Research suggests that some children repeatedly exposed to severe trauma – for example, sexual, physical and/or emotional abuse – develop the gift of ‘dissociation’ (a creative survival strategy that enables children to switch off psychologically from the traumatic experience). Over time, however, dissociation can develop into a conditioned response to any stressful situations. Thus what served effectively as a problem-solving strategy in childhood can become a debilitating condition that may seriously impede healthy adult functioning.

What Exactly Are Dissociative Disorders?

According to DSM-IV-TR (APA, 2000: 519), ‘the essential feature of the Dissociative Disorders is a disruption in the usually integrated functions of consciousness, memory, identity, or perception of the environment.’ Put simply, dissociation is a psychological mechanism that allows the mind or body to split off or compartmentalise traumatic memories or unsettling thoughts from normal consciousness.

DSM-IV-TR lists five dissociative disorders, as shown in Figure 8.1.




Dissociation is not a new theory. It was described by Pierre Janet (French physician and psychologist) in the early 1900s, and later by Sigmund Freud. Etzel Cardeña (1994) gives this concise definition of dissociation:

Mollon (1996) explains dissociation thus:

Dissociation In Relation To Self-Injury

It is becoming increasingly recognised that dissociative processes such as depersonalisation, derealisation and dissociative trance-states can frequently underpin self-injury, and numerous self-injury experts have noted a link between depersonalisation, derealisation and self-injury (see Conterio and Lader, 1998:176; Babiker and Arnold, 1997:78; Favazza, 1996:274; Walsh and Rosen, 1988:185). Many who self-injure report, (1) feeling ‘emotionally numb’, ‘detached from themselves’ or ‘dead inside’ prior to the act; (2) feeling little or no physical pain during the act, and (3) feeling more alive, more real, and more grounded following the act. Herman, in Trauma and Recovery (1994), while discussing dissociation and self-injury within the framework of major childhood trauma, identifies that:

Experiences Of Physical Pain

Physical pain from self-injury varies in intensity. The findings from the survey carried out for Healing the Hurt Within, 1st edition (Sutton, 1999) revealed that 59% of the respondents experienced no awareness of pain, 18% experienced an awareness of pain, and 23% experienced pain in varying degrees. In Favazza and Conterio’s 1989 study of 240 females who self-injure, 29% reported feeling no pain, 38% reported feeling little pain, 23% reported feeling moderate pain, and 10% reported feeling great pain. (p. 286) These findings support the theory that dissociation plays a significant role in the process of self-injury for a considerable number of people.

Depersonalisation

According to Conterio and Lader (1998:176) depersonalisation interferes with peoples’ awareness of pain. In essence, it produces a temporary altered state of consciousness, resulting in a disturbance in one’s perception of self, for example, a sense that one’s body is non-existent or as if one’s body and mind are separate. People who experience depersonalisation ‘have disconcerting feelings of being detached from their bodies and mental processes,’ says Favazza (1996: 247). Moreover, episodes of depersonalisation are reported to be extremely unpleasant and frightening, and self-injury appears to serve as an effective strategy for terminating distressing depersonalisation experiences.

Derealisation

Derealisation is listed in DSM-IV-TR as an associated feature of depersonalisation disorder. With derealisation one’s perception of the environment may be experienced as ‘strange or unreal’, or ‘the individual may perceive an uncanny alteration in the size or shape of objects (macropsia or micropsia) and people may seem unfamiliar or mechanical.’ (p. 530)

Respondents’ Experiences Of Depersonalisation And Derealisation

The respondents’ testimonies that follow, in which they are describing how they felt prior to, during and after self-injury, highlight episodes of depersonalisation and derealisation:

Icd-10 Classification Of Depersonalisation And Derealisation

ICD-10, Classification of Mental and Behavioural Disorders, (WHO, 1992), the other major diagnostic system used extensively in Europe, classifies depersonalisation and derealisation syndrome as a neurotic disorder rather than a dissociative disorder. It also notes that the syndrome can happen in ‘obsessive-compulsive disorder’ (OCD), ‘phobic disorder’, or ‘depressive illnesses’. Additionally, ICD-10 suggests that basic features of the syndrome ‘may occur in mentally healthy individuals in states of fatigue, sensory deprivation, [or] hallucinogen intoxication.’ (pp. 171–172)