DISSOCIATIVEDISORDER

DISSOCIATIVE DISORDER There is a disruption

or dissociation (“splitting off”) of the functions of identity, memory, or consciousness that normally make us whole.

types of dissociation

There are 5 types of dissociation:

1. Amnesia 2. Depersonalisation 3. Derealization4. Identity Confusion5. Identity Alteration

1.Amnesia This is when you can’t

remember incidents or experiences that happened at a particular time, or when you can’t remember important personal information.

2. Depersonalisation

A feeling that your body is unreal, changing or dissolving. It also includes out-of-body experiences, such as seeing yourself as if watching a movie.

3.Derealisation

The world around you seems unreal. You may see objects changing in shape, size or colour, or you may feel that other people are robots.

4. Identity confusion

Feeling uncertain about who you are. You may feel as if there is a struggle within to define yourself.

5. Identity alteration

This is when there is a shift in your role or identity that changes your behaviour in ways that others could notice. For instance, you may be very different at work from when you are at home.

types of dissociatiVE DISORDER

A. DISSOCIATIVE IDENTITY

DISORDER

B. DISSOCIATIVE AMNESIA

C. DEPERSONALIZATION /

DEREALIZATION DISORDER

A. DISSOCIATIVE IDENTITY DISORDER

(DID) two or more personalities—each with its own distinctive traits, memories, mannerisms, and even style of speech—“occupy” one person

often called “multiple personality” or “split personality” by laypeople

should not be confused with schizophrenia Schizophrenia (which comes from

Greek roots meaning “split mind”)Multiple personality involves the

“splitting” of cognition, affect, and behavior.

B. DISSOCIATIVE AMNESIA• Believed to be the most common type of dissociative disorder

• Amnesia - from the Greek roots (a : “not” & mnasthai: “to remember”)

• Formerly called “psychogenic amnesia”

• The person becomes unable to recall important personal information, usually involving traumatic or stressful experiences, in a way that cannot be accounted for by simple forgetfulness

• The memory loss is reversible, although it may last for days, weeks, or even year

• Recall of memories may happen gradually but often occurs suddenly and spontaneously

Amnesia is not ordinary

forgetfulness (such as forgetting someone’s name or

where you left your car keys).

Memory loss in amnesia is more

profound or wide ranging.

Dissociative amnesia is divided into 5 distinct types of memory problems:

1)Localized amnesia. 2)Selective amnesia.3)Generalized amnesia.4)Continuous amnesia.5)Systematized amnesia.

1) Localized amnesia.

Events occurring during a specific time period are lost to memory.

For example: The person cannot recall events for a

number of hours or days after a stressful or traumatic incident, such as a battle or a car accident.

2) Selective amnesia.

People forget only the disturbing particulars that take place during a certain period of time.

For example: A soldier may recall most of a battle,

but not the death of his buddy.

3.) Generalized amnesia.

People forget their entire lives—who they are, what they do, where they live, whom they live with.

Personal information cannot be recalled; but habits, tastes, and skills are retained.

For example:You would still know how to read, although you

would not recall your elementary school teachers.

4.) Continuous amnesia.

The person forgets everything that occurred from a particular point in time up to and including the present.

5.) Systematized amnesia.

The memory loss is specific to a particular category of information, such as memory about one’s family or particular people in one’s life.

People with dissociative amnesia usually forget events or periods of life that were traumatic—that

generated strong negative emotions,

such as horror or guilt.

•MALINGERINGFalsely claiming amnesia as a

way of escaping responsibility

For example:People sometimes claim they cannot recall

certain events of their lives, such as criminal acts, promises made to others, and so forth.

•FUGUE “Amnesia on the run”

A rare subtype of dissociative amnesia

Derived from the Latin fugere, meaning “flight”

Despite these odd behaviors, the person may appear “normal” and show no other signs of mental disturbance

For example:The person may be unable to recall past personal

information and becomes confused about his or her identity or assumes a new identity -- either partially or completely.

C. DEPERSONALIZATION/DEREALIZ

ATION DISORDERDepersonalizationA temporary loss or change in the usual sense of our own reality

People feel detached from themselves and their surroundings

For example:They may feel as if they are

dreaming or acting like a robot.

DerealizationA sense of unreality about the external world involving odd changes in the perception of one’s surroundings or in the passage of time—may also be present.

People and objects may seem to change in size or shape and sounds may seem different.

All these feelings can be associated with feelings of anxiety, including dizziness and fears of going insane, or with depression.

Although these sensations are strange, people with

depersonalization/derealization disorder maintain contact with

reality. They can distinguish reality from unreality, even during the depersonalization episode.

In contrast to generalized amnesia and fugue, they know who they are.

Their memories are intact and they know where they are—even if they do not like their present state.

Feelings of depersonalization usually come on suddenly and fade gradually.

OVERVIEW

CULTURE-BOUND DISSOCIATIVE SYNDROMESSimilarities exist between the Western concept of dissociative disorder

and certain culture-bound syndromes found in other parts of the world.

Amok • a culture-bound syndrome occurring

primarily in southeast Asian and Pacific Island cultures

• involves a trancelike state in which a person suddenly becomes highly excited and violently attacks other people or destroys objects

• People who “run amuck” may later claim to have no memory of the episode or recall feeling as if they were acting like a robot.

Zar• a term used in countries in North Africa

and the Middle East to describe spirit possession in people who experience dissociative states

• individuals engage in unusual behavior, ranging from shouting to banging their heads against the wall

THEORETICAL PERSPECTIVES

1.) PSYCHODYNAMIC VIEWS

• Involve the massive use of repression, resulting in the splitting off from consciousness of unacceptable impulses and painful memories, typically involving parental abuse

Dissociative amnesia may serve an adaptive function of disconnecting or dissociating one’s conscious self from awareness of traumatic experiences or other sources of psychological pain or conflict.

In dissociative amnesia and fugue, the ego protects itself from anxiety by blotting out disturbing memories or by dissociating threatening impulses of a sexual or aggressive nature.

In dissociative identity disorder, people may express these unacceptable impulses through the development of alternate personalities. In depersonalization, people stand outside themselves—safely distanced from the emotional turmoil within.

2.) SOCIAL-COGNITIVE THEORY

• Dissociation is conceptualized in the form of dissociative amnesia and fugue as a learned response involving the behavior of psychologically distancing oneself from disturbing memories or emotions.

• The habit of psychologically distancing oneself from these matters, such as by splitting them off from consciousness, is negatively reinforced by relief from anxiety or removal of feelings of guilt or shame.

3.) BRAIN DYSFUNCTION• Points to a possible dysfunction in parts of the brain

involved in body perception, may help account for the feeling of being disconnected from one’s body that is characteristic of depersonalization.

• Irregularity in brain functioning during sleepThe disruption in the normal sleep-wake cycle may result in intrusions of dream-like experiences in the waking state that result in dissociative experiences (such as feeling detached from one’s body).

Regulating the sleep-wake cycle may thus help prevent or treat dissociative experiences.

4.) DIATHESIS-STRESS MODEL• People who are prone to fantasize, are highly hypnotizable,

and are open to altered states of consciousness, may be more likely than others to develop dissociative experiences in the face oftraumatic abuse.

• Investigators continue to debate the role of fantasy proneness as a risk factor for dissociation in response to trauma .

• People who are not prone to fantasize will experience anxious, intrusive thoughts associated with posttraumatic stress disorder (PTSD) following traumatic stress, rather than dissociative disorders . eriences.

TREATMENT

ObjectiveTo increase the connections between your

feelings, thoughts, perceptions and memories, and to help develop a sense of empowerment that will make the feeling more ‘wholeness’ and reduce the ‘internal chaos’

The International Society for the Study of Trauma and Dissociation gives guidelines for the treatment of dissociative identity disorder only.

Talking treatments

Effective treatment for dissociative disorders may combine several methods, it always includes psychotherapy or counselling – usually over several years. disorder only.

The client-therapist relationshipThe therapist should be:

accepting of the patient’s experience

willing to learn how to work with dissociation and trauma

able to tolerate any level of frustration and extreme pain he patient may experience

be prepared to work with the patient long term

Medication•

There is no medication to treat dissociation.

• However, it can help treat symptoms also experienced, such as depression, anxiety, or insomnia etc.

• Should only be used when the targeted symptom is widespread throughout the system of identities and/or is experienced by dominant identity and the one who manages everyday life

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