June 11, 2009
I hope everyone has already recorded his or her score for the DES before reading this follow-up blog.
If you haven’t yet taken the DES, please do so before reading any further.
To explain the scoring of the DES, I’m going to quote some material from Dr. Colin Ross’s book “Dissociative Identity Disorder”. This information can also be found online at http://www.rossinst.com/dissociative_experiences_scale.html . Dr. Ross also provides a lengthy discussion about dissociation in the general population, charts, graphs, and comparative information with the DDIS, SCID-D, SCL-90, and MCMI.
The Dissociative Experiences Scale (DES) is a 28-item self-report instrument that can be completed in 10 minutes, and scored in less than 5 minutes. It is easy to understand, and the questions are framed in a normative way that does not stigmatize the respondent for positive responses. A typical DES question is, “Some people have the experience of finding new things among their belongings that they do not remember buying. Mark the line to show what percentage of the time this happens to you.” The respondent then slashes the line, which is anchored at 0% on the left and 100% on the right, to show how often he or she has this experience. The DES contains a variety of dissociative experiences, many of which are normal experiences.
The DES has very good validity and reliability, and good overall psychometric properties, as reviewed by its original developers (Carlson, 1994; Carlson & Armstrong, 1994; Carlson & Putnam, 1993; Carlson et al., 1993). It has excellent construct validity, which means it is internally consistent and hangs together well, as reflected in highly significant Spearman correlations of all items with the overall DES score. The scale is derived from extensive clinical experience with an understanding of DID. In the initial studies during its development and in all subsequent studies, the DES has discriminated DID from other diagnostic groups and controls at high levels of significance, based on either group mean or group median scores. In most samples, the mean and median DES scores for DID subjects are within 5 points of each other.
…The higher the DES score, the more likely it is that the person has DID. In a sample of 1,051 clinical subjects, however, only 17% of those scoring above 30 on the DES actually had DID (Carlson et al., 1993). The DES is not a diagnostic instrument. It is a screening instrument. High scores on the DES do not prove that a person has a dissociative disorder, they only suggest that clinical assessment for dissociation is warranted. This is how we report DES scores in our consults, as within or not within the range for DID, and as consistent or not consistent with the clinical and DDIS diagnosis of DID. DID subjects sometimes have low scores, so a low score does not rule out DID. In fact, given that in most studies the average DES score for a DID patient is in the 40s, and the standard deviation about 20, roughly about 15% of clinically diagnosed DID patients score below 20 on the DES…..
The DES is the only dissociative instrument that has been subjected to a number of replication studies by independent investigators. We found in our original replication (Ross, Norton, & Anderson, 1988) that it discriminated DID from other groups very well, with scores similar to those found by Bernstein and Putnam (1986), and this pattern has persisted in all subsequent research….
The DES can predict who will not, and who may have a dissociative disorder with high accuracy. As well, the DES taps into the dissociative component of general psychopathology… The DES is not just picking out a dissociative anomaly that is unconnected to anything else.
Because of the properties of the DES, and its extensive research base, It is the best self-report instrument for measuring dissociation available….
In other words, most trauma survivors that are clinically diagnosed with DID score in the 40’s on the DES, but survivors with DID can certainly score lower than 20 and higher than 69. Scores over 30 will indicate a high likelihood of the person having dissociative identity disorder.
Basically, the higher the score, the more likely the person has DID. The DES is not an official diagnostic tool, but it can certainly help to screen for people with dissociative disorders.
In my personal opinion, for dissociative people, the DES score will be somewhat dependent on who in the system takes the test. The parts that have more denial and dissociation from the rest of the system will likely score lower than others in the system that are more aware of the others inside. Also, I would guess that the DES score might vary with the different stages of therapy and treatment.
In any which way, the DES can be very helpful in your therapy process, and I strongly encourage you to discuss your scores in detail with your therapist. Various questions may have specific personal importance for you and can provide good foundational material for processing the ways your dissociation affects your life. The DES can give you an excellent starting place for talking about how life is for you as a dissociative person.
It can be helpful to take repeated DES tests over the course of your treatment, so you can record the changes over time. Hopefully, your dissociative scores will decrease as you progress through your therapy process.
- Which questions do you most relate to?
- If you have scored higher than 60% on any question, does your therapist understand that this experience is so common for you?
- Did you hear or sense internal arguing about how to answer any of the questions?
- Were you surprised to see any of the questions?
- Which questions asked you about dissociative experiences that you have not yet told other people that you experience?
- Do you find the DES to be upsetting? Comforting? Frightening? Confusing? …..? (fill in the blank)
Kathy Broady LCSW
April 1, 2009
Obviously, there is a tremendous amount of controversy and upset amongst the survivor community about how Showtime has presented dissociative identity disorder in United States of Tara series.
Thank you, everyone, for so many lively comments on the previous post about this topic. I think that’s excellent. It is very good to speak up about your cause and let the world know how it really is. One way to combat the misinformation is to make sure the correct information is out there, available, and viewable for those that really don’t know.
Now I have some questions for you.
If you were the writer of the Showtime series United States of Tara, and knowing dissociative identity disorder as well as you do….
In your opinion, how should the United States of Tara series end?
What would you like to see?
What would you have liked to teach about DID/MPD through this media opportunity?
I realize Toni Collette, Diablo Cody, and the other producers of the show are not likely to ask our opinion, but I’d still like to know. AND, I think this public blog site can be a good place to express your opinion. Don’t be silent about this — let the world know what you think!
Remember how we re-wrote the Hole in My Sidewalk poem? If you were to tackle this project, how would you re-write the Tara show??
Mostly what I want to know…. If you were the senior creative writer of the series, what would you include, and how would you end the season?
All creative and playful comments welcome.
Let’s have some fun!!!
March 26, 2009
Do you use twitter??
I’m totally new to the idea, but I’ve added it today to this blog.
I think it’s working correctly, so for those of you that enjoy twittering, my twitter name is Kathy_B_from_AC . That’s a shortened version of Kathy Broady from AbuseConsultants.com, of course.
Since I’m new to this, I’m not sure what all I’m inviting you to – but hey, it’s the newest thing, so… let’s have fun with it!
I hope you are all having a great day –
December 11, 2008
What is therapy? What is a therapist? And how can you tell if they’re any good?
In my experience, therapy is about speaking the unspeakable. It’s the telling of things that you haven’t had the safety or the opportunity to tell before. It’s expressing your deepest feelings without have to edit or omit or pretend for the sake of someone else. It’s exploring within yourself to find who you are, and who the other parts of you are. It’s looking at the painful truths of your life, coming to grips with even the most shame-filled realities of the ways you were hurt and the ways you hurt others—and then being able to move ahead with a greater peace, more resolve, a quiet solidity, and an acceptance of what has happened in years gone by. It’s the process of facing the past while also allowing it to fade away, becoming free from it, instead of being consumed by it or chained to it or terrified of it. It requires seeing and knowing some very harsh realities, but helps you find a way to be solidly ok with yourself anyway and to live a full and happy life despite the horror and pain.
A therapist is a listening person who can hear what you have to say and help you to process your experiences and move beyond them, a companion in your pain and a witness to your truth.
A safe trauma therapist is one who can contain your feelings and experiences, however intense, and remain themselves, present in the room with you. It is one in whom you can have the confidence of knowing they are on your side, as well as the reassurance of knowing they are their own confident person who will not be easily steamrolled, bullied, or deceived. Your listening person can’t be fooled by denial, manipulated by fear, scared off by anger, or accepting of projections. They must be strong enough to handle your pain, your emotions, your truths, without falling into their own emotional traps, and yet they need to be gentle enough to provide genuine compassion and comfort. Your listening person must be kind, but firm. Flexible, but unwavering. Provoking, but protective. Accepting, but honest.
Trauma therapy is not just about the recovery and processing of memories. It is also about learning to think and act in different and better ways. Emotional fallacies, cognitive distortions, controlling manipulations, and psychological defenses all have to be addressed. In therapy, your greatest wounds and your worst behaviors both will be exposed, examined, and engaged. Ouch—that’s really hard to do. No wonder therapy hurts.
Therapy is an enormously difficult personal challenge. It requires courage and willpower by the bucketful. Beyond that, it also takes a great personal commitment on your part to hold on to the therapeutic alliance through the difficult times. Sometimes this persistence can mean going against what feels “right”—so many of you have learned through hard experience that trust is a myth and caring is a painful lie.
And although healing therapy is desperately sought out by trauma survivors, and although it can be a life-saving, heart-warming, and incredibly powerful process—within each and every trauma survivor, there will also be long lists of reasons, recognized or unrecognized, conscious or deeply hidden, why therapy is not ok, not necessary, or not helpful for them. So it can be all too easy, when the going gets particularly tough, to turn from the onslaught of truth and from the therapy that has unleashed it. It is too easy, sometimes, to deflect the truth onto someone or something else, discard that person or thing from your life as you no doubt wish you could do with the truth and just keep running.
Your commitment to therapy will be tested again and again. I commend each and every one of you who daily move forward on blind faith, against what feels like your better instincts, to find true healing.
Externally, there may other challenges to face. There may be others in your life that don’t want you to move forward. Maybe your family likes the status quo, and they don’t want you challenging their norm. Maybe your perpetrators don’t want you to realize the truth of what happened, or maybe they don’t care if you remember, as long as you blame yourself for their crimes. Or maybe someone is invested in controlling you now. They certainly wouldn’t want you to learn healthier ways of thinking and feeling.
It is crucial that you are willing to be honest with yourself in your healing—about yourself and about others in your life—even when painful truths are revealed. As hard as it is to do, facing the truth is the only way to achieve full healing.
Kathy Broady, LCSW
December 8, 2008
Do you feel like you can be very different people?
Do you have trouble remembering what happened through your week?
Do you have minimal memories of your childhood?
Do you feel a lot of conflict within yourself, and have unexplainable extremes in your behavior, thoughts, or attitudes?
Do you have conversations in your head, and do the voices in your head talk about you?
Read on…. This article is for you. And no, you are not crazy.
Dissociative Identity Disorder (DID), formerly known as multiple personality disorder (MPD) is an adaptive response to a very maladaptive environment. It develops in response to trauma severe enough that people can only handle the experience by mentally splitting themselves off from it. A common thought becomes, “that’s not happening to me – it’s happening to somebody else.” By forming other selves to handle traumatic situations, the person compartmentalizes the experiences and dissociates themselves from their occurrence. This allows the person to maintain a separated sense of self, safely secluded away from danger. even when their physical body is obviously forced to participate in intolerable activities.
The treatment for DID is based on reversing and repairing this splitting and separating. This amazing coping skill, once highly adaptive in traumatic situations and originally a life- and sanity-saving strategy, eventually causes great disturbances in a person’s life. Over the course of time, the depth of pain, the volume of emotionally laden memories and experiences, the constant conflict between too many opposing needs, the hidden loss of original self, and the chaos of having many separate selves all become too overwhelming to manage. The dissociative walls that once neatly separated these areas begin to crumble — complications, confusion, disarray ensues.
By this time, therapeutic treatment for dissociative disorders can be highly beneficial.
As these survivors gain safety from any ongoing abuse and any ongoing reason to dissociate, they can begin the process of healing and re-associating themselves with their parts. This occurs gradually, as they connect with the painful, emotional, intellectual, physical, and spiritual experiences that forced them to split and separate in the first place. Only as they re-learn about their traumatic history, meet the needs that went unmet at the time, find comfort for their pain, and develop a safe life without trauma, can they heal the emotional wounds that have been left unattended for so many years.
The dissociative treatment process is long and complex because of the depth of the issues involved. Typically for those with DID, the abuse occurred for years, with a wide variety of offenders, and a significant lack of comfort or assurance of safety. Pain, crisis and trauma became an “everyday normal reality” and no area of life was unaffected by such extreme trauma. Healing from this depth of injury takes time because there is so much healing to do.
If you are dissociative and you’ve carried your hidden pain within your hidden selves for too long, healing through the reconnection process is beautiful. It is not easy, but it is very much worth the effort.
Kathy Broady, LCSW