Peer Support for Abuse Survivors
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Your friend certainly has a history of significant trauma and neglect, and demonstrates several of the symptoms common to people who have been severely and chronically traumatized. These symptoms include dissociative symptoms, numbing, using self-injury to cope with overwhelming feelings, identity confusion, and perceptual changes. It is not possible for me to formulate a diagnosis accurately based on the information you have provided, and I will not try to formulate a diagnosis without seeing a patient face-to-face. With regard to the possibility of your friend having DID, I do not know how distinct and enduring are her different personality states, how well organized they are, or whether or not she has significant inability to recall important personal information, all of which are criteria needed to make the diagnosis of DID.
Useful concepts that may be of assistance to you in thinking about your friend are the concepts of “Complex PTSD” or “Disorders of Extreme Stress,” which emphasize the effects on a person of chronic trauma and being under the control of another. These concepts have not made it into the DSM IV, but are useful for thinking about the prolonged and pervasive effects of chronic trauma, abuse, and neglect. See the National Center for PTSD Fact Sheet
The best way you can help her as a friend is to be available and attentive, and to listen to her informed by what you now know of the pain she has endured, and the courage she has had to have in order to survive these ordeals. You also need to speak up for your needs in the relationship, and not let the relationship be about fixing her. Healthy relationships are never mostly about fixing one of the parties! You may need to tell her what you can tolerate to hear about, and what is too painful for you to hear about. Your friend knows that what she has shared is hard to hear: that is why she has waited so long to confide it. But remember that you are her friend, and not her therapist. It is not your job to help her in dealing with the effects of her trauma.
If she does want to talk to you about her trauma and how it affects her, at some point you may wish to inquire whether she has been in therapy to deal with her pain. When survivors begin to deal with their trauma, it is inevitable that they will get in contact with feelings and memories that are extremely painful and possibly overwhelming. In therapy, it is often useful to start by teaching distress management skills (grounding, relaxation, meditation, positive visualizations, techniques to combat runaway trains of thought, etc.) so that survivors will be better equipped to deal with these painful thoughts and memories when they are encountered. If your friend has not had the opportunity to learn some of these techniques, pursuing this course might greatly assist her in tolerating her pain when she begins talking about her traumas, whether she is talking to you, a therapist, or anyone else.
If your friend has trusted you enough to share these memories with you, then you are important to her and trusted, and just being her friend can help her a great deal to know that she is worth knowing and caring about.
Do you have a question relating to a mental health issue? Do you have a question relating to abuse or multiplicity? Do you have a question about medication? Once a month a new question will be answered and posted on this column. A special thanks to Dr. Yank for donating his time to answer the questions.
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