Module 6 - Dissociative Disorders

Hysterical Dissociative Disorder

What was Dissociative Identity Disorder called in the DSM-II?

Multiple Personality Disorder

What was Dissociative Identity Disorder called in the DSM-III?

cultural fads like demonic possession, satanic ritual abuse, etc.

What have symptoms of DID been historically tied to?

Sybil

• a woman who did not present with any MDP symptoms until she started therapy

• her psychiatrist coached her to pretend and imagine alters within therapy, via hypnosis and pentothal

• she was receiving therapy due to the trauma she had caused by severe childhood sexual abuse 

• many cases similar to this have been found

Sociocognitive Model

The model that states:

“MPD is an iatrogenic behavioral syndrome, promoted by suggestion, social consequences, and group loyalties. It rests on ideas about the self that obscure reality, and it responds to standard treatments.”
– Paul McHugh, Professor and Retired Director of Psychiatry at Johns Hopkins

Psychodynamic perspective

Perspective that states:

• ego is trying to escape from traumatic experiences

  • Childhood experiences in DID

  • Adult experiences in fugue

• Alters are defense mechanisms to isolate trauma to one identity and protect the others

Diathesis-Stress Model

Model that states:

• traumatic events trigger underlying vulnerabilities 

• vulnerabilities may include suggestibility, proneness to fantasy, borderline tendencies

Learning Perspective

Perspective that states:

• DID is an extreme example of state-dependent learning

• arousal and response levels are tied to this in DID

• Social reinforcement feeds suggestibility

  • attention and being treated as “special” by a clinician may drive, reinforce role-playing of clinician’s suggestions

• Social learning

  • Symptoms often spread within clinical populations

Self-hypnosis

• some researchers note similarities between DID and hypnotic amnesia 

  • can involve dramatic changes of state until cancellation signal is present

• They have argued that people with DID have developed a form of self hypnosis as a defense mechanism against stress

  • may also develop under treatment hypnosis

final fusion

Goal of DID treatment

localized

surrounding a specific event

selective

only selected disturbing details lost

generalized 

loss of entire life history

continuous

loss from an event until the present

Systematized

tied to specific domains, e.g. family

Dissociative fugue

form of amnesia accompanied by flight to a new location and assumption of a new identity