If you have OSDD, DID, or complex PTSD, you’ve almost certainly experienced decompensation, although you might not be familiar with the name. Decompensation means a significant worsening of psychological functioning. A deterioration. When a person decompensates, their symptoms usually grow much worse and coping strategies that had been helping are either much less effective or not effective at all. Decompensation can often lead to inpatient hospitalization because it means the person is psychologically overwhelmed to a critical level and at significant risk of severe self-harm or suicide. Decompensation is a psychological emergency. At a minimum, it can require increased services, whether that is increasing the number of therapy sessions per week or it might mean IOP or PHP services. These are intensive outpatient programs and partial hospitalization programs. Unlike a physical emergency such as a stroke, heart attack, or life-threatening injury, the psychological emergency of decompensation can last for weeks.
Decompensation happens as a result of severe stress and, unfortunately, the fallout from decompensation serves to only increase the stress. It becomes a vicious circle. Common causes of decompensation include:
- a sudden and intense stressor
- a new trauma
- physical illness (the more severe the illness, the more the stress and the more likely decompensation becomes)
- major disruptions in life such as life transitions (getting married, moving, having a child, becoming homeless, etc)
- Retraumatization by traumatic memories
With DID, decompensation can look like a loss of control over fronting. Maybe your system was pretty stable in who fronted and switching was controlled and intentional but when you decompensated, suddenly you were rapid switching with little control of who fronted or for how long. It can also mean the opposite where one alter gets “front stuck” with no ability to stop fronting even if desired. Frequently, communication within the system is negatively impacted and communication becomes less frequent and/or less fluid. A front-stuck alter may not be able to sense the others in the system and feel quite eerily alone. (And then this can lead to increased doubts about whether the body has DID, which can be an additional source of stress on top of all the others).
Other common outcomes of decompensation when you have DID or OSDD are:
- Increased dissociation
- Severe mood swings (Some of these may be from switching and others may be from increased triggering in this vulnerable state)
- Panic or severe anxiety
- Severe depression
- Feeling frozen from overwhelming demands and a lack of internal resources; an overall greatly reduced ability to function
- Increase amnesia and time loss
- Increased urges to self-harm
- Increased thoughts of suicide
- An inability or reduced ability to handle ADLs (activities of daily living), such as eating, sleeping, and showering
Next week, I’ll talk about what you can do during times of decompensation.