abpsych 4: dissociation

what is dissociation?

• detachment from reality

• feeling a disconnection between thoughts, emotions, identity, consciousness, and memory

• intact reality testing

depersonalization

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

derealization

experiences of unreality or detachment with respect to ones surroundings

depersonalization/derealization disorder

• the presence of persistent or recurrent experiences of depersonalization, derealization, or both

• reality testing remains intact

dissociative amnesia

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

dissociative identity disorder

• disruption of identity characterized by two or more distinct personality states

• involves a marked discontinuity of sense of self and sense of agency, accompanied by related alterations in affect, behavior, consciousness, memory, perception, cognition, and/or sensory-motor functioning

• recurrent gaps in the recall of everyday events, important personal information, and/or traumatic events that are inconsistent with ordinary forgetting

etiology: psychodynamic theory

defense mechanism (repression): people fight anxiety by unconsciously preventing painful memories, thoughts, or impulse from reaching awareness

etiology: behavioral theory

operant conditioning (reinforcement): anxiety diminishes when people “forget” or distract themselves from a trauma, which increases the likelihood of future forgetting or psychological distancing

etiology: sociocultural theory

social enactment (social learning): people begin to enact culturally learned means of coping with stress

etiology: post-traumatic model (PTM)

dissociation is a defensive response to severe physical, sexual, or emotional abuse and/or highly aversive events that often date to childhood

etiology: socio-cognitive model (SCM)

dissociative disorders are largely socially constructed and/or reinforced conditions that occur when people are exposed to media influences, broader sociocultural expectations, and suggestive procedures in psychotherapy

treatment

• little research on treatments (no ESTs), but CBT has promise

• focus on comorbid conditions:

  • DBT to enhance emotion regulation

  • EMDR, PE, CPT to address trauma-related symptoms

  • medications if anxiety or depression is present