Mixing Complex PTSD, Dissociative Identity Disorder and Bipolar II

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I have Complex PTSD with comorbid Dissociative Identity Disorder (DID) and Bipolar II. If you think this is a potent mix of conditions in one person, your right !!!! It is. It is one hell of a juggling act in the management of the symptoms of all the conditions.

They have all resulted from fourteen years of childhood abuse as the result of a paedophile ring in Ireland in the 1970s. On the surface, it may seem like PTSD and Complex PTSD are none too dissimilar — they both come as the result of something deeply traumatic, they cause flashbacks, nightmares and insomnia, and they can make people live in fear even when they are safe. But at the very heart of C-PTSD – what causes it, how it manifests internally, the lifelong effects (including medically), and its ability to reshape a person’s entire outlook on life – is what makes it considerably different.

To delineate some these hallmark challenges – as outlined in the proposed Complex PTSD criteria – we’ll begin with the one that shows up most frequently in day-to-day life: emotion regulation. Survivors with Complex PTSD have a very difficult time with emotions — experiencing them, controlling them, and for many, just being able to comprehend or label them accurately. Many have unmanaged or persistent sadness, either explosive or inaccessible anger, and/or suicidal thoughts. They may be chronically numb, lack the appropriate affect in certain situations, be unable to triage sudden changes in emotional content, or struggle to level out after a great high/low. It’s also very common for these survivors to re-experience emotions from trauma intrusively – particularly when triggered. These feelings are often disproportionate to the present situation, but are equalto the intensity of what was required of them at the time of a trauma — also known as an emotional flashback.

    Difficulty with self-perception is another fundamental struggle for complex trauma survivors — particularly because their identity development was either fiercely interrupted or manipulated by someone with ulterior motives. In its simplest form, how they see themselves versus how the rest of the world does can be brutally different. Some may feel they carry or actually embody nothing but shame and shameful acts – that they are “bad”.  Others believe themselves to be fundamentally helpless; they were let down by so many who could’ve stopped their abuse but didn’t, so it “must just be them”. Many see themselves as responsible for what happened to them and thus unworthy of kindness or love because “they did this to themselves”. And, countless others may feel defined by stigma, believe they are nothing more than their trauma, worry they’re always in the way or a burden, or they may sense they’re just completely and utterly different from anyone or anything around them – they are alien. Startling as it is, all of these feelings and more can live inside someone whom, to you, seems like the most brilliant, competent, strong, and compassionate human being you know.

Interruptions in consciousness are also a prevalent – and at times very scary – reality in Complex PTSD. Some may forget traumatic events (even if they knew of them once before), relive them intrusively, recall traumatic material in a different chronological order, or other distressing experiences of what is called dissociation. Dissociation is a symptom that exists on a spectrum, ranging anywhere from harmless daydreaming or temporarily “spacing out”; to more disruptive episodes of feeling disconnected from one’s body or mental processes, not feeling real, or losing time; all the way to the most severe, which includes switching between self-states (or alters), as is seen in Dissociative Identity Disorder. Episodes of missing time can range anywhere from a few minutes, a couple days, or even large chunks of one’s childhood. The larger gaps in time are typically only seen in DID, but those with C-PTSD alone can still endure ‘interruptions in consciousness’ that result in memory gaps, poor recall, traumatic material that is completely inaccessible, or, conversely, re-experiencing trauma against their will (e.g. flashbacks, intrusive images, body memories, etc.)

    Difficulty with relationships may seem like a natural progression since each area mentioned thus far can affect how fruitful your relationships are. But, these challenges go beyond a lack in quality or richness. This refers more to a survivor’s potential to feel completely isolated from peers and not even knowing how to engage, to harboring an outright refusal to trust anyone (or just not knowing why they ever should), trusting people way too easily (including those who are dangerous, due to a dulled sense of alarm), perpetually searching for a rescuer or to do the rescuing, seeking out friends and partners who are hurtful or abusive because it’s the only thing that feels familiar, or even abruptly abandoning relationships that are going well for any number of reasons.

The official symptoms of dissociative identity disorder have been most recently defined by the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition. The following are the diagnostic symptoms of DID:

  • Two or more distinct personalities exist in one individual; one personality is always present (Understanding Dissociative Identity Disorder Alters)
  • Dissociative amnesia including gaps in the recall of important personal information and everyday events
  • Severe distress and impairment in functioning because of the disorder
  • The disturbance is not part of normal cultural or religious practices
  • The disturbance can’t be explained but substance use or another medical condition

Bipolar II is similar to bipolar I disorder, with moods cycling between high and low over time.

However, in bipolar II disorder, the “up” moods never reach full-blown mania. The less-intense elevated moods in bipolar II disorder are called hypomanic episodes, or hypomania.

A person affected by bipolar II disorder has had at least one hypomanic episode in his or her life. Most people with bipolar II disorder suffer more often from episodes of depression. This is where the term “manic depression” comes from.

In between episodes of hypomania and depression, many people with bipolar II disorder typically live normal lives.

So as you can see there is a real cocktail of symptoms between the three disorders but also a crossover. Depression, self-harm and suicidality are common to all three and mood swings are too.  The best way I have found to manage the conditions is as follows:

Anyone who lives with bipolar disorder knows life is filled with unexpected ups and downs. After I was diagnosed with bipolar 2, it took me some time to figure out what my triggers are and what I need to do to stay well. The more I have learned about the illness and my other two disorders and myself, the easier it is to manage day-to-day. Everyone is different, but these are some things I have found helpful.

1. Know My Limits

I used to try to do everything and please everyone, but I shortchanged myself by not addressing my needs. I had to learn when to say “no,” even if it causes disappointment. I finally realized nothing is worth compromising my health and sanity for. I only turn into a person nobody wants to be around.

2. Keep Alcohol Consumption to a Minimum

When I was depressed, I couldn’t wait to have a glass of wine or three at the end of a hard day to escape my mind. I paid a big price for those moments of “peace” because the next day was usually filled with feelings of hopelessness, sadness and lots of tears.

3. Bite My Tongue

Anger and agitation are common during my mood swings. It doesn’t take much to set me off. I never thought twice about saying what I thought. However, saying what you think when you’re in an irrational state of mind usually leaves behind a trail of hurt feelings because everything seems worse than it is. I’m not perfect, but I have tried to tone down my temper and wait until I cool off to talk about anything that’s bugging me.

4. Food Is Not My Friend

I never considered myself an emotional eater, but during my last period of depression, I gained weight. That’s when I realised I was eating my feelings in chocolate, ice cream and cheese. I guess I did that all of my life, but my metabolism no longer supports this coping mechanism. Now I am left with pants that don’t fit and lower self-esteem, so I am currently working on improving my habits.

5. I Need to Move

One of the most annoying things to hear when I’m depressed is how great exercise is. When I can barely get off of the couch and I have the energy of a sloth, do you think I’m going to find it in me to sweat it out at the gym? Once I got on the proper medication to pull me out of my depression, I joined a pilates class. And, yes, it does make me feel good, but the medication is what gave me the ability to walk in the door. Exercise is tremendously helpful, but is not a cure, at least for me.

6. Don’t Sit for Too Long

I struggle with afternoon fatigue.  When I sleep during the day, I can’t sleep at night, which only leads to trouble. I now try to save the couch for nighttime relaxing and tackle something on my to-do list during the day; even if it’s something simple like folding the laundry or weeding the garden. When I accomplish something, I feel much better and less overwhelmed.

7. Remember I’m Not a Failure

I had visions of living a glamorous lifestyle. It didn’t take me long to learn that stress is a major trigger for bipolar disorder. Guess what? That high-powered life I thought I wanted is exactly the opposite of what I need to stay healthy. Instead, I rewrote my vision of success.  I’m now retired. I’m healthy and my family is happy, so that’s my new definition of success. Money and power don’t equal happiness.

8. Think Before I Act

When I start to get a flood of ideas in my head or feel like signing up for classes or volunteer work, I take a step back and give myself time to think. If I still want to do it a week later, then it’s OK; I just try to avoid impulsive decisions. Although my intentions are good, I know I can’t overextend myself or I will get stressed.


I would love to hear from you so please leave a comment. All feedback is much appreciated. Thank you. Erin

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