AP Dissociative Disorders Week 13

What is dissociation?

A disconnection between a person’s thoughts, memories, feelings, actions or sense of who they are,

How does dissociation help a person during a traumatic experience?

Dissociation can help a person tolerate what might otherwise be too difficult to bear

Risk factors for dissociative symptoms

• earlier onset of trauma

• neglect and sexual, physical, and emotional abuse by parents

• cumulative earlier life trauma and adversities

• repeated sustained trauma or torture associated with captivity 

DSM-5-TR Definition of Dissociative Disorders 

Marked by disruption and/or discontinuity of consciousness, memory, identity, emotion, perception, body representation, motor control, and behavior 

Criteria A of Dissociative Identity Disorder

• Disruption of identity characterized by two or more distinct “personality states.” Some cultures may view this as an experience of possession.

• The disruption in identity involves marked discontinuity in sense of self and sense of agency, accompanied by related alterations in:

  • affect, behaviors, consciousness, memory, perception, cognition, and/ or sensory-motor functioning 

• These signs and symptoms may be observed by others or reported by the individual 

Criteria B of DID

Recurrent gaps recalling everyday events, important personal information, and/ or traumatic events 

What is DID associated with?

Significant trauma/abuse in childhood (90%)

Individuals with DID have an increased risk of?

Suicide, (70% at least one attempt)

How does DID present in children/adolescence?

• Does not present with different personality structures, but rather present independently acting imaginary companions or “mood” states 

Criteria C of DID

Syptoms cause clinically significant distress or impairment

Criteria D of DID

The disturbance is not a normal part of a broadly accepted cultural or religious practice

Note: In children, the symptoms are not better explained by imaginary playmates or other fantasy play 

Criteria E of DID

The symptoms are not attributable to the physiological effects of a substance or another medical condition 

Treatment of DID

Focuses on

1. Identifying and working through past trauma or abuse

2. Managing sudden behavioral changes

3. Merging separate identities into a single identity

Criteria A of Dissociative Amnesia

An inability to recall important autobiographical information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting 

Dissociative Amnesia consistencies 

• Localized or selective amnesia for a specific event or events 

• Generalized amnesia for identity or life history

  • Symptoms primarily retrograde and often associated with a traumatic event

What is the awareness level of someone with dissociative amnesia

Awareness of amnesia varies

Criteria C of Dissociative Amnesia

The disturbance is not attributable to the physiological effects of a substance or a neurological or other medical condition (TBI) 

Criteria D of Dissociative Amnesia

The disturbance is not better explained by DID, PTSD, acute stress disorder, somatic symptom disorder, or major or mild neurocognitive disorder

Dissociate Amnesia with dissociative fugue specifier

Apparently purposeful travel or bewildered wandering that is associated with amnesia for identity or other important autobiographical information

Which sex is disproportionately affected by dissociative amnesia?

Women

Criteria A of Depersonalization/Derealization Disorder

The presence of persistent or recurrent experiences of depersonalization, derealization, or both 

What is depersonalization?

Experiences of unreality, detachment, or being an outside observer with respect to one’s thoughts, feelings, sensations, body, or actions 

What is derealization?

Experiences of unreality or detachment with respect to surroundings (individuals or objects are experienced as unreal, dreamlike, foggy, lifeless, or visually distorted) 

Criteria B of Depersonalization/Derealization Disorder

During the depersonalization or derealization experiences, reality testing remains intact

Criteria D of Depersonalization/Derealization Disorder

The disturbance is not attributable to substance use or another medical condition 

Criteria E of Depersonalization/Derealization Disorder

The disturbance is not better explained by another mental disorder