Partial DID or OSDD? Classifying and Diagnosing Types of Dissociation
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- čas přidán 18. 05. 2024
- In this video from The CTAD Clinic, Dr Mike Lloyd (Clinic Director) discusses the different classification systems for diagnosing dissociation, with a focus on sorting out how to diagnose #PartialDID or #otherspecifieddissociativedisorder #OSDD or #dissociativeidentitydisorder #did using the DSM-V and ICD-11
I knew that I had more than OSDD going on, and my therapist called it DID because my symptoms were more than OSDD, but I always felt like a fake because I never quite fit overt DID definitions. Having a real word for what I experience helps my denial a ton. It's harder to feel like I'm faking when I know there's recorded explanations for *my* specific symptoms, even if they don't exactly fit what's listed in the DSM.
same here
THIS IS FASCINATING! This has helped me come to the conclusion that I was misdiagnosed with osdd. During the interview with the professional I had a lot of trouble answering the questions and I had a lot of dissociation so I know looking back I did not answer some of the questions correctly because I was too afraid of being completely honest, I think. Or I really just did not know the answer.
That being said, I was recently in the ER for insomnia which was triggered by taking the wrong medication (my Dr made a mistake. All is well tho she fixed it). I informed the staff in the ER that I needed to be with female staff only because I had been sexually assaulted in previous hospitalization experiences by male staff. They were having a shift change and the doctor in the ER was going to be male, so they tried introducing him to me without preparing me for it first and it triggered a trauma response where I was screaming and trying to get away from him but also telling him I knew he wasn't the problem, I was just scared.
I used my service dog to "put Pandora back in her box" as I like to call it, and afterward I was perfectly fine and willing to communicate again.
Long story short, They did have to put me on a psych hold because I wound up staying awake for 52 hours straight (mainly because they encouraged the spinning out of control instead of calming it🙄). I kept referring to myself in the third person and soothing myself like a small child. This was the first time I had undeniable evidence to myself and others around me that the DID i suffer from is indeed real. (I deny it all the time)
Ativan got me to sleep and they sent me home and I recovered with the help of a low dose of Ativan over the course of the next month. I am back to functioning normally. I work full-time, I have horses, I have a lot of friends, and I appear and I function as though I were one whole person.
But internally I do not feel like the same person everyday. I don't even eat the same foods. I struggle to form habits because of this. I do not have strong amnesiac barriers because of lots of trauma informed therapy, but I definitely have strong amnesia surrounding my childhood trauma. If my CPTSD is triggered, then my amnesia barriers seem to come down and I relive the nightmares of my childhood over and over again. But this only happens if I am under extreme duress, do not get adequate sleep, etc. once the duress subsides, so does the pain of chronic flashbacks.
I was thinking that maybe I have partial DID, but perhaps I have full-blown DID with a well integrated system.
There's a lot to discuss with my therapist!
Great to hear more about OSDD and how other forms of DID present
Hope it is helpful!
I feel like there is also a ranking of 'how severe your disorder/suffering is' and 'how bad your trauma has been' between DID and OSDD. Where things are considered worse for DID and lighter for OSDD (and partial DID). But, being diagnosed with DID and in close relation with someone with OSDD, I think this is not so straightforward. Having clearly distinct parts that can speak and act for themselves can be easier to understand and communicate with. There are names to refer to, parts can talk to a therapist and explain their view, etc. Not that there is anything easy about living with DID. But I think OSDD can be (even) harder to accept/make sense of/go to therapy with than DID. And the type and amount of trauma can be the same for any of the dissociative disorders. Or people could judge the trauma in the early life of someone with for example DPDR as much 'worse' than my trauma. I guess I just wanted to say that these things are complex and subtle, and unfortunately there can be a struggle to feel (and be) validated in any of these diagnoses and the impact.
I’ve never heard of partial DID before. This is very interesting!
I can understand this, because if a mental health care professional does not have a full history or background on the patient yet, they need to put them somewhere to bill and treat. Good video.😊 also since I have touched the subject on self harm issues I would love to see you talk about this issue as well and why this behavoir takes place and how a professional works on that issue in this disorder, if you have time.
That would definitely be a good idea, thank you!
made so much sense. not to self diagnose ( i will send this over to my psychotherapist ), but i do know where am i in the spectrum. thank you doc!
Thank you as always for these incredibly helpful videos!!
It's so refreshing for an expert to be talking about nuance and flexibility within the spectrum of dissociative disorders, rather than exact categorization of symptoms.
Thank you!
Always up to date, relevant and helpful. Thank you Dr. Lloyd, g
Very welcome!
Thanks Dr Lloyd for attempting to clear up the criteria for the different diagnoses. Here on the ground I feel like things are a lot more blurry since whenever we individuals were “built” we weren’t following published rules, therefore we can be messier than the criteria acknowledge. Other than for treatment, which is largely the same across the differences, I can see that diagnosis might be used for purposes such as disability or treatment intensity.
Perhaps a useful view might be also defining us by degree of impairment, rather than simply the display/intrusiveness of parts: those who cannot function fully in life, those who function okay with breaks in that ability, those who limp along with disruptions in relationship or capability barely visible to outsiders (all subject to change). I’m not sure that diagnosis accurately captures the above.
Hi, the actual diagnostic categories do take functional impairment and distress into account, they are necessary features. This was purely looking at the differences between specific classifications.
Hmmm... I was diagnosed with OSDD (DDNOS back then) in 1995 because, as well as having alters, I also showed symptoms of Dissociative Fugue and Derealisation, which, back then, fell into their own, separate categories of the five classified under Dissociative Disorders. I always assumed I got what's now known as the OSDD diagnosis because I technically didn't fit into just one of the first four categories, so they threw me into the fifth, 'catch-all' of DDNOS ('Dissociative Disorders Not Otherwise Specified,' I believe it stood for?)
However, having listened to your definitions in this video, Partial DID sounds a lot closer to how I experience my system and alters. So now I'm kind of confused! The Dissociative Fugue and Derealisation are still things I occasionally experience in times of extreme stress along with my alters influencing my behaviour - but I'm not sure, with the new classifiations, if that still keeps me in the 'catch-all category' of OSDD or not?
Well it’s time to speak about sth “more” than my cPTSD to my psychologist.
I started using “parts” terminology bc it literally describes what it feels inside. I’m usually aware about everything around me but I rather frequently (depends on how many triggers are in a day) move towards inside and specific part act through me. The passenger in a car is perf analogy. I know what’s happening, I have my own opinions or feelings about it but can’t help acting like a specific part wants. For example self-harming in very high stress situations: my adult self knows it’s not a good idea but can’t do anything but doing what one of my teen part wants and they want to escape through pain like they were doing years ago. I have many inner conflicts on a daily basis, I feel that some parts although having different coping strategies act and support each other and some parts hate others (especially teen ragefull part hates child part fawning to attach bc teen blames the child for being not good enough and making teen “do the dirty work”). My inner world (not like a specific place but like everything that’s happening inside) has always been complex, and I think that my parts are too differentiated to be “just” cPTSD parts but I really don’t know if I’m not exaggerating. It’s all weird and messy. Always in conflict. Always pretending something.
Excellent discussion! We've been wondering about these distinctions. Thanks for sharing 💜
You are so welcome!
One thing that’s never been clear to me with respect to the distinction between DID and OSDD is whether when you have OSDD another part can totally take control and you disappear and lose all memory of what happened (i.e., complete amnesia).
I have never received a diagnosis but three and a half years ago I happened to look up on the Internet someone I knew very briefly over 35 years previously and was surprised at how upset I was at learning that someone I knew so casually died a few years after I knew him. This bothered me for six months until finally after looking up some pictures of him on the Internet memories started to return to me. I recalled that the second time I was with him as we left a nightspot together and he turned to say something to me, he dissolved into mist and I have absolutely no recollection of what happened that night after that. As a matter of fact, I remembered nothing about him for 15 or 20 years. I also recalled that several years earlier somebody had come up to me in a nightclub very excited to see me and ultimately stalked away in anger because I had no recollection of him, which I thought at the time was a bizarre case of mistaken identity.
So although I never received a diagnosis of DID or OSDD, and perhaps never had either of them, some part of me was obviously taking over in nightlife settings and I don’t know how often it happened. I also believe now that something traumatic happened to that part the second evening “I” was with that fellow, as a result of which the part ultimately disappeared. A few years later, I attended a support group for adults abused as children and remembered that I had suffered extremely horrific abuse as a small child, perhaps because that part was no longer functioning to keep the knowledge from me.
But that’s beyond the scope of my question. I think it would be helpful for the sources to clarify with respect to OSDD whether complete amnesia can occur which they generally don’t do. Of course, ultimately it doesn’t matter for me what I had or didn’t have because it was a long time ago, and perhaps it doesn’t matter for anyone as long as they have a good clinician who can help them, but we all seem to have a need to put a name to what’s happening or happened to us.
The last three and a year years have been quite a journey for me. The CTAD Clinic videos have been a great source of information about dissociation for me and I am very grateful that you have made them available to the public.
Tom
Chicago, Illinois
USA
OSDD is not one thing. It is a collection of presentations which either fall short of DID (DSM), or both fall short of DID, and cannot be classified as P-DID. So, under the DSM, OSDD would be “Distruption of identity characterized by two or more…personality states, but lacking of part of the “marked [and/or “distinct”] discontinuity in sense of self and sense of agency” criteria, lack of all of the “related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning” or lack of “recurrent gaps in the recall of [events] inconsistent with everyday forgetting. Under the ICD, “Distruption of identity characterized by two or more…personality states, but lacking of part of the “ related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning” criteria, or the “ and possibly also the “personality states recurrently take executive control of the individuals’s consciousness and functioning” criteria.”
Whereas P-DID under the ICD-11 would be “Distruption of identity characterized by two or more distinct personality states,” and “marked discontinuity in sense of self and sense of agency” and “related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning”but lacking only the “personality states recurrently take executive control of the individuals’s consciousness and functioning” criteria of DID.
How can you get an accurate diagnosis if you can't tell the truth and be heard?
Other than being reassessed by different professionals and have your diagnosis formally changed- is it possible that your diagnosis changes over time? Like someone starts with DID but with treatment it begins to look more like partial DID and then OSDD? Or is it once you are in a category that’s it and it’s that you still have DID but you’ve learned skills that make it more “functional” for daily life ?
This is often the goal of treatment!
you explain things so well - thankyou!
Thank you very much for this invaluable info! This helps a lot.
this is very informative...
Thanks you always help me rrally inderstand myself
Thanks so much
diagnosed twice with DID via clinical symptoms and The MID but P-DID is really accurate to our experience
I was recently diagnosed with CPTSD and during the assessment a lot of questions about dissociation and parts came up. And I started to wonder if maybe these internal conflicts I have and these "extra" thoughts are actual -parts-. I didn't get an OSDD or any such additional diagnosis because the therapist said that since this is a new thing for me to consider, more time and therapy needs to be spent to figure out if the term "dissociative symptoms" in my medical journal is enough to describe my experiences or if there needs to be a secondary diagnosis.
It's all confusing and troubling, this video did help me understand the differences between the different states/diagnoses. I found myself nodding along in understanding and recognition of a few things, too. Thank you for the video.
I always thought that one criteria for DID is amnesia on a day to day basis and that if you don`t have this kind of amnesia you have partial DID or OSDD not DID. Did I get that wrong?
You don't have to have daily amnesia to qualify for a DID diagnosis, as far as I know. And you can also get an OSDD-1 diagnosis if you have amnesia, but your parts are not distinct enough for a DID diagnosis, or that's at least what I've read online (in the DID/OSDD community spaces they often call it OSDD-1a)
I've also heard DID amnesia can look very different from system to system. Some have complete amnesia between switches, others don't have any amnesia between switches, and many have a mix of these two
@@xx-sof-xx ok. thanks. But what does "distinct enough" means? Like that they have different names and ages?
@@butterflyb.9135 Thanks for your answer. Does that mean your are all the time there, but sometimes you just observe the others? But how does the amnesia occur then? I am jut curious☺
Oh you just described me exactly as i would have described myself. Things are finally moving forward for me now at last.
Glad to hear it!
It’s striking to me that amnesia was not centered. I think that is a shift either internationally (either with a more ICD focus rather than a complete DSM focus, or if that is simply a difference of emphasis.
Thankyou
Im even more confused now on where i fit. I had thought OSDD based on what i've read over the last few years, but as discussed here it sounds more like DID. The biggest thing that doesn't fit is that we really don't have memory loss between alters fronting, and we have a lot of co-fronting. So like, we have a bad memory as a collective and things are fuzzy, but for the most part we ALL have the same fuzzy and the same memories. Switching doesn't make other memories clear and different ones fuzzy. They are all always fuzzy no matter who is up.
The only thing that concerns me about this partial diagnosis is that when it comes to support, government funding ect, that you will only get partial funding or supports when its the same treatment.
I sincerely hope that is not what the “partial” aspect would reflect.
If your parts don't have agency, their ability to mess with your life, your job, and your relationships is very different. Being triggered and having to manage a system's needs is very tough. Full stop. Makes life very painful and difficult. But...Being unable to recall where you were, what you did, or being unable to respond/move because a part has taken control of your body and speech is incredibly disruptive to functioning. You can lose your job, lose your partner, lose your kids, and lose your life because they put you in dangerous situations. I am not saying that partial DID isn't painful and crippling. At all. It is. But DID can be the functional equivalent of schizophrenia in ways that OSDD and partial DID rarely are.
By the process of healing DID won‘t be that extreme anylonger. You guys will be able to communicate and shoot for the same aim, at least you won’t fight against each other anymore. But though, at least from my own experience, there will remain several different opinions
It was my understanding that the difference between DID vs OSDD-1B was that DID has memory segmentation (each headmate having only access to memories they personally experienced, or were directly told about by others, and mostly blackout in-between) whereas OSDD-1B does not (each headmate is still a distinct person, but all have shared memory, though possibly with depersonalisation/derealisation as to memories belonging to a different headmate).
You didn't mention this framing at all, and instead described OSDD as being about headmates that are less distinct from each other or that aren't full persons (e.g. that only rarely present and only for very narrow purposes); I thought that was only OSDD-1A.
Have I misunderstood something?
For me it feels like I have a “ self” that manages the parts but the parts run the body. Sometimes with co-consciousness but other times it feels like the “ self” is just an observing from the back and can collect clues that a part is forward and what part is forward but isn’t able to influence decision making. The “self” is put in the back when I am triggered or if a new part comes forward. I thought I had achieved full integration of parts but just learned of another part I had some awareness of but no access too. That part was triggered forward a few weeks ago and since then I have been losing so much time and feel like I’m in the back more often than the front. It’s been difficult feeling like I have had such a large regression in such a short amount of time.
I haven’t been formally diagnosed but have a great therapist who is understanding and as validating as she can be but sometimes it feels like even she doesn’t understand my experiences as they feel so difficult to articulate to others.
I'm still slightly confused. I am formally diagnosed with CPTSD, and I self-diagnosed with OSDD/P-DID about a year ago, because I have distinct personality states, but no black-out amnesia and I'm usually the host (or at least have significant influence from the host), and the lines between parts can be a bit blurry (some are more distinct, but the clear distinctions only really come forth when heavily triggered). I was never quite sure whether my self-assessment was correct, or if DID was a more accurate diagnosis. It's kind of hard for me to know my own symptoms because of amnesia and regularly going into denial. Based on your video, I'm pretty sure I have P-DID,. But it's not clear whether that would be DID or OSDD in the DSM-V. Not that it matters, I guess, since where I live (Norway) the ICD-10 is what's currently in use (despite being outdated). I probably won't get a formal diagnosis, since it makes no difference for treatment and I'm getting my treatment privately (and in the UK, since crossing borders was the only way to get the expertise I needed).
Can partial did and OSDD come together? Partial did makes a lot sense, but all the internal confusions and dialogues and the DP /DR reactions come and go. My life today is rich and good but I still seek the understanding of us.
Also how does this fit in when DID is often covert, so many people with DID will starting thinking they have partial DID. I still have parts that dont even know they have DID.
Its rarely safe to be covert particularly in the culture and misconceptions of this disorder.
That’s why it is important to diagnose in the basis of what is evident, then change according to new information, should it be less covert in therapy, for example.
How have you found a diagnosis to change over time? It's fair to have an initial diagnosis of one of these types of dissociation, but does the type shift as treatment continues? Does the client go from symptoms of DID to no DID, or can they shift to more generic OSDD, and then to no symptoms?
I dont know what to do anymore. Like you mentioned in another video, I survive day to day, my life goes on, but I'm not really living, im not thriving, and i feel like im living with a giant cloud of despair behind me all the time. How can i ever grow and learn as a person if they keep taking control and ruining my life and the things that happen dont happen to me and i dont feel the effect those things have on my life
💙💙💙
I have DID and am fairly integrated now. I am interested in learning about hypervigilance in my marriage. I want to stop scanning him for whether or not he is satisfied or about to judge me (which he does NOT do!)
In the moment, I long for peace and healing. After a lot of good therapy some of the criterias fade out. I suppose some other difficulties often come with us as well? Like depression, suicidal thoughts, ocd, body dysmorphia or eating disorders..?
I have a question. I watch all of your videos, by the way! I really like how you explained in a video with the glasses and a pan of water, how DID is explained. that being said, if were all pieces of the same pie, so to speak, if one part has a lot of reasoning, or higher IQ level, does that take away from the rest? or is that a shared type of thing? I came to realize I was 3 hours from home with nl shoes on and no car once, then I was back at home. so I'm glad what ever did that, fixed it, but I was just wondering if say a personality trait, or reasoning, or mood, as you are finite, it stands to reason what makes you, you, is finite, getting myself confused lol. sorry for the drawn out question here. but was wondering if that the case. Love your videos, they have been the most helpful at attempting to manage!
Thank you for the feedback! I would say parts are only limited by the nature of the whole, we are still discovering possibilities, so keep an open mind!
@@thectadclinic will do! thank you for your approach to,, and explaining DID has helped me greatly and not to be ashamed of it! thank you. and i look forward to more videos!
Does the ICD not distinguish between OSDD 1a and 1b?
Is there a skid d for children and teens?
I wonder if y'all understand that plurality has existed healthily throughout human history and that the reason people are disordered when they are plural systems is the trauma of hiding and the trauma of having to reinvent the wheel and not knowing what to do because no one is around to teach anymore how to navigate these kinds of things, not pathologize, not imprison in institutions, not be afraid, and these peoples are so often left without the cultural rituals for knowledge transmission and learning that many cultures have previously developed for such people.
“Then they retreat” leaving us to pick up the mess 😩
That does happen.
This is a strange way to talk about it though, aren't OSDD-1a and -1b Diagnoses within the DSM-5?
The ICD is a completely different diagnostical System (the International one) and it uses a slightly different way to categorize and name certain Symptoms and Disorders.
So: There is no OSDD in the ICD-11...👀
pDID (partial DID) in the ICD-11 is OSDD (DSM-5) basically. [pDID used to be called DDNOS in the ICD-10].
To distinguish between the two, as if it was in the same Diagnostical-System is not accurate and confusing!👀🤔
What is your reason to do so anyway? (Maybe it is handled differtenly in the UK? I am from Germany, we only use the ICD. So there is no OSDD-Diagnosis at all. But it would still be confusing to explain it, as if there where even more Diagnoses🤷🏼♀️)
Your comment (thank you!) shows the inherent difficulty with OSDD - the 1a and 1b are all about amnesia, without really taking into account the way alters work. Partial DID is in the ICD-11, not in the DSM-V (which is used here) but so is OSDD, but for different reasons - it is more like unspecified DD in the DSM-V. I don't think the two collaborated and left us with lots of interesting conundrums!
would you know any experts in your field that one could reach out to when living in other countries than the UK?
The Netherlands, Germany, Sweden, or other European countries that would have institutions comparable to the CTAD Clinic?
There are plenty of specialist centres, go to ESTD for a map of people involved across Europe.
Partial did makes a whole lot of sense. But still the internal confusion and diffusion is that more like OSDD?
Likely to be, as there is no real external process, other than reactive.
What do you call someone with partial DID until stress level events cause DID for long period of time, 12 months?
As someone diagnosed with severe DID (psychiatrist words on paper) Since having our baby we made a deal we would have one main part to have stability. The only thing we have ever all agreed on. Yet as soon as stress comes in, that kinda falls apart.
That just sounds like DID but with periods of time that others don't front as frequently. I doubt the diagnosis changes due to circumstances.
This is the first time Ive heard of partial DID and what that is.
Im wondering if I can have D.I.D. without complete amnesia? The only complete amnesia I have is most of my childhood has been forgotten.
@@JesusLightsYourPath You absolutely can. It is how I kept myself in denial through all of these years. One way is having amnesia but you get an "info dump" of memories that don't make you look too closely. Or you have someone that always keeps track. No system is the same and the "fact" that it is rare is a myth that's debunked since long. It just tries to keep you in denial as is the nature of the condition.
As one heals and becomes less dissociative, more unified, more or less functional, does the diagnosis change?
It can be, as in 'downgraded', but that doesn't happen much, it's more that DID (for example) remains the diagnosis, but without the difficulties. A person could have it completely removed if fully healed.
Is there a partial osdd?
Can partial did develop in adulthood or do you need to have childhood trauma for it to develop? The icd 11 says onset can occur in adulthood.
You could see the issue being about either development, or onset. The first can occur and be hidden, the second occurs later because it was hidden.
@@thectadclinic that make no sense to me, can you reword it?
@@bombbomb2658 DID develops early but is hidden, then surfaces later in life as ‘new’
@@thectadclinic I know that DID develops in childhood due to trauma, but I am asking about Partial DID. In the ICD-11 it says this: ''The onset of Partial Dissociative Identity Disorder may occur at any stage of life, from early childhood to late adulthood.''
Does that mean that it can develop as an adult with only trauma in adulthood, no childhood trauma, or do they mean it still develops from childhood trauma but the symptoms can start to show at any point in life, example: late adulthood.
That is my question. I got a person telling me that it has been proven that DID can develop in adulthood and that they developed DID from ages 18-24, their trauma years. They gave no sources for this claim. From this, i got into a discussion with someone else about it and they brought up P-DID and how it according to the ICD-11, could develop as an adult. It seemed like the word 'onset of' was interpreted in two different ways. One as that the development can start in late adulthood with no childhood trauma and the other way as symptoms can start to show in late adulthood but still require childhood trauma. In the end they seemed to agree with me on that it still required childhood trauma but now we are both confused with what the person(s) who wrote the ICD-11 meant with 'onset of'. I hope this clarified my question.
To simplify it even more: Does P-DID require childhood trauma, but symptoms can occur at any point in life, childhood or late adulthood?
@@bombbomb2658 machen sie keinen Unterschied zwischen Did und part. Did..beides erfordert ein Kindheitstrauma. Das kann auch auf der Ebene des Bindungstraumas erfolgen, muss also nicht körperliche Gewalt sein. Es entsteht immer in der Kindheit, kann sich aber sehr lange verstecken....und z. B. auch erst mit 50Jahren ausbrechen. Meist geht diesem Ausbruch, bzw. dem Zusammenbruch des versteckens ein besonders stressiges Ereigniss voraus.
this is interesting, the only part I've found that can take executive control is a two yo who's only role is attatchment
What category does polyfragmented DiD fall into?
What kind of accent do you have?
Not much of one at all, really.
Is there somewhere that documents the recommended treatment protocols for DID/partial or OSDD? Can’t seem to find anything specific on NICE guidelines etc
The ISST-D have the international standard guidelines, free to download from their website.