Dissociative disorders

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Dissociative disorders

• Dissociative Amnesia
• Dissociative Fugue
• Dissociative Identity Disorder

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Dissociation

• Disruption in the usually integrated functions
  of
• consciousness
• memory
• identity
• perception of the environment (DSM-IV, p.477)

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Other occurrences of dissociative symptoms

• Other disorders
• Acute Stress and Posttraumatic Stress
• Somatization Disorder
• Conversion Disorder
• Cultural expression or activity
• Religious experiences
• Dissociation is not inherently pathological

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Dissociative Amnesia

• Important personal information cannot be recalled
• Usually related to trauma or stress
• Beyond normal forgetting
• Usually reported as gaps in otherwise intact
  memories of a persons own life

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What is lost?

• Victim memories Trauma or stress
• Perpetrator memories
• Violence
• Suicide attempts
• Self-mutilation

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Types of Dissociative Amnesia

• More common
• Localized amnesia Period of time
• Selective amnesia Certain events selected from a
  series
• Less common
• Generalized amnesia Entire life
• Continuous amnesia From an event on
• Systematized amnesia Categorical

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Dissociative Fugue

• Sudden relocation (fugue) with amnesia
• May assume a new identity, and function well.
  May seem more healthy than before the fugue.
• Upon recovery, may be amnesic for the fugue
  episode

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Amnesia, fugue, and the law

• Sometimes claimed as a criminal defense
• Persists through hypnosis, barbiturate interviews
• No available test to distinguish it from
  malingering
• Consider the gain produced by the symptom
• Crime due to true dissociation is irrational or
  produces no secondary gain

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Dissociative Identity Disorder

• Two or more distinct personalities
• Host and alters
• Median 10 personalities (women15, men7)
• Range 2 to gt100
• Control of behavior rotates among personalities
• Often cued by stressors, switch in seconds
• Some personalities appear rarely

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More DID features

• At least some of the personalities are unaware of
  the others, and demonstrate amnesia
• Sometimes the voices of alters are experienced as
  hallucinations
• Some alters are supportive
• Others are the voice of the perpetrator

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Etiological validity of DID

• 90 of cases are women
• Memory loss for extended periods of time in
  childhood is common
• Repeated, severe, usually sexual abuse is common
• Posttraumatic symptoms are sometimes seen

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Cultural context of DID

• Highest rates in U.S.A. and Australia
• Is child abuse highest here?
• Is DID a media creation?
• Is DID iatrogenic?

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Depersonalization Disorder

• Repeated or enduring feelings that one is
  detached from ones body or self
• May feel like an automaton or a detached observer
• May feel loss of control of actions or speech
• May coexist with derealization
• Reality testing remains intact

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Dissociative Disorder NOS

• Subclinical DID
• Derealization without depersonalization
• Dissociation due to coercion
• Brainwashing
• Cult indoctrination
• Dissociative trance disorders Culture-bound
• Ganser syndrome