Through the lens of attachment relationship: stable DID, active DID and other trauma-based mental disorders.

Some people with DID, despite years of DID-specific therapy (using the three-phase approach, ISSTD, 2011), seem unable to get better. In particular, they seem unable to remain physically safe ("Phase One") and report continued exposure to abuse. As every fresh hurt causes fresh dissociation, their DID becomes further entrenched over time. Moreover, as dissociation makes the person more vulnerable to being re-abused, they become caught up in a vicious cycle, which further obstructs their efforts toward recovery. In this paper, I propose the existence of two distinct presentations of DID, a Stable and an Active one. While people with Stable DID struggle with their traumatic past, with triggers that re-evoke that past and with the problems of daily functioning with severe dissociation, people with Active DID are, in addition, also engaged in a life of current, on-going involvement in abusive relationships, and do not respond to treatment in the same way as other DID patients. The paper observes these two proposed DID presentations in the context of other trauma-based disorders, through the lens of their attachment relationship. It proposes that the type, intensity and frequency of relational trauma shape-and can thus predict-the resulting mental disorder. It then offers an initial (partial) classification of trauma-based attachment modes and their corresponding symptomatic sequels. The analysis and formulations presented in this paper are based on attachment theory and extensive clinical observations.

Boundary modifications in the treatment of people with dissociative disorders: a pilot study.

This article examines the prevalence and types of modifications to professional boundaries that occur in the treatment of people with dissociative disorders (DDs) and considers some of the implications of the findings. The study is based on the replies of 163 professionals to a 20-question survey. The survey compared the boundaries that each practitioner kept with patients/clients (P/Cs) who suffered DDs to their boundary practice with all of their other P/Cs (non-DDs). Boundaries were deemed modified when professionals treated their DDs P/Cs differently than their other P/Cs. Professionals' general boundaries were not examined. The results showed a marked tendency for the modification of professional boundaries when treating people with DDs. These results appeared to be independent of country or profession but were more pronounced among the more experienced professionals. Areas of greatest modifications were identified. The prevalence of these modifications points to their potential importance in understanding some features of DDs.