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cutting

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When faced with choosing between attributing their pain to __eing crazy_ and having had abusive parents, clients will choose __razy_ most of the time. Dora, a 38-year-old, was profoundly abused by multiple family perpetrators and has grappled with cutting and eating disordered behaviors for most of her life. She poignantly echoed this dilemma in her the

LF
Lisa Ferentz

Treating Self-Destructive Behaviors in Trauma Survivors: A Clinician's Guide

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The case of a patient with dissociative identity disorder follows:Cindy, a 24-year-old woman, was transferred to the psychiatry service to facilitate community placement. Over the years, she had received many different diagnoses, including schizophrenia, borderline personality disorder, schizoaffective disorder, and bipolar disorder. Dissociative identity disorder was her current diagnosis.Cindy had been well until 3 years before admission, when she developed depression, "voices," multiple somatic complaints, periods of amnesia, and wrist cutting. Her family and friends considered her a pathological liar because she would do or say things that she would later deny. Chronic depression and recurrent suicidal behavior led to frequent hospitalizations. Cindy had trials of antipsychotics, antidepressants, mood stabilizers, and anxiolytics, all without benefit. Her condition continued to worsen.Cindy was a petite, neatly groomed woman who cooperated well with the treatment team. She reported having nine distinct alters that ranged in age from 2 to 48 years; two were masculine. Cindy__ main concern was her inability to control the switches among her alters, which made her feel out of control. She reported having been sexually abused by her father as a child and described visual hallucinations of him threatening her with a knife. We were unable to confirm the history of sexual abuse but thought it likely, based on what we knew of her chaotic early home life.Nursing staff observed several episodes in which Cindy switched to a troublesome alter. Her voice would change in inflection and tone, becoming childlike as ]oy, an 8-year-old alter, took control. Arrangements were made for individual psychotherapy and Cindy was discharged.At a follow-up 3 years later, Cindy still had many alters but was functioning better, had fewer switches, and lived independently. She continued to see a therapist weekly and hoped to one day integrate her many alters.

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When you have a persistent sense of heartbreak and gutwrench, the physical sensations become intolerable and we will do anything to make those feelings disappear. And that is really the origin of what happens in human pathology. People take drugs to make it disappear, and they cut themselves to make it disappear, and they starve themselves to make it disappear, and they have sex with anyone who comes along to make it disappear and once you have these horrible sensations in your body, you__l do anything to make it go away.

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and afterward, after it was done, it was too much, and I felt like I was going to... I don't know.... explode, and it was just too much, I had to let it out you know? I had to-I interrupted her hysteria It's okay, I understand.That was a lie. I didn't get her cutting at all. She'd done it sporadically, ever since the accident and it scared me each time. She'd try to explain it to me, how she didn't want to die - she just needed to get it out somehow. She felt so much emotionally, she would say, that a physical outlet - physical pain - was the only way to make her internal pain go away. It was the only way she could control it.

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Richelle Mead

Vampire Academy