Trauma usually comes with problems in self-regulation and self-control but people differ in the way it shows.
Under-control (UC) like chronically unmanageable emotions or intense, often destructive, impulses are usually diagnosed as BPD, sometimes it shows in impulsive eating disorders like binge eating or bulimia. We think that under-control is addressed well in DBT, so we won’t go into detail about that.
The other extreme is over-control (OC) that is usually diagnosed as obsessive-compulsive (P)D or shows in restrictive eating disorders or treatment-resistant depression.
In DID we generally find UC and OC, with EPs and some protectors usually showing under-control and ANPs, abuser-imitating parts and some protectors showing over-control (while this is overly simplified, the distinction between OC and UC parts can often be much more useful for therapy than using the language of EP/ANP) We separated the tendencies of control between our parts, so we need to learn how to manage both.
Impulse control and DBT
People who show intense struggles with self-regulation are often placed in DBT treatment. That includes people with problems that are based on OC. They regularly reach the limits of what is humanly possible to control, so there are slips into seemingly impulsive behavior. That’s normal, the basic problem is still over-control.
When DID systems show both UC and OC the element of structural dissociation that is at the core of the problem is often ignored, they get misdiagnosed has having BPD and end up in DBT treatment as well.
Classic DBT treats under-control and we need to be very careful not to reinforce OC patterns when we work with DBT as part of trauma treatment. Especially survivors of early complex long-term abuse have learned that control is needed for survival and perfect obedience to rules will keep them safe. Like a lot of the abuse we endured, DBT teaches controlling behavior that is not appreciated. Therapists need to be aware of the possibility that patients are slipping into a trauma pattern of over-control instead of showing real treatment success in self-regulation.
Impulses and mindfulness
In DBT we are taught a certain kind of mindfulness to help us control our emotions and impulses. The idea is to
- notice
- observe
- don’t act
- let it pass
This is a great idea when our impulses are harmful or create long-term difficulties for our lives. If we are struggling with under-control it gives us the chance to reflect on our spontaneous impulse and frees us from the compulsion to act on it.
It can be a good concept when we have DID and parts of us communicate impulses that don’t serve the system or that would lead us to act in an inappropriate way for an adult body in a setting that is not safe for that. Just waiting will not let this pass though; we will have to communicate and negotiate. Parts cannot be ignored forever and if we don’t take care of it their impulses only grow over time until there is a loss of control.
Over-control
When our problem is over-control, chances are that we are already suppressing our impulses on a grand scale. This is the survival technique we have learned as children, never to act just because we feel like it. We were the toddlers who learned never to sing a little song or swing our legs to not annoy the adults, never to show any emotion on our face and never to just say what we think. For some of us this is so deeply engrained in our traumatized being that we barely even notice normal impulses anymore.
In DID we can notice how OC parts will do everything in their power to suppress the impulses of UC parts to avoid drawing attention to the system. That is often at the root of punishing parts, the desperate attempt to avoid showing normal human weakness or needs or under-control because that was extremely dangerous during TraumaTime.
Nobody is asking OC parts to give up control. The goal is never to lose control. But we have to ask ourselves why nature gave humans things like impulses.
The role of impulses
Not all impulses are harmful. It might be hard to believe when they got us into trouble during TraumaTime, but healthy impulses are part of a clever design.
When we have a normal human need, something is set in motion in our body and mind. We have a thought, feel an emotion, a body sensation and an impulse to act. This is supposed to motivate us on all levels towards actions that will meet our need.
If we had to make it a habit to ignore our emotions and impulses it usually means we also had to dissociate our body sensations and our needs. As adults we struggle to feel our needs or take proper care of ourselves because there is nothing there to guide us.
There are different ways to work our way out of this, like learning to feel emotions and body sensations again. Another way to approach it is to use a slightly different version of that mindfulness exercise to re-connect with our impulses.
An exercise to practice it is this:
“What is one small thing you could change right now to make the situation a little bit better?“
Listen to your body to find the impulse.
- Notice: It can feel vague or weird at first, when we are used to automatically dissociate our impulses. Be patient with yourself and take even small hints seriously
- Feel it for a moment: drop as much of the distant observer position as you feel comfortable with and try to sense the impulse and where in the body you can feel it
- Reflect: Why do you think this impulse is there? What need is it pointing towards? Does the action belonging to your impulse met the need (sometimes it doesn’t). Notice how you use your brain, you are not losing control.
- Decide on an action: you don’t have to act, if you think that following the impulse is inappropriate in that situation. But if you came to the conclusion that it is harmless, even if it is weirder than what you usually allow yourself, you might just as well try it and see what happens.
- Stay with the sensation. Mindfully check if following the impulse changed anything and in case it did, what that feels like in the body. It is normal to feel like you did something wrong at first, that happens because it feels so unfamiliar. Just stay with the sensation in your body, that is telling you the truth about the present.
If the impulse comes from another part of us, we can do the same and try to sense what is does on the inside. Not all the impulses we get from our Littles will be inappropriate. They might just be more aware of something that we as a system need.
Harmful impulses are often a sign that we missed a bunch of other impulses that came first and the more we become aware, the less we will get to that stage.
When we deal with over-control we need to learn to trust our impulses again.
I am not telling you to follow every single one of them or to act in unreflected ways. But this is the path to really good self-care. Our body tells us what it needs if we listen to its impulses a little bit more carefully. That is how we can know when we are hungry or need the toilet, even if our body awareness is still low. Getting our needs met will increase our quality of life tremendously.
I know how scary it can be to feel needs without ever feeling that they can be met. I think it is actually impossible to push people with OC into suddenly feeling needs without causing a crisis and have them spin back into even more control. That’s why we approach the problem from the other direction and just follow healthy impulses. That way we create a physical experience of needs being met in the present before we even open a wound of unmet needs of the past. The grief about that will probably come up in this process but it will have lost its sharp edge when we experience it through the felt-sense of needs being met now. Experiencing how good it feels to get needs met can shift the OC dynamic into something that supports self-care.
Maybe following impulses offers a safe way to slowly figure out this awkward idea of being allowed to have normal human needs.
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