出版社：Dissociative Disorders Research Publications,International Society for the Study of Dissociation, ,University of Oregon Scholars' Bank
摘要：Recent studies demonstrate that the majority of dissociative disorder (DID) patients inflict self injury, and that 1-2.1 % of DID patients have succeeded in killing themselves. Six female DID patients ranging from 26 to 38 years in age suicided. All had received prior diagnoses of borderline personality disorder and affective disorder. In four cases the suicide attempts were planned to evade detection; in one case there was implicit planning by default; in the last matters defied ready classification. The major motivations for suicide appeared diverse, and included vindictiveness, the overwhelming impact of flashbacks that could not be distinguished from reality, inner warfare among the alters, anticipated object loss, guilt in connection with a parent's death, and pain and hopelessness associated with abandonment. However, these patients' traumata and burdens did not seem more overwhelming than those of comparable DID patients. Five of the completed suicides had in common the use of lying to attain their goals, ready rationalizations for dishonest and inappropriate behavior, disrupted or failed therapeutic alliances, a delusional intensity of the alters' convictions that they enjoyed complete separateness, and the alters' entertaining mutually incompatible subjective understandings of their personal realities. In these five an unresolvable clash between objective and subjective realities had occurred before the fatal events, and the patients, profoundly invested in their views, were unable or unwilling to accommodate to the demands and constraints of conventional reality. Suicide may have provided the illusion of the omnipotent reestablishment of their desired construction of reality, and precluded further painful confrontations, humiliations, and narcissistic deflations. The sixth suicide appears to have been due to inadequate treatment.
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