Dissociative Disorders

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Dissociative Disorders

• Theodore M. Godlaski
• College of Social Work
• University of Kentucky

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Things to Keep in Mind

• Dissociative states are not uncommon or, in
  themselves, pathological
• In some cultures they are sought after and valued
• They have been a part of religious ritual and
  spiritual practice
• They are only considered disordered when they
  lead to significant impairment or distress.

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Things to Keep in Mind

• At the base of all these disorders is the human
  ability to mentally and emotionally separate
  oneself from painful or traumatic experience.
• This is accomplished by simply forgetting that
  the event ever occurred or by believing that it
  occurred to someone else.
• Individuals who suffer from Dissociative
  Disorders share the common feature of being
  highly suggestible.

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Some General Considerations

• The four diagnoses are hierarchical and only one
  can be used at any given time
• Dissociative Identity Disorder
• Dissociative Fugue
• Dissociative Amnesia
• Depersonalization Disorder

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Dissociative Amnesia

• This is perhaps the best known of these disorders
  due to recovered memories of childhood sexual
  abuse forming the basis for numerous prosecutions
  and law suits in recent years.
• There is serious debate about the validity of
  such recovered memories

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Dissociative Amnesia

• The predominant disturbance is one or more
  episodes of inability to recall important
  personal information, usually of a term addict or
  stressful nature, that is too extensive to be
  explained by ordinary forgetfulness.
• The disturbance does not occur exclusively during
  the course of Dissociative Identity Disorder,
  Dissociative Fugue, Post-Traumatic Stress
  Disorder, Acute Stress Disorder, or Somatization
  Disorder and is not due to the direct physiologic
  effect of a substance or to a neurological or
  other general medical condition.
• The symptoms cause clinically significant
  distress or impairment in social, occupational,
  or other important areas of functioning

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Dissociative Amnesia

• Most clinicians are cautious about using this
  diagnosis for lost childhood memories in adults
  and reserve it for inability to remember recent
  events.
• Individuals experiencing it seem remarkably
  undistressed by their inability to remember.
• In most cases memories returned, at first in
  fragmented form, over a relatively brief period
  of time.

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Dissociative Fugue

• This disorder is extremely rare and most
  clinicians have never encountered an actual case.
• In assessing an apparent case careful evaluation
  should look at the possibility of delirium,
  dementia, or substance intoxication.
• This disorder tends to occur primarily in men who
  have been experiencing high levels of distress
  arising primarily from conflicts in personal and
  professional identity.
• The disorder has also been observed in natural
  disasters and military combat.

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Dissociative Fugue

• The predominant disturbance is sudden, unexpected
  travel away from home or once customary place of
  work, with inability to recall one's past.
• Confusion about personal identity or assumption
  of a new identity.
• The disturbance does not occur exclusively during
  the course of Dissociative Identity Disorder and
  is not due to direct physiologic effects of a
  substance or a general medical condition.
• The symptoms cause clinically significant
  distress or impairment in social, occupational,
  or other important areas of functioning

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Dissociative Identity Disorder

• This disorder enjoyed some notoriety during the
  Victorian era and once again came to prominence
  in the late 20th century.
• It was formerly referred to as Multiple
  Personality Disorder.
• It is a rare disorder in which the individual
  appears to have more than one identity, or
  personality.
• Often the predominant personality is completely
  oblivious to alternate identities, while some
  alternate personalities or identities have access
  to the memories of the predominant identity.

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Dissociative Identity Disorder

• The presence of two or more distinct identities
  or personality states (each with its own
  relatively enduring pattern of perceiving,
  relating to, and thinking about the environment
  and self).
• At least two of these identities or personality
  states were currently take control of the
  person's behavior.
• Inability to recall important personal
  information that is too extensive to be explained
  by ordinary forgetfulness.
• The disturbance is not due to the direct
  physiological effects of a substance or a general
  medical condition. Note in children the
  symptoms are not attributable to an imaginary
  playmates or other fantasy play

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Dissociative Identity Disorder

• Generally individuals who have this disorder are
  identified initially because they complained of
  having lost periods of time during which they
  apparently were doing something but have no
  recollection of what.
• Long-term psychotherapy is the treatment of
  choice.
• Therapy consists in attempt to uncover trauma
  which may underlie the establishment of alter
  identities and the reintegration of these
  alternative personalities are identities into the
  predominant identity.

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Depersonalization Disorder

• Depersonalization is a surprisingly common
  experience especially among younger males.
• Approximately 30 of individuals that had one or
  more episodes of depersonalization in their
  lifetimes.
• Episodes of depersonalization usually become less
  frequent or disappear as the individual gets
  older.
• The disorder is rarely diagnosed, however,
  because depersonalization is often considered
  either not pathological or part of another
  diagnosis.

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Depersonalization Disorder

• Persistent or recurrent experiences of feeling
  detached from, and as if one is an outside
  observer of, one's mental processes or body
  (e.g., feeling like one is in a dream).
• During the depersonalization experience, reality
  testing remains intact.
• The depersonalization causes clinically
  significant distress or impairment in social,
  occupational, or other important areas of
  functioning.
• The depersonalization experience does not occur
  exclusively during the course of another mental
  disorder, such as Schizophrenia, Panic Disorder,
  Acute Stress Disorder, or other Dissociative
  Disorder, and is not due to the direct
  physiologic effects of a substance or a general
  medical condition.

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Depersonalization Disorder

• Onset of this disorder usually occurs between the
  ages of 15 and 30 and has been noted in children
  as young as 10 years of age.
• The course of the disease is generally chronic
  and stable.
• Depersonalization Disorder is notoriously
  refractory to both psychotherapy and chemotherapy.