FAQ 1: What is Applied Behavior Analysis (ABA)? + Glossary of ABA Terms

Glossary of ABA terms at the bottom. FAQ 2

Table of Contents

1. What is ABA?
2. How is ABA done?
3. Glossary

I was asked recently for a definition of ABA. I quickly found that when googling “What is ABA?”, the results are heavily weighted in ABA’s favor. The top result was Autism Speaks (a notorious anti-autistic, fear-mongering organization). Autism Speaks paints a lovely picture, pointing to increased language and adaptive behaviors, ABA being around since the 60s, individualistic, “evidence-based,” and how qualified BCBAs are doing the programming.

It neglects to mention any prevalent controversies or professional complaints in the field. It leaves out the emerging evidence that long-term ABA has adverse effects. And it conveniently doesn’t mention the RBT’s role in ABA or the suspect nature of ABA research.

No wonder this person was having a hard time finding a comprehensive definition.

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Since major ABA organizations like ABA-I have taken over the conversation on what ABA is, there is a lot of misunderstanding in every community.

ABA practitioners often have a rosy view of ABA, unaware of a movement from the autistic community against it.

Parents are thrown into a position where every doctor and autism resource is catastrophizing their child, telling them their child will never be able to care for themselves or communicate if they don’t act now.

Autistic people, especially newly diagnosed, may have heard of the controversy and use catchy slogans like “ABA is conversion therapy” that they’ve seen in the community without a real understanding of what ABA is and why it’s problematic.

Which makes informed, nuanced conversations between these groups nearly impossible.

What is ABA?

Applied behavior analysis is an extension of the field of behaviorism. Put simply, behaviorism believes in shaping human and non-human animal behavior through rewards and punishments. ABA uses reinforcers to change behavior according to the social, motor, and other functional/adaptive goals that the client sets. It also seeks to decrease “problem behaviors,” which are loosely defined but typically include behaviors like self-harm, aggression, eloping (running away), and “vocal non-compliance” (which can involve saying no, screaming, crying, etc.)

ABA does not focus on the emotional domain, as it is a purely behavioral-focused therapy. Only cognitive therapies like cognitive behavioral therapy (CBT) handle cognitive/emotional processes directly. While ABA and CBT may share the name “behavioral therapy,” the method and focus of the therapy are very different.

Behavioral therapies like ABA aim to create greater socialization, self-sufficiency (often referred to as adaptive skills), and communication skills through changing behavior with rewards and punishments. The problem is defining those goals as they are subjective goals that ABA therapists attempt to make objective.

ABA can be applied across various contexts. Many ABA providers are trying to re-contextualize it to treat substance abuse, alter education, or provide treatment for other mental health disorders. Despite this, the most widespread use of ABA is on young autistic children, usually between the ages of 2-7. As such, this is the ABA that I am talking about. My concerns about it applied elsewhere stem from my worries about assent from minors/vulnerable populations, but my focus is ABA on autistic children.

How is ABA done?

ABA is used as a description of a field of many practices, so there is no one way that ABA is done. All ABA, however, share some characteristics and are based on the same fundamental principles.

The structure of ABA involves a board-certified behavior analyst (BCBA) who possesses a master’s degree and has obtained certification from the Behavior Analyst Certification Board (BACB, which isn’t confusing at all /s). The BCBA usually meets with the parents and child and does an assessment of some type. The assessment typically assesses the skills the child currently has compared to what the assessment determines is typical for the child’s age. The broad term for this process (including parent interviews, observation, and formal assessment) is a Functional Behavior Assessment (FBA).

They may also do something called a Functional Analysis. A Functional Analysis seeks to scientifically determine the function of a behavior. To determine this, they test a child using things that are known triggers to see if the child reacts. This is to determine if the “problem behavior” is for the function of access, escape, attention, or automatic reinforcement. Because it uses children’s triggers and is often used on non-speaking children, ethical issues can be very prevalent in my experience.

The function of access, escape, attention, and automatic reinforcement believes that ALL behavior (and in the context of the therapy, ALL autistic behavior) falls into four categories. Access believes the child is doing something to gain something (typically tangible, like a toy). Escape believes they are doing it to avoid something (typically unwanted tasks or sensory). Attention believes they are doing something to get attention (get a reaction). Automatic reinforcement is doing something to return to homeostasis (like stimming).

Following this assessment, a treatment plan will begin targeting behaviors using these functions. Generally, if something is for the function of access, you make the thing the child wants access to unavailable until they provide the desired behavior. If it’s escape, you return the child to the task and model appropriate ways of asking for escape or not letting them up until they finish. If it’s attention, many therapists will use planned ignoring, where the therapists ignore a child until they stop doing the attention behavior or display the “appropriate way” to ask for attention.

The ones actually performing this therapy are called Registered Behavior Technicians (RBTs). They are currently only required by the BACB to have a high school diploma, complete a 40 hr training, and pass the RBT exam. They are not allowed to create the programming, but they are the ones implementing the program. Generally, most training programs very minimally prepare RBTs to handle behaviors such as aggression (with emphasis on restraint in many places) and very little information about autism.

RBTs must have 5% of their hours supervised, but only half of those have to be individual. So if an RBT works 40 hrs a week, only 4 hrs per month have to be individual supervision.

The RBT (generally one-on-one) will run the child through their goals, collecting data from trials. For NET, they will follow the child around and figure out ways to incorporate goals. This may look like stopping a child at a slide and saying “go” before letting the child down the slide or bringing the child to sit next to another child and play alongside them. For DTT, they would sit the child down with flashcards or objects and have the child label them. A kid would be rewarded with a wanted item, break, or other reinforcers for labeling correctly.

All ABA therapists use the “prompt hierarchy” (also called errorless teaching). The prompt hierarchy consists of verbal, second verbal, gestural, model, partial physical, and full physical. This means you work from “least restrictive to most restrictive” until the child performs the desired behavior. For example, if I want a kid to put on their shoes, I would remind them to put them on, tell them again, gesture at the shoes, model grabbing the shoes and putting them on, touch the kid’s hand to prompt them to put them on, and finally, grab the kid’s hands and have them put on their shoes.

The final concept crucial to all ABA I’ll present is the ABCs of behavior. The ABCs of behavior is antecedent, behavior, and consequence. All behavior has the factors immediately before that elicit a response, the behavior, and the consequence of that behavior. This is why behaviorists look for the function of the behavior. It’s to see what is reinforcing a behavior to later manipulate it into happening more or less often.

Please let me know if I missed any terms in the glossary or if the definition isn’t correct, more information in part 2.

Glossary

ABCs of Behavior – The ABCs of behavior is antecedent, behavior, and consequence. That is, all behavior has the factors immediately before that elicit a response, the behavior, and the consequence of that behavior.

Adaptive Skills – Skills of self-sufficiency like personal hygiene, day-to-day activities, interacting with others, managing money, and other functions required to take care of yourself.

Allistic – Not autistic.

Applied Behavior Analysis (ABA) – ABA focuses on shaping behaviors through reinforcement with the goal of improving communication, social, and adaptive functioning. Since it is a branch of behaviorism, it does not focus on the emotional domain or other internal states. It also seeks to decrease “problem behaviors” (as defined by the individual ABA provider). There are many different types and settings.

Aversives – harsh or abusive punishments like beatings, spray bottles, verbal harassment, withholding food, restraint, seclusion, public shaming, uncomfortable noises/sensory stimuli, and shock treatment.

Behavior Analyst Certification Board (BACB) – The independent body overseeing all ABA professionals and programs. It creates ethical standards, tests, requirements and publishes updates about ABA.

Board Certified Behavior Analyst (BCBA) – possesses a master’s degree and has obtained certification from the BACB. The BCBA usually meets with the parents and child, does an assessment of some type, and creates programming for the client that RBTs implement.

Behavioral Therapies – Behavioral therapies like ABA aim to create greater socialization, self-sufficiency (often referred to as adaptive skills), and communication skills through changing behavior with rewards and punishments.

Cognitive Behavioral Therapy (CBT) – CBT is a cognitive therapy that takes a multi-modal approach. It helps people identify their cognitions and consequent behaviors, allowing them to gain better emotional recognition and self-regulation. While ABA and CBT may share the name “behavioral therapy,” the method and focus of the therapy are very different.

Cognitive Therapies – Only cognitive therapies like CBT handle cognitive/emotional processes directly. Cognitive therapies are helpful if the client’s concerns are emotional issues, cognitive distortions, or self-regulation skills.

Conflict of Interest – A personal relationship of a researcher to an organization or consequence that would bias the results. They must be disclosed, but only certain types like financial conflicts of interest are commonly disclosed. One of the most common in ABA is clinical/training conflict of interest, where working in ABA or consulting ABA providers may bias the researcher towards a favorable result.

Desensitization – The process of exposure to an aversive stimulus. It is intended to be done in small iterations of the feared object/sensation but is often practiced as forced exposure to the item/sensation. Improper desensitization practices are traumatic for the client, making it a controversial technique.

Differential Reinforcement – Reinforcing one behavior over another behavior. There are four types, DRI, DRO, DRA, and DRL. DR of incompatible behavior (DRI) seeks to reinforce a behavior that is incompatible with the one the therapist doesn’t want (like chewing gum prevents whistling). DR of other behavior (DRO) reinforces when a behavior doesn’t happen over a period of time. DR of alternative behavior (DRA) reinforces alternative behaviors to the one the therapist wants to reduce (like raising your hand instead of yelling). DR of low rates (DRL) reinforces lower rates of a behavior instead of eliminating the behavior.

Discrete Trial Training (DTT) – Commonly included in old aba. The client is shown many flashcards with requirements to label them, point to the correct one, or do another similar task. After a certain number of correct answers, they are provided with a reinforcer, though punishment is also sometimes used to deter wrong answers or increase the effectiveness of a reinforcer. It is practiced less often due to its historically abusive nature and lack of generalizability.

Discriminative Stimuli (Sd) – An Sd is a stimulus that indicates what behavior someone should be doing. If I call your name, that is an Sd for you to respond.

Early Denver Start Model (EDSM) – Commonly included in new ABA. EDSM was proposed to target younger children (between 18 mo – 5 yrs) to start fostering skills as young as possible. It is highly effective at teaching skills but is questioned for the vulnerability of the population it’s used on.

Extinction Burst – The immediate increase of behavior after a behaviorist has targeted behavior for reduction. This is somewhat controversial as it can also indicate a withdrawal of consent.

Extinction Plan – A plan a BCBA sets to reduce a “problem behavior” through punishments and reinforcers.

Four Functions of Behavior – The function of access, escape, attention, and automatic reinforcement believes that ALL behavior falls into four categories. Access believes the child is doing something to gain something (typically tangible, like a toy). Escape believes they are doing it to avoid something (typically unwanted tasks or sensory). Attention believes they are doing something to get attention (get a reaction). Automatic reinforcement is doing something to return to homeostasis (like stimming). It is phenomenological, making it difficult to provide evidence for the categories.

Functional Analysis (FA) – A Functional Analysis seeks to scientifically determine the function of a behavior. In order to determine this, they test a child using things that are known triggers to see if the child reacts. This is to determine which of the four functions of behavior are reinforcing the “problem behavior”.

Functional Behavior Assessment (FBA) – The assessment a BCBA or other professional administers to determine the skills and behaviors the child currently has compared to what is typical for the child’s age. This includes parent interviews, observation, formal assessment, and may include a functional analysis. FBAs are not exclusive to ABA.

Group Design – A study design involving more than one participant.

Judge Rotenburg Center (JRC) – An ABA organization that is highlighted at major ABA conventions currently practicing electric shock torture . The shocks they administer are four to twelve times stronger than a police taser. They recently went after an autistic-run non-profit for publishing statements regarding the inhumane treatment.

Motivating Operations – the environment and/or circumstance that will make a reinforcer more or less motivating. For example, if I present a cookie when you’re full, you’re going to want it a lot less than if I present it to you when you’re hungry.

Naturalistic Environment Teaching (NET) – Considered part of the new ABA. Developed in the 80s, NET tried to address the issues with generalizability in DTT. The therapist follows the child and attempts to implement goals using natural reinforcement. It still shares a lot of ABA techniques that were used in DTT.

New ABA – A loosely defined cut-off in time for the evolving field of ABA. ABA therapists often claim that the “new ABA” is good, pointing to advancements in naturalistic techniques that are not as explicitly punitive. The “old ABA” vs. “new ABA” debate has served to silence people that experienced ABA, regarding them as having “old ABA” and therefore not having an informed perspective on current ABA practices.

Non-speaking/Non-speaker – A person that does not communicate verbally. People who did not speak used to be referred to as non-verbal, but this is inaccurate because many non-speakers have verbal abilities to communicate. They may not reliably speak or speak at all.

Non-verbal language – Communication without words, like body language, gestures, or silence.

Old ABA – A loosely defined cut-off in time of what was considered historical ABA. It generally encompasses a conglomerate of unethical practices like the rigidity of DTT, aversives, and punishing autistic behavior like stimming. If you talk to most ABA therapists, they would agree that the old ABA was bad. The “old ABA” vs. “new ABA” debate has served to silence people that experienced ABA, regarding them as having old ABA and therefore not having an informed perspective on current ABA practices.

Ole Ivar Lovaas – One of the attributed founders of ABA. He believed that autistic children were “not people in the psychological sense” and that they responded best to manipulating behavior. One of the major criticisms of “old ABA” is that its methods heavily influenced Lovaas’s involvement in The Feminine Boy Project, which was foundational to conversion therapy for gay and trans youth.

Pairing – The process where a therapist tries to establish themselves as a reinforcer for the child. The therapist gives children non-contingent access to reinforcers like their favorite items, activities, and even food preferences. The therapist provides the child with their full attention and doesn’t make any new demands, showing interest in whatever they are doing. After the child is bonded to the therapist, reinforcement and attention becomes contingent on fulfilling demands. The child has to comply with demands to receive this loving support to which they’ve grown attached. Therapeutic rapport is a more ethical way of establishing client relationships.

Picture Exchange Communication System (PECS) – An ABA speech therapy that involves a child exchanging a picture for a reinforcer. This is highly controversial among speech therapists as generally only a very limited number of communication options are given, and it makes communication contingent which can have a punitive effect on not communicating “the right way.”

Pivotal Response Training (PRT) – Commonly categorized in “new ABA”. PRT sets crucial developmental skills for different ages and attempts to teach children those pivotal skills through reinforcement and punishment. The biggest critique of this therapy is interpreting what skills are pivotal and implementing allistic versions of these skills.

Planned Ignoring – The therapist intentionally ignores the child until attention is requested “the appropriate way” or the child stops doing the behavior the therapist targets for reduction. Highly controversial, but commonly practiced.

Positive Behavior Support/Intervention (PBS or PBI) – Commonly categorized as “new ABA”. System-wide implementation of an ABA approach, generally used in schools. Its goals are to examine the structure and environment, target a specific group using ABA techniques, and finally examine individuals and correct behavior on the individual level. While it does take ABA a step in the right direction by examining the environmental structure, it still contains the problem of ABA ignoring non-behavioral factors.

Problem Behavior – A loosely defined concept that each ABA provider sets for the client. Typically this includes behaviors like self-harm, aggression, eloping (running away), and “vocal non-compliance” (which can include saying no, screaming, crying, etc.). Problem behaviors can be reductivist and generally eliminates the behavior without eliminating the cause.

Prompt Hierarchy (also called errorless teaching) – The prompt hierarchy consists of verbal, second verbal, gestural, model, partial physical, full physical. You work from “least restrictive to most restrictive” until the child performs the desired behavior. For example, if I want a kid to put on their shoes, I would remind them to put them on, tell them again, gesture at the shoes, model grabbing the shoes and putting them on, touch the kid’s hand to prompt them to put them on, and finally grab the kid’s hands and have them put on their shoes.

Punishment – Anything that reduces the frequency of a behavior. Punishment is sorted into two categories, positive and negative (which can be aversive or natural). Positive punishment adds something negative as a consequence to a behavior. Negative punishment removes something as a consequence.

Reinforcer/Reinforcement – Reinforcers/reinforcement is anything that increases the likelihood of a behavior. This similarly has positive and negative. Positive reinforcement means adding something the person likes as a consequence. Negative reinforcement means removing something the person doesn’t like.

Single-Subject Design – A study containing one subject. Behaviorism created single-subject designs to measure baseline and subsequent behaviors, which has been the foundation of much of ABA’s evidence base. While single-study designs can help prove a behavior has successfully changed, they are not generalizable to broad populations. They also only prove that the behavior successfully changed. They don’t adequately address any effects of the intervention beyond behavior change.

Verbal language – Using words to convey meaning, does not have to be spoken.

The Abuser Within – Persecutor Alters in Dissociative Identity Disorder

CW: Suicide attempt

During my freshman year of college, I sat in my biology course, taking a final. Somewhere in the back of my mind, something clicked into place. I knew enough about my triggers to know I was suicidal, but I didn’t want to die.

As if my body weren’t my own, I floated home. I woke up four days later after being put in a medically induced coma.

I felt light and told everyone that I felt so much better. I wasn’t lying. The me that was inhabiting my body didn’t want to die.

So, how did I go from depressed but wanting to live to making an attempt on my life on the same day?

At that time, I didn’t know I had someone inside me that learned that death was a coping mechanism.

So, when I first learned about my system, this conflict arose. This person was willing to risk our lives and well-being. They would control from behind the scenes and take over the body. And during that initial high amnesia time, I would often wake to a horror scene of terrible coping mechanisms.

I hated them. I wanted them gone from the system, locked away forever. And most of the system agreed. We turned against this alter, telling them we didn’t want them in the system. This increased amnesia and this power struggle. They fronted (took over the body) more often, and I lost more time, waking to destructive actions.

Then I saw this video. This alter was a persecutor.

What are persecutors?

Persecutor alters typically hold trauma and cope in destructive ways, often jeopardizing the system’s safety.

Persecutors often engage in anti-social behaviors. They may burn bridges with relationships, engage in self-harm or suicide, berate the system, use drugs, alcohol, sex, or other addictive behaviors, lash out at inappropriate times, or do unsafe things and put the body at risk of harm.

They can be a direct reflection of real abusers in the system’s life (introjects), children with a lot of trauma, fictive villains, non-humans, or other less savory self-parts.

Persecutors sound like the worst, don’t they? That’s often how (particularly new) systems view their persecutors.

When an abuser is outside the body, the system is well equipped to handle them by any means necessary. When that abuser is inside the body, it becomes a sort of auto-immune response. The system will often self-destruct in an attempt to rid it of this perceived pathogen.

In reality, persecutors are nothing more than protectors with harmful coping mechanisms.

Breaking down the wall

Once I understood that my persecutor was just an injured part of me, it was easier to know how to help them.

I sat with myself and meditated as part of self-therapy, holding space for them to come forward.

Marion (Host/”Me”): I know you’re hurting.

Zed (Persecutor): You don’t know sh*t.

Marion: You have a lot of pain from everything they did to you. All the pain you’ve gone through.

Zed: Oh yeah? And how would you know that? All you’ve done is said how awful I am and how I’m ruining your life.

Marion: I’m sorry, I shouldn’t have done that.

Zed: …

Marion: That trauma you went through, I can feel it. I know how hard that was for you. I’ve experienced trauma too.

Zed: You don’t understand me. Stop trying to pretend you do.

Marion: Do you want proof I’ve suffered? Do you want to see how I know?

Zed: I don’t believe you understand me.

Marion: (Describes my trauma in detail)

Zed: I’m… sorry.

Marion: Yeah, I understand what it’s like to hurt as badly as you do. It’s horrible, isn’t it?

Zed (crying): yes, yes it is.

Marion (crying): It’s so tiring, trying to act like everything is normal when your pain is hanging over you every minute. Come here.

Zed: (hugs)

Marion: That’s why I’m here. That’s why we’re all here. We are here to keep you safe. And we are safe. This is all that’s happened and why we’re safe.

Zed (nods): okay…

Marion: What if we find something that could help you process the hurt you’ve been through? I remember you like sewing and crafts?

Zed: Mmhm.

Marion: Okay, we’ll go to the store, and you can pick out ANYTHING you want to work on. And I’ll give you some time to front so you can work on it.

Zed (crying): thank you.

This wasn’t the only conversation we had. We talked over months, and I got to know that part of myself. They were a trauma holder that was only a child. They were trying their best to cope with the overwhelming emotions they experienced and were trying to keep us safe. They were also dealing with mental health issues that the rest of the system didn’t experience.

They didn’t need more people labeling them as dangerous and bad. They needed genuine connections to people that loved them. We stopped calling them a persecutor after that conversation. Persecutor painted them as an enemy against the system when they were really a protector and trauma holder.

But what our persecutor has done is REALLY bad

All things considered, my system was lucky that our persecutor was a child. Zed still had access to adult coping mechanisms and did many things I won’t discuss here, but they mostly did damage internally. They very rarely took out their trauma on other people.

Other systems may have persecutors that act in much more destructive ways. If they’re an introject, they could be very triggering, reminding you constantly of abuse you’ve endured. They may have caused you to lose jobs, material support, or even be involved with the court system.

System accountability is essential. All members are accountable for what one has done. And that may require owning up to difficult actions that don’t feel like you did.

A part of you did. And you should accept that as if you had done it. Take whatever steps you have to to be accountable in whatever your situation is, especially if external people were harmed.

Beyond that, recognize that this persecutor is part of you. They are you. There is no distancing or cutting them off, and any attempt to do so will likely backfire.

Recognize why they’re acting the way they are. What trauma did they endure to react this way? How old are they? What do they think the consequences of their actions are? Do they realize how it impacts others in your system, or do they only consider themselves?

Dealing with persecutors as a system

While I don’t know your situation and what is necessary for you, there are some universal principles in dealing with persecutors.

• Reframe your way of thinking about them. They’re not persecutors, they have a role in the system. They exist for a reason. Do they hold a trauma you couldn’t function if you lived with? Have they learned harming you or others is a way to stay safe?
• Hold a meeting through whatever communication you can. Send whatever alter they are most likely to get along with. Find out what they need and who they are.
• If you can’t communicate, examine their behaviors. What coping mechanisms have they been using? What is this communicating?
• Remember, they’re part of you. Resisting them only hurts the system. Work with them and accept them as they are.
• Set boundaries. Accepting them doesn’t mean letting them do things that harm the body. If a gatekeeper or other alter needs to step in or a rule needs to be set, do it.
• Give them a safe space. That could be a hobby, a change in scenery, or personal items. Once they trust you, they will be open to other coping mechanisms.
• Swallow your pride. It’s really easy to dismiss them as the worst, out to get you, and the problem. Be open to the fact there’s likely more to them that you haven’t seen.

Dealing with the system as a persecutor

• Have patience. They often have a hard time understanding why you’re doing what you’re doing to keep yourself (and them) safe.
• Be open to their attempts to communicate. You don’t have to agree with them, just hear them out. And if they disrespect you, you can tell them to f*ck off.
• Consider your body as shared. While you do have the right to make decisions for yourself, others may be negatively impacted if you don’t consider them. Just like they shouldn’t have the right to alter the body without consulting you, don’t do the same.
• Know that most of them hold trauma too. They may be acting out of their own trauma responses.
• Let them know what you want directly. What is it that you’re trying to get? What do you need? How will you get it?
• Pick an art form. It could be painting, music, writing, knitting, theatre, designing shoes, dancing, etc.
• Connect with others. Is there a group that would understand you better than your system does? If the system has a therapist, could you be honest about how you feel about the system?

“There is a way out of the suffering. It’s a hard route that requires both the system and the persecutor(s) to face aspects of themselves they may not like and trauma that hurts beyond recognition.

But the other side is so much better. It’s worth the work. And it’s like breathing for the first time in your life. It doesn’t mean it never hurts, but it no longer becomes unbearable because you have the support of a whole system to carry that pain.

I’m sorry you went through what you did. We deserved better.” – Zed (“reformed” persecutor)

Is ABA Therapy a Cult? – Examining ABA Through the BITE Model

Unfortunately, the question doesn’t have a simple yes or no. The BITE model (which I define later) is helpful because few organizations are cleanly “cult” or “non-cult”. The cult-like behavior exists on a continuum, highlighting aspects of unhealthy organizations.

ABA as an organization of leadership, “doctrine”, and widespread behavior shows a startling number of unhealthy, controlling behaviors.

My story of leaving ABA and Mormonism is not universal, but it is also not unique.

I hope that no one walks away from this article saying, “Yes, ABA is a cult!” or “No, it is not a cult.”

This article is intended to highlight areas that ABA needs to change to become an organization that is less unhealthy for its members and its clients.

My Experience

My supervisor(s) called me into her office. I had recently confronted her about an unethical situation, and we had argued about whether it was handled adequately. I argued that the way my coworkers discussed the kids as manipulative showed a much larger disregard for their humanity than just an isolated incident. She claimed she had handled the situation by posting a written protocol for feeding.

I sat quietly for an hour as she and another supervisor detailed how I was a terrible employee. They critiqued my autistic traits, complaining that I didn’t make eye contact, didn’t understand subtext, was insubordinate, and detailing how my coworkers hated me. My immediate supervisor went off about how I had “so many behavioral issues,” that I didn’t respect him and his wife, and they talked about me at home (yes, he and his wife were BOTH my supervisors) and that I “hadn’t improved my behavior.”

Ten minutes before the confrontation with my other supervisor (the BCBA above him), he praised me for how I had made significant improvements, that he was “seeing me put in the effort to ‘fix’ my behavior” (like making eye contact with him), and that he and his wife felt like I was really listening to them. I hadn’t changed any of my behavior other than staying silent. His judgment was purely perception-based, which is why it changed so quickly.

The only thing that had changed was expressing discomfort with how management handled vulnerable children. I was being punished for autistic advocacy and my superiors’ wounded egos.

The clinical director called me that evening via Zoom. Off-record she cut me a deal. She would excuse the $800 training costs if I left now, and we could “avoid some difficult conversations.” She wanted me to quit, telling me that all I had to do was walk away and “put this unpleasant situation behind us.” I declined, knowing I only had a few weeks left at the job. How bad can 3 weeks be? I thought to myself. I certainly didn’t consider myself a quitter and needed to pay rent.

That led me to the most significant situation, which gave me PTSD from the job. I was able to speak out against the situation, but at the cost of my job and wellbeing. I shook my head that I had declined the silencing deal but glad I stuck around long enough to expose the clinic.

I had left terrible jobs before. I had abusive bosses in the past, terrible working conditions, and soul-sucking dread of going to work. Somehow, leaving ABA was different. I couldn’t put my finger on it until it dawned on me.

It was just like leaving Mormonism.

A Shelf-Breaking Parallel to Leaving Mormonism

I had a similar sense of guilt and secrecy of information that went against “what the leaders said.” Ostracization from my peers for not doing things “the right way.” Others speaking for my experiences. Invasive questioning about my past to be used against me. Getting my needs met ONLY when I did things they wanted me to. The threat of losing material support for leaving. And the constant pressure to stop being autistic.

I even had a “shelf-breaking” moment in ABA. A shelf-breaking moment is referred to in ex-Mormon communities as an analogy for all the slight cognitive dissonances and questions you can’t answer placed on a mental shelf. Eventually, your shelf gets too heavy, and one thing “breaks the shelf,” exposing all the things you had been ignoring. Generally, once someone’s shelf breaks, they leave Mormonism because their entire life is thrown into upheaval.

It’s no surprise that a clinic in the heart of Utah with overwhelmingly Mormon leadership operated like a church. The same power structures enabled toxic in-group behavior and scrutiny of any perceived threats to the hierarchy.

The B.I.T.E. Model

The BITE model is a proposed theory for explaining how cults use control tactics to brainwash people into believing in an ideology and remaining part of a group.

Hassan (2020) proposes four main tactics. Organizations use behavior, information, thought, and emotional control to influence thinking.

He presents the idea on a continuum, from mind control tactics that range from healthy and constructive for the individual to destructive and unhealthy. Mind control tactics that maintain the individual’s free will and sense of self can be helpful (e.g., trying to control those areas to help a person with substance abuse abstain from substances).

Conversely, you have cults and other harmful organizations that utilize these tactics for retaining and gaining influence.

There are three levels that the BITE model examines as well. Traits of control for individuals, leaders, and organizations.

Mormonism tends to fall into the BITE model cleanly (organizationally, not necessarily individually). My experience with the organization is that it seeks homogeneity, is elitist, is deceptive (about history in particular), has an authoritarian structure, and asserts there are no legitimate reasons to leave. While this exists for the organization as a whole, it is especially pervasive in Utah, where the organization has legal control.

While the BITE criteria are too lengthy to list (you can find them here), the more criteria the organization meets, the more destructive and unhealthy it is.

Since ABA is a field, it is tricky to know what counts and whether such a broad structure of many different types of settings, practices, and ideals can be singly defined.

This is why I want to analyze this from the perspective of the ABA organization, which entails the authority groups in the field like the BACB and how they lead the field of ABA as well as widespread behaviors in the field. I will not be counting control behaviors that I experienced personally but will call attention to my experiences to highlight how dogmatic principles appear in application.

Behavior Control

Behavior control is the most obvious control tactic within the field of ABA. Since it is steeped in controlling behavior, it follows that it would exist at a structural level too.

From my experience, these were the criteria that working in ABA met. While this could exist in any hostile working environment, it is worth noting that autistic practitioners in the field have been met with similar experiences.

My ABA clinic made me financially dependent by not paying enough (which is common for RBTs). It also didn’t provide good health insurance, which I need as a disabled autistic person. I was in a terrible catch-22 because I was never making enough to have that amount of money to leave. Turnover for RBTs is common, and a widespread complaint of parents in ABA.

Since ABA is a work environment, the majority of time is spent there. That means the pro-ABA propaganda that circulates significantly influences a particular way of thinking.

Rewards and punishments are used to modify staff behavior. This seems to be almost universal. It’s unfortunately common for ABA clinics to use ABA on their employees. Many view it as good management without considering violating consent and professional boundaries.

Advocacy is often punished, encouraging group-think.

4/22 Pretty alright.

Information Control

The second criterion is how the organization restricts access to dissenting information. The way that autistic people who talk about their ABA experiences are often dismissed as radical, one-offs, or a relic of the past comes to mind.

I would argue that ABA meets the criteria for deception. A major complaint of parents, providers, and survivors is that ABA is not transparent about its outcomes. The ABA industry is not clear about the integrity of its research and hides behind jargon that effectively dismisses critiques of someone that is a novice to the field.

The ABA industry withholds information that disagrees with the field, including research indicating long-term negative effects, diminishing the scientifically dubious emergence of ABA, and rhetoric surrounding recovering from autistic behavior.

It also isn’t upfront about the current harmful practices and uses systems (like credential training) to instill a rosy view of ABA from the beginning.

The BACB does not go after individuals for social media posts, but many individuals in the field weaponize reporting dissent of the field in an attempt to de-credential practitioners. Many current practitioners are afraid to come forward about their experiences as a consequence.

Case-loads are often an issue because BCBAs tend to be overworked, and RBTs are not given adequate training to handle their clients. This creates an environment where practitioners are often too busy to think about what they’re doing or question ways that their practice may be contributing to harm in the field.

Countless sources are promoting ABA, including many official journals, newsletters, and other media. They often misrepresent positions of ABA critiques and requests from autistic people.

3/6 – This is a problem.

Thought Control

The third criterion focuses on how an organization uses rhetoric, values, and rituals to control the thoughts of its members.

ABA requires members to internalize the group’s “doctrine” as truth. It uses previously mentioned information control techniques and threatens credentials for dissenting opinions.

In this same vein, ABA encourages members to view the world phenomenologically from an applied behavioral perspective, confusing many practitioners into saying that non-ABA constructs are ABA innately.

It develops an us vs. them mentality between members and autistic individuals/dissenters of ABA. It recontextualizes ethics, encouraging an “ends justify the means” approach to therapy.

One of the most significant thought control tactics is reducing complex topics into platitudes to stop critical thinking. I’d be hard-pressed to find an ABA practitioner that hasn’t heard at least one of these phrases: “all behavior is communication!”,”quiet hands”,”what’s the ABC?” or “if a dead man can’t do it, it ain’t behavior!”.

ABA as an organization discourages reality checking, using denial of the potential (and documented) harms, rationalization, and justification of current harm.

A major autistic organization facing legal weaponization from the most unethical facility in ABA (JRC) while ABA-International continues to support the facility shows that critical questions about the organization are not looked at fondly.

And anyone with any familiarity with ABA knows of the claims that it is the only and/or most effective autism therapy, shunning other autism therapies with a considerable evidence base.

6/11, not good.

Emotional Control

The last section focuses on how an organization manipulates emotions to create loyalty.

The first criteria that ABA meets are that it often blames individual members for any faults and never holds itself or its leadership accountable. Many times when criticisms are brought up by former members, both leading organizations and current practitioners flood to talk about how those were “isolated incidents”, “individual clinics” or “the rare unethical practice.” I have never seen the head of any ABA organization acknowledge and accept current criticisms of ABA.

They promote feelings of guilt by discouraging members from affiliating with the critical autistic community or negative opinions. Social guilt is often employed to hold the group accountable, pressuring practitioners into feeling they’re doing an immense disservice to their coworkers or organization if they leave. Many practitioners also fear losing their current professional connections if they speak their critiques or decide to leave.

People that leave are often seen as less scientific or swayed by “emotional appeals” and that they couldn’t have reasoned their way out of the organization. This creates pressure that there are no good reasons to leave. Many ABA practitioners mention it’s “such a shame I’m not part of the field anymore.” They see my critiques as more helpful if I were in the field and that by leaving, I have squandered my opportunity to change the field. Part of this stems from other control methods like viewing ABA as the only way.

4/8 yikes.

So, is the ABA organization a cult?

If you are an ABA therapist brave enough to tackle this article, I encourage you to reflect on your experience with leadership and the experiences you hear from others. Why do so many autistic people disagree with ABA? Is there something there that might be worth exploring? Do you recognize any of the behavior described?

If you are not an ABA practitioner, I hope you can see where ABA needs improvements and what change should be pushed for.

I think the end goal for everyone is the utmost ethical treatment of autistic people. Let’s dismantle the unethical structures that currently exist and hold leadership accountable.

I Don’t Want to Cope: A List of Therapy Tricks Without the BS

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CW: Brief descriptions of childhood trauma.

I sat in my therapist’s office at 16, soft spa music lilting in the background.

Breathe in, 2…3…4…, Breathe out, 2…3…4…

I followed her directions, but I couldn’t help but roll my eyes. I had been assaulted a year prior, my parents were in the process of a messy divorce, and I had lost almost all of my friends in a short period.

And this woman wanted to solve that with breathing?

I hated going to therapy. It was a waste of time. I was tired of BS tactics to try to “regulate” or whatever.

Another therapist had erroneously suggested I had BPD. Queue the big book of worksheets and attempt to “fix” me instead of the traumatic environment I was in.

I saw another therapist that told me I was too dysregulated to do EMDR. She presented the “window of tolerance,” this imaginary window of emotions that you can realistically regulate, and extremes on either end of extreme dysregulation. The next 6 months of therapy with her consisted of chastising me for not being in my “window of tolerance” and any progress squashed by her enormous case-load resulting in her not remembering what we had done session to session.

And that’s not even getting into my traumatic inpatient experience.

I began to think I was the problem. Therapist after therapist failed to help me. I was an “extreme case.” A case no one wanted to take because I had a severe mental illness, something many therapists are not truly equipped to handle.

With an industry that was supposed to help me, why was I struggling so hard to find a therapist? I was told that was the solution. But none of their “tricks” worked on me.

Eventually, I met my current therapist. I had never understood people telling me I just had to “find the right therapist” before I had met her.

I saw progress in a short period that exceeded all of my therapy combined. She used many of the same techniques as the other therapists (breathing exercises, trauma-focused CBT, etc.), but suddenly they were successful.

How can the same technique that didn’t work be successful? I didn’t understand until I got further in my psychology courses.

Therapeutic Rapport > Therapy Technique

One of the most significant concepts I learned in my Bachelor’s program was The Three C’s of Resilience presented in Change 101 by Bill O’ Hanlon.

Resilience to psychologically damaging events requires connection, contribution, and compassion.

In short, you have to feel connected to your community, feel like you can contribute to the world, and be in relationships that allow you to fully express yourself and be met with compassion for your experiences.

This rang true for my own journey to resilience, and I quickly saw how my therapist played a crucial role in that.

Therapeutic rapport, building a relationship with a client through unconditional positive regard, is key to success in therapy. And it’s one of the biggest reasons (in my humble opinion) to do the work to find a therapist if you have the means.

The techniques themselves (the grounding exercises, cognitive techniques, or other mindfulness practices) can be helpful, but don’t do much when your problems extend beyond “cognitive distortions.” Unlike Cognitive Behavioral Therapy (CBT) would lead you to believe, your problems aren’t all in your head. There’re real problems in the world you’re dealing with.

My favorite philosophy book by Susan Brison discusses how the violent sexual assault she went through left her with a broken sense of self. She discusses how having a narrative of trauma and telling it allows for a re-integration of that fractured self. A supportive therapist that you connect with can be the audience to that challenging event, mitigating any risk and helping you heal yourself.

It’s also why a bad relationship with a therapist can be so damaging. If your self-narrative is met with judgment, coldness, or indifference, you internalize that. It makes it difficult to heal. You lose connection and compassion.

In a perfect world, all therapists would be helpful, open-minded, and compassionate. Unfortunately, we don’t live in one.

Doing the Work on My Own (and you can too!)

Luckily, most techniques therapists use can be found on Google or in a library. That doesn’t mean you’ll be able to apply them with the same skill as a therapist, but ultimately therapy is only successful if you can find a way to make the techniques work for you.

Since everyone is different and many therapies take a one-size-fits-all approach, my experience hating all mentions of “mindfulness” is not unique.

For a while, I was without insurance and couldn’t afford housing, much less a therapist. It was a luxury, something only people who already have their life together could do. Mental illness makes it hard to work, not working makes it hard to afford basic life necessities, and not having basic life necessities aggravates mental illness. And so, the vicious cycle continues.

During this time, I made progress without a therapist. I figured that I had all the tools at my disposal, why not therapize myself?

(Note: I am not saying do this INSTEAD of therapy. This is meant to be a guide only if a therapist is unavailable to you or as supplemental to therapy. There are some risks of doing therapy homework by yourself, like no barriers stopping you from pushing yourself too far or not having someone present if you’re at risk of harming yourself. Exercise extreme caution and keep someone close to you in the loop with what you’re doing.)

I delved into self-help books and autobiographies, examining how someone with extreme trauma went from completely falling apart to a functional human being.

List of Coping Skills and Why They Work

Mindfulness

Mindfulness is beaten like a drum for coping skills. It’s often accompanied by images of uncomfortable chairs, gurus, and boredom. Mindfulness is often a rigid process, and it seems like there’s a “right” way to do it.

The truth is, mindfulness can be many things you wouldn’t even think of. We naturally turn towards mindfulness in our lives to help us calm down.

Mindfulness works by engaging the parasympathetic nervous system. This relaxes the body and helps essential processes. It doesn’t matter how you’re mindful, just as long as you are fully aware in the moment. It also works well for dissociation.

Mindfulness techniques you might not think of:

• Eating a fine meal and really savoring the flavor
• Sucking on sour candy (my favorite are jolly ranchers for this) – can also be done with spicy or minty foods
• Riding a roller coaster and being aware of how you feel
• Writing in a journal or typing in a notes app
• Creating a piece of art
• Listening intently to a new (or favorite) song
• Holding your breath
• Ecstatic dance or dance that makes you aware of your body
• Metacognition (e.g., I am on the couch, reading an article, I feel thirsty)
• Self-hypnosis (youtube videos)
• Driving in silence
• Stimming breaks
• Stepping outside
• Blowing bubbles
• Small amounts of pain – pinch your forearm and observe the sensation (don’t do this if you think it will be a self-harm trigger)
• Pet an animal
• Walk barefoot
• Holding instant hot or cold packs
• Scream in your car or isolated place
• Build a lego set

Vagus Nerve Stimulation

This is one of my new hyperfixations because it is SO COOL. The vagus nerve is a nerve that runs through your body that controls your heartbeat and has a part in the autonomic nervous system.

You stimulate this nerve subconsciously every day by completing different activities. It can also be a handy trick for reducing anxiety because it reduces your heart rate and can help kick the parasympathetic nervous system in gear.

It is important to note that if you’re prone to heart attacks, manual stimulation (particularly the modified Valsalva) of the vagus nerve can be risky without a doctor present.

Things that stimulate the vagus nerve:

• Modified Valsalva Maneuver – a maneuver used in medicine to slow down the heart
• Cold showers, putting your face or hands in ice water
• Pooping (no, really)
• Meditation or prayer
• Singing or chanting (this is part of why “om” is chanted during meditation)
• Laughing
• Massage (here’s how to give yourself a massage)
• Hugging (yourself, a stuffed animal, or a loved one)
• Cough
• Sit-ups

Environment Changes

If you’re in an unsafe environment, it can feel like life is hopeless. While completely changing your life situation takes a long effort, small things can help you feel safer.

One of the protective factors for people in difficult situations is a sense of control and a sense of purpose. You can control the smallest things and see positive psychological benefits.

Environment changes:

• Create a YOU space. Wherever you can go to make a safe space, create it. It may be your room, your closet, the local coffee shop, Mcdonalds, a friend’s house, a park, a classroom, a car, or anything else where you can get away. Having a safe destination can make a big difference in maintaining some level of stability.
• Purchase a non-lethal weapon
• Get a pet, even something as small as an ant farm
• Get a plant
• Volunteer for a cause you care about (think mutual aid, what would you want help with?)
• Create a portable coping kit
• Set a goal and create a to-do list to accomplish it (can be silly like learning to do the splits)
• Create a safety plan (who you would call, what you need to grab, and things that help you calm down)
• Dye your hair (even one strand or the bottom with help from a friend)
• Donate something
• Make an eco-system

Distractions

Sometimes nothing works. You’ve tried all the coping mechanisms you can think of and you’re still overwhelmed. It’s okay to distract yourself in a healthy way before you can get to a place to confront the experience or emotion.

Distraction is good when you’ve tried other things and they haven’t worked or your experience is so distressing you need to buy yourself time to calm down.

Healthy distractions:

• Video games
• TV or a movie
• Watching cartoons (be aware this can trigger littles if you’re a system)
• Talking with a friend
• Exercise
• Going for a walk
• Making art
• Watching comedy
• Baking or cooking
• Hobbies
• Go to the library
• Coloring
• Do something outside the house
• Wreck this journal

Recommended Resources

• The Neurodivergent Friendly DBT workbook
• The Diagnostic Criteria for Complex PTSD (C-PTSD): A Beginner’s Guide
• A list of a bunch more ideas for “nontraditional mindfulness”: 101 grounding techniques
• A free Acceptance and Commitment therapy resource: ACT lessons
• A book you can buy: Art therapy workbook
• A free list: 100 Art Therapy Exercises
• The complex PTSD workbook
• Autobiographies of people who have been through similar circumstances (I personally like A Teenager’s Journey, Scared Selfless, and The Glass Castle)

Let me know in the comments if there are any resources I missed!

Autistic ABA Practitioners – The Canary in the Coal Mine

[I]t was a traumatic experience as an RBT and can’t imagine how these kids feel getting the “treatment”. I will never forget my time there and how I was treated. It will stay with me forever.

Nancy Cervara, autistic ex-RBT

CW: Positive discussion and traumatic experiences in ABA. The views in the following article do not represent the views of Life of Lieu unless specified otherwise. The quotes have remained intact and represent the views of the people interviewed.

This experience reflected my own. I will forever be impacted by how working in Applied Behavioral Analysis (ABA) traumatized me, and I was troubled to hear that I was not alone.

Something that is very rarely explored in the ABA discussion is the clinician’s experience with it. I am unaware of a source that has examined autistic ABA practitioners’ perspectives.

I was pleasantly surprised at the outpouring of support from autistic ABA clinicians and ex-clinicians that wanted to share their perspectives. There has been a valuable voice missing from a nuanced dialogue.

“New ABA” is at the heart of contention, with parents and providers swearing it’s changed so fundamentally that it is now ethical and safe. ABA survivors and autistic people have warned that it is the same therapy with a new coat of paint.

One of the significant problems in this conflict is that most survivors of ABA abuse experienced what has been cleverly categorized as “old ABA.” Often, their experiences are dismissed by parents and ABA providers alike because they didn’t go through this “new ABA.”

One group of autistic adults has an inside look at exactly what the “new ABA” is all about.

Autistic ABA practitioners. One of the most hated groups in all of ABA. They are patronized and subjected to ableist situations daily by their peers and rejected and despised by their own community. And yet, they are one of the most valuable resources in reflecting the current state of ABA.

A common critique of ABA is that there aren’t enough autistic individuals represented in leadership and research.

Why is that?

I obtained interviews from six current or former ABA practitioners that provide valuable insight into barriers autistic people face in the field and changes that need to be made.

Who Was Interviewed?

Current Practicioners	5/6
Practiced Discrete Trial Training (DTT)	6/6
Practiced Naturalistic Teaching (NET)	5/6
Worked in “All” Settings (Clinic, School, Home)	3/6
Diagnosed After Working in ABA	5/6
Has/Had BCBA Credentials	4/6

Interview Demographics

Barriers Placed by Neurotypical ABA Peers

Weaponizing Professionalism

“I told the HR director that that supervisor was in violation of the ADA and that individual’s rights…I pointed out that if the organization claimed to be trauma-informed then they needed to be trauma-informed for both their learner and their employees. The HR director was not happy with me, and later on, before I left, there were attempts to entrap me with write-ups for things that had been resolved months before, which I resolved as soon as they were brought to my attention.” – Brian Middleton, BCBA

“I opened my mouth about how I did not like the things we did. Someone told on me and I was harassed for two weeks and they lied about me leaving kids in dirty diapers and other things. They eventually had forced me to quit and told me that if I ever want to come back to the company, that write up will follow me.” – Nancy Cervera, ex-RBT

“I would like to be quoted anonymously…Too many good people in the field have had their credentials questioned. Sad that I have to fear for my credentials but I do.” – Anonymous BCBA of Divergence and Dissonance

“The director of one of the companies I worked at is the president of our state licensing board and I am concerned I could face repercussions for speaking out against her, as I know other people who already have.” – Anonymous BCBA 1

Anti-Autistic Sentiments

“I was definitely discriminated against for common characteristics of autism-my direct way of speaking, especially-and it was always a situation with an overly sensitive neurotypical person. I was always giving them the benefit of the doubt… but they never did the same for me when it came to how direct I am. They automatically assumed I meant the worst.” – S. Adams, BCBA

“Disclosures about my challenges have most often resulting in people trying to manage me so that my challenges impact them less. Usually in ways that are not only unhelpful, but also make my job harder.” – Anonymous BCBA 1

Do you think ABA is a safe environment to work in as an autistic person?

“No, not in the slightest.” – Anonymous BCBA of Divergence and Dissonance

“Yes and no. It depends on whether the people in charge of the organization understand what autistics need or not.” – Brian Middleton, BCBA

“No, definitely not. I am autistic and knew it was terrible the moment I stepped in for my first day. I didn’t know I was autistic then, but realized it after.” – Nancy Cervera, ex-RBT

“No. Based on my experience, its an unequivocal no. I honestly believe that the stress and trauma I have experienced in this industry has contributed to me developing fibromyalgia.” – Anonymous BCBA 1

“As long as the environment is genuinely supportive and provides accommodations, it should be safe. Every clinic is not the same, but I can’t confidently say that most are genuinely safe spaces for autistic voices…If you’re a neurotypical person reading this, you can make ABA a safe place for us to work by first listening to our voices. It’s possible.” – Tee (she/her), RBT

Reactions of the Autistic Community

“I’ve received death threats. I’ve been called racial slurs, and I’ve been called an abuser.” – Tee (she/her), RBT

“I have received a lot of hate. It hurts, but I understand why. I have been told that I am a token. I have been compared to someone who has been through conversion therapy. I have seen the ban lists where my name was next to some other people with whom I completely disagree. I have received hateful messages, including some threats… I have learned that my best course of action is to keep teaching and modeling how to be a humanistic behavior analyst.” – Brian Middleton, BCBA

What Needs to Change?

Better Education

“More well-rounded educational requirements for clinicians, higher standards and better training for RBTs, required learning directly from autistic people in some format.” – Anonymous BCBA of Divergence and Dissonance

“First, inclusion on extensive training on autism & neurodiversity awareness, acceptance, and inclusion training in all ABA programs, and a requirement that all BCBAs that serve such populations received that training as well… Second, there needs to be extensive training on how the commonly accepted and used techniques used in behavior analysis can and do cause harm. This includes training and demonstrating how assent-based interventions work in a contrast to compliance training.” – Brian Middleton, BCBA

“I firmly believe that extensive knowledge of childhood development and psychology should be required to work in this field of work. When you understand and acknowledge these subjects, you will understand why specific ABA techniques and expectations are problematic.” – Tee (she/her), RBT

Focus on Self-Advocacy and Autonomy

“[G]reater focus on self advocacy and autonomy and less focus on “problem” behaviours that are generally symptomatic of a problematic environment and unmet needs.” – Anonymous BCBA of Divergence and Dissonance

“The goal should not be compliance; the goal should be cooperation. We should be working to improve the quality of life of the autistic individuals we serve.” – Tee (she/her), RBT

“[T]here needs to be an emphasis on self-management, autonomy, and generalization practices in behavior analysis. There is extensive research in ABA on these topics, yet there is not a lot of it being applied.” – Brian Middleton, BCBA

Better Success Measures

“I also think a way needs to be found to shift away from productivity and worth being measured in hours, an arbitrary social construct that is meaningless to large numbers of ND people.” – Anonymous BCBA 1

“[B]etter social validity measures involving the client rather than just the stakeholders.” Anonymous BCBA of Divergence and Dissonance

It Can’t Change

“I would eradicate ABA completely. The worst type of “therapy” there is.” – Nancy Cervera, ex-RBT

“I’m honestly in a place where I’m not sure if the field can be reformed…” – Anonymous BCBA 1

“[I]t is more than obvious to me that advocating against the oppression of Autistics (mainly children and those with high support needs in various life areas) within the field of ABA is toxic and detrimental to one’s mental and emotional health. ” – NT ex-practitioner*

* NT ex-practitioner wasn’t formally interviewed but I requested to use their quote as I felt it was a good summation of some of the other sentiments expressed here.

Silver Linings

“When I realized that this field of work had caused so much damage and destruction, I had a major meltdown that caused a downward spiral for a few months. I didn’t think there was a way to practice ABA ethically, but there is. It’s not necessary to use intensive interventions; it’s not even essential to use punishments. We can change motivation from extrinsic to intrinsic. It’s hard work, but it’s possible and worth it.” – Tee (she/her), RBT

“I believe that ABA can be a humanistic approach to learning and teaching. I believe that there is a better way. I am committed to making it so that the dominant species of ABA is one where the autonomy and individuality of the individuals served are respected. I fully accept that I will be hated and reviled by people on both sides for my view, and I also hope that there will be meaningful change in this field sooner rather than later. In fact, I am already seeing it. That, more than anything else, tells me that ABA can be and is able to do and be better.” – Brian Middleton, BCBA

“I’ll likely choose to leave the field at some point, but at the moment I try to improve my own work and provide ethical and affirming supports. The work I am taking on allows me a great deal of freedom to do so.” – Anonymous BCBA of Divergence and Dissonance

“I guess I could walk away from all of this by recognizing that the rigidity and ableism in this industry is what exacerbated my struggles to the degree that I was actually able to recognize I had a disability. I was able to cope and mask effectively enough to get by until ABA made it abundantly clear that I was not enough and was not valued.” – Anonymous BCBA 1

Catatonia – More Than Just Freezing

My heart races as I freeze, my whole body flexed in an uncomfortable position. I cannot move or speak, and I am stuck staring ahead. This feels like sleep paralysis, but I’m awake?

It feels like I should be able to move. I command my legs and arms to move, but nothing happens. My brain is trying desperately to maintain this illusion of control.

Like sleep paralysis, I have the urge to scream, but nothing comes out. The more I fight, the worse I’m pulled into this sense of helplessness. It’s a waking nightmare.

I’m experiencing catatonia.

Over time, catatonia becomes another mental health symptom I greet with resigned familiarity.

At least 1 in 10 people with severe mental illness will experience catatonia at some point.

Despite this, information on catatonia is not widely available. I didn’t learn the name for my catatonia from any doctor or therapist. I had to actively search to find a name for what I was experiencing.

Who Experiences Catatonia?

Catatonia is a prominent feature in schizophrenia (up to 35% of people with schizophrenia). It is classified under psychotic disorders but “can occur in the context of several disorders, including neurodevelopmental, psychotic, bipolar, depressive disorders, and other medical conditions” (DSM-V, 2013).

Nearly one-third of people with bipolar have it, roughly 3-12% of autistic people have it (across multiple studies), one small sample found 87% of people with Tourette’s met the criteria, and in one sample of inpatients with catatonia, 57% had experienced childhood trauma (ACEs). Psycho-physiological symptoms, BPD, dissociative amnesia, and paranormal experiences may also be correlated with catatonia.

What is Catatonia?

While they are under the same definition in the DSM-V, catatonia is often split into two categories. There are two main types of catatonia, akinetic and excited.

Akinetic is the most common. It is characterized by at least three of the following symptoms:

• immobility
• mutism
• withdrawal
• refusal to eat
• staring
• echolalia
• echopraxia
• atypical inflexible postures (posturing)
• resistance to movement
• repetitive movements
• declining requests or not responding for no apparent reason (negativism)
• grimacing

Excited type may be characterized by any of the symptoms in akinetic type but is also characterized by agitated psychomotor behaviors, which may express as meaningless movements or vocalizations and may result in self-injury or aggression.

Considering the prevalence of catatonia in autism, there are significant implications with excited catatonia type. Self-harm and aggression may be expressions of catatonia in autistic people, which further raises ethical concerns for behavioral interventions if catatonia is not considered as a differential diagnosis.

In extreme cases, there may be malignant catatonia which can be lethal. This is generally descriptive of drastic physiological changes (like blood pressure and hyperthermia) in catatonic episodes or other complications like malnutrition from a prolonged inability to eat.

Catatonia exists on a continuum of severity ranging from minutes to weeks. Historically catatonia was only diagnosed if it was extreme, but now it is considered commonly associated with many mental and medical diagnoses.

Treatment for Catatonia

Treatment for catatonia typically uses electro-convulsive therapy (ECT) or benzodiazepines. In addition to these treatments, psychological therapy also seems to help some people with catatonia. Transcranial magnetic stimulation (TMS) is a potential treatment for catatonia, though the evidence is preliminary.

For less severe forms of catatonia, formal treatment may not be needed. Catatonia is not an extreme enough symptom for me to need treatment for it. Things that have helped me personally are grounding exercises and anxiety coping mechanisms, as anxiety from catatonia can often aggravate it.

If you experience catatonia, you are not alone. Since the condition is not well known and carries some stigma, it can feel very isolating. But it’s far more common than people realize.

Please let me know your experience with catatonia in the comments or reach out to me through the contact form.

I Think I have Dissociative Identity Disorder (DID), Now What?

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Check out Pt 1: How Do I Know if I Have Dissociative Identity Disorder (DID)?

When I was diagnosed with DID, I couldn’t believe it. It felt like I must be faking it. I was obviously just exaggerating symptoms and lying to the clinician, right?

Even though logically, I knew the recognition was coming from a genuine place of seeing me switch in therapy, experiencing amnesia, and even starting to put names to my alters, it felt unreal.

Self-doubt seems to be one of the universally experienced symptoms post-recognition of DID or OSDD-1b.

Add any doubt you receive after revealing your recognition to other people or seeing people online who present the way you do being called fake. It can be unbearable at times.

I still sometimes feel that creeping self-doubt after seeing comments discussing how a creator is “obviously faking” for symptoms that I also experience. That’s the danger of fake-claiming.

If your system has a host, this can be especially difficult. To a host, the world feels like a singular experience. Sure, you sometimes feel “influenced” in particular directions, but that’s just how most people think, right? Don’t people experience conversations in their head with people that don’t exist in the outside world?

(Note: Before you self-diagnose, please understand the importance of differential diagnoses and DID)

One of my favorite metaphors for being a system vs. not having distinct parts is to think of your thoughts like a tree. For non-systems, thoughts are like roots stretching from the ground to make a singular tree. There may be many different roots, but they’re all part of the same tree. For systems, thoughts are like the same root system that makes up multiple trees. Each is its own distinct tree with unique thoughts, still tied to the same root system but do not form just one tree.

That is to say, non-systems don’t have conversations in their head with people that aren’t in the external world. They aren’t “influenced” by other voices in their head. They have one singular voice. It’s the same voice regardless of where they are.

So, while the hosts in our system were desperately trying to cling to this idea that they were the only people there, a gatekeeper, Penn, decided to try to prove that we were a system.

He binged research pointing to case studies that fit our description to a frightening degree. He categorized photographs by alter to show the physical differences in our presentation. He examined evidence on different dissociative disorders and tried to log dissociative amnesia. It’s hard to know what you don’t remember.

I was consumed with trying to “prove” to myself that I didn’t have it. It was professionally confirmed, and I still felt there was no way. No matter how much evidence was presented, it felt like I was just looking for signs to trick others.

And then, one night, an event happened that made me never seriously question being a system again. I accessed memories.

I wish I could say that I magically recovered a significant portion of my past when I started working with my system instead of against it. But it was an external event that triggered a dissociative episode so bad I could see myself outside of my body.

And then I was flooded with memories of traumatic events like a psychological dam had suddenly been broken. I wrote and wrote everything that was coming to mind so that I didn’t lose it. At that moment, I finally felt like I couldn’t be faking it. How do you fake suddenly remembering years of your life?

Forcing Myself to Remember

Whether you’re a newly recognized system or questioning, some common experiences come up.

When you have dissociative amnesia, you can’t control when you remember your past. It’s so tempting to go digging for it, to try to intentionally trigger yourself to find out your own history. I’ve done it, and I’ve heard many others do it.

It feels like this, desperately trying to connect the events in your life:

Don’t do it.

I know, easier said than done. There’s a kind of distress that people without dissociative amnesia won’t understand. It feels like information that’s on the tip of your tongue, something you should know, but you just draw a blank. Only the information you’re blanking on is severe, stomach-wrenching trauma.

It’s further reinforced by trying to remember to “prove” you’re not a system.

“If I can just force myself to remember, then it’s not dissociative amnesia. I have a right to know my history!”

I can assure you, if you don’t remember it easily, forcing yourself to remember isn’t going to work. It’s like trying to force yourself to not be sad. Chances are you’ll only make yourself more miserable.

Siding with Abusers by Gaslighting Myself

CW: The following section contains descriptions of child abuse.

Something that seems true in almost all trauma victims is that they feel at some point that their trauma wasn’t bad enough to be “real trauma.” This goes for DID as well. Many times I’ve seen new systems say, “but my trauma wasn’t bad enough to create DID!”

When you hear stories of other people that experienced trauma, it’s easy to feel that self-doubt. It’s not like I experienced that. Mine was mild.

“Comparison is an act of violence against the self.“

Iyanla Vanzant

Who does that voice sound like? Does it extend the same compassion you’d give a friend?

When you’ve experienced complex trauma, you internalize the voices of your abuser(s).

Every child develops a mental representation of their caregiver to self-soothe as they grow older. When your caregiver is also an abuser, you internalize a mental model of an abuser that is central to your understanding of yourself.

You may have heard your abusers say things like, “you’re being dramatic,” “it wasn’t that bad,” “you’re remembering that wrong,” and “I did what was good for you.” How else would they be able to get away with abusing others?

Your internalized abuser says those things too. They tell you that you do not remember things accurately or the trauma wasn’t that bad.

You’re not your abuser. Don’t gaslight yourself and give them that power.

Your trauma was bad enough. It was real. And your experience is not comparable to others because it’s what you experienced.

It Doesn’t Matter if You’re Faking

Chances are, this article won’t permanently change your mind on whether you’re faking being a system. You’ll likely go through the ups and downs of believing you are and aren’t.

At the end of the day, it doesn’t matter if you’re faking.

Wait, but what if I’m taking resources away from ‘real systems’? What if I’m spreading false information by saying I’m a system?

If the label fits and it helps you, use it. You’re not taking away resources by using resources that help you. It’s not selfish to use what works.

Both non-systems and pro-dxd systems can spread misinformation. Spreading accurate information is not a prerequisite to being a “valid system.” If you’re making it clear you are only speaking for your experience, it doesn’t matter if you change your mind later. You’re being honest about what fits and helps you now.

You’re not saying you’re a system to gain anything. You’re looking for answers that fit your situation. It doesn’t matter if “you’re faking.”

And if you’re seeking a professional diagnosis, it’s been demonstrated multiple times that people who intentionally fake DID (actors) can be easily distinguished by professionals from those that experience real symptoms.

Now What?

It can be incredibly lonely and confusing when you first realize you’re a system. That’s why it’s important to find others that share your experiences.

Logging Tools:

• Simply Plural App
• Plural Kit Discord Bot
• DID System Journal

Here are some of the groups I recommend joining:

• Dissociative Identity Disorder Support Group
• DID Uncensored, Dissociative Identity Disorder
• Inclusive D.I.D. memes
• r/DID
• r/DIDToolbox
• CPTSD Sufferers and support
• Autistic DID/OSDD Systems

Here are some resources to get you started:

• I Don’t Want to Cope: A List of Therapy Tricks Without the BS
• The Diagnostic Criteria for Complex PTSD (C-PTSD): A Beginner’s Guide
• 14 genders, 1 body: How to Navigate Gender Identity as a Dissociative Identity Disorder (DID) System Pt. 1
• Dissociative disorders – causes, symptoms, diagnosis, treatment, pathology
• Entropy System – A Beginner’s Guide to DID
• Acrylic and Aether’s Best for Beginners
• DID Research
• Alters in Dissociative Identity Disorder (MPD) and DDNOS
• A Professional Educator’s Guide to DID
• Grounding 101: Featuring 101 Grounding Techniques!
• Adverse Childhood Experiences

Learning you’re a system is a very overwhelming and exciting process. You are not alone in this process, and there are resources you can use to learn more about yourself. Please reach out through the contact form if you have any questions.

Congrats on getting a little closer to understanding yourself, and good luck on the path of self-discovery ahead!

How Do I Know if I Have Dissociative Identity Disorder (DID)?

Disclaimer: I am not a licensed professional. I cannot diagnose you, and my advice should be taken with a grain of salt. I know what it’s like to be a system, but I don’t know your unique experience and if another diagnosis might fit your experience better.

“I love my job,” I told my therapist, detailing how the social interactions were challenging and invigorating.

In the next session, I walked in and proclaimed, “I hate my job!” and detailed all of the horrible interactions I had to deal with every day.

My therapist smirked and took down detailed notes to confront me with later. Alex would front (take over the body) in the mornings for our sessions, and he loved the job, and I would front in the afternoons and absolutely despised it.

Anytime I’d go out to eat, it felt like I had many different voices talking over each other about what I wanted. Choosing was nearly impossible, and no matter what, it felt like I wasn’t fulfilling my needs.

Sometimes I loved writing with a passion. Other times I couldn’t stand it.

My “style” consisted of various clothing styles across different genres. I had low-cut sparkly tops, cargo shorts, flowy robes, polos, and ripped jeans all in the same drawer.

If you asked me what music I listen to, I’d have to say “a little of everything.” And I didn’t mean that I mainly stuck to a few genres but was open to others. It meant I had playlists full of classical, punk rock, rap, country, EDM, folk, etc.

My gender expression and sexuality fluctuated wildly, but I never felt “genderfluid.” I felt like a man, woman, or trans at any time, but I didn’t feel like I was fluid between them.

I had male and female pseudonyms that I would use online in different interest groups. I wrote papers under pseudonyms not because I wanted to remain anonymous but because I “liked how it sounded.”

When I was upset, I acted like a child, my voice getting higher, my cognitive functioning through a fog, and only finding comfort in items “made for children.”

It’s easy to look back now and see how being a system affected how I interacted with the world. When I found out I was a system, there was a click. I finally had an explanation for my unstable, shifting sense of self (which had been misdiagnosed as BPD). I understood my “zoning out,” my dissociative hallucinations, rapidly changing emotions, and being told I was “like a different person” sometimes, and why I felt the need to have so many names.

Wading Through the Sh*t

I have Dissociative Identity Disorder. And if you’re here, you think you might have it too.

It can be scary suspecting you have the diagnosis. There are so many different sources pulling you in all directions.

When I looked up “Do I Have DID?” going through this process, there was quiz after pseud0-scientific quiz asking for your credit card information. There were articles pathologizing and referencing systems as if we were rare monsters causing chaos everywhere we go.

YouTube videos sensationalized and demonized the disorder, saying, “come one come all! See the DID System perform the fantastical switch to become a whole new person!” References to Split and other problematic media are littered with connections to real systems.

All the scientific articles were arguing about the existence of DID, with little on what it actually looks like. And if you want to find research from the last 10 years, you’re pretty much out of luck.

Tik Tok, Reddit, and other social media users have loudly degraded anyone public about being a system. When there’s so much wrong information and incentive not to figure out you’re a system, how are you supposed to work through your own experience?

Finding out you’re a system is not just about wading through pools of bullsh*t to find good information. It’s also about deconstructing what you’ve known your whole life of what it means to be a person.

A Breakdown of the DSM Criteria

Let’s first examine the DSM-V criteria for DID. Since I am American, this is the criteria I am most familiar with but the ICD criteria is similar. Try to read this non-judgmentally. You are trying to find a label for your experience, not fit your experience to a label. I’ve paraphrased the criteria below to help with readability.

Dissociative Identity Disorder Diagnostic Criteria (F44.81)

1. Two or more distinct personality states with their own sense of self and change in consciousness, memory, perception, cognition, and/or sensory-motor functioning. Discontinuous sense of self and agency. It may be described as a possession. It can be noticed by the individual or other people.
2. There are gaps in remembering everyday events, important personal information, and/or traumatic events beyond normal forgetting.
3. Clinically significant distress or impairment in functioning.
4. Not attributable to cultural/religious practice or physiological effects of a substance or medical condition. In children, it can’t be better explained by imaginary play.

(American Psychiatric Association. (2013). Dissociative Disorders. In Diagnostic and statistical manual of mental disorders (5th ed.). doi: 10.1176/appi.books.9780890425787.x08_Dissociative_Disorders.)

It’s one thing to look at the criteria, but it’s another to understand it. One of the difficulties of any diagnosis (but especially uncommon diagnoses) is that it’s hard to know what the symptoms look like in application.

Criteria 1 Examples: Two or more personality states

• Your brain functions like a conversation of multiple people talking or thinking at once
• You hear voices that aren’t yours
• You regress significantly and feel powerless
• You regularly feel like you’re a different person altogether, or others have mentioned you’re a different person
• You’ve had an experience of possession
• Your preferences shift dramatically, you may have opposite food, gender, etc. preferences, and this happens regularly
• You have body or gender dysphoria
• Others comment that you sometimes talk or act differently, or you’ve noticed this change. This could be significant changes in vocal tone, vocabulary, posture, situation assessment, facial expressions, etc.
• You feel non-human at times or like you’re the wrong age
• When someone mentions you did something, you don’t feel like “you” did it
• You can identify distinctly different “versions of you”

Criteria 2 Examples: Gaps in Memory Recall

• You cannot remember a period in time beyond what would be considered normal forgetting (e.g., you can’t remember anything between age 12-13)
• People mention how forgetful you are, or you notice you feel your memory is unreliable
• You can recall specific memories very vividly sometimes but can’t remember those same memories at other times
• You remember details of an event but can’t remember anything emotional, as if you read it out of a newspaper instead of experiencing it
• You sometimes forget your name, address, phone number, or other vital information
• You minimize when you do forget something most people wouldn’t forget, blaming it on other factors like being tired
• You can’t remember a particular location at all that you visited frequently
• You find yourself “waking up” somewhere, especially when stressed with no recollection of how you got there
• You sometimes forget significant skills like driving, your job, your ability to write or speak, etc., especially while stressed
• You recall the same memories very differently at different times, with no explanation for why your viewpoint changed
• You have to write things down regularly if you want to remember them. You find notes you don’t remember writing

Criteria 3 Examples: Distress or Impairment

• Your poor memory makes it difficult to work, attend school, parent, or take care of yourself
• You feel haunted by not knowing parts of your past
• Being a different version of yourself makes it hard to maintain friendships or has gotten you in trouble at work, school, or in public
• You struggle to date because there’s a conflict in your head about who you’re dating, or your partner complained that you were “inconsistent”
• You struggle to remember important deadlines or meetings
• Losing the memory of how to perform certain skills makes it difficult to take care of yourself or affects other areas of your life
• You find it overwhelming that you can never make a consistent decision on a direction in your life or a sense of self
• You spend an inordinate amount of time deciding what to eat, wear, listen to, and it makes making any decision difficult
• You feel like you have no control over your life
• You regularly feel helpless
• You feel like you’re constantly on the verge of a breakdown
• You struggle to maintain relationships because people have said you’re “unreliable,” “wishy-washy,” or “unstable”
• You experience any of Criterion 1 or 2 symptoms, and that causes you trouble in some area in your life or a lot of stress

Differential Diagnosis: The Biggest Risk of Self-Diagnosis

This is where Criterion 4 comes in. Self-diagnosis is sometimes necessary, especially when only 55% of clinicians believe the diagnosis is valid. Unfortunately, many clinicians don’t have any experience diagnosing DID, and the psych field has not treated DID systems well. That leaves a lack of information in a situation where a professional diagnosis is needed.

I am not against self-diagnosis because financial and cultural barriers are insurmountable for many minorities and impoverished people. This is an unfortunate reality of our current medical system.

But there are dangers to self-diagnosing DID that need to be addressed. The most significant one is differential diagnosis.

Since DID is so complex, many disorders mimic DID symptoms that may be difficult to spot without a trained eye. If you misdiagnose yourself with DID when you don’t have it, this could have serious consequences.

For example, simple partial seizures are where someone is fully aware but frozen. They may experience hallucinations, deja vu, and headaches. All of these symptoms may mimic a dissociative episode and cause a misdiagnosis.

Absent seizures (the most common type) are similar, where a person freezes and gets a blank look on their face. It is very short and results in a lapse in memory. This can look like dissociative amnesia.

The only way to diagnose seizures is through an EEG which requires a doctor. The last thing you want to do is have epilepsy and misdiagnose yourself as having dissociative identity disorder. The two have very different treatments, and untreated seizures can be fatal.

DID and epilepsy can co-occur as well, so it is worth looking into even if you receive an official DID diagnosis.

A few other differential diagnoses that are important to rule out are BPD, characterized by a discontinuous sense of self and dissociation similar to DID. OSDD is characterized by dissociative amnesia without alters, vice versa, or other specific circumstances (like intense brainwashing or only occurring for a short time). PTSD – which could present as gaps in recall or personality disturbances. Schizophrenia – shares psychotic symptoms with many DID presentations, and negative symptoms could be interpreted as dissociative or personality disturbance.

If you have the means to get a diagnosis, it is important that you seek a professional for DID. If you’re looking for a website to help find someone that can diagnose DID, try this or this.

If you don’t have the means, you are welcome to self-identify but know that there are certain risks of missing a serious medical or other psychiatric condition.

Now What?

After reviewing all the information, if you feel like you are a system, I recommend checking out my next article, I Think I have DID, Now What?. I detail common experiences of newly discovered symptoms and resources you can utilize to further investigate your experience.

Growing Up as a Closeted Trans Man in the Mormon Church

CW: The following article contains descriptions of transphobia, sexism, and sexual assault. Reader discretion is advised.

“Gender* is an essential characteristic of individual premortal, mortal, and eternal identity and purpose…We further declare that God has commanded that the sacred powers of procreation are to be employed only between man and woman, lawfully wedded as husband and wife.”

The Family: A Proclemation to the World

*”The intended meaning of gender in ‘The Family: A Proclamation to the World’ is biological sex at birth.” – churchofjesuschrist.org

I sat in a dark classroom inside a church, my nine-year-old body fitting perfectly between the chalkboard and wall. I cried quietly as a Boys Scouts ceremony happened in the next room. My brothers received awards for activities I wasn’t allowed to do, receiving merit badges for shooting, hiking, and woodworking.

I couldn’t articulate my deep sense of injustice then or the looming gender dysphoria as I was painfully shown my place as a woman.

Everyone knew I was different. I was an ugly duckling, making waves in the regular ducks’ pond.

I was taken to a pitch-black room at my first “young women’s” activity (a youth group for girls 12-17). A leader placed a gold bow on my back and sent me inside. I stumbled through the room with obstacles placed around me and someone shuffling in the dark.

I tripped over a chair and caught myself on the hard gym floor. The person shuffling about snatched the bow off my back at that moment. I persevered to the end of the maze, where a picture of white Jesus was illuminated.

I was admonished for losing my virtue. The leaders told us that we would have our virtue taken from us if we weren’t careful and that navigating the world would be like navigating that dark room. Only through Jesus would we be forgiven.

The boys played basketball in the other half of the gym while we received this lecture.

That night, I wrote in my diary that I would swear to protect my virtue at all costs. I anxiously scribbled away, feeling the world’s weight on my shoulders. I was responsible for keeping every bad thing from happening to me, or at least that was the message I got.

Sexism and Dysphoria

“Why are women not allowed to have the priesthood?” I asked once again. Adults never seemed to answer my questions straightforwardly, and I was determined to get an answer.

“Because women have an advantage over men. They can have kids! God had to give the priesthood to men to make it more even.”

“Women do have the priesthood! Women are lucky they can receive the gifts of the priesthood without having the responsibilities of holding the priesthood.”

“Wives exert priesthood power through their husbands. They don’t need the priesthood to receive the blessings.”

“The prophet speaks for God, and he has revealed that men have the divine right to the priesthood. We don’t know whether that will change in the future.”

I didn’t understand their answers. Women universally couldn’t have children or were married. I was more than willing to take on extra responsibilities if it meant I could hold an esteemed position of spiritual power. Believing something because someone said it was true didn’t make sense to my autistic brain either.

I still don’t understand their answers, and at some point stopped trying to understand.

Every time I asked, I was reminded that God had made a mistake. I wasn’t meant to serve underneath a man. I deserved the same rights as my brothers. And I didn’t have any path to correct that mistake. If God was so perfect, why did he place me in harm’s way?

That’s what I asked myself when my “virtue” was stolen in real life. I learned it was my fault, that I hadn’t done enough to protect it. I had fallen like in that dark room.

Because I had been born a girl, my assault was seen as a personal transgression. I was rejected by my peers and left to process the feeling of discordance with my own body.

Finding My Body in a Starbucks

Years later, I sat in a mall Starbucks in North Carolina. I anxiously filled out pages in My Gender Workbook.

I meditated on my life and understanding of myself. I was prompted to think about “what makes a woman a woman?” My experiences flooded, reminding me of every stereotype and attitude I had internalized. I quickly shot them down with the thought, “But is every woman like that?”

I couldn’t ontologically address what the essence of womanhood was. And at that moment, the binary bullsh*t became clear. There was no single essence of womanhood. I was lied to my whole life. And if there wasn’t a singular definition of woman or man, which did I want to be? The answer was clear. I was born in the wrong body.

“Lieu!” the barista called out, my new masculine name on the cup. I grabbed my cup, grinning. Years of gender suppression had been lifted all at once. I was a free man.

Trading One Injustice for Another

Last month, Utah became the 12th state to forbid trans kids in sports, overturning a veto from the governor. Out of 75,000 kids in Utah high school sports, only four are trans, and only one was in girl’s sports. The bill literally targets four individuals. There is no excuse for this.

BYU is currently under investigation for its treatment of LGBTQ+ students, which alleged discrimination goes beyond their exemptions as a private religious institution under Title IX. Half of the LGBTQ+ students surveyed said they didn’t feel safe at BYU.

82% of trans youth in Utah have experienced some form of mistreatment. 56% of trans people that interacted with police said they experienced some injustice, 34% had been mistreated by a healthcare professional, 43% have experienced homelessness, and 1 in 5 had a professional try to stop them from being trans (U.S. Transgender Survey Utah Report, 2015).

Being trans in Utah is not just inconvenient, it’s life-threatening. There is discrimination on every systemic level, and there are many contributing factors; political, cultural, structural, and interpersonal. 

There has to be a fundamental shift in how we view gender minorities in Utah to solve this problem.

We’ve already gathered data. We need to increase education for professionals so there are more trans-friendly practitioners. We need to improve education in the general community about what being trans is and separate it from politics. We need to teach children about their trans peers, teach adults about transition’s realities and understand transitioning is not a choice but a medical necessity.

I’m a program director at a small non-profit called  Genderbands that focuses on helping fund transition. When 29% of trans people and roughly 40% of BIPOC trans people live in poverty, one of the most significant barriers to transition is financial.

You can help by supporting trans-led organizations like this and writing or calling legislators. Attend protests. Let them know that transphobia is unacceptable.

The steps to fix the problem are not small. It requires a community to move forward with this level of action. We need allies rallying behind the cause through volunteering and being public about their support. We need funding for local trans organizations and greater access to low-income care. We need education on a broad scale in schools and health offices. There is a lot of work for trans people in Utah (and everywhere) to be accepted.

Validating the Hurt

One of the most shocking parts of my transition is what it’s like to live in the world as a white man. I can confidently say my life has gotten much easier because of how others see me. Before transitioning, I understood that my struggles were largely due to my gender but being validated in such a concrete way broadened my understanding of gender and intersectional privilege.

Some of the ways I experience privilege now are that I’m no longer harassed when I’m going about my daily life. I’m taken more seriously, my ideas are seen as more credible. I’m not critiqued for being “outspoken” and I don’t have to be as hypervigilant about my surroundings.

My experience seeing my PTSD improve after transition both supports the medical necessity for transition and the idea that treating symptoms of trauma like they are isolated from systemic oppression doesn’t work. My hypervigilance improved because of removing the system of oppression that required me to be hypervigilant, not because of any groundbreaking therapeutic technique.

I have the unique experience of living as both a man and a woman and can validate that women are not crazy in their experience of oppression. Living as a man in Utah has been a much more positive experience, as long as I’ve passed.

It’s about time that we stop gaslighting minorities living in Utah and take steps to understand and uplift minority experiences.

A Professional Educator’s Guide to Dissociative Identity Disorder

(Infographic Below)

Finding accurate information on DID as a professional educator can be challenging due to widespread misinformation and under-recognition. Use this guide to help inform your curriculum and your practice.

DID Systems are incredibly vulnerable

Approximately 61%-72% of DID patients attempt suicide, and 34-38% engage in self-harm (Brand, 1997). Samples of people with high levels of trauma have also been related to increased substance abuse, risky sexual behavior, and decreased life expectancy (Felitti et al., 1998). This is why educators must be informed about the condition and spread scientifically supported information to future clinicians.

DID patients are waiting >3 years for diagnosis

25% of dissociative disorder patients had >10 years delay to get a diagnosis, and 57% had a > 3-year delay (Leonard et al., 2005). This is striking compared to the 1.3 year average for anxiety and mood disorders (Jorm, 2012).

DID Myths Vs. Facts

Myth

• Therapists create DID, and acknowledging alters makes symptoms worse.
• DID is overt, you can easily tell when a person has it.
• DID is incredibly rare.
• DID is a dubious condition.
• Integration is the only proper treatment for DID.

Fact

• DID is formed from trauma and can only be successfully treated by acknowledging alters (5th ed.; DSM–5; American Psychiatric Association [APA], 2013; Brand et al., 2014).
• DID is primarily covert, which is why the DSM-V criteria was expanded to include self-reported identity states (APA, 2013).
• DID affects approx. 1.5% of the population, or ~5 million Americans (APA, 2013).
• DID is well-established in research and can’t be replicated fictitiously (Brand & Chasson, 2015).
• Integration can be beneficial but not practical or possible in all cases (Ringrose, 2011).

The Iatrogenic/Sociocognitive Model is Harmful and Demonstrably False

Only 55% of clinicians believe DID is a valid diagnosis despite scientific evidence (Leonard et al., 2004). It’s no surprise that there are considerable delays in diagnosis and treatment.

Edit: 40% of clinicians were unable to identify DID from a clinical vignette. This directly correlated with their skepticism of the disorder (Perniciaro, 2014). It’s no surprise that there are considerable delays in diagnosis and treatment.

The false belief of DID as an iatrogenic condition has led to under-diagnosis, rampant misinformation, and lack of research. There are no excuses for clinicians or educators to assert this belief still, considering the extensive literature supporting the trauma model and disproving the socio-cognitive (APA, 2013; Brand et al., 2014; Loewenstein, 2018).

Conclusion

It can be challenging to get accurate information as a professional educator on Dissociative Identity Disorder with the medical and cultural attitudes surrounding DID and the lack of research and education. As a professional educator, you directly influence the way future clinicians will treat patients with the disorder, which is why it’s essential to ensure the information is accurate. DID is a valid, scientifically supported disorder that is more common than many clinicians believe. DID patients are vulnerable and experience significant delays in treatment which actively harms this population. Luckily, as an educator, you can help change the stigma around DID and support it as a traumagenic condition, assisting in shaping the future of DID research and treatment.

References

American Psychiatric Association. (2013). Diagnostic and Statistical Manual of Mental Disorders, 5th Edition: DSM- 5 (5th ed.). American Psychiatric Publishing. https://doi.org/10.1176/appi.books.9780890425596.dsm08

Brand, B. (1997). Establishing Safety with Patients with Dissociative Identity Disorder. Journal of Transnational Management Development, 2(4), 133–155. https://doi.org/10.1300/j130v02n04_07

Brand, B. L., & Chasson, G. S. (2015). Distinguishing simulated from genuine dissociative identity disorder on the MMPI-2. Psychological Trauma: Theory, Research, Practice, and Policy, 7(1), 93–101. https://doi.org/10.1037/a0035181

Brand, B. L., Loewenstein, R. J., & Spiegel, D. (2014). Dispelling Myths About Dissociative Identity Disorder Treatment: An Empirically Based Approach. Psychiatry: Interpersonal and Biological Processes, 77(2), 169– 189. https://doi.org/10.1521/psyc.2014.77.2.169

Felitti, V. J., Anda, R. F., Nordenberg, D., Williamson, D. F., Spitz, A. M., Edwards, V., Koss, M. P., & Marks, J. S. (1998). Relationship of Childhood Abuse and Household Dysfunction to Many of the Leading Causes of Death in Adults. American Journal of Preventive Medicine, 14(4), 245–258. https://doi.org/10.1016/s0749- 3797(98)00017-8

Jorm, A. F. (2012). Mental health literacy: Empowering the community to take action for better mental health. American Psychologist, 67(3), 231–243. https://doi.org/10.1037/a0025957

Leonard, D., Brann, S., & Tiller, J. (2005). Dissociative Disorders: Pathways to Diagnosis, Clinician Attitudes and Their Impact. Australian & New Zealand Journal of Psychiatry, 39(10), 940–946. https://doi.org/10.1080/j.1440- 1614.2005.01700.x

Loewenstein, R. (2018). Dissociation debates: everything you know is wrong. Controversies in Psychiatry, 20(3), 229– 242. https://doi.org/10.31887/dcns.2018.20.3/rloewenstein

Perniciaro, L. A. (2014). The influence of skepticism and clinical experience on the detection of dissociative identity disorder by mental health clinicians

Ringrose, J. L. (2011). Meeting the needs of clients with dissociative identity disorder: considerations for psychotherapy. British Journal of Guidance & Counselling, 39(4), 293–305. https://doi.org/10.1080/03069885.2011.564606