Dissociative Disorders

Patient Story: Dissociative Disorders

Sandra’s Story

Sandra was a 25-year-old soldier hospitalized for sudden changes in behavior and episodes of apparently poor memory. She was confused about her recent history, and believed that she was in a different hospital located 800 miles from the place where she had in fact been admitted. The diagnoses initially considered included schizophrenia, bipolar disorder, antisocial personality disorder and substance abuse. She was started on neuroleptics (tranquilizers) with little benefit.

At this later hospital admission she was initially thought to have dissociative fugue or amnesia. She was tested and found to be highly hypnotizable, and was asked to relive the time when she had in fact been admitted to the other hospital. She recalled the earlier experience and then was helped to reorient to the correct time and location. It was determined that for some years she had suffered significant gaps in memory. She also had significant, sudden changes in her expression of emotions and behavior – while Sandra was generally agreeable and helpful, she would suddenly become hostile and uncooperative.

She reported being told that she had said and done things she vigorously denied because she had no memory of having done them. On one later occasion she was admitted to the emergency department with a deep cut to her thigh, saying tearfully that she had been running in a field and fell. This explanation that was both vague and inconsistent with the type of injury. In this case, hypnosis was used to help her recall how the injury occurred by moving in time to earlier in the day.

A different component of Sandra’s identity, who called herself Mary, calmly reported taking out a knife and cutting her leg “so deep that even I couldn’t look at it.” She said she was doing it to punish Sandra for letting herself be abused – “If I can’t win, then she can’t win.” When asked whether she was afraid that she might die from blood loss, she said, “No, she’ll take care of it. But even if she did die, I could get to be with someone else.” When asked how that could be, she replied, “Why not? I got to be with her.”

Sandra began psychotherapy, which helped her to see these parts of her identity as poorly integrated portions of her overall self, rather than as distinct “personalities.” She was encouraged to integrate them and learned to appreciate Sandra’s cooperativeness and Mary’s assertiveness, both in moderation. She later said, “I came to understand Mary as me, Sandra as me. Before that I didn’t want to – then I’d have to be responsible…..”

She came to this understanding by working through memories of a troubled childhood. Her parents had divorced when she was six years old, and her mother became involved with a man who abused drugs, primarily cannabis, and started to sexually abuse Sandra when she was 11. She had limited memory of the abuse, but gradually became more able to discuss it. She recalled, for example, a time when her mother’s boyfriend got high and forced her to fellate him. She relived some of her revulsion and terror, but then smiled and said, “I gagged and threw up all over him. He threw me against the wall, but I spoiled his fun.”

She was taught to how to restructure her memory of the abuse to include her ability to disrupt it. She also started taking antidepressants for her comorbid depression. She responded well to the combination of antidepressants and psychotherapy, and came to dissociate only rarely. Sandra began developing more stable and healthy relationships. Her diagnosis was dissociative identity disorder.