Dissociation World

Dissociation exists on a continuum with these everyday symptoms at one end and at the other more severe symptoms such as amnesia and identity alteration. At this end dissociation is often described as ‘going away’ as the sufferer voluntarily leaves their own body. These severe symptoms usually indicate a dissociative disorder especially if they are persistent, difficult to control and affect the sufferer’s everyday life.

There are five dissociative disorders:

1. Dissociative Amnesia – this is indicated when there is an inability to recall important personal information

2. Dissociative Fugue – this refers to the situation where a sufferer finds themselves in a place with no memory of getting there and sometimes with no knowledge of who they are.

3. Depersonalisation Disorder – this is a recurrent feeling of being detached from yourself or your feelings.

4. Dissociative Identity Disorder (DID) – previously known as multiple personality disorder this is characterised by the existence of two or more separate identities within one person who are able to take control.

5. Dissociative Disorder Not Otherwise Specified (DDNOS) – this often precedes a diagnosis of DID and is used until a definitive diagnosis of DID is able to be made.

Causes

Although dissociation is a common experience those with an actual dissociative disorder almost universally have a background of childhood trauma especially sexual and physical abuse. Over 99% of those diagnosed with DID have a history of prolonged and severe childhood sexual abuse usually with an early age of onset (before the age of eight) and the abuser being one or more of the child’s caregivers. There has been no genetic link indicated. This is probably because everybody is capable of dissociation as a young child but few people are in the situation of having to use it on a regular basis. This regular usage as a defence leads to the ability to dissociate being retained into adulthood and therefore leads directly to dissociative disorders.

There are a few cases where dissociative disorders have developed after a single trauma and they have been observed in those kept in captivity for long periods of time. Little is currently known about the phenomenon of dissociation itself. It is currently considered to be a highly creative and intelligent defence and a ‘trick of the imagination’. However newer studies have shown that dissociation is a biological phenomenon – brain imaging has shown that associative pathways in the brain are shut down during the dissociative experience. This suggests that the dissociative experiences may well be ‘real’ as opposed to imaginative.

Link to the excellent site is in the banner...

To Drug or Not To Drug

Lately I’ve been playing with a question I was asked after a workshop I presented on SIV. A psychologist stopped to talk after the training and was arguing the need to have the right to restrain people who self-injure.

I gave him my thoughts about how retraumatizing people who already are living in a world of pain serves no one, including the staff of the institutions in which restraint and seclusion (tying people down to beds and/or locking them in padded rooms) remain prevalent He remained adamant that all SIV must be stopped, that clinicians should not have to tolerate anyone who continues to self-injure. He proposed using psychiatric drugs to achieve this as well, but did admit that there are no drugs, used appropriately, that achieve the result he was after.

It was his next statement that I found interesting. He was adamant that if a psychiatric drug could be created to take away the need to self-injure, that all the people living with SIV would be more than interested in taking it forever. I told him that I didn’t think this to be true, but that I would ask the experts, the people who live with SIV. I believe that SIV is not “all bad” as this psychologist was presenting, that SIV serves a purpose in many people’s lives that helps them cope with the aftereffects of trauma and the struggles of healing.

While living with SIV certainly has its down side, it also has a purpose. And as people come to understand the trauma in their histories the need for SIV abates as healing progresses. A drug that would solve the problem so simply would likely do what so many of the other drugs used previously have done, make a person so numb that they might lose touch with their pain and struggle but also become so numbed as to not feel truly alive. I presumed that the price of permanently drugging oneself out of the need for SIV would be too high to pay. I believe that SIV fades away as we learn to understand, experience, and release the pain, rage and disconnection that it manages. We can learn a great deal about ourselves from the urges to self-injure.

But he made me think and now I am curious. Any thoughts out there?

Ruta Mazelis, Editor of The Cutting Edge

Dissociation

Grounding Skills are interventions that assist in keeping a person in the present. They help to re-orient a person to reality and the immediate here-and-now. Grounding skills are useful in many ways.

However, then can be used to help re-orient oneself when experiencing intense and overwhelming feelings and intense anxiety. They help to regain one’s mental focus. These skills usually occur within two specific modalities:
1. Sensory Awareness
2. Cognitive Awareness

Sensory Awareness Grounding Skills
• Keep your eyes open, look around the room, notice your surroundings, notice details.
• Hold a pillow, stuffed animal or a ball.
• Place a cool cloth on your face, or hold something cool such as a can of soda.
• Listen to soothing music.
• Put your feet firmly on the ground.
• FOCUS on someone’s voice or a neutral conversation.

Cognitive Grounding Skills
Re-orient yourself in place and time by asking yourself some or all of these questions:
• Where am I?
• What is today?
• Whatis the date?
• What is the month?
• What is the year?
• How old am I?
• What season is it?

• List as many grounding skills as you can.
• Practice several grounding skills every day
• Construct a list of those which are most helpful and effective.

Goals When Using Grounding Techniques
1. To keep myself safe and free from injury.
2. To re-orient myself to reality and the here-and-now.
3. To identify what I attempted to do to prevent the dissociative experience.
4. To identify skills that I can use in the future to help myself remain grounded.
5. Choose a new response: What action, if any, do you want to take to feel better in the present?

For example, a flashback
may indicate that a person is once again in a situation that is in some way unsafe. If this is the case, self-protective actions should be taken to alter the current situation. On the other hand, a flashback may simply mean that an old memory has been triggered by an inconsequential resemblance to the past such as a certain colour or smell. In such cases, corrective messages of reassurance and comfort need to be given to the self to counteract the old traumatic memories.

Image: Out of Body Experience by ~parallelspaces

Link: NHS (pdf)

Treatment Strategies

Self-injurious behavior can be reduced and eventually extinguished once the adolescent is ready to embrace alternative behaviors designed to promote healthier communication, self-comfort and genuine healing.

Psychotherapy — It is extremely important to work with a helping professional who has an expertise in self-injurious behavior or related disorders. Psychotherapy can provide a non-judgmental and supportive environment where self-injury can be processed openly and the meaning behind the injury can be explored. Trained therapists can provide safer, alternative ways to communicate, self-soothe and cope. The use of journaling, art therapy, relaxation techniques, visualizations, cognitive re-framing and affect management are all recommended and useful.

Appropriate contracts that encourage the teenager to write, draw, exercise and self-soothe before engaging in self-injurious behavior are more effective than contracts that demand the immediate cessation of the behavior. When the self-injury is severe, the teenager is unable to integrate strategies and abide by a safety contract or additional problems such as substance abuse or a threatening eating disorder are evident, inpatient treatment is often required.

In addition to working with a trained therapist some teens are able to utilize resources such as personal journaling and drawing, meditation, spiritual support and healthy self-injurious behavior substitutes such as physical exercise.

Psychopharmacology — When self-injurious behavior connects to untreated depression or anxiety, medication can be extremely useful. Anti-depressants can dramatically reduce the negative feelings and cognitions associated with the cycle of self-harm. Anxiolytics prevent the escalation of panic and generalized anxiety, which decreases the need for dissociation and self-injury. Providing a pharmacological safety net also may allow adolescents to process painful trauma memories without becoming flooded or overwhelmed.

[taken in part: *PRP Online]* Performance Resource Press

Alternatives

Each Tuesday we've been focusing on alternatives.. I've written on alternatives to anger, and the use of ice. This week, a few suggestions on alternatives to the feeling of dissociation.

Harming yourself is not the only way to cope with your feelings. Here are some of the ideas other young people have come up with to find different ways of coping. Some may work for you! A lot depends on thinking about why you are self harming. People often harm themselves because they can find no other way to relieve a feeling of being overwhelmed by intense emotions.

Dissociation

Dissociation : Feeling so overwhelmed by everything going on around, you want to escape or distract yourself by making a louder metaphorical noise.

• Try squeezing ice or putting a hand in a mixture of water, salt and ice for a few seconds.
• Try putting a rubber band around a wrist then pinging it when you need to. I always have a band on my wrist...its become habit now, like biting my nails...lol.
• Try taking a cold/hot shower.
• Try biting into something like a lemon or a hot pepper. This Ive used, and wasabi.
• Try doing something creative like making a collage, write poetry, bake or paint.
• Try to focus on breathing. I count as I breathe, 1001, 2001, 3001, 4001 etc, in through nose, out through mouth.
• Try to play taxing games like tetris, minesweeper or snake.
• Try choosing an object in the room and describing it as you would to a blind person - its size, weight, colour etc. I sort of do this, but I say, 'Im in the lounge, sitting on a blue chair, my feet are on carpet, I can see a window etc'
• Try scribbling on paper. I do this free form, with no thought, just purging...
• Try being around people, perhaps playing games with a younger sibling, hugging someone or helping someone else.
• Try opening the dictionary in random places and learning new words, also try thinking in another language as you may have to simplify your thoughts. I wouldnt be able to focus enough for this one.
• Try creating a mental 'safe place'. I'm not good at this one but sometimes I combine it with my breathing exercises

Whatever my trigger, I remember the feeling of being overwhelmed, and chanting in my head 'This is not fucking real' over and over, the trick was for me to learn the feeling, sounds easy eh! but to identify it and in the early days just to focus on the word 'Stay'

[taken from Icet.org]

A Flow Diagram Of Two Theories Of Self-injury.

Hyperstress: an overload that occurs when stressful events pile up and stretch the limits of a person's adaptability .

Dissociation: Dissociation is a psychological state or condition in which certain thoughts, emotions, sensations, or memories are separated from the rest of the psyche. For this reason, it is sometimes referred to as "splitting."

Ice, Ice Baby ... :)

Long before I knew anything about my why's, or of triggers, before therapy or even understanding that my coping skills were destructive, I knew I was dealing with a physical feeling that I couldn't contain.

I don't feel from 12 onwards that I ever did anger, lost my temper, got cross, I did rage. It was pure & unadulterated, I went from 0 to 100 in 10 seconds. It was frightening for me as I had little memory of these episodes but I knew from the reactions of those around me in the aftermath that it was frightening for them.

I learnt how to control and contain the anger ... but it was at a high cost to me and even more destructive.

Years later one of the first therapists in recovery gave me a list of alternatives to destructive behaviour, ie walk with a friend, garden WTF! Needless to say she didn't last long...lol...

The first alternative for me that worked was ice ... I stocked up on the stuff ... I would put it in the sink with a few inches of water (while the tap run I would run ice over my hands & wrists) I would plunge my hands in till I couldn't feel them ... if the anger surfaced through this I would put my face in or splash it with water. Focusing on getting the water ready, the sensation of cold slowed my thinking quickly. I went from the hectic to the here and now, the urge ebbed ... it stopped the flashes of memory almost instantly... I now know this as grounding

Over time, I abandoned the ice and used cold showers.

There are alot of alternatives to SH out there, and the key is identifying the emotion behind it, your own 'why'. For me it was anger and disassociation. I will bring together articles from the net and do a weekly post on alternatives (on Tuesdays)but I wanted to share one that worked for me and why.... If you have others let us know and we can build up a collection. What works for me may not be so for others and your input would be great as always..... Abz

The History and Mentality of Self-Harm

Morning Edition, June 10, 2005 · An estimated 2 million Americans practice some form of self-injury, and there is a common misperception that -- like anorexia -- the problem afflicts mostly young women. But self-mutilation isn't exclusively a modern adolescent issue. The disorder is an ancient one, and it is best understood as an attempt to relieve rather than inflict pain.

A reader commented that SH is a societal problem, so I looked around the net and came across this 5min radio exert that has a small part at the start on self harm from a historical context, then goes on to interview a young woman and talks of disassociation experienced with SH. It is 3yrs old but still relevant, I feel.

I couldn't embed it but the link to the interview is here. I found the sentence used...

' it is best understood as an attempt to relieve rather than inflict pain.'....

one of the simplist explanations to explain to those who don't know, what one is experiencing.

Let me know what you think....

Image:Alone by ~-sylph-