Reply to Letter to the Editor “Upper-Extremity Self-Amputation in a Case of Dissociative Identity Disorder”

Letter to the Editor

Sir: I am grateful for the opportunity to respond to Dr. Brenner’s case report detailing the possible link between dissociative identity disorder and upper-extremity self-amputation. It is fascinating to note that many of the symptoms that appear to accompany these severe acts of self-mutilation—the belief that one’s hand has behaved badly and therefore needs to be removed, the seeming calm and increased organization that follow such an act, and the apparent lack of appreciation for the seriousness of the act—all are consistent with classically described dissociative symptoms. Although I have not heard of any cases (until now) of more definitive dissociative symptoms surrounding acts of self-amputation, it is entirely possible that a dissociative state would more easily facilitate such drastic actions as a means of resolving internal conflicts.