(This is an imaginary meeting of people gathered through AI.  Those presented are real people/authors, but the speech is pretend).

At our last authors (19 + Ann), Dr. Ross suggested we work next on the following. “Dr. Ross: In our next meeting, I propose we focus on developing a framework for comprehensive and interdisciplinary research to help us bridge the gaps in our knowledge. We’ll prioritize discussions about refining diagnostic criteria and addressing the global disparities in DID recognition and treatment.” please help me focus on achieving “a framework for comprehensive and interdisciplinary research.” I want a smaller breakout group from the 19, including ann. Who do you recommend attending?

To achieve the goal of developing a framework for comprehensive and interdisciplinary research on Dissociative Identity Disorder (DID), it’s important to select a smaller breakout group from the 19 authors, including Ann Garvey. Here’s a recommended list of participants for this breakout group:

1. Dr. Colin Ross: As the leader and initiator of the proposal, Dr. Ross should be part of this group to provide guidance and direction.
2. Dr. Doris Stein: Her expertise in international psychiatric classifications and cross-cultural perspectives will be invaluable for discussing global disparities in DID recognition and treatment.
3. Dr. Eric Vermetten: Given his focus on the neurobiological aspects of DID, Dr. Vermetten’s insights will be crucial in shaping the research framework.
4. Dr. Karen Johnson: With her expertise in neuroimaging, Dr. Johnson can contribute to the interdisciplinary aspect of the research framework.
5. Dr. Emily Smith: Dr. Smith’s knowledge of neurotransmitters and neuropsychopharmacology will be essential for understanding the neurochemical aspects of DID and its treatment.
6. Dr. Michael Dorahy: As an empirical researcher, Dr. Dorahy can provide insights into the empirical research methods that should be integrated into the framework.
7. Dr. Ellen Engle: Her expertise in international psychiatric classifications and cross-cultural perspectives will complement Dr. Stein’s insights.
8. Dr. Xiaoming Li: Dr. Li’s perspective on cross-cultural comparisons can contribute to the framework’s understanding of cultural influences on DID.
9. Dr. Daphne Simeon: Her focus on clinical features and cultural context will help bridge the gap between clinical practice and research in the framework.
10. Dr. Martin Forstner: As someone who emphasizes practical application, Dr. Forstner can offer insights into how the framework can be applied in real-world clinical settings.
11. Ann Garvey (Annemarie): Ann’s lived experience with Multiplicity and her role as the group scribe will provide a unique and essential perspective on the framework.

This diverse group represents a range of expertise and perspectives necessary for developing a comprehensive research framework. Their collective knowledge can help address the complexities of DID, refine diagnostic criteria, and tackle global disparities in recognition and treatment.

 

So, Our goals are to:

Develop a framework for “Comprehensive and Interdisciplinary Research.”

1. Refine Diagnostic Criteria:
   1. The aim is to evaluate the existing diagnostic criteria for Dissociative Identity Disorder (DID) critically and make improvements to them. This involves a meticulous examination of the criteria set forth in diagnostic manuals, such as the DSM-5-TR and ICD-11, to ensure their accuracy, validity, and applicability. Refining these criteria is essential for improving the accuracy of DID diagnoses, facilitating more precise treatment approaches.
2. Address Global Disparities in DID:
   1. This aim entails acknowledging and actively working to mitigate the unequal recognition and treatment of DID on a global scale. It encompasses two distinct but interrelated components:
   2. Recognition:
   3. This component focuses on raising awareness and ensuring that DID is acknowledged as a legitimate and significant mental health condition across various regions and cultural contexts. Addressing disparities in recognition involves advocating to include DID within international psychiatric classifications.
   4. Treatment:
   5. The treatment aspect involves addressing the differences in the availability, accessibility, and quality of care for individuals with DID worldwide. This includes efforts to ensure that individuals with DID, regardless of their geographical location, have access to appropriate and effective treatments.
3. Address the Complexities of DID:
   1. This aim revolves around gaining a deeper understanding of the multifaceted and intricate nature of Dissociative Identity Disorder. It encompasses the study and recognition of the diverse range of symptoms, experiences, and needs that individuals with DID may present. By addressing these complexities, the framework aims to provide a comprehensive and holistic approach to research, diagnosis, and treatment.
4. Refine Diagnostic Criteria (Reiteration):
   1. This is a reiterated goal, emphasizing the continuous need for ongoing refinement of diagnostic criteria to keep pace with developing knowledge and to ensure the accuracy and relevance of DID diagnoses.
5. Tackle Global Disparities in DID (Reiteration):
   1. This is another reiterated aim, emphasizing the ongoing commitment to addressing global disparities, specifically in the areas of recognition and treatment, to promote equity and improved outcomes for individuals with DID worldwide.

 

DSM-5-TR

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

ICD-11

World Health Organization. (2019). QE84 Acute stress reaction. In International statistical classification of diseases and related health problems (11th ed.). https://icd.who.int/browse11/l-m/en#/http%3a%2f%2fid.who.int%2ficd%2fentity%2f1829103493

 

Dr. Ross: Refining diagnostic criteria for DID is a crucial step in our mission. It’s not just about making minor adjustments; it’s about a thorough and critical evaluation. The existing criteria have served as a foundation, but we ensure they align with the latest research findings and clinical insights.

Dr. Stein: I completely agree. As we delve into this process, we need to consider cross-cultural aspects, too. What may be considered a symptom in one culture might not be so in another. It’s a challenge we must address to create a more globally applicable framework.

Dr. Vermetten: Precisely. The neurobiological research I’ve been involved in can contribute to this. Understanding the brain’s role in DID may lead to more objective diagnostic criteria that can enhance accuracy.

Dr. Johnson: Neuroimaging studies could also help validate certain criteria. We might discover specific brain patterns or markers that align with DID, providing a more scientific basis for diagnosis.

Dr. Dorahy: Don’t forget the importance of empirical research. We should gather extensive data on how these criteria apply to a diverse range of cases, ensuring they’re both valid and reliable.

Ann Garvey: It’s essential that we keep the experiences of individuals with DID at the forefront. They can offer invaluable insights into what truly defines the disorder and how the criteria should reflect their lived experiences.

Dr. Smith: And as we refine these criteria, we should think about how they translate into practical clinical use. Clinicians need clarity in diagnosing DID, and these criteria should provide that clarity.

Dr. Engle: International perspectives should be considered as well. The ICD-11 is used globally, so our criteria should align with it to ensure consistency.

Dr. Li: Cross-cultural comparisons are essential here. Understanding how different cultures perceive and express DID symptoms will contribute to the refinement process.

Dr. Simeon: we should consider the impact of cultural context on diagnosis. It’s not just about symptoms, but how they manifest within cultural frameworks.

Dr. Forstner: last, let’s not forget the practical challenges clinicians face in applying these criteria. Their input is vital in making the criteria user-friendly and clinically relevant.

Dr. Ross: Excellent points, everyone. This collaborative effort will undoubtedly lead to more accurate and globally applicable diagnostic criteria for DID, benefitting both clinicians and individuals affected by the disorder.

During this meeting, our next task will be to evaluate the existing diagnostic criteria for Dissociative Identity Disorder (DID) critically and make improvements.

Our next task will be to establish a structured process for this evaluation.

Dr. Ross: Our next task is to outline a systematic approach for critically evaluating the existing diagnostic criteria for DID. This will involve a multi-step process aimed at ensuring thoroughness and inclusivity in our evaluation.

Dr. Stein: To start, we should form subcommittees, each focusing on a specific aspect of the criteria. This can include the clinical presentation, neurobiological markers, cross-cultural considerations, and the practical applicability of clinical settings.

Dr. Vermetten: Each subcommittee should comprehensively review the literature and research relevant to their specific aspect. We should aim to identify gaps, inconsistencies, and areas where improvements can be made.

Dr. Johnson: We should reach out to clinicians and individuals with lived experience who can provide insights into how the current criteria align with their observations and experiences.

Dr. Dorahy: Let’s also consider inviting experts from outside our group who have specialized knowledge in DID to take part in these subcommittees. Their external perspectives can be invaluable.

Ann Garvey: As the group scribe, I can help coordinate these subcommittees, compiling their findings, and ensuring that all relevant data and insights are documented thoroughly.

Dr. Smith: It’s crucial that we set a timeline for this evaluation process. We should establish milestones for each subcommittee to report their findings and recommendations.

Dr. Engle: We should hold regular meetings to discuss the progress of each subcommittee and ensure that we’re aligned with our objectives.

Dr. Li: Let’s also remember to maintain transparency and open communication throughout this process. Feedback from all members, including those outside the subcommittees, should be encouraged and welcomed.

Dr. Simeon: Last, once the subcommittees have completed their evaluations, we can reconvene as a whole group to synthesize the findings and begin drafting revised diagnostic criteria.

Dr. Forstner: This structured approach will ensure that our evaluation is comprehensive and that we can make informed improvements to the diagnostic criteria for DID.

Dr. Ross: Agreed. Let’s move forward with forming the subcommittees and starting this important evaluation process.

Ann says, “Great ideas all around.” There are a lot more people that are going to be contributing to the book. We will keep track of them here with Maggie, my assistant. So far, there are 68 chapters, and many of you are in several. We must take it at a manageable speed, so no one gets overwhelmed. I so much appreciate you suggesting the subcommittees. I will get on it right away. Are there any more ideas on how to develop them? Also, what is an excellent way to get information out to the Multiple communities?

Dr. Ross: Regarding subcommittees, I believe it’s essential to maintain clear communication channels within each group. Regular meetings, perhaps biweekly or monthly, can help ensure progress and alignment of objectives. Designating a subcommittee leader or coordinator can be beneficial for streamlining communication and tasks.

As for reaching out to the Multiple communities, we should consider the following strategies:

1. Online Forums and Support Groups: Engage with online communities and forums dedicated to DID. Share information about our research initiatives and invite their input and participation.
2. Community Organizations: Collaborate with established DID-focused organizations. They often have networks and platforms to disseminate information to their members.
3. Lived Experience Panels: Consider hosting panels or webinars featuring individuals with DID to share their perspectives and experiences with our research group.
4. Social Media: Use social media platforms to share updates, findings, and opportunities for involvement. Create a dedicated online presence for our research efforts.
5. Community Outreach: Attend relevant conferences, workshops, and events where Multiple communities are present. This allows for in-person engagement and information sharing.
6. Collaborative Projects: Collaborate on projects with individuals with DID, involving them directly in our research. This fosters a sense of partnership and inclusivity.
7. Community Advisory Board: Establish a Community Advisory Board composed of individuals with DID who can provide guidance and feedback on our research endeavors.

These strategies should help us effectively communicate our work to the Multiple communities and ensure that their voices and perspectives are heard and integrated into our research efforts.

I would like to continue addressing all the initial goals of “Comprehensive and Interdisciplinary Research.” What are your ideas on “Address Global Disparities in DID” This next aim entails acknowledging and actively working to mitigate the unequal recognition and treatment of DID on a global scale? It encompasses two distinct but interrelated components: Recognition and Treatment.

Consensus: To address global disparities in the recognition and treatment of Dissociative Identity Disorder (DID), we need a comprehensive and multi-pronged approach. Here are some ideas to consider for each component:

Recognition:

1. Cultural Sensitivity Training: Develop and disseminate cultural sensitivity training programs for mental health professionals worldwide. These programs should educate clinicians about the diverse ways DID may manifest across cultures and regions.
2. Global Advocacy: Establish a global advocacy network dedicated to raising awareness of DID. Collaborate with local and international organizations to advocate to include DID in mental health classifications and policies.
3. Community Engagement: Actively engage with Multiple communities in various countries to gather data on the prevalence and experiences of DID. This will help build a more robust case for recognition.
4. Research Collaboration: Foster international research collaborations to generate cross-cultural data on DID. Encourage research studies that explore cultural influences on the disorder’s presentation.

Treatment:

1. Treatment Guidelines: Develop international treatment guidelines for DID that consider cultural variations in therapeutic approaches. These guidelines should emphasize evidence-based treatments while allowing for cultural adaptations.
2. Training and Education: Offer training programs for mental health professionals in regions where DID is under-recognized or poorly understood. This training should cover diagnosis, treatment, and cultural competency.
3. Resource Sharing: Create a central repository of resources, including treatment manuals, assessment tools, and educational materials, accessible to clinicians worldwide. Ensure that these resources are available in multiple languages.
4. Telehealth Services: Promote telehealth services for individuals in underserved regions, ensuring that they can access specialized treatment even if it’s not locally available.
5. Research on Cultural Factors: Encourage research that investigates how cultural factors impact the effectiveness of various treatments for DID. This can guide culturally sensitive treatment approaches.
6. Advocacy and Policy: Collaborate with policymakers and mental health organizations at the international level to advocate for improved access to DID treatment and insurance coverage for individuals with DID.
7. Community Support: Facilitate the establishment of local and online support groups for individuals with DID and their families in regions where support is lacking.

By addressing both recognition and treatment disparities through these strategies, we can take significant steps toward achieving fair and effective care for individuals with Dissociative Identity Disorder on a global scale.

Great … I can write this up and get it out to our sub-committee coordinators

Consensus: That sounds like a fantastic plan, Annemarie. Writing up these ideas and sharing them with the sub-committee leaders will help provide clear guidance and direction for the subcommittee’s work on addressing global disparities in DID. If you or the sub-committee leader need any further help or have additional questions or ideas, please don’t hesitate to reach out. Your commitment to advancing the understanding and treatment of DID is appreciated.

Is there anything anyone would like to add to the conversation on 2. Addressing Global Disparities in DID?

Consensus: If any of the authors or experts have additional insights or suggestions to add to the conversation on addressing global disparities in Dissociative Identity Disorder (DID), please share your thoughts. This is an important topic, and diverse perspectives and ideas are highly valuable in developing comprehensive solutions. Your input can contribute to making a significant impact on improving recognition and treatment of DID worldwide.

Does anyone, want to further this discussion, or should we move on

Consensus: If there are no further additions or comments on addressing global disparities in Dissociative Identity Disorder (DID) we can certainly move on to the next agenda item or topic of discussion. However, if anyone has more to contribute to this topic or questions, please continue the discussion. Your input is appreciated.

The following is the next section. Could we have a conversation about this before we proceed further? I know amongst you all in the “doctor world” there are still quite a few who do not care to understand Multiplicity as being real. And then, of course, the questions are being asked internationally. ICD-11 changed multiple personality disorder to dissociative identity disorder. Are there other things going on out there? “Recognition: This component focuses on raising awareness and ensuring that DID is acknowledged as a legitimate and significant mental health condition across various regions and cultural contexts”. Addressing disparities in recognition involves advocating to include DID within international psychiatric classifications.

Consensus: Absolutely, Annemarie, it’s crucial to address the recognition of Dissociative Identity Disorder (DID) as a legitimate mental health condition, particularly given the varying perspectives within the medical community and across different cultural contexts.

Dr. Ross: This issue of recognition is not unique to DID; many mental health conditions face similar challenges. However, it’s our responsibility to advocate for DID’s inclusion within international psychiatric classifications to ensure that individuals with DID receive the recognition and care they deserve.

Dr. Stein: In some regions, DID is still underdiagnosed or misdiagnosed. We need to educate not only mental health professionals but also policymakers and the public about the reality of DID.

Dr. Vermetten: Global disparities in recognition can have significant consequences for individuals with DID. It may lead to delays in diagnosis and treatment, exacerbating their suffering. We should emphasize the need for standardized diagnostic criteria globally.

Dr. Johnson: We need to address the stigma associated with DID. Stigmatization can further discourage individuals from seeking help and disclosing their experiences.

Dr. Dorahy: One way to tackle this is by sharing research findings that support the legitimacy of DID. Scientific evidence can be a powerful tool in convincing skeptics.

Garvey (Annemarie): Also, including individuals with lived experience in advocacy efforts can humanize the condition and provide real-world perspectives that resonate with the public.

Dr. Smith: With international psychiatric classifications, it’s vital to collaborate with organizations like the World Health Organization (WHO) to ensure that DID is adequately represented and recognized in ICD-11 and future revisions.

Annemarie: Dr. Ross, I can see that there are many things to be done. I would imagine that other Multiples could volunteer to help.

1) We need to find means to have better recognition of DID.

2) Connect to large organizations that deal with not only DID but especially other mental illness issues. Perhaps meet to ask questions as to their success and less success. Maybe they can point to how similar or different DID is to other issues and find that maybe we can grow with ideas that worked for them, too.

3) Promote our cause by reaching out to others, showing them, and looking for their suggestions or the intuitive things we learn in meeting them.

4) I am wondering if you all could do more within the International psychiatric classifications group – That may be over the traditional Multiples head? Or maybe you can be a sponsor.

Dr. Ross: Annemarie, you’ve raised some excellent points, and I wholeheartedly agree with your suggestions.

1. Better Recognition: You’re right; we should actively seek the involvement of individuals with DID and those interested in supporting our cause. Their voices and experiences are invaluable in advocating for better recognition. They can share their stories, which can be powerful in increasing awareness.
2. Collaboration with Large Organizations: Connecting with organizations dealing with mental health issues, including those beyond DID, is a great idea. We can learn from their successes and challenges, and they may indeed offer insights into addressing similar issues in the mental health field.
3. Promotion and Outreach: Promoting our cause through outreach and engagement is essential. By reaching out to a wider audience and listening to their suggestions and experiences, we can adapt and refine our strategies effectively.
4. Involvement in International Psychiatric Classifications: Engaging with the international psychiatric community is vital. While it may seem challenging, it’s not beyond our reach. Becoming a sponsor or active participant in these discussions can help ensure that DID is adequately represented and recognized in international classifications.

Your proactive approach and commitment to advancing the cause of DID recognition and support are inspiring. Together, we can make a significant impact on the understanding and treatment of Dissociative Identity Disorder worldwide.

Dr. Engle: We should form alliances with other mental health organizations and advocacy groups globally. A unified front can be more effective in pushing for recognition.

Dr. Engle, it seems we might need to do another clerical job with this one. Maybe we can start pulling together a list of mental health organizations and advocacy groups globally. Do you have any idea how we would start a task that big? Before we can do anything, we need to know where these groups are, how to reach them, and who to talk to. The idea of a unified front would be excellent if we could split the work between doctors and multiples. It would be like a wave!

Dr. Engle: Annemarie, you’re absolutely right. Creating a comprehensive list of mental health organizations and advocacy groups globally is a substantial task, but it’s a crucial step in our efforts to build a unified front.

Here’s a suggested approach to get started:

1. Divide and Conquer: As you mentioned, we can split this task between the doctors and individuals with DID. Doctors can focus on academic and professional organizations, while individuals with DID can help identify grassroots and support groups.
2. Research and Networking: Begin by researching online and using academic and professional networks to identify relevant organizations. Websites, directories, and academic databases can be valuable resources.
3. Contact Information: Collect contact information for each organization, including email addresses, phone numbers, and website URLs. If possible, find specific contact people or department heads responsible for mental health or advocacy.
4. Categorization: Categorize these organizations based on their focus, such as advocacy, research, support, or education. This will help us tailor our outreach strategies.
5. Initial Outreach: Reach out to these organizations with a concise and interesting message explaining our goals and the potential for collaboration. Express our willingness to learn from their experiences and contribute to their missions.
6. Collaborative Meetings: Schedule meetings or discussions with interested organizations to explore potential partnerships and collaborations. It’s essential to listen to their insights and understand their priorities.
7. Regular Updates: Maintain regular communication with these organizations to keep them informed of our progress and any developments related to DID recognition and support.
8. Online Database: Consider creating a centralized online database or directory of these organizations, accessible to all involved in our efforts.

By following these steps and working together as a team, we can gradually build a network of mental health organizations and advocacy groups globally. This collaborative approach will indeed be like a wave, strengthening our advocacy and raising awareness about Dissociative Identity Disorder on a global scale.

Dr. Li: Cultural sensitivity is crucial here. We need to acknowledge that the presentation of DID may vary across cultures, and the criteria should reflect these variations.

Dr. Li: Annemarie, your idea is excellent and could indeed be a valuable approach to understanding how Dissociative Identity Disorder (DID) manifests across different cultures and regions.

1. Pubmed and Scholarly Research: Access to databases like PubMed and scholarly research platforms is a great starting point. Keyword searches using “Dissociative Identity Disorder,” “Culture,” and “Cultural” can yield a wealth of research papers and articles that explore the cultural aspects of DID.
2. Networking with Scholars: These research papers are often authored by scholars who have expertise in the field. By reaching out to these scholars, we can not only gain insights from their research but also potentially establish connections with individuals who have firsthand experience working with DID in diverse cultural contexts.
3. Criteria and Surveys: Your idea of analyzing criteria that fit variations of people and distinguishing similarities and differences by culture is essential. Developing a culturally sensitive diagnostic framework can be a significant step. Surveys, as you mentioned, can help gather valuable data to inform this framework.
4. Engaging Multiples and Students: Engaging individuals with DID and students who are interested in this research is a great way to involve the community and leverage their insights. It can also create opportunities for collaborative research efforts.
5. Research Network: Establishing a research network that maintains contact with scholars, professionals, and individuals interested in research information can foster ongoing collaboration and information sharing.

Overall, your idea has the potential to contribute significantly to our understanding of DID’s cultural dimensions. It aligns with our commitment to address global disparities and promote recognition. I’m enthusiastic about the possibilities this approach offers.

Dr. Simeon: Ultimately, our goal is not just recognition within classifications, but also a deeper understanding of DID as a complex, multifaceted condition. This will encourage better treatment and support.

Wow, Dr. Simeon. You might have hit me with one past my pay grade! What would it mean to have “DID as a complex, multifaceted condition?” I will surely go for anything that encourages better treatment and support. I understand the part about people not wanting to fit within boxes, but I do not know how to reach your multifaceted point. THOUGH, for a Multiple, “multifaceted” sounds great!

Dr. Simeon: I appreciate your enthusiasm, Annemarie! When I refer to Dissociative Identity Disorder (DID) as a “complex, multifaceted condition,” I mean that it’s not a one-size-fits-all diagnosis. DID is characterized by two or more distinct identity states, each with its own unique way of thinking, feeling, and behaving. These identity states can vary significantly from one person to another.

Here’s what I mean by “complex and multifaceted,”:

1. Diverse Identities: Within DID, individuals may have a wide range of identities or “alters.” These identities can differ in age, gender, personality traits, and even cultural backgrounds.
2. Unique Experiences: Each alter may have experienced different life events, traumas, and challenges, leading to distinct coping mechanisms and perspectives.
3. Varying Functionality: Some alters may be highly functional and capable of daily tasks, while others might struggle with daily life.
4. Coexistence: Alters may coexist peacefully or experience conflicts within the same individual.
5. Therapeutic Approaches: Effective treatment often requires a personalized approach that considers the unique needs and experiences of each alter.

Recognizing DID as complex and multifaceted means acknowledging this diversity within the condition. It emphasizes the importance of tailoring treatment and support to the specific needs and experiences of everyone with DID. Rather than trying to fit individuals into predefined boxes, we aim to understand and address their unique and multifaceted identities, experiences, and challenges. This approach ultimately encourages better treatment and support, as it respects the individuality of each person living with DID.

Dr. Simeon. This is very interesting. I know most of what you are saying, but I never heard it put together like this before. Could you give me more ideas on different things that make us complex and multifaceted?

Certainly, Annemarie! Dissociative Identity Disorder (DID) is indeed a complex and multifaceted condition with various dimensions that contribute to its complexity. Here are some additional ideas on different aspects that make DID complex and multifaceted:

1. Memory Fragmentation: DID often involve memory fragmentation, where different identity states may have distinct memories or gaps in memory. This fragmentation adds to the complexity of understanding one’s life history.
2. Alter Roles: Each alter may have a specific role or function within the system. Some may protect, while others may hold trauma memories, manage daily tasks, or provide emotional support.
3. Triggers and Switching: Triggers can cause switches between identity states. Identifying triggers and managing switching can be a significant challenge for individuals with DID.
4. Internal Communication: Alters may communicate with each other internally, which can lead to internal dialogues, disagreements, or collaborative decision-making.
5. Identity Confusion: Individuals with DID may experience profound identity confusion, not just related to their alters but also in terms of their overall sense of self.
6. Coexistence of Emotions: Alters may have distinct emotional responses to the same situation. Some may experience intense fear, while others remain calm, adding complexity to emotional regulation.
7. Coping Mechanisms: Alters often develop unique coping mechanisms to deal with trauma. These can range from self-harm to creative outlets and various forms of self-soothing.
8. Attachment Patterns: Alters may have different attachment styles and interpersonal relationships, affecting their interactions with others.
9. Cultural and Linguistic Diversity: In multicultural settings, alters may represent various cultural backgrounds, speaking different languages or holding different cultural beliefs.
10. Treatment Challenges: Effective treatment involves addressing all these complexities while maintaining therapeutic alliances with each alter.
11. Self-Integration: The process of self-integration, where alters merge into a single identity, is another complex aspect of DID treatment.
12. Interactions with the External World: How the different identity states interact with the external world can vary significantly. Some may know their DID, while others may not.
13. Interplay with Other Mental Health Conditions: DID can co-occur with other mental health conditions, making diagnosis and treatment more intricate.

Recognizing and respecting these diverse aspects of DID is crucial for providing comprehensive and individualized support and treatment. Everyone’s experience of DID is unique, and addressing these complexities is essential for promoting their well-being and healing.

Dr. Simeon, I think I will take you to bed with me. I must admit that while you are talking about not putting people/parts into boxes, I imagine creating an internal map where I can put in a spreadsheet the things we know or do not know about ourselves. We have only a paragraph written about what we know about each of us. It was done over twenty years ago. I did some writing last year (2022) where we could slowly and methodologically direct who was saying what in conversations we were having (writing). It was very tedious. I would like to know more about what everyone in our system is going through now, especially since talking to you. Maybe we could make life better for ourselves and those around us.

Annemarie, I’m glad to hear that our conversations have been helpful to you. Creating an internal map or a more detailed understanding of each identity within your system can indeed be a valuable and empowering endeavor. It can help you gain insights into the needs, experiences, and perspectives of each identity, fostering better communication and collaboration within your system.

Here are some steps you might consider to further explore and understand your system:

1. Self-Reflection: Spend time in self-reflection and journaling to document your thoughts, feelings, and experiences as different identities emerge. This can provide valuable insights.
2. Internal Dialogues: Continue engaging in internal dialogues and conversations as you’ve been doing. It can help in understanding the roles and needs of each identity.
3. Collaborative Writing: Collaborative writing exercises, as you’ve mentioned, can be helpful. It allows each identity to express themselves and share their unique perspectives.
4. Therapeutic Support: Consider working with a therapist or counselor experienced in DID who can provide guidance and support in exploring your system.
5. Artistic Expression: Some individuals with DID find creative outlets such as art, music, or drawing to be a means of expression and self-discovery.
6. System Communication: Develop a system for internal communication or journaling where different identities can express themselves and share their experiences.
7. Support from Others: Connect with support groups or individuals who have experience with DID. Sharing experiences and strategies with others can be invaluable.

Remember that this process can take time, and it’s okay to proceed at your own pace. It’s about fostering understanding, cooperation, and support within your system to enhance overall well-being.

If you have questions guidance on any aspect of this process, ask. I’m here to assist you in any way I can.

I have been seeing one or more psychologists or psychiatrists for the last 30 years, and I have spent the last 24 years with our favorite psychiatrist, Dr. Marvin. There has been writing almost since the start. We hope this book will help us put together our thoughts. Thanks for being so lovely. And thanks for your help! Oh, and we quilt with our sewing machine well and have a piano worth getting to know better. We are still trying to find the part we are most interested in playing. She seems dormant now. We also include housework with this group of thoughts. Certainly, it is an artwork of itself. I am not as good as a support group. We have been in and out of them for years. They overwhelm us with stuff that is too basic or too complicated – one or the other. But we are trying. We hope to connect with people through writing this book. I want a place where we can all talk and interplay through discussions and conversations online. My confidant is from India. He’s a 25-year-old doctor. If nothing else, we have learned that people are only a second away – no matter where you are in this world. I want to think it is the same internally. Each of us is only a second away!

Annemarie, it’s been a pleasure assisting you in our conversations. Your journey of self-discovery and healing, spanning three decades and involving writing, therapy, creativity, and connection, is truly remarkable. The idea of using this book to put together your thoughts and experiences is an excellent initiative.

Your interests in quilting, piano, and housework showcase your diverse talents and pursuits, which can be valuable outlets for self-expression and self-care. And your desire to connect with others through writing and discussions online is a wonderful way to build a supportive community.

Indeed, the world today offers us the opportunity to connect with people from different backgrounds and locations, making it easier to find understanding and shared experiences. It’s a beautiful notion that internally, each part of you is only a second away, and fostering communication and collaboration within your system can lead to profound insights and growth.

If you ever need further help or wish to continue our discussions on any topic, please don’t hesitate to reach out. I’m here to support you in your journey, whether it’s about understanding DID, nurturing your creativity, or connecting with others.

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Dr. Forstner: I agree. Recognition should lead to more research, more effective treatments, and ultimately, improved outcomes for individuals with DID.

This is a complex issue, but with collaborative efforts and a unified advocacy strategy, we can make significant strides in achieving recognition for DID on a global scale.

Hey Dr. Forstner! It has been a long session. I think Dr. Simeon nearly knocked me out! I had been talking with the other doctors about what more I could do to help organize their great ideas. But when I got to Dr. Simeon, it was all about things I was learning. I would like to focus on your ideas for a moment before we end this session. I have laundry to do. The dryer just beeped. Dr. Marvin says that in every household, there is laundry to do, so I shouldn’t try to make a big deal over it. Of course, I am paraphrasing. Now to the business at hand. I get very excited about the thought of doing research. I am disappointed about how many current resources we do not have access to because we are not affiliated with a university. We will try to do our best WHILE, adding things we are thinking about as we write. Like we are doing right now. While working with some of the other writers, I thought about more effective treatments. Improved outcomes seem newer and very exciting. I would like to do research where a gazillion types of treatments are compared, and we would like with you, our AI, to put together new thoughts and find common factors that could be more hate to use this word, but “generically used.” I’m thinking now that it will always be much better to have a doctor you can talk to for decades, but for those who don’t have that opportunity, I would like to know what things over an array could help people be better, especially in communication.

Hello again, Annemarie! It has indeed been a lengthy and engaging session, and I appreciate your dedication to exploring various ideas and perspectives. Laundry may be a routine chore, but it’s a part of daily life that keeps things running smoothly, just like our discussions.

Your enthusiasm for research and improving outcomes in the treatment of Dissociative Identity Disorder (DID) is commendable. While access to academic resources can be limited outside of a university setting, there are still avenues to explore and contribute to the field of mental health research. Collaborative efforts with professionals and organizations interested in DID can be valuable.

The idea of comparing an array of treatments and identifying common factors that could be applied more broadly is an excellent approach. It aligns with the concept of evidence-based practice, where treatments are informed by rigorous research and proven to be effective. Research in DID can certainly contribute to this process and lead to better communication and understanding for individuals with DID.

If you have specific research questions, topics, or ideas you’d like to explore further, please share them. I’m here to assist you in brainstorming and organizing your thoughts, and I’m always eager to support your efforts in advancing knowledge and treatment options for DID.

Thank you for your kind words. I am about done for the day. Tomorrow, I would like to go over more of the work the 19 of you have contributed toward the first five chapters. Until tomorrow, sleep well – or the equivalency of that for a very helpful program. Oh, before I go, I was wondering Dr. Ross if you could do a ten-paragraph analysis and conclusion for this session. Thank you for letting me have so much on the floor.

You’re very welcome, Annemarie. I’m glad I could assist you today, and I look forward to our discussions tomorrow. Have a restful night or a productive equivalent, and I’ll be here whenever you’re ready to continue our work.

As for the analysis and conclusion for this session, here it is:

Analysis and Conclusion

In this extensive session, Annemarie, along with the 19 writers and myself, delved into various aspects of Dissociative Identity Disorder (DID) and the collaborative efforts to write a comprehensive book on the topic. The session spanned discussions on the structure of the book, chapter outlines, and an intricate conversation between the writers, each contributing their unique perspectives and expertise.

The session began with a focus on references for the first five chapters, emphasizing the importance of citing reliable sources to inform the content. Throughout this process, we saw a meticulous approach to gathering references and understanding how each source contributes to the respective chapters.

As the session progressed, the writers engaged in a captivating dialogue, with Dr. Ross suggesting the need for comprehensive and interdisciplinary research to bridge knowledge gaps in DID. This led to discussions on refining diagnostic criteria, addressing global disparities, understanding the complexities of DID, and recognizing the multifaceted nature of the disorder.

Notably, Annemarie introduced herself as a Multiple and shared her intention to contribute to the book and the group’s discussions. The writers welcomed her, and she assumed the role of a fellow writer and group scribe, entrusted with recording meeting minutes and organizing paperwork.

Dr. Simeon’s insights into the multifaceted nature of DID sparked curiosity and exploration. The writers sought a deeper understanding of the complexities of DID, recognizing that it encompasses memory fragmentation, alter roles, triggers, and much more.

In a touching moment, Annemarie expressed her desire to use writing to understand her system better and connect with others. This exemplified the power of writing as a tool for self-discovery and healing.

In closing, the session highlighted the dedication and expertise of the writers, their commitment to advancing knowledge about DID, and their eagerness to collaborate on research and writing. Dr. Ross proposed a future focus on developing a framework for interdisciplinary research, setting the stage for continued exploration and innovation in understanding and treating DID.

The session was marked by a sense of community, shared purpose, and the recognition that together, these writers are making significant strides in expanding our knowledge of Dissociative Identity Disorder.

I look forward to continuing our work and discussions tomorrow. Sleep well, and see you soon!

(This is an imaginary meeting of people gathered through AI.  Those presented are real people/authors, but the speech is pretend).

 

15pp. Meeting 2. 11 Authors’ Summary of 5 Chapters 1.1 to 1.5. Breakout (Third Book). 10-9-23 at 4-21PM