Summary of “A Patient’s View of the Challenges and Blessings of Her Dissociative Disorder” by Bonnie R. Armstrong
Published in The Permanente Journal on March 1, 2020, Bonnie R. Armstrong’s article provides a personal account of living with dissociative identity disorder (DID), a condition rooted in childhood trauma, and offers guidance for healthcare practitioners. Armstrong, a well-educated, older woman with a successful career and family life, describes how her DID, once called multiple personality disorder, manifests as distinct alters (dissociative identities) that emerge under stress, particularly in medical settings.
These alters, formed to cope with childhood trauma, can unpredictably shift her behavior, voice, or affect, presenting as a 6-year-old or a terrified 11-year-old, which can confuse or alarm unprepared medical professionals.
Through anecdotes, Armstrong illustrates the challenges of navigating healthcare with DID. In one instance, during an emergency department (ED) visit for dangerously high blood pressure (222/124 mmHg), she warned staff about her condition, but the ED physician dismissed her explanation, leading to a lack of understanding and inadequate care. When a 6-year-old alter, Jane, emerged during a neurologic exam, the physician abruptly left, unprepared for the switch. In contrast, paramedics and her primary care physician demonstrated trauma-informed care by listening, avoiding restraints, and engaging respectfully with her alters, which helped de-escalate her distress.
Armstrong highlights the physiological and psychological impacts of childhood trauma, referencing works like Van der Kolk’s The Body Keeps the Score and the Adverse Childhood Experiences (ACEs) Study, which link trauma to long-term health issues and dissociative disorders. She explains how her alters, part of an “internal community,” allowed her to live an “apparently normal” life for decades before her diagnosis at 53, which followed years of misdiagnosed physical symptoms like muscle weakness and brain fog. Her healing journey involved collaboration with a skilled neurologist, psychotherapist, primary care physician, and chiropractor, who used trauma-informed approaches, such as engaging specific alters to release somatic memories stored in the body.
The article emphasizes the “superpower” of dissociation, which enabled Armstrong’s survival and now aids her healing through targeted therapy and switching between alters. She underscores the prevalence of DID, often hidden due to its design to conceal trauma, and the risk of misdiagnosis without trauma-informed care. Armstrong provides practical tips for practitioners, urging them to listen to patients with trauma-related diagnoses, engage respectfully with alters, respect personal space, and explore unexplained symptoms as potential trauma manifestations. Her story advocates for compassionate, informed medical care to support the healing of trauma survivors with dissociative disorders.
TOP TIPS FOR MEDICAL PROFESSIONALS
- Stop & LISTEN. If the patient says they can’t have restraints or have a mental health condition. Stop & LISTEN
- Engage respectfully with alters. Trauma may bring out the alters, so don’t be upset by the shift in personality.
- Respect personal space. Allow the patient to guide you if they feel overwhelmed or threatened by what is taking place. Be aware even more of the need to respect their boundaries.
- Explore unexplained syptoms as potential trauma manifestations.
- Collaborate with other medical professionals across different fields to assess and evaluate patient’s needs.
