F44.81

In an effort to attempt to get some of my therapy paid for by out of network insurance coverage, I asked my therapist to write me up invoices for January and February. We briefly discussed what diagnosis codes she should use. I was overwhelmed by the conversation at the time and ultimately indifferent to the code choices. I just told her to write whatever seemed most appropriate. 

Today she gave me those invoices. Here’s a screenshot showing the codes she chose:

  
90834 is a CPT code just indicating that she sees me for individual psychotherapy. 

F44.81 is an International Classification of Diseases, 10th edition (ICD-10) code. I honestly wasn’t sure what my therapist would put for this. I figured it would be genereric, like “anxiety disorder” or “mood disorder – unspecified”, which is what Zooey always listed on her invoices, and what my psychiatrists frequently use. 

But I looked up the code and here is what it says online:

F44.81 – Dissociative Identity Disorder 

This is a specific ICD-10-CM code that can be used to specify a diagnosis. This is the American ICD-10-CM version of F44.81. Other international ICD-10 versions may differ.

Clinical Information:

  • A disorder characterized by the presence of two or more identities with distinct patterns of perception and personality which recurrently take control of the person’s behavior; this is accompanied by a retrospective gap in memory of important personal information that far exceeds ordinary forgetfulness. The changes in identity are not due to substance use or to a general medical condition.
  • A dissociative disorder in which the individual adopts two or more distinct personalities. Each personality is a fully integrated and complex unit with memories, behavior patterns and social friendships. Transition from one personality to another is sudden.

Applicable To: Multiple personality disorder. 

ICD-10-CM F44.81 is grouped within Diagnostic Related Group (MS-DRG v32.0): 883 Disorders of personality and impulse control. 

I know this is not news to you (or me), but this is the first time I have ever actually seen this on paper for myself. 
This is real

I really have this. I have officially (on paper I can see with my own eyes) been diagnosed with Dissociative Identity Disorder. My therapist believes me. And she believes me with enough conviction to bill my insurance using that specific code. 

Holy shit. I have a lot of feels right now. 

What Is The Point?

This morning’s session was so damn weird. I felt very frustrated going into the session and the sound of my own voice only made it worse. It’s hard for me to even piece together what happened, so please bear with me through this post.

I didn’t mention this during my recap, but I lost some time towards the end of Wednesday night’s session. I remember the therapist asking a question and then everything goes blank. I knew I must have switched, but I am missing that time. Which really freaks me out. I hate it when I don’t know which part was out or what happened when they were fronting. My imagination tends to go to the worst case scenario, so I was anxious as hell going into session today because I was terrified of what may have happened and how the therapist might respond to that.

So I said nothing. I walked in and just sat there for a good three minutes (100 years in therapy time). Then, eventually, I started talking about how frustrated I felt. I didn’t want to be explicit about losing time because I wasn’t sure I even wanted to know what had happened during that time. I was also afraid that if she started talking about whatever occurred in that gap, it would trigger the same (or a different) part and we’d either switch again or I’d end up in some sort of dissociative or distressed state.

I spend so much time worrying about how I come across and how I’m being perceived in therapy. I am constantly in fear that I will say something that will trigger myself and then I’ll be held accountable for not being more responsible in choosing my words or not having solid enough grounding skills. Except….and this is important….there’s so much that needs to be said. Not just big, ugly trauma stuff, but little stuff as well. Important little stuff that has a pretty big impact on my day-to-day life. Unfortunately, all of that little stuff generally has a direct link to the big ugly stuff. Since I’m trying to avoid the big ugly stuff, I end up doing all of these verbal ninja moves to get my point across with allusions and vague references, rather than just being completely forthcoming. It’s exhausting. And lonely.

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The Importance of Accuracy in Media Representations of Mental Illness

I’ve recently seen a lot of buzz on social media around Leonardo DiCaprio‘s decision to play Billy Milligan in the upcoming film “The Crowded Room”.

For those who aren’t familiar with the name, Billy Milligan was the first person to successfully use Multiple Personality Disorder (now referred to as Dissociative Identity Disorder) as a part of an insanity defense in court. Milligan was diagnosed with MPD and found to have 24 different personality states. This diagnosis came after an evaluation by a team of psychologists in preparation for his defense against several violent crimes, including armed robbery and rape. Milligan’s attorney claimed that his female lesbian alter, Adalana, was responsible for the three rapes he was charged with and a Yugoslavian communist alter named Ragen committed the robberies.

Here’s the thing, I understand that this is a true story. Milligan was said to have suffered early childhood abuse consistent with the development of dissociative disorders. And he was legitimately diagnosed with MPD/DID. So in that respect, this is admittedly a refreshing departure from the use of DID as the “plot twist” wherein someone pretends to have DID for the sake of getting away with a crime (I’m thinking specifically of Edward Norton’s character in “Primal Fear“).

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Which, by the way, the idea that DID patients are all fakers is a tremendous stereotype surrounding DID. I remember when I first started searching for information on the disorder. I was immediately inundated with research papers and websites about how to tell whether someone is “really” dissociative or just pretending to be. Seriously. Here is one little gem for you:

“While most psychologists demonstrated belief that DID is a valid diagnosis, 38% believed that DID either likely or definitely could be created through the therapist’s influence, and 15% indicated that DID could likely or definitely develop as a result of exposure to various forms of media (Cormier & Thelen, 1998).”

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Meeting The Many Faces of DID

imagesEvery month I go to a drop-in peer support group for people with Dissociative Identity Disorder (DID). I started going in September, after I was discharged from a hospitalization that was three days of hell. I was desperate to figure out how to work within this system of ours and I thought that talking to other people who were dealing with the same issues might be a good resource. My first meeting was terrifying. I didn’t know what I was going to walk into and I had lots of pretty scary ideas. I wasn’t wrong, but I wasn’t right, either. In the last six months I’ve met many people with DID who are as varied as humanity itself.

This particular group tends to be mostly females, but there are certainly males that attend. I’ve met people that are on full disability, barely able to string sentences together, struggling to survive each day. I’ve also met lawyers, doctors, professors, therapists, artists, students, etc. who have lives that are far more stable than many “singlets” I know. There are Black, White, Latino, Asian, Pacific Islander, and Middle Eastern members. There are people who identify as gay, straight, bisexual, transgender, asexual, and everything in between. Some are teenagers, others are well past retirement age. Some of us are married, others are single. Some have kids, others don’t. There are able-bodied individuals and people that use a variety of different assistive devices.

Among each of us there is also tremendous variability in how our DID presents itself. Some individuals have almost full integration. Others won’t even say the dreaded “i-word”. Some have complete amnesia between the most commonly presenting part (the “host”) and other parts. Some have full co-consciousness and cooperation among parts. Some were diagnosed 20 or 30+ years ago, when it was still called “Multiple Personality Disorder”. Others, like me, are brand new to their diagnosis and trying to navigate all that comes with it. Some are going to therapy three or four times a week, traveling long distances and spending tremendous money to manage their symptoms. Others have run their course in treatment and feel they no longer need therapy. And still others, sadly, don’t have access to the resources to get the help they desperately want and need.

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