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Manual of Articles Sections 15 - 28
What exactly is dissociation?
DSM lists five dissociative disorders:
Dissociative Fugue — defined by an abrupt, non-scheduled journey away from one's home or usual place of work, accompanied by a loss of memory of one's past, confusion over one's identity, or assuming a new identity.
Dissociative Identity Disorder (DID — formerly Multiple Personality Disorder) is the most extreme form of dissociation. It is characterized by two or more separate identities or personality states that recurrently take control of the individual's behavior, accompanied by a loss of memory of significant personal information that is too all-embracing to be explained by normal absent-mindedness.
Depersonalization Disorder — defined by an unrelenting or frequent feeling of disconnection/detachment from oneself (mind-body split), during which reality testing remains intact. Depersonalization is sometimes accompanied by derealisation (a sense that the external world feels strange or unreal).
Dissociative Disorder Not Otherwise Specified (DDNOS). This term is used to classify disorders where dissociative symptoms are a predominant feature but do not meet the criteria for any specific Dissociative Disorder. Paraphrased from APA criteria (pp. 489-503)
Etzel Cardeña gives this concise definition of dissociation: 'In its broadest sense, 'dissociation' (Janel's désagrégation) simply means that two or more menial processes or contents are not associated or integrated.’
Dissociation in relation to self-injury
Rachael, a participant in my current research into self-injury, gave this response when invited to explain how she felt prior to her most recent episode of self-injury: 'I am not exactly sure how I felt specifically this time. I do know that during previous times, I have felt spacey, not part of myself, and detached... this feeling is hard for me to explain. It is almost as if it is not "me"... it feels like something else has taken over and I no longer control it... it feels as if "I" am not really present during the time.'
For purposes of clarity, probably one of the best explanations of the relationship between dissociation and self-injury comes from Ruta Mazelis (1998)[sup6] author of The Cutting Edge: A Newsletter People Living with Self-Inflicted
Violence: 'Whereas SIV [self-inflicted violence] is used as a coping mechanism to manage excruciating emotional slates, it can also serve to alter feelings of profound numbness or deadness... SIV seems to be an effective tool for managing dissociation in both directions — to facilitate it when emotions are overwhelming, as well as lo diminish it when one feels too disconnected from oneself and the world.'
In a clinical setting, depersonalization may be described in terms of 'looking down or in on oneself', 'standing beside oneself, 'outside oneself, 'blank spells', or as a 'floaty, foggy, dazed out, phased out, zoned out, or trance-like feeling.' In some cases, the 'I' may be dissociated — for example 'she is not me'.
In derealisation the environment may be experienced as two-dimensional, strange, unreal, or The individual may perceive an uncanny alteration in the size and shape of objects'. (DSM, p. 500) In this context self-injury can serve as an extreme grounding technique to bring oneself back to the here-and-now ('I do exist", 'I am alive/real').
Amnesia, self-injury and DID
Jessica, a research participant diagnosed with dissociative identity disorder, describes the process of amnesia during the act, due to an 'alter' personality taking control: 'I have DID and there is an alter... Sometimes when I consciously self-injure she will come out and take over and finish the job. I will not know what damage has been done until I wake up the next day. I become so detached that it is like I become in a trance-like state and it is like I am watching someone else doing the cutting.'
Interestingly, Ross (1997,p.151)[sup7] argues that, 'the persecutor's underlying motivation is actually positive'. This is a view I share and if we return to the example given above, one positive scenario might be that the persecutory 'alter' believes she/he is acting in the 'host's' best interests. In other words, she/he is trying to prevent the truth coming out about the abuse for fear of 'not being believed' or other possible dire consequences (for example, the 'system' being emotionally overwhelmed or flooded with memories, mental disintegration, or rejection and abandonment by significant others).
Dissociative Identity Disorder: A Controversial Diagnosis
- Gillig P. M. (2009). Dissociative identity disorder: a controversial diagnosis. Psychiatry (Edgmont (Pa. : Township)), 6(3), 24–29.
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