Mental Disorders Resulting
From Severe Trauma or Sadism

By The Stranger

Dissociative Identity Disorder
Dissociative Identity Disorder is the most extreme manifestation of chronic post-traumatic stress disorder, usually resulting from childhood abuse. Most people with borderline personalities dissociate occasionally or sometimes even often, but those with DID have dissociation as their main method of coping with the intolerable emotions and physical sensations associated with abuse. There is some evidence that an individual with a high number of personality fragments (such as fifty or higher) is likely to have experienced many different types of abuse, and nearly all survivors with DID have suffered unusually terrifying and painful sadistic abuse. The childhood experiences of Truddi Chase and her Troops, authors of "When Rabbit Howls," and of Dr. Cameron West, author of "First Person Plural," are typical examples of what it takes to cause a child's personality to split into separate distinct fragments. However, not everyone who is sadistically abused in childhood develops a dissociative disorder. Other children become antisocial and disruptive, or retreat into extreme passivity and elective mutism, or have psychotic episodes. Some develop habits of severe self-mutilation, repeated suicide attempts, or substance abuse and addiction. Someone with DID can easily fall into the traps of these self-reinforcing behaviors as well.

Some people with DID have personality-states that separated in very early life and are the "mental age" of babies or very young toddlers; most have at least one state, or "part," who is a child between the ages of one and nine years old, because it is between these ages that the disorder develops if it is going to show up at all. In an individual with DID, the person who is present most of the time around other people is called the host. People with DID also commonly have one or more "protectors" who can act aggressive or run away when anyone "on the outside" does something threatening. Other common parts are helpers, who come out when the host is tired or scared, "teenagers" who tend to have a lot of BPD-type traits, and "bad ones" who torture the host with self-injurious behavior. People with DID have the option of rigorous, difficult therapy to help them face the devastating abuse that played such a major role in their lives as children. This therapy is very painful and can aggravate self-destructive symptoms if the clinician is not aware of the need for proper pacing and occasional sessions that focus only on self-care in the present. Some people choose not to enter therapy; some decide to work with a professional toward the goal of integrating their fragmented parts; and others use therapy as a way to establish effective communication and cooperation between the parts, remaining fragmented but learning how to function best in that state.





Stockholm Syndrome
is an adaptation to extreme stress in conditions of captivity, torture, and/or institutionalization. It occurs most often in prisoners, abused spouses and children, kidnapping victims, and members of destructive cults. The syndrome is not a clinical diagnosis; the purpose of identifying signs of Stockholm syndrome in an individual is to understand how he or she can seem to "consent" to abuse or captivity and even have fond feelings for the perpetrator, which is a difficult concept for most of us to understand. The presence of Stockholm syndrome indicates that even though an individual may have mixed feelings toward her abuser, including compassion and even love in addition to fear, she is still very much a victim of abuse and not responsible for her own victimization.

Although the classic definition of Stockholm syndrome applies to victims of violent crime and torture, I also want to emphasize that these dynamics occur on a continuum. I believe battered women can suffer from a form of the syndrome, as well as abused children (often including those who are victims of Munchausen by Proxy abuse). The defining characteristic of Stockholm syndrome is the tendency to react to threatening circumstances not with the usual fight-or-flight response, but by "freezing," as some animals do by playing dead in order to fool predators. Stockholm syndrome is a position of passivity and acquiescence that works in a similar way as a strategy for survival.

The person with Stockholm syndrome identifies with her captor and willingly submits to his demands; she is often grateful and loving towards him in response to a reprieve from torture, brief periods of freedom from captivity, and minimally decent treatment (such as adequate meals after having been starved). Children with Munchausen syndrome by proxy often display this disorder by being complicit with the parent who is making them ill; they don't tell doctors what is really wrong, even after they are old enough to understand what is happening. These children may believe the parent is fragile and really needs them to be sick, or they are afraid of losing the parent's love if they tell. They also have not truly learned that this behavior is dysfunctional, especially if it has been going on since their infancy. People who are kidnapped and held for long periods of time often learn to behave in ways that will earn them favor with the captor; total obedience can be the victim's only technique for trying to survive in these circumstances.

This was the case for Colleen Stan, the victim of a sadistic sex offender who kidnapped her for several years and tortured her with captivity, rape, and physical injury. He also told Colleen that she had been sold to him as a sex slave by a powerful "Company" who would certainly kill her and her whole family if she tried to escape. Colleen believed she might never be released, so she did her best to adjust to the horrific situation and stay as strong as possible. Kidnapping victims also learn that they can sometimes avoid physical abuse by pleasing their captors or even pretending to love them. People with Stockholm syndrome also tend to suffer from post-traumatic stress, and those with a history of childhood or domestic abuse can have borderline personality disorder. Survivors with Dissociative Identity Disorder (described below) can have alters with Stockholm syndrome, which tends to result in the "host" being the target of cruel reenactments of old trauma by the alter who identifies with the abuser.

I believe that a form of Stockholm syndrome occurs in women who are in love with killers and end up witnessing and participating in their crimes, such as Charles Manson's female co-defendants and possibly serial killer Paul Bernardo's wife Karla Homolka. Witnessing abuse and murder is traumatic enough to influence women to keep silent even if they are not being physically harmed themselves, and in fact their husbands tend to be violent towards them as well as other women. Karla Homolka and the wife of Colleen Stan's kidnapper were both physically abused and degraded.






Munchausen By Proxy Syndrome
is the deliberate inducement of symptoms of illness for the attention and care of medical professionals. It can take the form of virtually any medical or psychological illness. Common practices of Munchausen patients include injecting infectious materials into their skin or bloodstream, feigning grand mal seizures, and convincing emergency-room physicians that they require surgery. Some individuals have had multiple operations for various complaints of severe pain. One woman whose case is described by Dr. Feldman (link below) starved herself and shaved her head to convince her co-workers she was suffering from breast cancer. Most people with Munchausen syndome also have combined traits of histrionic, antisocial, and/or dependent personality disorders. People who begin by inducing illness in themselves can sometimes transfer the syndrome to their children, resulting in Munchausen syndrome by proxy (MSBP). Munchausen patients have usually had difficult childhoods with parents who abused or neglected them, and sometimes a period of hospitalization where they learned that being ill could result in being properly cared for by doctors and nurses in a safe environment. Alternatively, they may have had a parent or sibling with a serious illness who was frequently hospitalized. The onset of Munchausen syndrome can be triggered by feeling rejected or abandoned, a sudden change in lifestyle (such as marriage or the birth of a child), the death of a loved one, and/or other factors like preexisting depression.

Recognizing MSBP in children who have been repeatedly hospitalized or have died from undetermined causes can be difficult and painful for the family, whether the disorder is present or not. There are several online self-help groups for mothers falsely accused of MSBP-type abuse, and they point out the current trendiness of this diagnosis and the potential for false "discoveries" of cases by overzealous professionals. However, MSBP is a reality. Signs of it include repeated hospital visits for infections, breathing problems, or seizures that are not apparently caused by a diagnosible medical illness like epilepsy or asthma. Physicians should look closely at children whose symptoms change over time as they continue to require hospitalization; for example, a baby comes to the emergency room multiple times with trouble breathing, doctors are unable to identify the problem, and then the baby develops a series of skin infections unrelated to the respiratory distress. Localized infections on the skin and high fevers can be caused by deliberate injections of bacteria. Certain medications can induce seizures in children. Trouble breathing and loss of consciousness may be caused by smothering, followed by an immediate trip to the emergency room to revive the child. This symptom is most likely to be seen in very young children because they are defenseless against choking or smothering by a parent.

The most tragic variation of MSBP is, of course, a child who dies as a result of suffocation, gradual poisoning, or overdose. Families with more than one child that has died from "Sudden Infant Death Syndrome" (suffocation while sleeping) tend to put doctors on alert for the possibility of MSBP smothering. Deaths from MSBP are usually unintended by the parent, and death results from the child's inability to withstand the severe stress of the manufactured "symptoms." Mothers, who are the perpetrators of MSBP abuse more often than fathers, can become blind to the severity of the damage they are inflicting on the child because they experience the attention from medical professionals and other supportive people like intoxication. To admit that a child could die would mean having to consider relinquishing the attention they have become so dependent on; many MSBP mothers, unable to accept this option, assume they will remain in control of exactly how sick the child becomes. The parent's denial of the terrible danger of inducing sickness in a child is similar to an abused child's belief that her parents don't realize they are hurting her, that they are in control and will ultimately make sure she is not permanently injured or killed, or even that no one is hurting her at all and the problem is her own weakness. MSBP parents who were abused as children may have established this set of beliefs at a young age and continued to deny the gravity of abuse when they become parents themselves.