Is There Anything that Will Work for my DID? * Dr. Leland Heller is a family physician who has treated thousands of patients with the Borderline Personality Disorder. BPD is a medical disorder and that this and other Biological Unhappiness disorders are treatable with medication first and then by retraining the brain * Biological Unhappiness * BiologicalUnhappiness.com

IS THERE ANYTHING THAT WILL WORK FOR MY DID? Is There Anything that Will Work for my DID? Ask The Doctor Dr. Leland Heller Biological Unhappiness Is There Anything that Will Work for my DID? Is There Anything that Will Work for my DID? IS THERE ANYTHING THAT WILL WORK FOR MY DID? Is There Anything that Will Work for my DID? Question: I’ve been diagnosed with DID for some time now.  Every time I have an insurance change, I have to go through the entire diagnosing process over again and causes serious disruptions in therapy.  Do all diagnosis have to go through that?  I always get stuck taking a MMPII and I’ve never had valid results.  I’ve told them that’s what happens.  The psychiatrists and psychologists ask me why.  The last time I wrote to the manufacturer who stated it doesn’t test for dissociation.  But I know some DID’s are able to take ‘valid’ MMPI’s.  Do you know why some can take valid MMPII’s and other DID’s can’t? Your theories on medications are interesting.  I’ve had several bad experiences with Prozac.  Paxil did very little.  Zoloft, nothing.  Effexor, nothing.  And Celexa didn’t get a fair trial because I started Adderall at the same time which felt like they canceled each other out.  My problem with Prozac occurs in about 6 months.  Eating disorders kicked in and other self destruction problems that normally aren’t an issue for me without very extreme stress, including suicidal.  Typically I don’t display a lot of BPD symptoms without being under extreme stress and even then, I don’t identify with the feelings associated.  Relationships are stable, sticking with therapy hasn’t been a problem, haven’t had cutting urges or been hospitalized, no threats, etc.  But for now, I’m assuming that a BPD part could become dominant–that I haven’t had to deal with much yet.  Previously, I went through 4 trials with Prozac with different providers–7 to 10 years ago.  I was at maximum dosage almost immediately. I tried the Tegretol for about a year and it just put me into a ‘knock out sleep’ which I wasn’t fond of.  Towards the end, my blood pressure and cholesterol raised to dangerous levels, pointing to additional medication and normally they are extremely low (“you’ll never have heart disease”).  Some of my discomfort was probably due to the fact that I use frequent switching to mask changes and slowing that down was disruptive.  I’m not sure if masking changes was to prevent others from noticing DID or to keep me from being aware of DID, since I was fairly newly diagnosed at the time. I discovered I was a ‘non-absorber’ decades ago, trying to get medication for my asthma under control.  The doctor wondered where the medication was going.  That hasn’t changed.  I’m at maximum dosage within a month or two for pretty much any medication.  Tegretol makes me nervous because it doesn’t take a lot to cause a serious problems.  I had one experience where several parts came out in succession and took it without me realizing it.  I think I’ve got that fixed, but it makes me nervous now. What did work was 400mg of Wellbutrin and 90mg of Adderall daily.  The Adderall was a godsend, literally.  It calmed me down and I could fall into a nice sleep during the first 20min.  I could focus.  My friends notice immediately when 4 hours is up just based on my spaciness.  Several therapists have been surprised the Adderall worked because they didn’t notice signs of ADD or ADHD.  The therapists seem to be more aware of the differences between ADD/ADHD vs. PTSD than the psychiatrists have been. What was suggested to me was that my ‘normal’ anxiety level is routinely high and the Adderall adds enough to kick my brain ‘over the edge’ to shut it down, creating the sedating effect I experience.  In other words, I’m beyond the ‘fight or flight’ syndrome– which calms me.  At the time I started taking it, I was ‘freezing’ and had been out of therapy for awhile.  The medication change allowed me to function again.  Well, now I’m back in regular therapy and I’m freezing up with or without the medication.  I’m wondering if that might mean I’m better (less anxious) when the medication can’t put me ‘over the edge’ as well. I feel like I’m living in flashbacks of half present and half past.  There’s no difference for me between 5 minutes, 5 years or 40 years ago, emotionally and I can’t keep up with it daily to keep track of, process, or contain (whatever I’ve just remembered) at that rate. I don’t have a psychiatrist familiar with or one that ‘believes in’ DID.  (You’d think DID was a religion).  That also means I don’t have a psychiatrist that I can be too honest with.  I’ve gotten used to that and I’ve adjusted by doing my own basic research into the direction I want to take with medication.  I can usually give them the idea of what to prescribe and let them make the final adjustments.  I know this isn’t ideal or standard.  It’s just the best I can do under the circumstances.  I’m grateful I have access to that much. I realize you can’t make specific recommendations because you haven’t seen me, but I would be interested in hearing the general direction you might take with such a situation and why. I think your basic concept that there’s a continuum is interesting (PTSD -> complex PTSD -> BPD -> DID).  I’ve heard it’s impossible to have DID without PTSD, and in that way, it would make sense for the same to be true for BPD as well.  The other theory I’ve heard developmental age related since DID (and BPD?) required developing during childhood, unlike PTSD and DID tended to form at an earlier developmental age than BPD.  As far as I can tell, my abuse began very young (< 3).  DID formed before a personality did, resulting in chronic dissociative states and BPD formed after some sense of identity was formed (the terrible two’s) resulting in transitory dissociation. The reason why I bring that up was because that might alter therapy somewhat.  For example: your website made me aware that I honestly don’t have the vaguest concept of what ‘safety’ is or feels like.  I used to teach English as a second language to Hmong people from Cambodia.  They don’t have a written language at all.  Just instilling the idea that what they spoke could be put on paper and read was 90% of my efforts.  When I explained the challenge to friends, I’d say it was like explaining what the color looked like to a person that had been blind from birth.  If someone had a basic identity allowed to form, then they might also have an instinctive concept like what safety feels like.  I didn’t know if you had additional thoughts about that since that’s also part of the theory behind ISSTD’s guidelines. I’ve had a couple of therapists test me for DBT and I wasn’t able to keep consecutive track of what was happening enough.  They explained it as I was too ‘compartmentalized’ and information isn’t flowing between the barriers.  I’m not sure how ‘retraining’ the brain would help resolve that, but I haven’t finished reading your website yet.  My ‘self help’ library is frightening and it’s like movies, I never have to worry about reading or seeing something twice.  It always feels like the first time.  Obviously, your website has given me information already. Dr. Heller’s Answer: I’ve treated approximately 15 patients with DID, diagnosing another one this week.  Virtually all have done very well compared to their baseline condition.  It’s not uncommon for me to ask if any particular personality has needed to come out since our last visit.  This is difficult for the occasional individual who don’t remember the episode.  DID is usually a disabling condition, although some are able to maintain employment and families (it is usually extremely difficult).  The right medications really make a difference, especially the correct “as-needed” medications. It’s caused by profound abuse and has lots of interesting phenomena, such as one personality having breast cancer and another one doesn’t.  There’s far more that’s not known about the DID than is known.  Virtually everything is theory based on minimal good research. The principles of treating DID are the same as I use on everyone, with the addition of Remeron (mirtazapine) and techniques to help the individual feel safe.  Make all the medically treatable diagnoses and come up with a comprehensive plan to treat them all. Every one I’ve treated had the BPD.  Remeron (mirtazapine) is needed for all of them due to its PTSD effects, particularly sleep and nightmares.  I usually recommend a motion sensor over the bedroom door that will squeal if anyone gets into the room.  A large dog can be helpful as well and made a huge difference for one of my DID patients. In my experience, the MMPI is useful for following treatment, not for making diagnoses. The other personalities are there to protect you.  I don’t try to “integrate” the personalities or get the individuals to “fight” the other personalities.  I try to help individuals with DID understand they are there for protection.  What makes the other personalities stay away is having the individual doing well emotionally and feeling safe. You jump to a lot of conclusions about medications, why they work, why they have side effects, etc.  Most of them are probably incorrect.  An example, the Adderall could have triggered a hypomanic episode that made you feel great.  It’s not just the medications, but the right medications, in the right sequence, and at the right doses.  There is no “mental health” pill.  Prozac doesn’t “stop working”.  What likely happened is you either went into a BPD dysphoria episode or temporarily needed Wellbutrin (buproprion). Being a poor absorber of medication (such as after gastric bypass surgery) complicates the treatment, but liquid medication can usually be used, and blood levels can be monitored for Tegretol. 50% of those with the BPD have ADHD.  The cognitive generalized anxiety disorder (genetic worry – the “caveguarder gene”) is also very common and if it is not treated properly will cause most medications to have adverse effects. Not everyone has the same symptoms.  20% of individuals having a heart attack do not have chest pain.  While symptoms are important, it’s the diagnoses that are the most important.  From there, adjustments to medications can be made based on symptoms and side effects. Is There Anything that Will Work for my DID? 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 Ask the Doctor Home Is There Anything that Will Work for my DID? MENU: Is There Anything that Will Work for my DID? 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You can watch and listen to Dr. Heller in the comfort and convenience of your own home.  Provides full explanations and treatment descriptions of Borderline Personality Disorder (BPD) – 90 minutes, other Biological Unhappiness disorders – 90 minutes. Click here to find out more about Dr. Heller’s educational videos. Is There Anything that Will Work for my DID? “Biological Unhappiness” “Open this book and it will open your mind.  By combining proven medical procedure with hope and inspiration, Dr. Heller has made a significant difference in thousands of patients who had little hope for recovery.  “Biological Unhappiness” contains critical information for those who have lost hope.”Zig Ziglar, motivational speaker, author, See You at the Top, Over the Top, Success for Dummies, Raising Positive kids in a Negative World. Is There Anything that Will Work for my DID?    Is There Anything that Will Work for my DID? Dr. Leland Heller  Dyslimbia Press, Inc. 1713 US Hwy 441 N, Suite E • Okeechobee, FL  34972 • 863-467-8771 Email: Hours: M-Thu. 8:30AM-5PMFri. 8:30AM-12 Noon*(*During November through April, the office is open until 3PM on Fridays.) All material not explicitly credited otherwise is copyrighted © 1999-2011 Dr. Leland Heller. All Rights Reserved.  May not be duplicated without the permission of Dr. Leland Heller or Dyslimbia Press. Biological Unhappiness™, BiologicalUnhappiness.com™, & Dyslimbia Press™ are trademarks of Dr. Leland HellerDesigned and/or hosted by the webmasters at: US-Webmasters.com (TM) Start here to find it FAST!(TM)