. See coping
(defense) mechanism, dissociation as denial, 21
depersonalization, 18, 52-67
alien abduction experiences and, 277, 283
compartmentalizing emotions and, 57–58
as a core symptom, 31, 34-36, 52–67
creative visualization and, 263-64
definition of, 31
derealization with, 69–70
identity disturbance dimensions and, 101–2
integration and, 272
internal dialogues in, 55–56, 62–63
manifestations of variations of, 53
mental clouding (feeling foggy) and, 60–61
mild, 53, 54–55
moderate, 53, 56-57
near-death experiences and, 292, 293
out-of-body experiences in, 61-62
past life experiences and, 289
questionnaire for evaluation of, 64–67
severe, 53–54, 58–63
spectrum of severity in, 53–54
surface versus hidden symptoms and, 254–55
depersonalization disorder, 32
depression, xv, xvi, xviii, 6, 32, 274, 295
depersonalization and, 56, 60
dissociative disorders in men and, 119
as a symptom, xix, 13, 15, 113
derealization, 68-81
alien abduction experiences and, 277 282, 283
amnesia with, 70
as a core symptom, 31, 34-36, 68–81
definition of, 32, 68
depersonalization with, 69–70
identity disturbance dimensions and, 101–2
integration and, 272
mild, 72–73
moderate, 74–75
past life experiences and, 289-90
questionnaire for evaluation of, 79–81
severe, 75–78
signs of, 69
surface versus hidden symptoms and, 254–55
theories of, 70–72
warrior personality and, 121
detachment, feeling of. See depersonalization; derealization
diagnosis. See also SCID-D
false memories of sexual abuse and, 23–24
five core symptoms and, 32–33, 34–35
interview questions used in, xv, xvi-xvii
need for a trained clinician for, 33
Diagnostic and Statistical Manual (DSMIV), 84
dialogues in depersonalization, 55–56, 62–63
dialoguing, in communication, 268–69
DID. See dissociative identity disorder dissociation
continuum of, xvi, 6
as a coping (defense) mechanism, xix, 5, 8–18
definition of, xi
everyday experience of brief, mild episodes of, 16-17
incidence of, xi-xii, xiv, xix
myths about, 19–28
physiological basis for, 14–15
self-descriptions of, 3-5
dissociative amnesia, 32, 35, 37
dissociative disorder not otherwise specified (DDNOS), 277
identity alteration and, 106-7
five core symptoms and, 32
derealization and, 75
men and abuse and, 118-24
dissociative fugue, 32, 35
dissociative identity disorder (DID)
description of, 6
five core symptoms and, 32
incidence of, xi-xii, xix
memory impairment in, 17
myth about, as a real illness, 26
normal dissociation as a coping mechanism compared with, 11–13
risk factors for developing, 17–18
distraction techniques, 263
dream, feeling of being in. See depersonalization
drinking problems. See alcohol abuse
drug abuse, 15, 17, 18,107, 119
drug therapy, 23, 28, 274–75
Eadie, Betty J., 292–93
emotional abuse. See abuse
emotional numbness, xv, 5, 10, 13, 28
emotions, decompartmentalizing, 57–58, 270
Erikson, Erik, 85-86
false memories of abuse, 22–24
family
anxiety from rejection in, 267–68
cognitive distortions developed in, 266–67
identity disturbances in children and, 87–89, 90–91
retraction of abuse claims and, 24
fantasy, and derealization, 77–78
fear, 14–15, 59
feeling of unreality, xvi, 10, 18. See also depersonalization; derealization
feeling outside oneself, xv, 4–5. See also depersonalization; derealization
Firth, Barbara, 261
flashbacks, 13, 42, 46, 76–77, 119,134, 162
Ford, Judy, 259
four C’s approach, 253, 255-74
comfort and, 258–64
communication and, 264–69
connection and, 270-73
cooperation and, 269-70
identification as first step in, 157–58
Fraser, George, 27
Frye, Jennifer J., 267, 278
fugue episodes, 32, 35, 102, 113
gender, negation of, 267. See also men; women
Gergen, Kenneth, 83
Gloria (case history), xii-xiii grounding techniques, 262–63
Heim, Albert, 291
highway hypnosis, 38
Hopkins, Budd, 275, 281, 282, 285, 286
Howland, Francine, xiii
hypnosis, 23, 40, 273, 277, 279–80, 286, 287–88
identity
definition of, 83
formation of, 85–86, 102–3
memory and, 38
identity alteration, 100–117. See also multiple personalities
alien abduction experiences and, 277 283–84
circumstantial evidence for, 111–12
as a core symptom, 31, 34-36 100- 117
definition of, 32
identity confusion differentiated from, 101–2
integration and, 272–73
mild, 100, 104–5
moderate, 101, 104–5
past life experiences and, 289
questionnaire for evaluation of, 115–17
reports from others on, 112–13
severe, 101, 108–13
spectrum of severity in, 100–101
surface versus hidden symptoms and, 254–55
three dimensions of, 101–2
treatment of, 113–14
identity confusion, 82–99
adoption and, 90–91
alien abduction experiences and, 277, 283
contemporary life and, 83–85
as a core symptom, 31, 34–36, 82–99
definition of, 32, 86
factors affecting, 86–89
identity alteration differentiated from, 101- 2
integration and, 272
mild, 89–90
moderate, 90–93
past life experiences and, 290
questionnaire for evaluation of, 97–99
severe, 93–95
sexual identity and, 91–92, 95–96
surface versus hidden symptoms and, 254–55
three dimensions of, 101–2
workplace and, 96
imaginary friends, 16
incest, 87–88, 95-96. See also sexual abuse
integration, 271–73
internal dialogues, 268–69
International Society for the Study of
Dissociation, xiv-xv, 23
invisibility, sense of, 59, 123-24. See also depersonalization
Jean W., case history of, 128, 207–50, 294
Kletti, Roy, 291
Kluft, Richard P., xi, 256
learning theories of identity formation, 85
letter-writing exercises, 268-69
Linda Α., case history of, 128, 169–206, 294
Louden, Jennifer, 259–60
Mack, John E., 282
manic-depressive illness, xv, xviii, 106
memories and occurrence of false memories of sexual abuse, 22–24
replaying of, 14-15
retracting, 23, 24
memory
flashbacks and, 13
gap in. See amnesia impairment of, in DID, 17
normal versus abnormal dissociation and, 13
panoramic memory, 10, 13
physiological basis for dissociation and, 14–15
self-image and, 38
trauma and, 42
memory lapses. See also amnesia as a coping mechanism in trauma, 10, 13
as a dissociative symptom, xv, 13
identity alteration and, 108
normal experiences of brief, mild episodes of, 16–17
self-descriptions of, 4, 5 men
abuse and dissociative disorders and, 17,118–24
compartmentalizing emotions by, 58
feeling invisible and, 123–24
sex ratio in DID diagnosis and, 118
symptoms of dissociative disorders in, 119
warrior personality and, 120–22
mental clouding, 13. See also amnesia depersonalization and, 60–61
Miller, Alice, 278–79
mission statements, 264–66
mood swings, 4, 7,15,106,119, 271, 274
Moody, Raymond, 292
Morse, Melvin, 292
movie, feeling that one is watching a, xv, 4, 53. See also depersonalization; derealization
multiple personalities, xii-xiii
amnesia and, 46–47
circumstantial evidence for, 111–12
faking or exaggerating, 27
four C’s approach to, 255-74
functioning of individuals with, 22
incidence of, xiii-xiv, 21
keeping separate parts hidden, 21–22
memory gaps and, 42
myth about, as freaks of nature, xi-xii, 22
naming of alters in, 110
reports from others on, 112-13
multiple personalities (continued)
skepticism among clinicians about, 19 therapy and, 109–10, 113–14
multiple personality disorder, xi, 6. See also dissociative identity disorder (DID)
myths about dissociation, 19-28
Nancy L., case history of, 127,129-68, 294
near-death experiences, 8-9, 10 291–93
normal dissociative episodes
abnormal dissociation compared with, 11–13
as a coping (defense) mechanism, xix, 5, 8–18
everyday experience of brief, mild episodes of, 6,12,16–17
five core symptoms on SCID-D interview and, 32, 34, 36
incidence of, xiv, 12, 20
mild amnesia and, 37, 38-40
mild depersonalization and, 54-55
mild derealization and, 72–73
myths about dissociative symptoms and, 20–21
self-descriptions of, 3–5
Noyes, Russell, 291
numbing of emotions, xv, 5,10, 13, 28
obsessive behavior, 15
obsessive-compulsive disorder (OCD), XV, XVIII
out-of-body experiences, xvi
depersonalization and, 54, 61–62
dissociation as defense in trauma and, 8–9, 20
warrior personality and, 121
overgeneralization, 266
panic attacks, xv, xviii, 7, 13, 15, 32, 61
panoramic memory, 10, 13
parenting, strategies for, 259, 261-62
parents. See family past life experiences, xvi, 286–91, 293
perception changes, in derealization, 69
perfectionism, 266–67
personality switch. See identity alteration
physical abuse. See abuse
physiological basis for dissociation, 14–15, 25–26
posttraumatic stress disorder (PTSD), 15, 70, 284–85
Powers, Susan Marie, 284–85, 290–91
psychoanalytic theories, 71, 85
psychosocial theories of identity formation, 85–86
psychotherapy, 28
four C’s approach in, 253, 255-75
undetected dissociative symptoms in, 6-7
questionnaires for self-evaluation
for amnesia, 48-51
for depersonalization, 64-67
for derealization, 79-81
identifying multiples using, 157–58
for identity alteration, 115-17
for identity confusion, 97–99
using, xviii, 33-34
rape, 69, 77, 95, 178–82
reading, as a self-comforting strategy, 260–62
reality, feeling of lack of, xvi, 10, 18. See also depersonalization; derealization
reorienting techniques, 262-63
repression, 16
role switching, 104–5. See also identity alteration
Rounsaville, Bruce, xvii
Sagan, Carl, 282
schizophrenia, xviii, 295, 296–97
SCID-D (Steinberg Clinical Interview for
DSM-IV Dissociative Disorders), 19, 23, 27. See also questionnaires for self-evaluation
development of, xvii-xviii
five core symptoms on, 32-33, 34-36
screening, questions used for, xv, xviii. See also SCID-D
self, feeling of detachment from. See depersonalization; derealization
self-comforting strategies, 259-64, 271
self-destructive behavior. See self-injury
self-injury (self-mutilation)
amnesia and, 43
depersonalization and, 59–60
in dissociative disorders, 15, 18
trauma and, 42
sex change, and identity confusion, 95–96
sex differences. See gender, negation of; men; women
sexual abuse. See also abuse; incest
alien abduction experiences and, 277–81
association between dissociative disorders and, xi
confusion about sexuality and, 95-96
depersonalization and, 69
derealization and, 76-77
dissociation as a defense in, 16-17
identity confusion and, 93–95
incidence of, xix
myths about forgetting details of, 24–26
myths about occurrence of false memories of, 22–24
past life experiences and, 286–91
reporting, 24, 25
retracting memories of, 23, 24
as a risk factor for developing dissociative disorders, 17-18
sexual behavior, compulsive, 17, 119
sexual identity, 32, 91–92
shame, and derealization, 73
social anxiety disorder (social phobia), 119, 120
splitting off, 14. See also derealization state-dependent learning, 42
Steinberg Clinical Interview for DSM-IV
Dissociative Disorders. See SCID-D stress
depersonalization and, 54-55
dissociation as coping mechanism for, xix, 5, 12, 14–15, 20
students, dissociative disorders in, 18 Sybil, xi, xvi, 21, 27
symptoms, xiv, xv–xvi
continuum of dissociation and, xvi, 6
coping (defense) mechanism and, 8–9
denial of, 21
five core, 31–34
inability to identify, 6-7
myths about, 20–21, 22
normal versus abnormal, 11–13
self-descriptions of, 3-5
surface versus hidden, 254–55
therapy. See psychotherapy; treatment
Three Faces of Eve, The, xi, 21
time sense, xv. See also amnesia as a coping mechanism, 10, 11, 20 gaps and distorted sense of, 39-40, 42, 45
trances, 41, 46–47, 110–11
trauma. See also abuse
amnesia triggered by, 46
depersonalization and, 54, 58, 60
derealization and, 68-69, 71, 72 74–75, 76, 78
dissociation as coping mechanism to, xix, 8–11, 14-15, 20, 26, 298
memory and, 42
as a risk factor, 17–18
treatment. See also four C’s approach; psychotherapy
drug therapy in, 274-75
hypnosis in, 273-74
myth about ability to cure DID, 27–28
treatment (continued)
time frame for, 28
unreality, feeling of, xvi, 10, 18. See also depersonalization; derealization
violence, and dissociative disorders in men, 119, 121, 122
Viorst, Judith, 261
visualization, 263–64
visual perception changes, in derealization, 69
Waddell, Martin, 261
warrior personality, 120–22
watching oneself. See depersonalization
Watkins, Helen, xi
Watkins, John, xi
Weiss, Brian, 287, 289, 291
Wilbur, Cornelia B., 27
women
childhood abuse experiences of, 17
depersonalization and, 58
identity confusion and, 92–93
self-mutilation among, 18
sex ratio in DID diagnosis and, 118
shame and derealization in, 73
workplace
compartmentalization of emotions in, 270
depersonalization and, 57–58
identity alteration and, 105
identity confusion and, 84, 99