G3.11: A patient with DID says the voices are not like schizophrenia.

More severe dissociative disorders like Dissociative Identity Disorder (DID) (formerly known as Multiple Personality Disorder, MPD) have occurred in some cases of extreme childhood trauma. A strong alter character may develop in the child’s mind that takes over during scary times as a defense strategy. The protective personality may cope with the harsh situation and leave the core personality not only protected from coping with the negative event, but also may leave the memory of the event suppressed from the core personality’s memories. The child or adult may be left with no memories of what happened while the alter personality was in charge.

A person with the condition describes “multiplicity” as being like a bus that has a variety of passengers who may take over driving occasionally, and go and do things without asking, and the bus may not remember it. The “host” or main personality is not the bus driver but is the whole bus.

The full description is in the book, Living with Your Selves, by Sandra J. Hocking and Company;  (G3.34), some of the author’s alters helped write parts of the book. The author would like people to understand that the condition can be coped with and that it isn’t possession by any external force. The alters were all protectors at some stage of the host’s difficult life.

The main difference between DID and less severe forms of dissociative disorders is that memory is suppressed in DID in order to protect the core child personality from whatever trauma is or was going on in the child/former child’s life.

My own feelings of disconnection as a child or as an over-worked adult have never included missing blocks of time or forgetting whole days, which can be symptoms of DID.

Seeing bad memories from above as if watching oneself from the ceiling can be a symptom of milder forms of dissociation. Conversations that you aren’t part of or other voices taking place inside the head may be symptoms of DID. Sandra Hocking mentions that hearing voices externally from inanimate objects like a bicycle would be a symptom of a different type of mental health problem and she encourages talking to someone (other than the bicycle) if any odd voices are being heard.

Recent research has shown that the “voices” that people with schizophrenia symptoms “hear” are actually their own internal sub-vocalizations – their own inner thoughts – but that some disconnection occurred in the brain that seems to make them unable to recognize the “voice” or “voices” as their own thoughts or memories.

Hearing voices may be a symptom that is due to many possible reasons rather than being due to “schizophrenia” – it may be more of a set of symptoms that all resemble “schizophrenia-like symptoms.” Several different nutrient deficiencies may cause a symptoms of “hearing voices“. If a person was deficient in all of the nutrients, which is not uncommon in malnutrition, then supplementing only one of the nutrients would be unlikely to show much improvement in the schizophrenia-like symptoms even though it might have been helping somewhat. All of the nutrients are important for health.

  • The voices heard by patients with these symptoms have been found to be the patient’s own internal monologue but the patient no longer recognizes the voices as their own thoughts or memories from their past.  See:  “When People With Schizophrenia Hear Voices, They’re Really Hearing Their Own Subvocal Speech, Unlike most people, they just can’t tell it’s themselves.By Eliezer Sternberg  (G3.35)

G3.12: Nutrient deficiencies may be a physical and treatable cause symptoms of “hearing voices.”

  • Folate and vitamin B12 deficiencies can cause schizophrenia like symptoms; possibly due to an increase in levels of c-reactive protein. Folate and vitamins B6 and B12 are needed to breakdown c-reactive protein. (G3.36)
  • Genetic differences in metabolism can affect the risk of deficiency in folate and vitamin B12. Genetic screening for methylation cycle differences can help clarify whether extra supplements of the more bioactive methylated forms would be more helpful than standard supplements.
  • And a zinc deficiency and/or copper excess is more common for patients with schizophrenia; so pyroluria, a condition also thought to be due to genetic differences may be an issue. (G3.37)
  • A zinc deficiency prenatally may be linked to schizophrenia later in life: (ncbi.nlm.nih.gov/1491625) (G3.38)
  • Vitamin D deficiency is more common in people diagnosed with schizophrenia. (G3.39)

Health isn’t easy on a good day for someone of average age and average metabolism. Seeking help from mental health counselors and other healthcare professionals can help provide care for a variety of topics that may not fit easily in visit with the family physician.

A specialist in research explains the oxidative stress chemical process in the background section of a review paper regarding the possible connection between psychiatric disorders and oxidative stress. (G3.110) The short story on the chemistry is about balance between the waste produced when burning energy for use in metabolism and antioxidants available to neutralize the oxidizing chemicals produced as waste. The oxidizing waste chemicals are smaller parts of what was once the larger molecule of sugar, glucose. We do need to be able to use the stored energy from glucose, so having plenty of colorful fruits and vegetables in the diet gives the balance of antioxidants necessary to neutralize the “free radical” waste products. They are like the ions of calcium or magnesium in the way they are “free” to donate or take energy from other molecules, which may leave them in disrepair.

An excerpt gives a summary of oxidative stress and the potential link to psychiatric disorders, (G3.110)

Hence, oxidative stress can be considered as a state where the level of oxidants [hydrogen peroxide, superoxide, nitric oxide, etc.] produced by biological reactions exceeds the oxidants scavenging capacity of the cells. These oxidants modify cellular macromolecules [proteins, DNA, lipids] and alter cellular functions [19] resulting in apoptosis or necrosis [2022].” (Apoptosis or necrosis = cell death)

“The brain with its extensive capacity to consume large amounts of oxygen and production of free radicals, is considered especially sensitive to oxidative damage [12, 23]. Therefore, it is not surprising that oxidative stress is implicated in several disorders of the brain including neurodegenerative disorders [2326], psychiatric ailments [27], and anxiety [28]. This association is largely due to the high vulnerability of brain to oxidative load [27].

Read more: Oxidative Stress and Psychological Disorders, (G3.110).

  • The topic of psychiatric disorders, TRP channels, oxidative stress, infertility and pre-eclampsia is more complex than I’ve led you to believe in this overview and this page is already long so the discussion will be continued on a separate page focused more on TRP channels – they are an exciting topic, see G. Pre-eclampsia &TRP Channels.

So speak nicely to yourself, you might be listening. And it turns out that words can hurt after all, not just sticks and stones. A book called What to Say When You Talk to Yourself, by Shad Helmstetter, goes into more detail about the emotional impact that can occur due to how and what we think to ourselves. How we phrase our thoughts and goals can affect our success and enjoyment in life, that seems like a no-brainer, but maybe not to the nervous toddler who is still trying to stand up in the adult sized shoes – a little wobbly but trying. (G3.111)

The glossary section G. Fear & the Inner Child has more information and resources about early childhood experiences and emotional development and the possible creative benefits of dissociation. The section G. Autoimmune Disease & Vitamin D continues the medical discussion of oxidative stress, magnesium deficiency, and why an Epsom salt foot soak or bath might help an autoimmune condition in addition to improving a bad mood and soothing a muscle cramp and sore back – one stop shopping, now that is efficiency.

See a healthcare provider for medical advice, diagnosis or treatment.

  • Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.
  • The Academy of Nutrition and Dietetics has a service for locating a nutrition counselor near you at the website eatright.org: (eatright.org/find-an-expert)

Crisis Hotlines and Resources:

  • U.S. National Suicide Prevention Hotline: Call 1-800-273-8255, Available 24 hours everyday. (I.suicidepreventionlifeline.org)
  • National Helpline: Substance Abuse and Mental Health Services Administration: “SAMHSA’s National Helpline, 1-800-662-HELP (4357), (also known as the Treatment Referral Routing Service), is a free, confidential, 24/7, 365-day-a-year treatment referral and information service (in English and Spanish) for individuals and families facing mental and/or substance use disorders.”  (I.samhsa.org)
  • Rape, Abuse and Incest National Network, RAINN Hotline: 1-800-656-HOPE, (I.RAINN.org)
  • Child Welfare Information Gateway: a variety of toll-free hotline numbers for concerns involving the safety of children. (I.20)
  • Power and Control and Equality Wheels  The following training materials are for helping victims of domestic violence and batterers learn how to recognize problem behaviors but emotional manipulation or abuse of power and control can occur in many types of relationships not just between couples.The Power and Control Wheel (I.21) was developed by the Domestic Abuse Intervention Programs (DAIP). (I.22) Manipulative behaviors are grouped into eight categories in the model. An additional Equality Wheel (I.23) was developed to help guide batterers and victims of emotional or physical abuse towards healthier ways to interact. It is grouped into eight equivalent categories with examples of healthier ways to interact with each other. Problems frequently can involve communication issues by both people in a relationship.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

References:

G3.8: Severe child trauma may lead to Dissociative Identity Disorder (DID) or PTSD.

Dissociative Identity Disorder (DID) is a mental health disorder that can result when there was severe child abuse and/or neglect. Colin A. Ross, M.D. is a specialist in the treatment of DID, see his book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality for more information. (G3.32)

The author provides an example script he developed for patients to describe what cognitive therapy is and how it might help them. The script begins with lines that suggest that our feelings are sometimes affected by what we think and that if that is true then changing how we think may be the best way to change how we feel. He describes cognitive therapy as a method for helping the patient to learn what not to do rather than focusing on teaching them what to do.(p 339, G3.32)

Incorrect beliefs can develop during childhood that may have been helpful to the child at the time but may cause problems later in life. The author discusses false assumptions commonly believed by DID patients and he describes a few cognitive therapy techniques which he found helpful for challenging the old beliefs and guiding the patients to new beliefs. Counseling strategies and false assumptions are discussed within the section titled Cognitive Restructuring Techniques. (pp 338-345, G3.32)

G3.9: Cognitive Restructuring Techniques for “false assumptions.”

The false assumptions are discussed in the book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality within the section titled Cognitive Restructuring Techniques  (pp 338-345, G3.32) I found the ideas helpful and combined the false beliefs into a list, with notes summarized from my understanding of the text, words in italics are quotes from the text:

  1. “Different parts of the self are separate selves.” – Which can lead to the false belief that different parts of the self (alters) actually have different bodies and cognitive therapy may address the risk of one alter causing physical harm to the host (primary personality) by tackling the alters’ false belief that there are two or more separate bodies.
  2. “The victim is responsible for the abuse.”  This false belief may occur during developmental stages in early childhood when the child believes that what happens in the world is caused by the child’s actions. Cognitive therapy  can challenge the underlying belief that “I must be bad.”
  3. The abuse happened because I am bad.” Children can’t just leave their caregivers and the need to love and feel love is also strong so it can be a common false assumption that whatever is happening is right and the child is wrong or deserving of the mistreatment. Cognitive therapy can discuss the differences between a child’s and an adult’s responsibilities in life and whether traumatic events are something other children could cause to occur or that they deserve instead of normal love and affection.
  4. It is wrong to show anger.” Cognitive therapy can help teach what healthy anger is and how to control it. Underlying false beliefs can be challenged by asking: “Who says anger is bad? How do you know that?”
  5. The primary personality can’t handle the memories.” Cognitive therapy can help the DID patient to recognize that as an adult the primary personality is older and may have more ability to cope with painful memories. (paraphrased from the book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality: Cognitive Restructuring Techniques, (pp 338-345, G3.32))
  • The first and last of the assumptions listed above are more specific to DID in that amnesia is involved; the memory of the trauma is blocked from the primary personality. However a child in a trauma situation might also develop the last assumption about other people in their lives. They might feel a need to protect family or others from information that the child might fear is too disturbing in some way or had been told by someone else to keep secret.
  • Less severe cases of childhood trauma may result in the child growing up believing false assumptions similar to those listed in number 2, 3, and 4 without the child also developing amnesiac memory blocks or feeling like there are parts of the self that are separate from each other.

Dissociation can be a normal coping strategy but in DID it can become disruptive for the adult even though it may have helped the child survive traumatic events. Cognitive therapy strategies can help the patient recognize that the beliefs they had developed as a child are not necessarily true at all or they are not true now that the child is really an adult. Initial recognition of false assumptions can help change old beliefs and related behaviors quickly, but it can also take months or years repeating the new beliefs to replace the old childhood beliefs.

G3.10: Therapy for Dissociative Disorders can be Effective & Cost Effective.

Information from the book Dissociative Identity Disorder: Diagnosis, Clinical Features, and Treatment of Multiple Personality regarding the cost effectiveness of therapy for DID found it to be very cost effective and could save years of ineffective therapy. Clinicians have reported stable integration in children with DID in as few as 5 to 10 office visits. The shortest reported integration for a child patient occurred in just one session and the longest treatment reportedly took 30 sessions over five months. The point is made however, that it wouldn’t be ethical to treat a child with DID while they are still experiencing abuse because the therapy would be taking away the child’s coping strategies. (p256, G3.32)

Adults with DID have been reported to have spent as long as twenty years in ineffective therapy before the diagnosis of DID was made. Twenty years of therapy can cost $500,000. Research that examined the treatment of fifteen women found that it took an average of 8.1 years in therapy before a diagnosis of DID was even made, at an average cost of $166,786.97 each. In comparison the average length of treatment once a diagnosis of DID was given was 2.6 years. (p257, G3.32) Two to five years of therapy before reaching integration is typical for patients with DID. (p257, G3.32)

The diagnosis of DID became controversial in the past as some practitioners over diagnosed and may have led some patients to false memories during sessions. However it is a real condition that is not very common.

  • A narrative “dramatized” description of a patient with DID and her therapy is available in the book Jennifer and Her Selves. written by the patient’s psychotherapist: (G3.33)
  • A patient with the condition shared her own story and “survival tips” for others with Dissociative Identity Disorder. At the time she wrote her book the condition was still called Multiple Personality Disorder. The next section includes more of Sandra J. Hocking and Company’s story in their book, Living With Your Selves: A Survival Manual for People With Multiple Personalities, (G3.34) . Sandra wrote the book along with some of her “alters“, the other sides of her personality that were formed at different stages of her childhood or adult life.  More about her story and the difference between DID and schizophrenia will be included in the next post.

Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

References:

 

G3.7: Work Burnout is a type of Dissociative Disorder called Depersonalization Disorder.

A more frequent problem than is recognized is a milder form of a dissociative condition called Depersonalization/Derealization Disorder, commonly known as “work burnout,” than the more well-known but rare “Multiple Personality Disorder.” That name has been changed to Dissociative Identity Disorder (DID).  Symptoms may include depersonalization and/or derealization without the presence of other psychosis or memory and identity disturbances. It is one of the Dissociative Disorders which also include Dissociative Amnesia  and Dissociative Fugue and Dissociative Disorder Not Otherwise Specified, in addition to the more severe DID, Dissociative Identity Disorder. The disorders may be underdiagnosed or misdiagnosed even though symptoms consistent the Dissociative Disorders are often reported by people with psychiatric illness who also have a history of having experienced trauma. (G3.30)

  • Read more: Stress and Trauma: Psychotherapy and Pharmacotherapy for Depersonalization/Derealization Disorder. (G3.30)

Techniques that help patients reach a deeply relaxed state can help reach the nonverbal emotions and memories from early childhood that may not have been stored as “words.” Art therapy, journaling or poetry, music and movement and meditation can all help access or nonverbal memories. EMDR therapy incorporates rapid eye movement or hearing a sound that switches from the right to the left side of the brain rapidly. The stimulation in a rhythmic pattern helps reach a relaxed meditative state that is not as deep as hypnosis but might be somewhat similar. The therapist then guides the patient with some questions about a traumatic event or memory in order to try to reframe the issue from an adult’s perspective, in order to help the little child within the patient understand the issue from a more adult perspective. Forgiveness for parents who didn’t know better might be part of reviewing a traumatic childhood from the viewpoint of an adult. Parents may have just been young and foolish once too.

  • Eye Movement Desensitization and Reprocessing, EMDR Therapy: Using EMDR to Find Your ‘Safe Place’ in Trauma Recovery. (G3.31)

/Disclosure: This information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes./

References:

  • G3.30: Stress and Trauma: Psychotherapy and Pharmacotherapy for Depersonalization/Derealization Disorder, by J.P. Gentile, M. Snyder, P. M. Gillig, Innov Clin Neurosci. 2014 Jul-Aug; 11(7-8): 37–41. (G3.30)
  • G3.31: Using EMDR to Find Your ‘Safe Place’ in Trauma Recovery. By Camille Larsen, Aug.15, 2016, (G3.31.goodtherapy.org)

G3.6.1.8: If magnesium deficiency is cause of a diabetic patient’s pain, why give opioids instead?

Evidence based clinical research from 2009 could have helped save many lives lost to the opioid epidemic if patients were being told and treated with the discovery. (G3.101) Patients with diabetes and chronic pain often don’t experience much if any relief from the use of opioid medications, however that is the standard pain medication that is provided for chronic pain so it is often prescribed to diabetic patients anyway, just a prescription pad after all not a patient (not true). The research study provided magnesium to the diabetic patients as a pretreatment before providing the opioid or along with an IV drip of the medication, and not only was the pain reduced for patients who received magnesium, but the pain level was reduced for several days for the fortunate patients. And some trials of the experimental treatment didn’t provide the opioid medication and yet pain relief was felt by the diabetic patients.

Well that is exciting and it leads me to say – why even bother giving an opioid medication then, if it won’t help to relieve pain that is actually being caused by a magnesium deficiency? Because there is profit to be made by prescribing opioid medications but there isn’t profit to be made writing a magnesium prescription? Pondering is a waste of time for someone in pain.

The research discussion seemed to focus on using 30 mg of magnesium with IVs of morphine or other opioid medication for better pain control, but didn’t address or stress the fact that the 300 mg dose of magnesium had reduced pain levels for patients on its own, without any opioid medication having been given along with the nutrient. Pain control without needing an addictive drug that can cause death if overdosed?

Common sense can be inexpensive – consider the benefits of resolving a problem instead of treating symptoms and ignoring the underlying cause. (Magnesium can also be deadly in overdoses, but that really isn’t as common a cause of death as opioid overdoses.)

  • Read more: Magnesium ions and opioid agonists in vincristine-induced neuropathy, (G3.101).

Trying to replace a natural function with a patented medication is using patient’s pain for the purposes of profit.

Calcium channel blocker medications (PPIs for example) are trying to close the gates and keep the calcium out – and magnesium would be delighted to do that as nature intended if enough of the mineral were being absorbed from the intestines. However many issues with our modern food supply and the contaminants it may contain, may be leading to poor absorption of magnesium and increased loss of magnesium by the kidneys, (too much active hormone D3 can cause increased calcium absorption and loss of magnesium). Note the frequent use of the word “may” – more research is needed, in the meantime an Epsom salt bath or foot soak or use of a topical magnesium chloride product could bypass poor intestinal absorption problems. The magnesium sulfate used in Epsom salt would also provide sulfate which may also be beneficial due to possible contaminants in our modern food supply.

Talking about doing things “traditionally” is nice but our children are not growing up in the same chemical environment that we did, and we didn’t get to experience the food supply that our grandparents enjoyed.

Calcium channel blocker medications make a large profit for the pharmaceutical company – magnesium cannot be patented.

Now that it is clear that emotions and environmental triggers can cause inflammation, which at the same time is a cause of feeling “pain,” it is easy to see why childhood trauma or severe traumatic experiences or ongoing trauma can lead to developing inflammatory conditions such as inflammatory bowel conditions or fibromyalgia and migraine pain. The next section moves into psychological conditions that can be due to emotional trauma but may cause physical symptoms as well as mental symptoms.

See a healthcare provider for medical advice, diagnosis or treatment.

  • Disclaimer: Opinions are my own and the information is provided for educational purposes within the guidelines of fair use. While I am a Registered Dietitian this information is not intended to provide individual health guidance. Please see a health professional for individual health care purposes.

The Academy of Nutrition and Dietetics has a service for locating a nutrition counselor near you at the website eatright.org: (eatright.org/find-an-expert)

References:

Only one? – yes, it is an important one: